ASSESSMENT OF WORK RELATED-STRAIN, PERCEIVED STRESS

AND JOB SATISFACTION AMONG NURSES WORKING IN SELECTED

HEALTH FACILITIES IN OYO STATE

CHAPTER ONE

1.1. Background of the study

Nurses encompass the largest workforce and play an important role in the provision of direct

patient care. Additionally, nurses play a significant intermediary role between the patient and the

physician. In addition to providing direct patient care and dealing with the human suffering daily,

nurses are expected to meet multiple and conflicting demands imposed by nurse managers,

supervisors, medical and other administrative staff in the hospital. These lead the nurses to

experience stress, role conflict and workload, which seriously impairs the efficacy of delivery of

quality healthcare service. As nurses play a critical and most extensive role in providing holistic

patient care and deal with the patients having acute and chronic illness with disability and

discomfort from birth to death, there is no surprise that nursing has been unfailingly known

globally as stressful work.

Nursing is, by its very nature, an occupation subject to a high degree of stress. Every day the

nurse confronts stark suffering, grief, and death as few other people do. Many nursing tasks

are mundane and unrewarding. Many are, by normal standards, distasteful, even disgusting,

others are often degrading; some are simply frightening (Hingley, 2018 in McGrath, Reid, &

Boore, 2019). This quote highlights the importance of investing time and resources in

1
investigating, reporting, and ameliorating the level of stress among nurses especially when the

nature of their job readily exposes them to multiple agents of stress.

Besides, the ratio of population and nurses is also projected to be below the developed countries

(World Health Organization, 2018), emphasizing a further analysis of nurses’ job satisfaction

and stress level. Further, studies also indicate that workload increases due to nurse shortages,

leading to psychological distress (Li et al., 2018), which is likely to affect the care delivery to

patients. Based on each nurse’s individual differences, there is an increased chance of developing

work-related stress that leads to differences in job satisfaction. For instance, almost 3,950 nurses

in Oyo State Hospital received 2.06225 million patients within one year. Thereby, continuous

complaints are received by nurses regarding work-related stress. A previous study showed that

health care systems and patient care is negatively affected as a result of stress, depression, job

satisfaction, and psychological distress (Salam, 2018). Improved quality of care and a reduction

in medical errors are possible when work-related stress is reduced and job satisfaction is

increased among the nurses. This also helps contribute to the health policy of the country

(Alboliteeh, Magarey & Wiechula, 2019).

1.2 Statement of The Problem

Stress in the Nursing profession has been a major worldwide problem for quite some time now.

A study among a large sample of Swedish Nurses revealed that more than 80% of the Nurses

reported high to very high job strain (Peterson et al., 2018). A study among personnel of a

Nigeria health authority reported that Nurses were under the greatest pressure among all health

care personnel (Rees and Cooper, 2018). Stress and the negative outcomes of stress have been

recognized as financially costly to any health care organization. Negative outcomes of job stress

among Nurses include illness, decline in overall quality of care, job dissatisfaction, absenteeism,

2
and staff turnover (Schwab, 2018). Stress is associated with impaired individual functioning in

the workplace and other negative effects include reduced efficiency, decreased capacity to

perform, dampened initiative, reduced interest in working, increased rigidity of thought, a lack of

concern for the organization and colleagues, and a loss of responsibility.

Apart from the problems mentioned above, it appears that there might be difference in the levels

of stress experienced by Nurses working in the Psychiatry Hospitals and those that are working

with the General Hospitals. This study will fill the gap in research that has not been well

researched into.

Furthermore, the relationship between work related-strain, perceive stress and job satisfaction

will also be taken into consideration.

1.3. Objective of The Study

Broad Objective

To assess work related-strain, perceived stress and job satisfaction among nurses working in

selected health facilities in Oyo State

Specific objectives are

1. To determine the extent of work-related strain among nurses in selected health facilities in

Ouo State.

2. To assess the level of perceived stress among Nurses in Oyo state Hospitals

3. To assess the level of job satisfaction among nurses in selected health facilities in Oyo State.

1.4. Research Question

3
1. What is the extent of work-related strain among nurses in selected facilcities in Oyo

State?

2. What is the level of perceived stress experienced by nurses in selected facilities in Oyo

State?

3. How satisfied are nurses in selected facilities in Oyo State?

1.5. Research Hypothesis

1. There is no significance relationship between work related strain and job satisfaction

among nurses in selected facilities in Oyo State

2. There is no significance relationship between perceived stress and job satisfaction among

nurses in selected facilities in Oyo State.

