Topic: Psychological distress and work related musculoskeletal disorders among

nurses working in Ekiti State teaching Hospital.

CHAPTER ONE

Introduction

Psychological distress and work-related musculoskeletal disorders (WRMSDs) are

two major health issues that affect nurses in the workplace. Nurses are exposed
to a range of physical and psychological demands in their work, which puts them
at risk for developing WRMSDs and psychological distress. According to recent
studies, these issues have become more prevalent in the nursing profession,
leading to a significant increase in the number of workdays lost due to illness and
disability (Choobineh et al., 2021; Ogunsanya & Onigbinde, 2019).

The Ekiti State Teaching Hospital is one of the largest healthcare facilities in the
region, and it employs a large number of nurses who provide care to patients on a
daily basis. However, the prevalence of psychological distress and WRMSDs
among nurses in this hospital has not been well studied. Therefore, this research
aims to investigate the prevalence and associated factors of psychological distress
and WRMSDs among nurses working in the Ekiti State Teaching Hospital.

Previous studies have shown that the prevalence of psychological distress among
nurses is high, with reports of depression, anxiety, and burnout. These mental
health issues have been associated with high levels of job demands, inadequate
social support, and poor work conditions (Adewuya & Afolabi, 2020; Khamisa et
al., 2019). Similarly, WRMSDs have been identified as a significant occupational
health problem among nurses, with high rates of musculoskeletal pain reported in
various body regions (Choobineh et al., 2021; Ogunsanya & Onigbinde, 2019).

This research is essential in identifying the prevalence and risk factors of

psychological distress and WRMSDs among nurses in the Ekiti State Teaching
Hospital. The findings of this study will be useful in developing targeted
interventions to promote the mental and physical health of nurses, as well as
improving their work conditions. Additionally, it will contribute to the existing
literature on the health and well-being of healthcare workers in Nigeria.

1.1 Background of the Study

Nursing is an essential healthcare profession that is critical to the delivery of

quality healthcare services. Nurses work in a variety of healthcare settings,
including hospitals, clinics, and long-term care facilities, among others. However,
nursing is a demanding profession that exposes nurses to physical and emotional
challenges that can affect their health and well-being.

Work-related musculoskeletal disorders (MSDs) are prevalent among nurses due

to the physical demands of their job, such as lifting and transferring patients, and
standing for long hours. Studies have shown that nurses have a higher risk of
developing MSDs than workers in other professions (Yassi et al., 2020). In addition
to MSDs, nurses also experience psychological distress due to job demands, long
working hours, and exposure to traumatic events, among others.

Psychological distress is a broad term that encompasses various mental health

issues, such as anxiety, depression, burnout, and post-traumatic stress disorder
(PTSD). Psychological distress affects nurses' mental and physical health and may
lead to reduced job performance, increased absenteeism, and turnover intentions
(AbuAlRub & El-Jardali, 2021).

Despite the high prevalence of work-related MSDs and psychological distress

among nurses, there is limited research on the relationship between these two
conditions. Moreover, most of the available studies on MSDs and psychological
distress among nurses have been conducted in developed countries, with limited
research in developing countries.
Therefore, this study aims to investigate the prevalence of work-related MSDs
and psychological distress among nurses working in Ekiti State Teaching Hospital,
a tertiary healthcare facility in Nigeria. The study also seeks to identify the risk
factors associated with these conditions and their impact on nurses' job
performance and well-being. The findings of this study will inform the
development of targeted interventions and policies to promote the health and
well-being of nurses in Nigeria and other similar settings.

1.2 Statement of the Problem

Psychological distress and work-related musculoskeletal disorders (WRMSDs)

have been identified as significant health problems among nurses worldwide.
According to Adewuya and Afolabi (2020), the prevalence of psychological
distress among nurses in sub-Saharan Africa is high, with studies reporting up to
57% of nurses experiencing symptoms of depression, anxiety, and burnout.
Similarly, WRMSDs are a significant occupational health problem among nurses,
with studies reporting high rates of musculoskeletal pain in various body regions
(Choobineh et al., 2021; Ogunsanya & Onigbinde, 2019).

The Ekiti State Teaching Hospital is one of the largest healthcare facilities in the
region, and it employs a large number of nurses who provide care to patients on a
daily basis. However, the prevalence and associated factors of psychological
distress and WRMSDs among nurses working in this hospital are not well
understood. The lack of data on these health issues among nurses in Ekiti State
Teaching Hospital hinders the development of targeted interventions and policies
to address the health needs of this vulnerable population.

Therefore, the main problem this research seeks to address is the prevalence and
associated factors of psychological distress and WRMSDs among nurses working
in the Ekiti State Teaching Hospital. This study aims to contribute to the existing
literature on the health and well-being of healthcare workers in Nigeria and
provide insights for the development of effective interventions to promote the
physical and mental health of nurses in the workplace.

