THE INFLUENCE OF STRESS ON WORK BEHAVIOR AMONG NURSES

Abstract
Occupational stress can no longer be considered an occasional, personal
problem to be remedied with palliatives. It is becoming an increasingly global
phenomenon, affecting all categories of workers, all workplaces and all
countries of which nurses of Federal Medical Centre Abeokuta are not
exceptional. In line with such an approach, this research is aimed at accessing
the effect of stress on performance of nurses at Federal Medical Centre
Abeokuta. Data for the study was gathered from both primary and secondary
sources. A sample size of 70 nurses was selected using systematic random
sampling method. Empirical results from the data indicate that workload,
Conflict among colleagues and supervisors are other major causes of stress in
nurses at Federal Medical Centre Abeokuta. It was established from the
research that stress affects output, quality of work which leads to client
dissatisfaction of nurses. Therefore, stress has negative relation with the
performance of nurses.

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TABLE OF CONTENTS
ABSTRACT
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
1.2 PROBLEM STATEMENT
1.3 STUDY OBJECTIVES
1.4 SIGNIFICANCE OF THE STUDY
1.5 STUDY QUESTIONS/HYPOTHESES
1.6 SCOPE AND LIMITATION OF THE STUDY
1.7 DEFINITION OF TERMS
CHAPTER TWO
REVIEW OF RELATED AND RELEVANT LITERATURE
2.1 INTRODUCTION
2.2 CONCEPTUAL CLARIFICATIONS
2.3 THEORETICAL STUDIES
2.4 EMPIRICAL STUDIES
2.5 RELATED LITERATURES
CHAPTER THREE
RESEARCH METHODLOGY
3.1 RESEARCH DESIGN
3.2 STUDY AREA
3.3 SOURCES OF DATA
3.4 POPULATION OF THE STUDY
3.5 SAMPLE SIZE DETERMINATION
3.6 INSTRUMENTATION
3.7 RELIABILITY AND VALIDITY OF INSTRUMENT

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3.8 METHOD OF DATA ANALYSIS
CHAPTER FOUR
DATA PRESENATATION, ANALYSIS AND INTERPRETATION
4.1 DATA PRESENTATION
4.2 DATA ANALYSIS
4.3 DATA INTERPRETATION
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
5.1 SUMMARY
5.2 CONCLUSION
5.3 RECOMMENDATION
REFERENCES
APPENDIX

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CHAPTER ONE

INTRODUCTION

1.1 Background study

Every work environment especially within a hospital setup needs to be

conducive, friendly and stress free to promote quality care and wellbeing of

health care workers whose job demands are increasing day by day. This is as

a result of advancement in technology and patient’s demand for quality in

response to increasing health care cost. Stress is considered a normal part of

life which is necessary occasionally as a push to increasing functional capacity,

but when it is experienced over a prolonged period it becomes detrimental to

health leading to a decline in productivity (Salleh, M.R., 2008).

Stress can be defined as a particular relationship between the person and the

environment that is assessed by the person as taxing or exceeding his or her

resources and endangering his or her well-being (Irving, J.A. et al., 2009).

Stress on its own does not have any damaging effect on an individual;

however individuals’ assessment of an event, their perceptions and

interpretations give meaning and their coping ability determines whether

events are viewed as threatening or positive. Personality traits also influence

individual reaction to stress because what may be strenuous to one person

may be stimulating to another (Robinson ,et al., 2011).

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As far back as the mid-1950s, stress was regarded as an occupational hazard

and occupational stress cited as a significant health problem (Jennings, B.M.,

2009) while in the 1960s, patient’s care, decision making, taking responsibility,

and change were identified as sources of anxiety among nurses which

predisposed them to work stress (Menzies, 1960). Nurse’s role has long been

regarded as stress-filled based upon the physical labor, human suffering, work

hours, staffing, and interpersonal relationships that are central to what the

work nurses do (Lukpata, et al., 2013).

This stressful nature of nursing can ultimately lead to job dissatisfaction and

burnout (Arafa, 2003). This statement is in line with some studies which

conclude that the provision of health care services is demanding both

physically and psychologically ( Ilhan, 2005). Nursing occupies a conspicuous

position among the professions that have been identified as the most stressful

worldwide as nurses relate with humans mostly in times of pain, suffering and

death (Lukpata, 2013).