1.6. Significance of the study

This study will provide information to Nursing administrators, clinicians, and educators related

to perceived job stress and job satisfaction, employment of staff to the Oyo State Hospitals and

the Psychiatry Hospitals in Oyo State. Furthermore, understanding the relationship of job stress

to job satisfaction will give direction to Nurse Administrators as to the relative importance of

reducing stress or increasing other job satisfiers. This is because increased stress and/or

decreased job satisfaction increases the likelihood of job injury, absenteeism and staff turnover

which is expensive to the Hospital.

Apart from that, Nurses in clinical practice experience the rapid turnover of staff due to stress,

lack of satisfaction, or both, reduces the quality of care as new staff must be oriented and group

cohesiveness is weakened by constant changes in the group membership on a Nursing unit.

4
Increased understanding of both stress and satisfaction factors will prompt staff Nurses to take

personal measures to reduce stress, raise their level of expertise, and become proactively

involved in improving the working environment of their organizations. For Nurse Educators,

knowledge of the relationship between job stress, job satisfaction, and intent to leave

employment could be used in either Basic Nursing education settings or in continuing education.

This will enable the Nurse Educators to design and integrate effective stress management

techniques during their teaching of Nursing Students and in service education for practicing

Nurses in the Hospitals.

1.6. Scope of the study

This study is delimited to work related-strain, perceived stress and job satisfaction among

nurses in selected health facilities in Oyo State.

1.7. Operational definition of terms

Work related Strain: Work related Strain is a form of psychosocial stress that occurs in the

workplace. One of the most common forms of stress, it is characterized by a combination of low

salaries, high demands, and low levels of control over things such as raises and paid time off.

Stresses at work can be eustress, a positive type of stress, or distress, a negative type of stress.

Job strain in the workplace has proved to result in poor psychological health, and eventually

physical health. Job strain has been a recurring issue for years and affects men and women

differently.

Perceived stress: Perceived stress is the feelings or thoughts that an individual has about how

much stress they are under at a given point in time or over a given time period.

Job satisfaction: is a measure of nurses contentment with their job

5
Stress: a state of worry or mental tension caused by a difficult situation.

Nurses: individuals licensed by Nursing and midwifery council of Nigeria to practice nursing

CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction

Literature review is an important aspect of any research work. It helps to give an insight into the

research problem. It also helps to select methodology, devise research tools and analyze data.

The literature review relevant to this study is presented in the following section.

2.1. Conceptual Review

2.1.1 Concept of Stress

Stress is a dynamic response reciprocating between the person and the environment. The term

stress has continuously been re-examined in the context of pathophysiology, is nevertheless a

well-proven and contributing factor in etiology and prognosis of many inflammatory diseases.

Selye defined stress as “response state of organism to energies acting collectively on body

which, if excessive, i.e., straining the capacity of yielding processes beyond their limits, succumb

to exhaustion and death.” Socioeconomic factor, occupation portfolio, daily schedule,

competitive work environment, emotional trauma, etc., have led to increased level of stress in the

modern lifestyle.

6
Stress may act alone or in combination and may exert effects at different stages of the life course.

There have been multiple mechanisms advocated to bridge pathogenic properties associated with

stress including:

• A direct activation of psychosocial stress involving the central and autonomic nervous system.

• An indirect role of psychosocial stress through behavioral adaptations.

Stress may affect at risk health habits such as smoking, alcohol consumption, neglect of oral

hygiene, or poor compliance with dental care.

The potential negative influence of stress on medical health in general and on specific diseases,

in particular, has been subject of extensive research. The stresses evaluated in this study were

perceived stress and occupational stress measured by Perceived Level of Stress (PLOS) and

Expanded Nursing Stress Scale (ENSS), respectively.

Occupational stress was assessed because according to the WHO report, “Raising Awareness of

Stress at Work in Developing Countries” in 2007, and it is one of the most common forms of

stress in developing countries as the socioeconomic states, social inequalities, and

overpopulation forces employees to work based on job availability without a choice. People with

different jobs encountered different types and quantities of stress. Selye indicated that nursing is

one of the most stressful professions. Nursing is an occupation with a constellation of

circumstances leading to stress. Nurses were selected for the study because nursing is an

occupation with a constellation of circumstances leading to stress. Stress affecting nurses across

the globe has been convincingly documented in many literatures.

Nurses in Nigeria are overburdened as the nurse top patient ratio is low (1:2250). They are

responsible along with other health-care professionals for the treatment, safety, and recovery of

7
acutely or chronically ill, injured, health maintenance, treatment of life-threatening emergencies,

and medical and nursing research. Nurses do not only assume the role of caregivers but are also

administrators and supervisors of patients. These multiple work roles contribute to the significant

amount of occupation-related stress among nursing staff, particularly those working at the

bottom of the hierarchy such as staff nurses and nursing sisters, who end up sharing most of the

work burden. Shift duties, time pressures, lack of respect from patients, doctors as well as

hospital administrators, inadequate staffing levels, interpersonal relationships, death of patient,

and a low pay scale significantly add to their stress levels. These factors are intrinsic to nursing

and are compounded by environmental factors such as difficult patients and their families,

relationships with physicians, low institutional commitment to nursing, and the delivery of poor

quality care. Research has shown that nursing is a high-risk occupation in respect of stress-

related diseases

According to the American Institute of Stress, stress is defined by Hans Selye as the nonspecific

response of the body to any demand for change (1950). After this advancement, Selye’s coinage

of the term “stress” focused on the undefined reaction, which is the “nonspecific response” of the

body hence a focus closely linked to physical response. From this perspective, stress was

postulated as how the body responds to certain ‘stressors’, which are injurious.