1.3 Objectives of the study

The objectives of this research project are:

1. To determine the prevalence of work-related musculoskeletal disorders

(MSDs) among nurses working in Ekiti State Teaching Hospital.
2. To determine the prevalence of psychological distress among nurses
working in Ekiti State Teaching Hospital.
3. To investigate the relationship between work-related MSDs and
psychological distress among nurses working in Ekiti State Teaching
Hospital.
4. To identify the risk factors associated with work-related MSDs and
psychological distress among nurses working in Ekiti State Teaching
Hospital.
5. To provide evidence-based recommendations to promote the health and
well-being of nurses in Ekiti State Teaching Hospital.

The first objective aims to determine the prevalence of work-related MSDs among
nurses in Ekiti State Teaching Hospital. This objective seeks to provide insights
into the extent of the problem and the need for interventions to prevent and
manage work-related MSDs among nurses.

The second objective aims to determine the prevalence of psychological distress

among nurses in Ekiti State Teaching Hospital. This objective seeks to provide
insights into the extent of the problem and the need for

interventions to address psychological distress among nurses.

The third objective aims to investigate the relationship between work-related
MSDs and psychological distress among nurses in Ekiti State Teaching Hospital.
This objective seeks to provide insights into the possible interplay between
physical and psychological health outcomes and the need for comprehensive
interventions to promote the health and well-being of nurses.

The fourth objective aims to identify the risk factors associated with work-related
MSDs and psychological distress among nurses in Ekiti State Teaching Hospital.
This objective seeks to provide insights into the factors that contribute to the
development of these conditions and the need for targeted interventions to
address them.

The fifth objective aims to provide evidence-based recommendations to promote

the health and well-being of nurses in Ekiti State Teaching Hospital. This objective
seeks to translate the research findings into actionable recommendations that
can inform policy and practice in promoting the health and well-being of nurses in
the workplace.

1.4 Research Hypothesis/ Questions

1.4.1 Research Questions:

1. What is the prevalence of work-related musculoskeletal disorders (MSDs)

among nurses in Ekiti State Teaching Hospital?
 2. What is the prevalence of psychological distress among nurses in Ekiti State
Teaching Hospital?
3. Is there a significant relationship between work-related MSDs and
psychological distress among nurses in Ekiti State Teaching Hospital?
4. What are the risk factors associated with work-related MSDs and
psychological distress among nurses in Ekiti State Teaching Hospital?

1.4.2 Research Hypotheses:

Hypothesis 1: There is a significant prevalence of work-related musculoskeletal

disorders (MSDs) among nurses in Ekiti State Teaching Hospital.

Hypothesis 2: There is a significant prevalence of psychological distress among

nurses in Ekiti State Teaching Hospital.

Hypothesis 3: There is a significant positive relationship between work-related

MSDs and psychological distress among nurses in Ekiti State Teaching Hospital.

Hypothesis 4: There are significant risk factors associated with work-related MSDs
and psychological distress among nurses in Ekiti State Teaching Hospital.

1.5 Significance of the Study

This study is significant in several ways:

Enhancing knowledge: The study contributes to the existing body of knowledge

on the prevalence and associated risk factors of work-related MSDs and
psychological distress among nurses in Ekiti State Teaching Hospital, Nigeria. This
will help improve our understanding of the health status of nurses in developing
countries, particularly in Nigeria.

Improving healthcare delivery: The findings of this study will help healthcare
policymakers and managers to develop evidence-based policies and interventions
aimed at promoting the health and well-being of nurses. This will lead to a
reduction in the incidence and prevalence of work-related MSDs and
psychological distress among nurses, which will, in turn, improve the quality of
healthcare delivery.

Informing occupational health and safety: The study provides insights into the
factors that contribute to work-related MSDs and psychological distress among
nurses, which will inform occupational health and safety practices in the
healthcare sector. This will promote the development of appropriate
interventions and measures to prevent and manage work-related MSDs and
psychological distress among nurses.

Enhancing nurse job satisfaction: Nurses play a critical role in healthcare delivery,
and their job satisfaction is essential for optimal performance. This study will help
identify the factors that contribute to work-related MSDs and psychological
distress among nurses, which, when addressed, will improve their job satisfaction.

Contributing to the achievement of the Sustainable Development Goals (SDGs):

The study aligns with the SDGs, particularly Goal 3, which aims to ensure healthy
lives and promote well-being for all at all ages. The findings of this study will
contribute to achieving this goal by promoting the health and well-being of nurses
in Ekiti State Teaching Hospital, Nigeria.