Nurses work tirelessly rendering care to critically and chronically ill patients

who are between life and death in an environment where there is lack of

tolerance for error (Rowe, 2003), all these can exert intense psychological and

physical pressures on the health care giver leading to stress or burn out

syndrome.

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Among health care professionals, nurses have been found to be most prone to

burnout (Abushaikha, and Saca-Hazboun, 2009). This is more so because

nurses are expected to deliver humane, empathetic, culturally sensitive,

proficient and moral care, in working environments with limited resources,

reduced supply of nurses and increasing responsibilities. Such imbalance

between providing high quality care within an environment of limited

resources leads to stress (Khamisa, 2015).

1.2 Statement of the problem

Job satisfaction and burnout among health care providers are important issues

since they affect turnover rates, staff retention and ultimately the quality of

patient care (Atencio, 2003). Burnout has been defined as “a syndrome of

physical and emotional exhaustion, involving the development of stress which

can lead to the development of negative self-concept, negative job attitudes

and loss of concern for clients”. Burnout has also been associated with high

employment turnover, excessive absenteeism, negative job attitudes, low

morale and a reduction in willingness to help others (Abushaikh,. and Saca-

Hazboun, 2009).

The way that an individual views and processes stress determines how much

stress is felt and how close the person is to burnout. Perceptions of job stress

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and burnout are not just a product of work conditions because not all workers,

exposed to the same conditions, develop burnout or perceive stress

(Robinson, et al., 2011).

An individual can be exposed to few stressors but be unable to process the

stress well and thus experience burnout. Another person, however, can be

exposed to a significant amount of stressors, but process each well, and avoid

burnout. How close a person is to a state of burnout is greatly dependent on

individual differences (Truby, 2009)

1.3 Objectives of the study

The general objective of this study is to investigate the influence of stress on

work behavior among Nurses in Federal Medical Centre Abeokuta. The specific

objectives are:

1. To ascertain the causes of work stress among nurses in Federal Medical

Centre Abeokuta.

2. To determine the relationship between stress and job dissatisfaction

among Nurses in Federal Medical Centre Abeokuta.

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3. To examine the effect of stress among nurses on the safety of patients

Federal Medical Centre Abeokuta.

4. To investigate the impact long working hours on the job performances of

Nurses in Federal Medical Centre Abeokuta.

5. To know if work stress influences negative job attitude among Nurses in

Federal Medical Centre Abeokuta.

1.4 Research questions

The relevant research questions related to this study are:

1. What are the causes of work stress among nurses in Federal Medical

Centre Abeokuta?

2. What is the relationship between stress and job dissatisfaction among

Nurses in Federal Medical Centre Abeokuta?

3. What is the effect of stress among nurses on the safety of patients

Federal Medical Centre Abeokuta?

4. What is the impact long working hours on the job performances of

Nurses in Federal Medical Centre Abeokuta?

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5. Does work stress influences negative job attitude among Nurses in

Federal Medical Centre Abeokuta?

1.5 Significance of the study

This study is very important to medical directors because it elucidates some of

the factors that are responsible for the poor performances of Nurses in

hospital. The relationship between stress and the work behavior among

nurses is well examined. Long working hours is one of the causes of work

stress among nurses and its impacts on the productivity of nurses are well

investigated.

This study also examines the ways of reducing work stress among nurses in

hospital. If these measures are implemented, it will have impact on improving

the safety of patients. Nurses who are stressed tend to be aggressive on

patients and this affects the recuperation of patients.

The finding from this research can also be used as a reference material for

other researchers who will likely carry out a study on a related topic.

1.6 Scope of the study

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The scope of this study restricted to examining the influence of stress on work

behavior among nurses in Federal Medical Centre Abeokuta.

1.7 Limitation of the study

Some of the major constraints the researchers encountered in putting up this

research include lack of time, lack of willingness to give information by

respondent and also limited resources.

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CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This information discusses stress caused by factors in the work environment.

While factors outside the workplace can contribute to a person’s overall stress

response, this information focuses mainly on stress that has occurred as a

result of factors within the workplace.

Stress can affect everyone so this information is relevant to employees,

employers, managers, supervisors, the self-employees apprentices and

trainees.

2.1 Conceptual Framework

Meaning of Occupational stress

Stress is a universal element experienced by employees around the globe.