In the early 21st century, stress has also been described as a state when an individual's available

resources are unable to measure up with the psychological and physical needs at that moment in

time. In this case, stress is apparent according to one's situation and physical and psychological

state (Michie, 2020). Considering this, it is apparent that the definition of stress has adopted the

reliance on available resources hence stress becomes a variant of one’s capacity and accessibility

to resources. In this interpretation, it can be concluded that one’s stress level depends on what

8
one has in possession to counter their psychological and physical requirements. Therefore, stress

can be based on the availability of resources versus the required needs of an individual at that

specific time. Based on this viewpoint, stress could easily be computed by determining the ratio

of one’s psychological and physical needs to one’s available resources at a given time.

More recently, stress has been defined as “any situation in which internal and external demands,

or both, are appraised as taxing or exceeding the adaptive or coping resources of an individual or

group” (Lim et al, 2019). Although Lim and colleague’s viewpoint could be considered a new

way of considering stress, the fundamental components of the definition are closely related to the

definition of Michie (2020). This is because both of these define stress as a result of the ratio

between needs or demands and the resources. Therefore, in recent years, stress has been accepted

as “an essential part of life” (Beheshtifar et al, 2018). This view can be attributed to the changes

in lifestyles and civilization, as stress becomes part of the daily lives of individuals. Therefore,

stress is seen as part and parcel of everyone’s life unlike the previous notions that stress only

affects those who are in work areas. According to Beheshtifar et al (2018), stress has become a

necessary aspect of humanity, which provides the notion that stress has become universal.

2.1.2 Theories of stress

The COR theory was developed by Steven Hobfoll (2019) and explores the connection between

the individual and the environment and the level of interaction between pressures in the

environment and the individual’s ability to cope with those pressures. The underlying principal

of COR is that people try hard to acquire, preserve and nurture things that they value, they

surround themselves by and accumulate resources to help them cope better with life’s demands

and challenges. According to Hobfall, resources are things that positively contribute to an

individual’s well-being and can either be internal or external in nature. Internal or personal

9
resources include personal values and personality characteristics such as sense of achievement,

optimism and self-esteem. In a work environment, external resources include the level of

autonomy one has in one’s job, receiving positive feedback on performance and performance-

based rewards (Hakanen, Perhoniemi & Toppinen-Tanner, 2018). Supportive colleagues and the

level of organisational support available can also reduce stress levels and burnout and enhance

employees’ overall well-being (Halbesleben, 2020).

Two further principles of this theory are resource spirals and resource caravans. Resource spirals

is the concept that, when individuals lack the resources to deal with stressful experiences, they

become vulnerable and loss generates further loss of resources (Hobfoll, 2019). Conversely,

acquiring resources expands the resource pool, making it possible to gain further resources. For

example, high employability decreases the risk of unemployment and increases the likelihood of

career progression with further opportunities for growth and development, which enhance

employee engagement (Salanova, et al., 2018). The idea of resource caravans proposes that

resources can accumulate and develop from each other. For instance, if an individual’s self-

esteem is reinforced by adequate job performance, they are likely to be more optimistic

regarding their future performance. Xanthopoulou et al. (2019) demonstrated the application of

the COR theory in a two-wave longitudinal investigation among employees in an electrical

engineering company in the Netherlands. They found that work engagement increased in

employees with higher levels of resources such as self-efficacy, self-esteem, and optimism, their

study also illustrated the notion of spirals in relation to employee engagement.

Another theory worth mentioning is the JDC theory of stress, which was initially developed by

Karasek in 1979. He suggested that job demands or pressures alone are not significant enough to

10
have a major effect on stress levels, instead the amount of pressure that individuals experience

will be driven by the level of control they have over those demands.