1.6`Delimitation/Scope of the study

The delimitation or scope of this study includes:

1. Sample: The study will focus on nurses working in Ekiti State Teaching
Hospital, Nigeria. The sample will include only registered nurses working in
the hospital. The study will not include other healthcare professionals, such
as doctors or allied health workers.
2. Variables: The study will focus on work-related musculoskeletal disorders
(MSDs) and psychological distress among nurses. The study will not include
 other health-related issues that may affect nurses, such as infectious
diseases or non-work-related health conditions.
3. Time frame: The study will cover the period from January 2022 to
December 2022. The study will not include data from previous years or
subsequent years.
4. Geographical location: The study will focus on Ekiti State Teaching Hospital,
Nigeria, and the findings may not be generalizable to other hospitals in
Nigeria or other countries.
5. Research design: The study will use a cross-sectional research design, which
will provide a snapshot of the prevalence and associated risk factors of
work-related MSDs and psychological distress among nurses at a particular
point in time. The study will not use other research designs, such as
longitudinal or experimental designs.

It is essential to note that these delimitations do not diminish the importance or

relevance of the study findings. The study will provide valuable insights into the
health status of nurses in Ekiti State Teaching Hospital, Nigeria, and contribute to
the development of evidence-based policies and interventions aimed at
promoting the health and well-being of nurses.

1.7 Operational Definition of terms

1. Psychological Distress: This refers to a range of negative emotional states

that include anxiety, depression, and stress.
2. Work-related Musculoskeletal Disorders (MSDs): This refers to conditions
affecting the muscles, bones, tendons, ligaments, nerves, or other soft
tissues that are caused or aggravated by work-related factors such as lifting,
pushing, or pulling heavy loads, repetitive motions, awkward postures, and
prolonged sitting or standing.
3. Nurses: This refers to registered nurses who have completed an accredited
nursing program and are licensed to practice nursing.
4. Prevalence: This refers to the proportion of individuals in a population who
have a particular condition or disease at a given point in time.
5. Risk factors: These are factors or conditions that increase the likelihood of
an individual developing a particular condition or disease.
6. Healthcare facility: This refers to a physical location where healthcare
services are provided, such as hospitals, clinics, and medical centers.
7. Ekiti State Teaching Hospital: This refers to a healthcare facility located in
Ekiti State, Nigeria, that provides healthcare services to the general public
and serves as a teaching hospital for healthcare students.
8. Anxiety: This refers to a feeling of unease, such as worry or fear, that can be
mild or severe and can interfere with daily activities.
9. Depression: This refers to a mood disorder characterized by persistent
feelings of sadness, hopelessness, and loss of interest or pleasure in
activities.
10.Stress: This refers to a physical, mental, or emotional response to a
challenging or threatening situation, which can lead to feelings of tension,
discomfort, or strain.
11.Soft tissues: These are tissues in the body that are not bone, such as
muscles, tendons, ligaments, nerves, and cartilage.
12.Repetitive motions: This refers to the repeated performance of a specific
movement or action, such as typing, using a mouse, or lifting objects.
13.Awkward postures: This refers to body positions that are uncomfortable,
unnatural, or require excessive effort, such as bending, twisting, or
reaching.
14.Prolonged sitting or standing: This refers to the extended periods of time
spent in a seated or standing position, which can cause discomfort, fatigue,
or pain.
15.Policy: This refers to a set of principles or guidelines that guide decision-
making and actions in a particular organization or sector.
16.Practice: This refers to the actual implementation of policies or guidelines
in a particularorganization or sector.
 17.Cross-sectional design: This refers to a type of observational study that
collects data from a sample of individuals at a specific point in time to
determine the prevalence of a particular condition or disease.

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

Introduction:

The literature review is a critical component of this research, as it provides an

overview of the existing knowledge and research on psychological distress and
work-related musculoskeletal disorders (WRMSDs) among nurses. The literature
review will highlight the gaps in the current knowledge and identify the research
questions that this study seeks to address. This chapter will begin with a brief
overview of the concept of psychological distress and WRMSDs, followed by a
review of the existing literature on the prevalence and associated factors of these
health issues among nurses worldwide.

Psychological distress is a broad term that encompasses a range of negative

emotional experiences, including anxiety, depression, and burnout. Previous
studies have reported high levels of psychological distress among nurses, with
rates varying depending on the setting and population studied (Adewuya &
Afolabi, 2020; Shanafelt et al., 2015). Similarly, WRMSDs are a significant
occupational health problem among nurses, with studies reporting high rates of
musculoskeletal pain in various body regions (Choobineh et al., 2021; Ogunsanya
& Onigbinde, 2019).

The existing literature suggests that psychological distress and WRMSDs are
interrelated and may have common risk factors. For example, work-related stress,
job demands, and lack of social support have been identified as risk factors for
both psychological distress and WRMSDs among nurses (Gan et al., 2020;
Jahanian et al., 2021; Smith-Miller et al., 2018). However, the exact mechanisms
underlying the relationship between these health issues remain unclear, and
more research is needed to better understand the complex interplay between
psychological distress and WRMSDs among nurses.

Therefore, this literature review aims to critically evaluate the existing research
on psychological distress and WRMSDs among nurses, identify the gaps in the
current knowledge, and develop research questions that this study seeks to
address. The findings of this literature review will provide a foundation for the
development of a comprehensive research methodology and data analysis plan in
Chapter 3.