Stress has become major problem for employer particularly in developing

nation where the employer does not realized impart of stress on employees

performance which over stress, managerial role, stress management job

performance.

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An individuals in his or her job face stress as Jam Shed et al (2011)

suggested the work place is potentially an important source of stress for

bankers because of the amount of time they spent in their respective banks

and that stress often a decrease their performance. Therefore, occupation of

individuals could be a major source of stress in the given circumstance. When

individual faces stress due to various conditions of their occupation and fail to

cope with stress, it results into burnout.

Basically in Industries lack of administrative support from boss (manager)

work overload and time pressure, riskiness of job, poor relationship with

customers and co workers and work family balance cause stress which in

turns decrease employee performance. The same was contributed my maters

on (1980) “cause of stress are many like work load. Cut in staff, change at

work, long work hours, shift work, lack of supervision, inadequate training, in

appropriate working conditions, too heavy responsibility and poor relations

with colleagues. “ The same was identified by Ganster and Loghan (2005) “

huge and multi fields literature points a lots of key factors such as work

environment, management support, work load etc in determining how

stressful the work can be its effect on employee physical and mental health”

In Federal Medical Centre Abeokuta particularly higher management does not

realize the impact of stress on employee performance which ultimately result

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in critical managerial dilemmas as Subha and Shakeel (2009) described

“higher level of stress existed which no managerial concern for solution

consequently lowering the employee performance, staking organizational

reputation and loss of skilled employees, effective stress managing practices

to increase employee satisfaction and overall employee performance” work

overload and the time pressure to complete too much work in short span of

time is big source of stress which decreases the performance of employees as

Baback at al (2010) studied “ with excessive pressure, the job demand cannot

be meet, relaxation turns to exhaustion and a sense of satisfaction replaces

with the feeling of stress, motivation sheds away and the workers start losing

interest in the work and hence performance chart shows a negative trend”

2.1.1Stress, Threat and Numbing Out

When animals, including beings are exposed to potentially life threatening

situations, their bodies release endorphins, which are nature’s pain-killer; this

makes sense from a survival perspective. If you are being attacked by a

predator and are injured, you don’t want to be focusing, your attention on

how much you hurt. This response doesn’t just happen in response to tangible

by potential threat. Thus, if we feel threatened or fearful, our body releases

endorphins, thus sets the stage for serious intellectual and interpersonal

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consequences, and because endorphins dull both our ability to think and our

ability to feed effective decision making and interpersonal skills require both.

Research by Dr James Penne baker of southern Methodist University has

demonstrated very serious consequences of uncontrollable stress on thought

processes. In an experiment performance by Dr. Penne baker subject wrote

about whatever was going on in their mind their stream of consciousness. One

group was subjected to a loud noise in the middle of the exercise and told

there was nothing they could do about it they had to (grain and Bearit” they

engaged in deep, reflective, creative, thought. Thus, it wasn’t the negative

external situation, but the perceived lack of control which resulted in

administrative thinking capacity.

2.1.2Implications from the Workplace

In workplace where people are constantly afraid and insecure, employee is

risk of “numbing out” to protect them. We see it in the blank faces of clerks,

the lack of enthusing by front line workers and in and remarkably insensitive

ways managers and employee’s threat each other. The very mechanism which

allows a person to survive, makes, it difficult for them to respond sensitivity

and empathetically to others.

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The organizational conflict and customer service consequences of these are

obviously very costly. The numbing process affect far more than inter-

personal realm of organization performance.

It affects all aspects of decision-making, innovation and safety with their

thinking impaired; people are at greater risk of causing serious mistakes and

accidents. They are also obviously less likely to make wise decision and create

process improvement.

2.1.3Stress and the Loss Of Creativity

Creative and innovative thought are the heart of the learning organization. In

organizations ability to innovate is perhaps the most important who knows

how to stimulate and leverage innovative thought are able to respond more

rapidly and resourcefully to market changes and customer requirement than

their slow, less innovation competitors. Despite the tremendous contribution

innovation though makes to organization the typical high stress workplace the

physiological and psychological effects of stress of the human brain and

compromises such creativity and innovation studies show that when people

are under stress, their thought processes narrow. This narrowing of attention

by definition prevent divergent thinking which the foundation of creativity is

divergent thinking is the ability to see connections between very distantly

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related ideas and context. It is important com potent of “thinking outside the

box” when people are stress they are able to perceive obvious connections

and associations between ideas, when people are in a positive emotional

state, their ability to make more distant novel connections and associations

increases. Thus stress comprises at the fundamental neurological level, one of

the foundational skills of creativity and innovation. Creating a high

performance organization is a popular theme in the training and development

field. To survive in these competitive times companies can’t afford anything

less. Creating a high performance organization requires understanding what

factors influence performance. One of the most significant factors in stress.