The relationship between control and demands is illustrated in Figure 1. There are however,

several unresolved issues with this model. One is whether or not there is any interaction between

the effects of demands and control, and the second issue is whether the control factor is objective

or subjective in nature. Studies to date have mainly focused on workers’ perceptions of control

rather than determining objective measures of control. There is also controversy about the

universal applicability of this theory to different cultures. Although some studies have found a

moderate influence of perceived job control on the correlation between job demands and

psychological strain (Beehr et al., 2019), a recent study on Malaysian technical workers found

that self-efficacy impacted stress levels rather than job control (Panatik, O’Driscoll & Anderson,

2020). Therefore, it is possible that this model cannot be generalized to collectivist cultures. The

theory was further revised by Karasek and Theorell in 2021 to include social support as a factor

that influences occupational stress. They proposed that the positive effects of control can be

reinforced by receiving social support from colleagues and supervisors. Although there is

substantial evidence that support plays a role in reducing occupational stress (Cooper et al.,

2001), there is some debate over whether the impact is direct or indirect. There is also evidence

of a three-way interaction between demands, control and social support (Daniels et al., 2008).

Control and support were found to reduce strain and improve wellbeing by acting as coping

mechanisms in dealing with stressful situations. However, other research reported mixed results

of the JDC model due to issues with measuring perceived control and issues around the effects of

social support and whether the person wishes to receive any support at all (Wall et al., 1996).

11
However, despite the various controversies around the JDC model, it has numerous practical

applications for enhancing wellbeing and reducing the impact of stressors at work.

2.2. Theoretical Framework

2.2.1 Work-related Stress and burnout

Surveys carried out on workers in Oyo State have established that occupational stress is a major

contributor to ill-health, absenteeism, and early retirement, as well as being a health and safety

hazard. During the time, this resulted in approximately 6.5 million working days lost to industry

and commercial enterprises each year. This was equivocal to a financial loss of around £3.7-3.8

billion to British society, its industries and its citizens.

12
Oyo State Nurses workers ranked the level of emotional demands as the strongest predictor of

work related stress, particularly in the Hospitality and Health sectors. Time pressure, bullying

and harassment and being under-rewarded in relation to work effort also ranked highly as

predictors of job stress (Russell et al., 2019). Work-related stress has become a global

phenomenon, which has resulted in legal directives in many countries for employers to address

this issue.

If left unmanaged, chronic work related stress can develop into ‘burnout’. Burnout was first

investigated in healthcare workers (Maslach, 2021), and was said to be associated with emotional

exhaustion, depersonalization and diminished sense of achievement in professionals who work

with people. Controlling one’s emotions and expression of one’s emotions are thought to be the

key aspects of these professions. Constant interaction with patients, clients or children requires

empathy and emotional involvement which many people begin to struggle with over time. The

COR theory suggests that burnout occurs when existing resources are lost, not sufficient to meet

demands, or do not provide the anticipated returns.

(Hobfoll, 2019). Demands in the workplace include, stressful events, conflicts and role

ambiguity and heavy workloads. Resources include social support from colleagues or

supervisors, taking part in decision making, and autonomy (Burke & Richardsen, 2019).

According to Karasek (2018), autonomy is particularly important for reducing employee stress.

He found that employees who had high job demands with little control of decision making were

more likely to be nervous, anxious, exhausted and have trouble sleeping. Whereas those who had

high demands and more control were less likely to be stressed. For many employees, the main

decision is to establish the amount of resources they must invest to satisfy the demands while

protecting themselves from further depleting their resources.

13
Strain occurs when employees think to have insufficient emotional resources to cope with the

interpersonal stressors (Hobfoll, 2019; Maslach, 2020).

The characteristics of burnout include, low energy levels or exhaustion, being mentally distant

form one’s job, or experiencing negative emotions or cynicism towards one’s job (WHO, 2019).

In healthcare workers, these conditions may result in reduced work performance and have an

adverse effect on patient safety (Berland, Natvig & Gundersen, 2018). Burnout affects both

individuals and organizations, contributing to absenteeism and turnover which may decrease the

quality of care delivered to patients. Among other healthcare professionals, nurses in particular

were found to be the most susceptible to burnout (Rosales, Labrague & Rosales, 2019).

The most recent definition of stress by 21st century studies is closely related to the workplace

environment. Such terms as work stress, job stress and occupational stress have arisen, and have

henceforth been used interchangeably. Occupational stress or work-related stress may be viewed

as a characteristic of the work environment and usually as an objectively measurable aspect of

that environment (Cox, 2019). Symonds (2021) is of a similar view where: “stress is that which

happens to the man, not that which happens in him; it is a set of causes not a set of symptoms”

(Broome & Llewelyn, 1995, p.22). This definition was most applicable to workplace situations

especially in relation to the problems at work. In his two key books, Selye (2018) suggests stress

as a close response to work challenges. Selye (2018) elaborates that stress is not what happens to

you but how you react to it. At the end of the 20th century, Peter and Siegrist (2019) defined job

stress as a difficult response due to pressures at work. They emphasize that job stress is an

adverse reaction to excessive job pressures and demands. This definition focuses on what the

individual does in response to the pressure asserted or received at the workplace. Therefore, the

measure of work stress would be determined by the response of the individual at work.