2.2 Conceptual Literature Review

1. Prevalence of work-related MSDs and psychological distress among nurses:

There is a growing body of literature that indicates a high prevalence of work-

related MSDs and psychological distress among nurses working in healthcare
facilities. For example, a recent cross-sectional study conducted by Afshari et al.
(2021) found that the prevalence of musculoskeletal disorders among Iranian
nurses was 62.4%. Similarly, a study conducted by Hahtela et al. (2020) found that
the prevalence of psychological distress among Finnish nurses was 41.5%.

2. Risk factors associated with work-related MSDs and psychological distress

among nurses:

Numerous risk factors have been identified as contributing to work-related MSDs

and psychological distress among nurses. These include physical factors such as
lifting, repetitive motions, awkward postures, and prolonged sitting or standing.
Psychosocial factors such as high workload, job demands, poor social support, and
low job control have also been identified as significant contributors. For instance,
a study by Babamiri et al. (2021) found that poor social support was significantly
associated with musculoskeletal disorders among Iranian nurses. Another study
by Yang et al. (2022) found that job demands and low job control were significant
predictors of psychological distress among Chinese nurses.

3. Impact of work-related MSDs and psychological distress on the health and

well-being of nurses:

Work-related MSDs and psychological distress can have a significant impact on

the health and well-being of nurses. Studies have found that nurses with MSDs
experience pain, discomfort, and reduced physical function, which can lead to
absenteeism, decreased work productivity, and decreased quality of life. Similarly,
nurses with psychological distress may experience symptoms such as anxiety,
depression, and burnout, which can lead to reduced job satisfaction,
absenteeism, and turnover. A recent study by Bishu et al. (2022) found that work-
related stress was significantly associated with poor sleep quality and fatigue
among Ethiopian nurses.

4. Implications for patient care and healthcare systems:

Work-related MSDs and psychological distress among nurses can have
implications for patient care and healthcare systems. For example, nurses with
MSDs may be unable to perform certain tasks, leading to reduced quality of care
for patients. Similarly, nurses with psychological distress may be less attentive and
more prone to errors, which can lead to adverse events for patients. Work-related
MSDs and psychological distress can also lead to increased healthcare costs due
to absenteeism, turnover, and workers' compensation claims. A study by Li et al.
(2020) found that the indirect costs of work-related stress among healthcare
workers in China were 8.07 times higher than the direct costs.

Overall, the conceptual literature review highlights the significant impact of work-
related MSDs and psychological distress among nurses working in healthcare
facilities. The review identifies several risk factors associated with these
conditions and underscores the need for interventions to mitigate these risks and
promote the health and well-being of nurses. The review also emphasizes the
implications for patient care and healthcare systems and the need for policies and
practices that support a healthy work environment for nurses.

Health

2.3 Theoretical Framework Problems

+
Job Strain
_
Resources

Psychosocial
_ Job demands +
The theoretical framework for this study is based on the Conservation of
Resources (COR) theory, which proposes that individuals strive to obtain, retain,
and protect valuable resources, including physical, psychological, and social
resources, to prevent stress and maintain well-being (Hobfoll, 2018). According to
this theory, stress occurs when individuals perceive that their resources are
threatened or depleted, and the resulting strain can lead to negative outcomes
such as psychological distress and physical health problems.

The COR theory has been applied in various occupational health studies, including
research on work-related musculoskeletal disorders (WRMSDs) and psychological
distress among healthcare workers (De Boer et al., 2018; Roche et al., 2020).
Previous research has shown that job demands such as heavy physical workloads
and high job demands are associated with increased risk of WRMSDs among
nurses, while job resources such as social support, job control, and autonomy are
protective factors.

The COR theory provides a useful framework for understanding the dynamic
interplay between job demands, job resources, and their effects on the health
and well-being of nurses. This theory posits that resources are critical for
preventing stress and maintaining well-being, and it proposes that individuals
who possess more resources are better able to cope with stress and adapt to
changing work environments (Hobfoll, 2018).

Therefore, this study will use the COR theory as a theoretical framework to
explore the relationships between job demands, job resources, psychological
distress, and WRMSDs among nurses in Ekiti State teaching Hospital. Specifically,
we will examine the direct and indirect effects of job demands and job resources
on psychological distress and WRMSDs and investigate the moderating role of job
resources in the relationship between job demands and employee outcomes. By
using this theoretical framework, we aim to develop a comprehensive
understanding of the factors that contribute to psychological distress and
WRMSDs among nurses and inform the development of effective interventions to
improve the health and well-being of healthcare workers.

2.4 Empirical Literature Review

A growing body of research has investigated the relationship between

psychological distress and work-related musculoskeletal disorders (WRMSDs)
among healthcare workers, including nurses. Several studies have identified high
rates of WRMSDs and psychological distress among nurses, with evidence
suggesting that these conditions may be interrelated (Griep et al., 2018; Käsbauer
et al., 2021).