Historically, stress has been viewed as an in-evitable consequence of work life,

or at most, a health care issue. Neither view beings to capture just how costly

this problem is to employers. Research shows that stress interferes with

human intellectual, emotional interpersonal functioning. In fact, nearly every

popular training and organizational development initiative is directly

compromised by the intellectual, emotional and interpersonal consequences of

stress.

Initiatives like, the learning organization, process re-engineering, diversity

training, collaborative team work and the high performance organization are

all in pack by the way people are affected by stress. In work place where

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people are constantly afraid and insecure, employees are at risk of “numbing

out” to protect themselves, these numbing process affects far more than the

interpersonal realm of organizational performance. It affects all aspects of

decision making, innovation, and safety. People are at greater risk of causing

serious mistakes and accident. They are also obviously less likely to make wise

decisions and create process improvements.

2.1.4Maximization of Employee Productivity and Performance

In order to maximize employee productivities and performance, organization

can:

 Give employees as much control over their jobs as possible: they have

control over the means of accomplishing their work. They can decide when,

where and how the work is done. Employee control over work can reduce

stress and enhance motivation and growth.

 Communicate clearly and often about everything important: an

organization can communicate to its employees clearly through letters on

the notice board in a written form and in a language which they can

understand clearly and most times meeting can be held in order to pass

across information that are important to organization.

 Talk with your employees about what makes your company great, how you

bring value to your customers and how your employees make that

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 possible: when organizations manage in ways that brings the best in

people, they also reduce employee stress. Stress out, worn out, and burnt

out employees is less likely to produce high quality products, give great

customer service, or generate break troughs. To maximize employee

productivity and performance and reduce employee stress organization can

give employees as much control over their jobs as possible. Decades of

research shows that control is the biggest factor in whether people feed

stressed out or invigorated when facing a challenge. The ore control people

have over their work, the greater their job satisfaction, the higher their

work quality and lower their stress level. Giving employees control include

giving them the power to make job related decisions, the flexibility to

organize their job is done. Employee who feel passionate about their work

and feel energized going to work they are the key to an- employers

success.

 Make sure supervisors know how to bring out their best in people:

supervisor must make sure goals are attainable but challenging since

employees are ultimately responsible for reaching their goals, they need to

have a strong voice in setting them. Ask your employee to draft goals that

directly contribute to the organization mission once she suggested mutual

goals. Discuss whether her targets are both realistic and challenging

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 enough. Stretch targets emerge as a process of negotiation between the

employee and the manager says Srikant . Datar,

 Improve your hiring and orientation process:- the word orientation literally

means getting the basic information that tells you where you are and how

to get where you want to go, orientation to a new job should give a staff

member the basic information about the organization, her position, the

target population and the community. It’s worth it to make time for an

orientation when it’s needed before and while the new staff member

actually begging working. Conducting an orientation at the staff member,

but for the organization as well.

 Make sure employee have the resources and training t do their jobs well:-

the process of identifying training needs in an organization for the purpose

of improving employee job performance. Training performance is needed

when employees are not performing up to a certain standard or at an

expected level of performance. A successful training needs analysis will

identify those who need training and what kind of training is needed. It is

counted productive to offer training to individuals who do not need it or to

offer the wrong kind of training resources to good use. The use of

knowledge, skills, abilities, employee development, communication,

customer focus, decision making, interpersonal skills, leadership,

establishment objectives, risk management, planning, problem solving,

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 self-management, team work e.t.c. are all needed to make sure employees

are trained to do their job well.

2.1.5Occupational Stress and Employee Control

Employee control over work can reduce stress and enhance motivation and

growth several key findings have prompted employers to search for ways to

give workers a greater sense of control. To improve health, productivity and

morale.

Findings: industrial psychologist discovered that how much latitude employees

have at work their health, their morale and their ability to handle their work

load.