14
Furthermore, as stress has garnered increasing attention from public health and other researchers,

several definitions of job stress have surfaced over the past few decades. The National Institute

for Occupational Safety and Health defines job stress as "the harmful physical and emotional

responses that occur when the requirements of the job do not match the capabilities, resources or

needs of the worker" (NIOSH, 2021, p. 6). Thus, job stress has clearly been classified as

detrimental responses that one evokes when there is an imbalance between the standards of the

job expected and the tools that are available to the individual.

2.2.2 Causes of stress in Nurses

To identify Nurses’ perceptions of workplace stress, consider the potential effectiveness of

initiatives to reduce distress, and identify directions for future research, a literature search from

January 2018 to April 2020 was conducted by Mc Vicar (2020) using the key words Nursing,

stress, distress, stress management, job satisfaction, staff turnover and coping to identify research

on sources of stress in adult and child care Nursing. United Kingdom Department of Health

documents and literature about the views of practitioners was also consulted. His findings

revealed that workload, leadership/management style, professional conflict and emotional cost of

caring have been the main sources of distress for Nurses for many years, but there is

disagreement as to the magnitude of their impact.

Blair and Littlewood (2018) emphasized that work relationships are potential stressors. Two

sources of stress in this field are the conflicts with co-workers and the lack of staff support.

Another assessment showed that lack of social support from colleagues and superiors and less

satisfaction with the head Nurses contributed significantly to the appearance of stress

(Sveinsdottir, 2018), while the Health and Safety Executive identify the negative effect of lack of

understanding and support from their managers, on workers’ stress.

15
Clarke and Ruffin (2020) examined perceived sources of stress among 306 student Nurses from

three institutions in the USA. Data were collected using two self-reporting questionnaires. The

response rate was 72%. The initial questionnaire assessed demographic data and perceived

stressors, which were then used to form the basis of the second questionnaire assessing 28

potential stressors. The analysis of the mean results indicated that the major stressors for Nursing

students were the `total amount of work to be completed', `coping with exams', `handling

emergencies in the clinical area', `fear of making mistakes', `coping with the theoretical course

work' and `coping with terminally ill patients'. The factors causing least concern included `living

away from home', `interaction with fellow students', `interaction with academic staff', `handling

excreta' and `interaction with patients'. The area with the highest score for stress was studied. In

2021, Gillespie and Melby conducted a research aimed at determining stressors, effects on

patient care, and the impact of stress outside of the clinical setting. This research showed that

Nurses in an acute medicine environment had higher levels of stress than those working in

accident and emergency environment (Gillespie and Melby, 2003).

2.2.3 Job satisfaction and work-related stress in Nurses staff

Job satisfaction is essential for preserving the workforce of any organization. Lack of job

satisfaction is associated with high employee turnover, stress and burnout (Lephalala, Ehlers, &

Oosthuizen, 2018). According to Herzberg’s theory of motivation, intrinsic and extrinsic job

rewards can influence employees’ job satisfaction. Intrinsic factors refer to inherent job

characteristics such as autonomy, variety and level of responsibility, while extrinsic factors

include salary and benefits such as pension and health insurance (Chaudhury & Banerjee 2018).

Job satisfaction can give a good insight on employee well-being, physiological health and it can

also be an indicator of organizational functioning (Bhatnagar & Srivastava, 2019).

16
The relationship between job stress and job satisfaction in healthcare staff has been well

established in the literature. Factors such as adequate financial compensation, receiving time in

lieu for overtime hours and good relationships with patients, families and other staff members

can help to offset the negative effects of work-related stress (Grunfeld et al. 2021; Ogresta et al.,

2018; Ramirez et al., 1996; Salam et al., 2014). However, the level of care and concern that

nurses and HCAs show for their patients often goes beyond financial compensation and the

causes of stress are often intrinsic to the job (Rosales, Labrague & Rosales, 201). For example,

having to comfort bereaved parents in paediatric units or provide terminal care to patients with

life threatening diseases after developing a relationship with them over many months. Over time,

distressing patient situations may lead compassion fatigue in healthcare staff (Aslan, Erci, &

Pekince, 2021). Other stressors include tensions at home and organizational factors such as

frustration with one’s manager or colleagues.

Studies found that having good relationships with colleagues and managers was associated with

increased job satisfaction and lower job stress (Ramirez et al., 2021; Grunfeld et al., 2019).

Having good relationships with co-workers in particular may provide employees with emotional

and instrumental support as they have a comprehension of the internal working environment (Jia

& Shoham, 2021). Furthermore, positive relationships with coworkers were found to improve

communication and collaboration, leading to enhanced decision-making (Heath, Johanson &

Blake, 2004). A study by Wong, Spence Laschinger, & Cummings, 2019 also suggested that

positive relationships with peers are stronger drivers of work engagement than supervisory

relationships.