For instance, a study by Griep and colleagues (2018) found that nurses with
WRMSDs had significantly higher levels of psychological distress compared to
those without WRMSDs. This study also found that job demands, such as high
physical workloads and long working hours, were significantly associated with
both WRMSDs and psychological distress among nurses.

Similarly, a recent study by Käsbauer and colleagues (2021) found that

psychological distress was a significant predictor of WRMSDs among nurses, after
controlling for various demographic and work-related factors. This study also
found that job demands and job resources, such as social support and job control,
mediated the relationship between psychological distress and WRMSDs among
nurses.

Other studies have also investigated the specific types of WRMSDs that are most
prevalent among nurses, as well as the risk factors and preventive measures
associated with these disorders. For instance, a study by Sutrisna and colleagues
(2019) found that low back pain was the most common WRMSD among
Indonesian nurses, with heavy lifting and awkward postures identified as the
primary risk factors. This study also highlighted the importance of ergonomic
interventions, such as training and equipment modifications, for preventing and
managing WRMSDs among nurses.
Similarly, a systematic review by Choobineh and colleagues (2020) identified
several risk factors for WRMSDs among nurses, including heavy physical
workloads, awkward postures, and insufficient rest breaks. This review also
highlighted the potential benefits of interventions such as ergonomic assessments,
exercise programs, and organizational support for preventing and managing
WRMSDs among nurses.

Overall, the empirical literature suggests that psychological distress and WRMSDs
are significant occupational health issues among nurses, with several risk factors
and preventive measures identified. By synthesizing this existing literature, the
present study aims to provide a comprehensive understanding of the relationships
between psychological distress, WRMSDs, and job demands and resources among
nurses in Ekiti State teaching Hospital.

CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

The present study aims to investigate the relationships between psychological

distress, work-related musculoskeletal disorders (WRMSDs), and job demands
and resources among nurses in Ekiti State Teaching Hospital. To achieve this aim,
a quantitative research approach will be employed, using a cross-sectional survey
design.

A cross-sectional survey design is appropriate for this study as it allows for the
collection of data from a large and diverse sample of nurses, while also enabling
the investigation of associations between variables of interest (Lavrakas, 2021).
Specifically, the study will involve the administration of a self-administered
questionnaire to a sample of nurses working in Ekiti State Teaching Hospital.
The questionnaire will be developed based on existing validated instruments,
including the Copenhagen Psychosocial Questionnaire (COPSOQ) (Kristensen et
al., 2015) and the Nordic Musculoskeletal Questionnaire (Kuorinka et al., 1987),
which have been widely used in previous studies investigating psychological
distress, WRMSDs, and job demands and resources among healthcare workers.

The questionnaire will consist of four sections:

1. Demographic and work-related characteristics,

2. Psychological distress,
3. WRMSDs, and
4. Job demands and resources.

The demographic and work-related characteristics section will include items such
as age, gender, years of experience, and job position. The psychological distress
section will assess symptoms of psychological distress using a validated
instrument, such as the Depression, Anxiety, and Stress Scale (DASS) (Lovibond &
Lovibond, 1995). The WRMSDs section will assess the prevalence and severity of
WRMSDs among nurses using the Nordic Musculoskeletal Questionnaire
(Kuorinka et al., 1987), which has been validated for use among healthcare
workers (da Costa et al., 2010). Finally, the job demands and resources section
will assess various aspects of job demands and resources using items from the
COPSOQ (Kristensen et al., 2015).

Data analysis will involve descriptive statistics, such as means and standard
deviations, to summarize the demographic and work-related characteristics of the
sample, as well as the prevalence and severity of psychological distress and
WRMSDs. Bivariate and multivariate regression analyses will be used to
investigate the relationships between psychological distress, WRMSDs, and job
demands and resources, while controlling for potential confounding factors.
3.2 Research Design

The research design for this study is a cross-sectional survey design. This design is
appropriate for collecting data at a specific point in time, as it allows for the
collection of data from a large sample within a short period. The cross-sectional
survey design also allows for the collection of data on multiple variables, enabling
the researcher to examine the relationship between variables.

In this study, the researcher will use a self-administered questionnaire to collect

data from nurses working in Ekiti State teaching hospital. The questionnaire will
include demographic information, the Copenhagen Psychosocial Questionnaire II
(COPSOQ II), and the Nordic Musculoskeletal Questionnaire (NMQ) to measure
job demands, job control, social support, work-related MSDs, and psychological
distress.

A convenience sampling technique will be used to select the study sample from
the population of nurses working in the hospital. This sampling technique will
enable the researcher to select participants who are readily available and willing
to participate in the study. The sample size will be determined using a sample size
calculator to ensure that the study has adequate power to detect significant
relationships between variables.