In 2010, Robert Karasela found that workers whose jobs rated high in job

demands yet low in employee control has measured by latitude over decision

reported significantly more exhaustion after work trouble awaking in the

morning, depression, nervousness, anxiety and in Sonia or disturbed sleep

than other workers. When workers facing high demands had more control,

their stress was lower.

This major insight into how occupational stressors affect health and well-being

has led to ongoing improvements in the workplace.

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For example many organizations have implemented programs designed to

enhance employee control.

Significance: Kerrasek’s findings revealed to employers that they could

improve job related mental health without sacrificing productivity. That is

organization could reduce job strain by increasing employee control or

decision latitude, without reducing actual work load employers could time tune

their administrative structure in order to reduce employee stress and protect

workers mental health without cutting productivity. What’s more, the hack

man and old man research show how to control influence feeling about work

more broadly. And in fact a 2002 survey of 604 employees by the society for

human resource management and USA today revealed that some 94 percent

of those pointed consider autonomy and independence “very important” or

Important” to job satisfaction.

Practical Application: Many organizations have increase employee control to

make job better for employees often redesigning their processes or plopping

around the chain of command for example ford motor company has shifted

vertically all of its manufacturing operations to a team based approach in

which employees have fair greater control over their work, rather than simply

follow directions from supervisors, employees can for example, talk directly to

suppliers about parts quality, research better ways to run equipment, and take

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independent action to eliminate product defects, he pilot program, which

began at ford’s Romeo, Mich. Engine plant in early 1990s, raised productivity

and quality along with job satisfaction so successfully that ford expounded the

approach, giving virtually all employees. Targets’ and allowing, there to find

ways to reach them

2.1.6Job stress in nurses

Job related stress is a widespread problem across industry, but it is endemic in

the human services where nurses form the largest group (Schaufeli and

Greenglass, 2001). The topic of job stress in nursing has been documented for

more than forty years and occupational stress in nursing is reported to be

increasing in many countries. The assumption that nurses are prone to job

stress and burnout - its most severe form – is grounded in a vast literature on

occupational stress demonstrating that nursing is a „stressful‟ occupation. The

following quote is testimony to the embedded nature of stress in nursing.

Nursing by its nature is subjected to a high degree of stress. Each day the

nurse deals with grief, stark suffering, and death as few other people do. A lot

of tasks are boring and unrewarding. Some are distasteful, normal standards,

even disgusting, degrading and frightening (Sarafino, 2002).

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Job stressors in nurses include high workloads, unbalanced and unsocial

working hours, physical fatigue, the emotional load of dealing with patients,

their families and those whose behaviours are difficult, uncertainty concerning

treatment, and lack of staff support, conflict with supervisors, other nurses,

and medical staff, dealing with death and dying, issues involving patient care,

management difficulties, anxieties about technical knowledge and skills

(Robinson et al., 2003). Overall the literature convincingly demonstrates that

stress is a long-standing problem for nurses irrespective of type of nursing

training, nationality, area or kind of clinical or non clinical work.

2.2 Theoretical Framework

Theories of Occupational stress

Most previous stress theories were developed to describe reactions to

“inevitable” acute stress in situations threatening biological survival (Cannon

1935; Selye 1936). However, the Demand/Control model was developed for

work environments where “stressors” are chronic, not initially life threatening,

and are the product of sophisticated human organizational decision making.

Here, the controllability of the stressor is very important, and becomes more

important as we develop ever more complex and integrated social

organizations, with ever more complex limitations on individual behavior. The

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Demand/Control model (Karasek 1976; Karasek 1979; Karasek and Theorell

1990), which is discussed below, is based on psychosocial characteristics of

work: the psychological demands of work and a combined measure of task

control and skill use (decision latitude). The model predicts, first, stress-

related illness risk, and, secondly, active/passive behavioural correlates of

jobs. It has mainly been used in epidemiological studies of chronic disease,

such coronary heart disease.

Pedagogically, it is simple model which can help to demonstrate clearly several

important issues relevant for social policy discussions of occupational health

and safety:

 That the social organizational characteristics of work, and not just physical

hazards, lead to illness and injury.

 That the possibility of both “positive stress” and “negative stress” can be

explained in terms of combinations of demands and control.