Another stressor for healthcare workers is inadequate staffing levels. Previous studies found that

staff shortages were contributing to burnout and exhaustion in nursing staff and HCAs

17
(Donnelly, 2019; Donnelly, 2018; Lapane & Hughes, 2021). According to Donnelly (2019), staff

shortages coincided with a 34% increase in absenteeism due to stress among nurses, which has

resulted in an increased workload for remaining staff as they are expected to deliver the same

standards of care and meet patient demands with less resources. According to McVicar (2022),

the main causes of work related stress in healthcare organizations include poor organization of

work, such as work load and a narrow time frame to examine patients, leadership style,

professional conflict, emotional cost of caring together with lack of reward and shift work.

However, the perception of stress varies from one individual to another, therefore researchers

can never be too confident or conclusive

regarding the sources of stress.

Individual characteristics such as personality, personal experiences, emotional maturity, age, sex,

nationality (Al-Omar, 2020; Salam et al., 2019) family status, socioeconomic status and years of

employment can all impact on how an individual will perceive and react to stress (Mészáros et

al., 2018). For example, Salam et al. (2021) found that younger staff reported higher levels of

stress than older staff, and older, more experienced staff had higher levels of job satisfaction.

Research also suggests that there is a relationship between gender, job stress and job satisfaction

in healthcare professionals, however the evidence is conflicting. Cooper, Rout and Faragher

(2021) found that female general practitioners had higher levels of job satisfaction and positive

mental well-being in comparison to their male counterparts. On the other hand, Taylor (2021)

reported higher levels of job stress in female healthcare workers due to work-life balance and

additional demands of childcare and domestic responsibilities. Demographic factors, along with

the level of job satisfaction and autonomy one has in work-related decision making may

influence the extent to which he/she is affected by occupational stress.

18
Similarly, to Ramirez et al., Grunfeld et al. (2019) examined the effects of job stress and job

satisfaction in cancer care workers, however they used qualitative and quantitative methods to

allow for a greater depth of study. They found that work load and inadequate staffing levels are a

major source of job stress in cancer treatment facilities, which is consistent with other studies

(Salam et al., 2018; Ramirez et al., 2020). Interestingly, patient suffering did not emerge as a

significant contributor to job stress. In fact, helping patients and families was a unanimous

source of job satisfaction. Findings of this study suggest that cancer care units could benefit from

system changes to alleviate job stress due to heavy workloads and improved recruitment and

retention strategies for new trainees in systematic therapy.

A number of studies have investigated the prevalence of occupational stress specifically in

nursing staff within a hospital setting. Research carried out by the General University Hospital of

Murcia, Spain (Carrillo-García et al., 2018) evaluated work-related stress in nurses according to

the demand-control-support model. They found that intense work load, low decision making

capacity, the requirement of multitasking and lack of social support from superiors contributed to

the levels of stress in nurses. Furthermore, a study of Taiwanese hospital workers (Chou, Li &

Hu, 2019) found that nurses had the highest levels of burnout compared to other healthcare

workers, which is consistent with findings from other studies (Rosales, Labrague & Rosales,

2018; Ho, Chang & Tsao, 2020). The main causes of stress were over commitment and lack of

social support, younger healthcare professionals also reported higher levels of stress.

Islam et al. (2018) studied the effects of stress on nursing home and residential care workers in

the UK. They conducted a national survey on care staff working with dementia residents in

randomly selected care homes in Wales. focused on health and welfare; stress; productivity; job

content; job satisfaction; and overall experience of working in the field.

19
Results showed that staff working in nursing homes experienced greater levels of stress than

those working in residential homes due to work events, workload and scheduling. Staff in

smaller care homes also reported higher job satisfaction and lower burnout due to higher staffing

levels. Limitations to the study included a moderate response rate of 54% and the self-selection

of staff in nursing homes to complete the survey. These findings correspond with McVicar

(2019) in terms of work load and work organization having a strong impact on stress levels.

With regards to Mental Health Nurses, relatively few studies have examined influences on job

satisfaction. Most of the studies have sought to describe the negative relationship between stress

and job satisfaction rather than identify specific factors which have an impact on it. Landeweerd

and Boumans (2019) found out that Nurses who were satisfied when working in Psychiatric

Hospitals were more satisfied than when referred to General Hospitals. He attributed this to

factors such as luck of support, poor communication with doctors, small space and violent

incidents leading to job satisfaction. He also found out that all Psychiatric Nurses in all units

were satisfied with their work and those in admission units were most satisfied. This they

attributed to the relative quick results from their efforts and their work required interacting with

other Nurses. Farrel and Dares (1999) also assessed the level of job satisfaction of Nurses in the

General Hospital and discovered that they had low satisfaction due to lack of team work among

themselves.