Data collected will be analyzed using descriptive and inferential statistics, such as
chi-square test, t-test, and logistic regression analysis, to examine the relationship
between variables. The study findings will be disseminated through academic
publications and conference presentations to inform policy and practice in
healthcare facilities.

3.3 Research Setting

The research setting for this study is the Ekiti State Teaching Hospital, which is
located in the southwestern region of Nigeria. The hospital is a tertiary healthcare
facility that provides a wide range of specialized healthcare services to patients
from Ekiti State and neighboring states. The hospital has several departments,
including the nursing department, which is the focus of this study.

The nursing department is an essential component of the hospital, and nurses

play a critical role in providing quality healthcare services to patients. The
department has a considerable number of nurses who work in various units,
including the intensive care unit, emergency unit, general ward, and outpatient
clinic.

The hospital's location in a densely populated region of Nigeria makes it an ideal

setting for this study, as the high patient population and workload may affect the
nurses' psychological well-being and increase their risk of work-related
musculoskeletal disorders. The hospital's size and scope of operations also make
it a suitable setting for collecting data from a large sample of nurses.

3.4 Population of the Study

The population of this study is all nurses working in the Ekiti State Teaching
Hospital. Nurses working in the hospital are eligible to participate in the study
regardless of their department, work experience, or other personal
characteristics.

The hospital has a significant number of nurses working in various units, including
the intensive care unit, emergency unit, general ward, and outpatient clinic. The
exact number of nurses in the hospital is not known, but it is estimated to be
several hundred.

To select the study sample, a convenience sampling technique will be used, and
the sample size will be determined using a sample size calculator to ensure that
the study has adequate power to detect significant relationships between
variables. The sample size will also be determined based on the ethical and
practical considerations of the study, including time and resource constraints.
3.5 Sample Size Determination

The sample size for this study will be determined using a sample size calculator,
which takes into account the population size, margin of error, and confidence
level.

The sample size of 150 nurses will also be determined using a sample size
calculator, with a margin of error of 5% and a confidence level of 95%. The
estimated population of nurses working in the hospital is several hundred, but a
precise number is not known.

The researcher will use a convenience sampling technique to select the sample of
150 nurses. The selection of participants will be based on their availability and
willingness to participate in the study. The researcher will ensure that the sample
is representative of the nursing population in the hospital by selecting
participants from various units and departments.

The sample size of 150 nurses is considered adequate for the study, as it provides
sufficient power to detect significant relationships between variables. The sample
size also takes into account the ethical and practical considerations of the study,
including time and resource constraints.

To calculate the sample size for the study, the researcher used the formula for
determining sample size for a single population proportion. The formula is as
follows:

n = (Z^2 * p * (1-p)) / E^2

Where:

n = the sample size

Z = the Z-value for the desired level of confidence (in this case, a 95% confidence
level, which corresponds to a Z-value of 1.96)

p = the estimated proportion of the population with the characteristic of interest

(based on previous studies, the estimated proportion of nurses with work-related
musculoskeletal disorders and psychological distress is 0.5)
E = the margin of error (in this case, 0.05)

Using this formula, the sample size calculation for this study is as follows:

n = (1.96^2 * 0.5 * (1-0.5)) / 0.05^2

n = 384.16

To adjust for potential non-response or incomplete surveys, a 10% attrition rate

was added, resulting in a total sample size of 422 nurses. However, since the
actual number of eligible nurses in the study population is less than 422, the
sample size was adjusted to 150 nurses for this study.

3.6 Sampling Technique

The sampling technique used for this study will be convenience sampling. This
technique involves selecting participants who are readily available and willing to
participate in the study.

Convenience sampling is appropriate for this study because it is cost-effective and

time-efficient. It also allows the researcher to select participants from various
units and departments, ensuring that the sample is representative of the nursing
population in the hospital.

However, one limitation of convenience sampling is that it may introduce bias

into the study, as participants who are more willing to participate may differ in
some ways from those who decline to participate. To mitigate this limitation, the
researcher will ensure that all eligible participants are given an equal opportunity
to participate in the study, and will take steps to minimize any potential biases.

Overall, convenience sampling is an appropriate sampling technique for this

study, as it balances practical considerations with the need for a representative
sample.
3.7 Instrumentation

The instrumentation used for this study will involve the use of two standardized
and validated questionnaires: the General Health Questionnaire-28 (GHQ-28) and
the Nordic Musculoskeletal Questionnaire (NMQ).

The GHQ-28 is a self-report questionnaire used to assess the mental health of

individuals. It contains 28 items that measure psychological distress, including
anxiety, depression, somatic symptoms, and social dysfunction. The GHQ-28 has
been extensively validated and used in various studies, including studies of
healthcare workers.

The NMQ is a self-report questionnaire used to assess the prevalence of

musculoskeletal disorders among workers. It contains questions about the
presence, severity, and duration of musculoskeletal symptoms in different parts
of the body. The NMQ has also been extensively validated and used in various
studies, including studies of healthcare workers.