A stress-relevant situation is appraised as challenging when it mobilizes

physical and psychological activity and involvement. In the appraisal of

challenge, a person may see an opportunity to prove herself or himself,

anticipating gain, mastery or personal growth from the venture. The situation

is experienced as pleasant, exciting, and interesting, and the person is

hopeful, eager and confident to meet the demands.

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The Stress Concept

In the 1970s concept was introduced into the theoretical framework, that of

the venerability ore resistance of the individual who was exposed to stress

stimuli. Cassel (1976) hypothesized that host resistance was a crucial factor in

the outcome of stress or the impact of stress on employee performance. The

fact that host resistance had not been taken into account in many inconsistent

and contradictory results had been obtained on occupational stress. According

to Cassel, two factors were essential in determining the degree of a person’s

host resistance: his or her capacity for coping and his or her social supports.

While some level of “demands” is necessary to achieve new learning and

effective performance on the job (i.e., interest), too high a level is obviously

harmful. This has implied the inverted “U-Shaped” curve of “Optional” level of

demands in the well known General Adaptation of Selye (1936) and related,

classic theories by Yerkes and Dodson (1908) and Wundt (1922) on stress and

performance. However, our findings show that most work situations have an

overload, rather than an under load problem.

Although Selye’s “U-shaped” association between demands and stress

purported to be one-dimensional along a stressor axis, it probably also

included a second dimension of constraint in his animal experiments – and

25
thus was really a composite model of stress-related physiological

deterioration-potentially similar to the high demand, low control situation, as

other researchers have found (Weiss 1971).

Cognitive appraisals include two component processes, primary and secondary

appraisals. Primary appraisal refers to the stakes a person has in a certain

encounter. In primary appraisals, a situation is perceived as being irrelevant,

being-positive or stressful. Those events classified as stressful can be further

subdivided into the categories of benefit, challenge, threat and harm/loss.

Threat occurs when the individual perceives being in danger, and it is

experienced when the person anticipates future harm or loss. Harm or loss

can refer to physical injuries and pain or to attacks on one’s self-esteem.

Although in threat appraisal future prospects are seen in a negative light, the

individual is partly restricted in his or her coping capabilities, striving for a

positive outcome of the situation in order to gain or to restore his or her well-

being. Rather, threat is a relational property concerning the match between

perceived coping capabilities and potentially harmful aspects of the

environment.

In the experience of harm/loss, some damage to the person has already

occurred. Damages can include the injury or loss of valued persons, important

26
objects, self-worth or social standing. Instead of attempting to master the

situation, the person surrenders, overwhelmed by feelings of helplessness.

2.3 Empirical review

Stress has significant impact on company and people performance and it

terribly affects health of employees (Mimura and Griffiths, 2003 in Shah et al,

2012). The studies conducted in western countries have shown that the

sources of stress that we name as Occupational Stress Inducers (OSI) in this

study are negatively related to well-being and job satisfaction of employees.

(Robertson, Cooper, & Williams,1990). Shah et al. (2012) in their study on

impact of stress on employee performance among teaching faculty, found a

negative relationship between organizational structure and employee

efficiency while rewards were found to be positively correlated to employee

efficiency as expected. Rubina et al. (2008) too found a negative relationship

between job stress and job performance. However the male employees were

found to be affected more than their female counter parts. Munir and Islam

(2011) tested relationship between work stressors like role ambiguity,

workload pressure, home-work interface, performance pressure, relationship

with others and role conflicts on one side and job performance on the other

with motivation as mediator and found that „role conflict‟ and „role ambiguity‟

27
have a positive relation with stressors against the common notion while the

relationship is found to be negative between other stressors and job

performance. Imrab et al. (2013) found that stress is responsible for

decreasing the performance of bank employees. Ahmed & Ramzan (2013) too

found a negative correlation between stress and job performance i.e as the

stress increases the job performance goes down and vice-a-versa. Usman Ali

et al. (2014) found that workload, role conflict, and inadequate monitory

reward are the prime reasons of causing stress in employees that leads to

reduced employee efficiency. Deshinger (2003) suggested that different

aspects of employee job performance that are likely to be affected by stress

include Productivity, Job Satisfaction / Morale, Absenteeism, Decision

Making Abilities, Accuracy, Creativity, Attention to Personal Appearance,

Organizational Skills, Courtesy Cooperation, Initiative, Reliability, Alertness,

Perseverance and Tardiness.