2.3 Empirical Review

2.3.1. Relationship between Stress and Job Satisfaction among Nurses

A lot of researches have been done to establish the relationship between stress and job

satisfaction among Nurses which have yielded varied results. According to Nolan et al. (2021)

20
and Cushway et al. (2019) there is a negative relationship between stress and job satisfaction.

However, Davis (1974) also found that there has not been any significant relationship between

stress and job satisfaction in Psychiatric Nurses. This study is questionable due to the small

sample and also from a single Hospital. In the literature, it has been observed that workload is

the main stressor among Nurses. In comparing the satisfaction level of Psychiatric and General

Nurses, it was found out that the former were more satisfied. There is no consensus as to the

relationship between the stress and job satisfaction among Nurses.

2.3.2. Challenges of Nursing in Oyo State, Nigeria

In comparison to other countries, Oyo State has a unique set of challenges that affect nurses.

Even though Oyo state Government has invested heavily in the healthcare system, there still

exist challenges in the field of nursing. Although the country has recently increased the number

of nurses, the number is still not sufficient to meet the demand of the country’s population. Apart

from a shortage of nurses, other challenges affecting nurses in Oyo State include educational

challenges, social and cultural challenges, and challenges related to the country’s healthcare

system (Lamadah & Sayed, 2019).

Oyo State has increased the number of nurses employed by the PHCS in the last few decades. In

2014, the total number of nurses in Oyo State was 5,656. This number exponentially increased to

11,056 in 2016 the number of nurses was 139,701 (MOH, 2012). This is more than triple the

number of nurses employed two decades earlier. Although the growth rate of the number of

nurses in Oyo has been lower than the population growth over the same period, the shortage of

nurses in 2010 was estimated at 0% (Lamadah & Sayed, 201). Clearly, this affects the employed

nurses as their workload increases with the need. The country also recruits more than half of its

21
nursing workforce. This factor poses additional challenges to the nursing profession in the

country.

Their educational training, they possess may not have prepared them for this work environment

as most nurses are trained to provide services in their country of origin and not in a Middle

Eastern environment. The educational curricula vary according to the system of education of the

country of origin of the incoming nurses. As a result, there are educational gaps among nurses

regarding training and practice. For instance, a hospital that recruits’ nurses from twenty

countries receives nurses from twenty different training curricula hence posing the challenge of

standardization of practice. In response to this, hospitals are required to provide in-house training

programs, induction programs, orientation programs and other professional development

programs to ensure that the quality of nursing matches expectations. According to Lamadah &

Sayed (2019), nurses’ in-house professional development services vary greatly in the hospitals

especially between the three sectors: MOH, OGA, and PHCS. Consequently, nurses may not be

adequately prepared for their jobs even though these programs assert additional budget to the

hospitals. Despite the fact that many nurses are hired every year from different state to work in

Oyo State, the healthcare sector also faces the problem of many nurses leaving the profession or

leaving the country, which leads to a high turnover within the sector. Consequently, the

healthcare sector loses out financially because of the investment in recruitment, training and

employment. According to Almalki (2019), the home and work life of expatriate nurses working

in Oyo, social and cultural aspects, accommodation facilities, transportation, building and

infrastructure of the facilities, nature of work, job instability, privacy at work, patients and the

community, and distance between home and workplace were identified as major contributors to

the high turnover rate of nurses in Oyo State (Almalki, 2020).

22
Social interactions and events are also limited by gender separation. Oyo State nurses may also

face challenges in society since the nursing profession is poorly regarded by the public, and this

may impact upon their ability to get married (Gazzaz, 2019). In conclusion, challenges faced by

nurses in Oyo State are related to training, socialization and the healthcare system in the country.

These factors may contribute to work-related stress and burnout due to overload, and perceived

dissatisfaction of the management, which may consequently lead to high turnover, low levels of

job satisfaction, and poor performance.

2.4 Summary

Results of the literature review show that there has been much interest in the area of nurses’ staff

stress worldwide. Studies have used different surveys and qualitative methods, such as

interviews, to assessment of work related-strain, perceived stress and job satisfaction among

nurses working in selected health facilities in Oyo state. However, stress is subjective in nature

and the triggers of stress vary from one individual to another.

Therefore, it is difficult to measure individuals’ stress levels. When looking at work stressors in

nurses, factors that cause stress in one group may not have the same impact on the other group.

Research suggests that stressors for nurses include inadequate staffing, increased workload,

interruptions, poor pay, and difficult working relationships with other healthcare professionals.