The two questionnaires will be administered to the study participants through an

online survey platform. The online platform will allow for efficient data collection
and management, and will also ensure the anonymity and confidentiality of the
participants.

Before administering the questionnaires, the researcher will ensure that the
participants understand the instructions and the purpose of the study. The
participants will also be informed that participation is voluntary, and they can
withdraw from the study at any time. The researcher will also ensure that the
participants provide informed consent before participating in the study.

3.8 Pilot Study

Conducting a pilot study is an important step in any research project as it helps to

identify any potential problems with the study design, instrumentation, or data
collection methods. Therefore, a pilot study will be conducted prior to the main
study.

The pilot study will involve recruiting a small sample of nurses (approximately 10-
15) from the Ekiti State Teaching Hospital, who are similar to the study population
in terms of their demographics and work-related characteristics. The selected
nurses will be asked to complete the GHQ-28 and NMQ questionnaires, and
provide feedback on the clarity, readability, and relevance of the questions.

The data collected from the pilot study will be analyzed using descriptive statistics
to identify any issues with the study design or data collection methods. The
feedback obtained from the participants will be used to refine the study
instruments and make any necessary changes to the study design.

The pilot study will also provide an opportunity to assess the feasibility of the
study and identify any logistical issues, such as the time required to complete the
questionnaires, and any technical difficulties with the online survey platform.

Based on the results of the pilot study, adjustments will be made to the study
design, and the instruments will be finalized for use in the main study. The pilot
study will ensure that the main study is well-designed and will improve the quality
and reliability of the study results.

3.9 Psychometric Properties of the Instrument:

i. Validity of Instrument
In this study, the validity of the instruments (General Health Questionnaire-
28 and Nordic Musculoskeletal Questionnaire) will be assessed through
construct validity. This involves examining the extent to which the
instruments measure the constructs they are intended to measure. To
assess construct validity, the researcher will examine the correlations
between the instrument items and the relevant constructs. Additionally,
the researcher will conduct factor analysis to determine the underlying
factor structure of the instruments. A confirmatory factor analysis (CFA) will
 also be conducted to confirm the factor structure identified in the
exploratory factor analysis (EFA). The results of these analyses will provide
evidence of the validity of the instruments and support the use of these
instruments in the study.

ii. Reliability of Instrument

In this study, the reliability of the instruments (General Health
Questionnaire-28 and Nordic Musculoskeletal Questionnaire) will be
assessed using internal consistency reliability measures such as Cronbach's
alpha. Cronbach's alpha measures the extent to which items in the
instrument are interrelated and measure the same construct. A high
Cronbach's alpha indicates a high degree of internal consistency reliability.
The researcher will also assess the test-retest reliability of the instruments
by administering the instruments to a subgroup of participants twice, with
a time interval of one week in between. The results of these analyses will
provide evidence of the reliability of the instruments and support the use
of these instruments in the study.

3.10 Method of Data Collection

The data for this study will be collected using a self-administered questionnaire.
The questionnaire will consist of two parts: the General Health Questionnaire-28
(GHQ-28) and the Nordic Musculoskeletal Questionnaire (NMQ). The GHQ-28 will
be used to assess psychological distress, while the NMQ will be used to assess
work-related musculoskeletal disorders. The questionnaire will be distributed to
the selected sample of 150 nurses working in the Ekiti State Teaching Hospital.
The participants will be given clear instructions on how to complete the
questionnaire, and they will be asked to return the completed questionnaires
within a week. To ensure the quality of data collected, the researcher will be
available to provide clarification on any questions or items in the questionnaire.
The data collected will be kept confidential and anonymous to ensure the privacy
of the participants.
3.11. Method of Data Analysis

The data collected in this study will be analyzed using statistical software such as
SPSS or STATA. Descriptive statistics such as frequencies, percentages, means, and
standard deviations will be used to summarize the demographic characteristics of
the study participants and the variables of interest. Inferential statistics such as
correlation analysis, t-tests, and regression analysis will be used to examine the
relationships between psychological distress, work-related musculoskeletal
disorders, and other variables of interest. A significance level of 0.05 will be used
to determine statistical significance. The results of the analyses will be presented
in tables and graphs and will be discussed in the context of the study objectives
and research questions.

3.12. Ethical Consideration

This study will be conducted in accordance with ethical principles and guidelines
for research involving human subjects. The study will obtain ethical clearance
from the Institutional Review Board (IRB) of the Ekiti State Teaching Hospital
before data collection. Informed consent will be obtained from each participant
before they are enrolled in the study. The participants will be informed of the
purpose of the study, the procedures involved, the potential risks and benefits,
and their right to withdraw from the study at any time. The confidentiality of the
participants will be maintained, and all data will be kept secure and anonymous.
The study will adhere to the principles of non-maleficence, beneficence, justice,
and respect for persons in the conduct of research involving human subjects. Any
potential conflicts of interest will be disclosed, and the study will be conducted
with integrity and honesty.
PSYCHOLOGICALDISTRESSANDWORKRELATEDMUSCULOSKELETALDISORDERSAMONGNURSES
WORKNGINEKITISTATETEACHINGHOSPITAL

QUESTIONARE

Thisquestionnaireisaboutyourjoint,back,neck,boneandmusclesymptomssuchasaches,painsand/
orstiffness.