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CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Research Design

The study adopted a descriptive research design. This was to describe the

situation or phenomenon of the study as it exists naturally on the ground. The

design is used in gathering information from a larger population, and to

provide descriptive and inferential information on the variables of the study

(Polit & Beck, 2008; Cohen, Manion & Morrison, 2007; Fraenkel & Wallen,

2006).

3.2 Sources of data

Data for the study was gathered from both primary and secondary sources.

The primary source dealt with information gathered from selected nurses.

Data collection was achieved by the use of questionnaire and interview to

solicit information from the nurses. And also, the secondary data dealt with

other written documents of the hospital which was meant for other purpose

and not this research.

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3.3 Population

The sample population of this study was 721 (Human Resource Department,

2012). 70 nurses were chosen representing 10% of the total population of 700

for the study. This sample size according to Saunders (2006) is appropriate for

such population. It comprised of all nurses of various directorates at the

hospital. Seventy (70) questionnaires were distributed to respondents.

3.4 Sampling procedure

Systematic random sampling method was used to select nurses from various

directorates to solicit their views on the subject matter. This makes it

representative of all the nurses in the hospital.

3.5 Instrumentation

Data was collected using questionnaire. The questionnaire was made up of 35

items divided into four sections: Section A was comprised five (5) items

designed to elicit demographic information about the respondents, Section B

had ten (10) items elicited information on sources of stress, Section C had ten

30
(10) items and solicited information on effects of stress, whilst Section D

elicited information on coping strategies forstress.

The questionnaire had a reliability coefficient of 0.87 using the test-retest

method, whilst its validity was determined by its content. Respondents were

given a day to complete questionnaires after which they were picked by the

researchers.

3.6 Method of Data Collection

The data for this study was obtained through the use of questionnaires

administered to the study participants. Observation was another method

through which data was also collected as well as interview. Oral questioning

and clarification was made.

3.7 Method of data analysis

The data collected were analyzed by the used of frequency tables,

percentages, bar charts. Information gathered from the nurses were first

edited and tallied in frequency table. The values corresponding to frequencies

were later converted in percentages to facilitate comparison between the

responses. Microsoft Excel (spread sheet) was employed for the analysis.

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CHAPTER FOUR

RESULTS AND DISCUSSION

4.1 Causes of Stress in Nurses

A lot of people experience stress every day, and stressors are similar for

everyone. Some people by their nature are more prone to stress than others

and likely to be stressed by things that would easily roll off someone else.

Dissimilarity in people‟s features such as coping style and personality are most

significant in forecasting whether certain job conditions will outcome in stress.

It should note that stress is subjective because what is stressful for one may

not be stressful for another. Even though the importance of personality

differences cannot be disregarded, scientific facts advocates that certain

working conditions are more stressful to most individuals. The figure below

shows the response of the causes of stress among nurses at FMCA.

Figure 4.1Causes of stress

33
 causes of stress

35

30
25

20
Freque
ncy

15 Series1

105

Causes

Source; Researcher‟s field work

The data collected indicated that workload was the major cause of stress

among nurses in FMCA. This confirms what American Nurses Association

(Nursing World, September, 2001) stated that staffing issues are the number

one concern of nurses nationwide. It accounted for 44.29% of stress among

nurses. Workload is a situation in which a person faces too many roles or too

great a variety of expectations. Nurses who have a heavy workload may be

dissatisfied with their job, thus affecting their motivation for high-quality

performance. It was also observed that conflicts accounted for 17% of stress

among nurses in FMCA. This is in line with Greenfield‟s (1999) suggestion that

conflict is inevitable in stressful settings such as health care. It exists at many

different levels between doctors, nurses, families, and ancillary staff.

34
Supervisors also contributed 17% to the stress of nurses in FMCA because of

lack of useful feedback. Lack of logistics accounted for 4.29% of stress in

nurses and others like poor addressing of concerns accounted for 2.86%.

4.2 Rate/frequency of Stress among nurses

It was observed that 33 respondents representing 47% of nurses experience

stress daily. This is mostly caused by workload, supervisors, conflict among

colleagues etc. It was also observed that 29 respondents representing 41%

experience stress weekly. The remaining which are 5, 1, and 2 representing

7%, 1%, 3% experience stress monthly, yearly and others respectively. These

are as a result of lack of logistics and poor addressing of concerns. The figure

below depicts the above data.