While stressors for Nurses staff included poor pay, inadequate staffing, and increased workload

(Lapane & Hughes, 2019). However, the majority of studies on nurse’s staff stress and

satisfaction in healthcare workers focus on hospital settings (Chou, Li, & Hu, 2018; Donnelly,

2020; Grunfeld et al., 2018; Ramirez et al., 2021)

23
The future of healthcare facilities will present significant challenges for organizations and

employees. Healthcare workers are generally at a greater risk of stress and job dissatisfaction in

comparison to other professions (Parent-Thirion, et al., 2018), which leads to increased turnover

and absenteeism and impacts the efficacy of health services (Berland, Natvig & Gundersen,

2019; Puteri & Syaebani, 2018). The implication for hiring managers will be to attract and retain

healthcare staff, since pay increases are not always possible, managers will need to find creative

solutions to reduce stress and increase job satisfaction through intrinsic motivators. This study

aims to investigate the predictors of job stress and job satisfaction among Nurses staff. In doing

so, the author intends address the gap in the literature and assist healthcare managers to identify

and address the causes of job stress and satisfaction in their staff.

24
 CHAPTER THREE

RESEARCH METHODOLOGY

Introduction:
3.1 Research Design

The research design of this study is a non-experimental, descriptive research design. This

approach aims to assess the assessment of work related-strain, perceived stress and job

satisfaction among nurses working in selected health facilities in Oyo State

3.2 Research Setting

The research study was conducted at Oyo State General Hospital. The hospital is situated within

South West Oyo State. It was initially set up to provide healthcare services to citizen of Oyo

State. Over the years, the hospital has evolved into a tertiary health institution that offers medical

services. It functions as a IT training institution for various healthcare professionals, including

doctors, nurses, midwives, laboratory scientists, physiotherapists, and ophthalmologists.

The hospital is an active participant in the National Health Insurance Scheme (NHIS), which

enables it to provide healthcare services to a broader range of individuals. It is equipped with

various departments, with notable ones including the General Outpatient Department (GOPD),

Medical Outpatient Department (MOPD), Surgical Outpatient Department (SOPD), Accident

and Emergency (A&E), and more.

25
3.3 Target Population

The target population of this research are the Nurses staff selected General Hospital in Oyo, Oyo

State.

3.4 Sample Size Determination

Sample size will be conducted using mean formula.

3.5 Sampling Technique

The research employed a purposeful sampling technique, which is a non-random sampling

approach that involves deliberately selecting individuals who possess specific characteristics or

qualities relevant to the research objectives. In this study, the purposeful sampling technique was

used to select participants from the Nurses Staff in Oyo, Oyo State.

26
A total of 100 questionnaires will be administered to these selected staff. The purpose of this

data collection method was to gather staff and focused information related to the research

problem. By using purposeful sampling, the researchers aimed to ensure that the participants

included in the study possessed the necessary insights and work-related strain and job

satisfaction among staff, allowing for a targeted and meaningful examination of the research

topic.

3.6 Instrument for Data Collection

In this study, a carefully designed and reviewed adapted questionnaire was employed to gather

information from the respondents. The questionnaire was thoughtfully divided into four distinct

sections, each addressing different aspects of the research obhectives

Section A: Demographic Data

Section B: work related-strain, perceived stress and job satisfaction among nurses working in

selected health facilities in Oyo State.

Section C: Perceived stress

Section D: Job satisfaction

3.7 Validity of Instrument

The questionnaire will be meticulously crafted, incorporating specific variables derived from the

study objectives, research questions, and pertinent literature that significantly contributes to the

existing body of knowledge on the research problem. The goal is to enhance the precision,

accuracy, and validity of the questionnaire by making refinements based on previous

27
questionnaires utilized in related studies. This approach ensures that the questionnaire is finely

tuned to capture relevant information and provide valuable insights into the research topic.

3.8 Reliability of Instrument

Reliability pertains to the instrument's capacity to consistently measure the intended aspects. To

ascertain the reliability of the instrument, a pilot test was conducted involving individuals Nurses

staff from Oyo state Hospital. The obtained reliability coefficient was 0.7, indicating a

substantial correlation. This high correlation value validated the instrument's reliability and

paved the way for the commencement of the main study

3.9 Method of Data Collection

The researcher administered the adapted closed-ended questionnaire to the participants after

obtaining their consent and providing detailed explanations for each item within the instrument.

Participants were encouraged to complete the questionnaire honestly, and they were informed

about their right to withdraw from participation if they chose to do so. Subsequently, the

researcher collected the filled questionnaires from the participants immediately after completion.

3.10 Method of Data Analysis

The data collected from the completed questionnaires by the respondents was subjected to

statistical analysis using mean.

3.11 Ethical Considerations

The General Hospital Ethical Committee will grant approval for the project. The goal of the

research will be clearly explained to the nurses, and their permission will be sought before they

28
participate. As name, phone number, and address are not provided in the data collecting

instrument, the information will only be used for research purposes and will be kept private and

confidential. We strictly uphold your right to anonymity.

29