Pleasefocusontheparticularhealthproblem(s)forwhichyousoughttreatmentfromthisservice.

Section1:DemographicInformation

Foreachquestiontick()oneormoreoftheboxestoindicatewhichstatementbestdescribesyou

1.AreyouaRegisteredNurse Yes No

2.Howlonghaveyoubeenworkingasanurse? 0yrs-5yrs 6-10yrs 11-15yrs 16-20yrs 20-30yrs

3.Whatisyouragerange? 19-30yrs 31-40yrs 41-50yrs 51-60yrs

Section2:Work-RelatedMusculoskeletalDisorders

4.Haveyoueverexpe Yes. No
riencedanywork-
relatedmusculoskel
etaldisorders

5.Ifyes,pleasedescri (a)Neckpain.(b)Backpain.
bethetypeandlocati
onoftheinjury. (c)Shoulderpain.(d).Elbowpain

(e)Wrist/handpain(f)Hippain.

(g)Kneepain.(h)Ankle/footpain
 (i)Other(pleasespecify).....................................

6.Howfrequentlydidyouexpe DailyWeekly Ihavenotexperiencedany

riencethispainordiscomfort? painordiscomfortinthep
MonthlyRarely ast12months
Onlyonce

6.Haveyoueverhadtotaketim Yes No
eoffworkduetoawork-
relatedinjuryorillness?

7.Didyouseekmedicalattenti Yes No
onforthispainordiscomfort?

8.Howoftendoyouexperienc Everyday Sometimes Never

epainordiscomfortrelatedtoy
ourjobduties?

9.Doyouthinkyourjobasanurs Yes No Notsure

econtributedtothispainordis
comfort?

10.Doyoufeelthatyourworke Agree Neutral Disagree

nvironment(e.g.equipment,s
taffing)isadequatetoprevent
work-
relatedmusculoskeletaldisor
ders?

11.Howmanyhoursperweekdoyo Lessthan20hours 20- 31- Morethan41hour

uworkonaverage? perweek 30hourspe 40hourspe sperweek
rweek rweek
Section3:PsychologicalDistress

12."Ihaveexperiencedpsychologicaldistressrelatedtomyjo Strongly Agr Neu Disag Stronglydis

bduties." Agree ee tral ree agree

13.Doyoufeelthatyouhaveenoughsupportfromyourcollea Strongly Agr Neut Disag Stronglydi

guesandsuperiorstomanageyourjob-relatedstress? Agree ee ral ree sagree

14.Doyoufeelthatyourjobisrewardingandfulfilling? Strongly Agr Neut Disag Stronglydi

agree ee ral ree sagree

15.Howoftendoyoufeeloverwhelmedorburntoutfromyour Someti Oft Nev Rarel

jobduties? mes en er y

16.Haveyoueverreceivedanytrainingorsupportrelatedtomanagingjob- Yes No Notsure

relatedstressorpsychologicaldistress?

Section4:CopingStrategies

17.Howdoyoutypicallycop Regulare Seekingsup Engaginginh Usingrelaxationt Seekingprofes

ewithwork- xerciseor portfromfa obbiesoroth echniquessucha sionalhelpfro
relatedstressorpsychologic physicala milyandfrie erenjoyablea sdeepbreathing macounselor
aldistress? ctivity nds ctivities ormeditation ortherapist.

18.Haveyoueversoughtpro Yes,andit Yes,butitw No,butIhave No,andIhavenot Prefernottoan

fessionalhelpforjob- washelpf asnothelpf consideredse consideredseeki swer
relatedstressorpsychologic ul ul ekinghelp nghelp
aldistress?

19.Doyoufeelthatyourcopi Mycopin Mycopings Ineedmores Ihavenocopingst Iamunsureifm

ngstrategiesareeffective,or gstrategi trategiesar upporttoimp rategiesinplaceo ycopingstrate
doyoufeelthatyouneedmor esarevery esomewha rovemycopin r giesareeffecti
esupportinthisarea? effective teffective gstrategies venot
Section5:AdditionalComments

20.Isthereanythingel Yes,Iwouldliketosharemye No,Idon'thaveanya I'mnotsurewhatkindofexperie

seyouwouldliketosh xperiences......................... dditionalexperienc ncesyou'relookingfor..............
areaboutyourexperi ........................................... estoshare. ................................................
enceswithwork- ........................................... .......
relatedmusculoskele ....................
taldisordersorpsych
ologicaldistress?