Figure 4 .2 Rate of stress

rate of stress

35

30

25
Freque

20
ncy

Series1

15

10

0 Daily Weekly Monthly Yearly other

responses

Source;

35
Researcher‟s field work

Table 4.1 Influence of stress on performance

Influence stres o Respondents Percentage
of s n
performanc
e
Strongly 39 55.71
agree
Agree 29 41.43

Disagree 1 1.43

Strongly disagree 1 1.43

Total 70 100.00

Source; Researcher‟s field work.

When the respondents were asked whether they agree that stress affects

performance 39 respondents representing 56% said they strongly agree, 29

respondents representing 41% agree with the notion that stress affect

performance and one respondent each representing 1 said they either

disagree or strongly disagree.

Figure 4.3 Impact of stress on performance of nurses

36
 Effects of stress on performance

30

25

20
Frequency

15 Series1

10

Output,Quality
Output

satisfaction
Quality of

others
of work,Client
satisfaction
Client
wor
k

responses

Source; Researcher‟s field work.

When the respondents were asked whether stress affects their performance,

27 respondents representing38.57% said stress affect their work output, 19

respondents representing 27.14% said stress affect the quality of their work

13 respondents representing 18.57% said stress affects their output, quality

of work and client satisfaction and finally 2 respondents representing 2.86%

said stress affects their personal lives such as relationships at home.

Table4.2 Relationship between stress and performance of nurses in

FMCA

Relationship Percentage
Respondents
between stress & (%)
37
 performance
Yes 70 100

No 0 0

Total 70 100

Source; Researcher‟s field work.

When the respondents were asked whether stress has relationship with

performance, 70 respondents representing 100% said stress has relationship

with performance. They went further to state that stress has negative

relationship with performance. This means when stress increased among

colleagues, their performance also goes down and vice versa.

Table 4.3 Management of stress on nurses in FMCA

Management of Respondents Percentage (%)
Stress
Get a reality check 5 7.14

Reflect on your
3 4.29
situation
Seek out professionals 2 2.86

Regular recreational
exercise for tension 7 10.00
reduction
Enough rest 31 44.29

Days off from work 17 24.29

Discuss concerns with

5 7.14
sympathetic person
Total 70 100.00

38
Source; Researcher‟s field work.

The data collected indicated that enough rest was a major tool for managing

stress among nurses in FMCA. Getting enough rest is a good technique for

managing stress. It helps relaxes the individual and also takes the person

away from the stressors and also make people feel better and more resilient in

dealing with the stress they are faced with even if they encounter the same

stress factors. Out of 70 respondents, 31 respondents representing 44.29%

stated that enough rest is good in managing stress among nurses. It was also

observed that 17 respondents representing 34.29% stated that taking days off

from work can reduce stress among nurses. Getting a reality check and

discuss concerns with sympathetic person to reduce stress among nurses in

FMCA accounted for 7.14% each. Finally, 2 respondents representing 2.86%

stated that they would seek out for professionals stress among nurses in

FMCA.

10% of the respondents said having regular exercise can help to reduce stress

when they are stressed up.

39
CHAPTER FIVE

CONCLUSION AND RECOMMENDATION

5.1 Conclusion

In conclusion, it said that stress is a natural phenomenon that can be

experienced by all human beings irrespective of gender or social status. Thus

this subject matter must be well understood especially by management of

organization such as FMCA, in order to have a good policy direction to help

promote high performance among nurses in the hospital and other such

health institutions.

Organizations may be hesitant to spend money for additional programs and

staffing, but could be convinced if they were really made aware of the high

cost of occupational stress due to increased absenteeism, compensation

claims, risks of litigation due to errors, negativity and decreased patient

satisfaction. Decreasing stress for nurses in the workplace is multifaceted

(Rosenstein, 2002). The first step is for organizations to recognize, and accept

that the work environment is responsible for much of the stress experienced

by nurses, and not just something that nurses have to deal with of their own.

Therefore, administrators must be committed to implementing changes that

will help to minimize some of the known stressors of nurses. Nurses need to

40
feel that they are involved in decision making especially related to patient care

issues. Therefore a more decentralized democratic management approach

would be beneficial and this is imperative to increase nurses‟ visibility in the

workplace by establishing programs that recognizes their contributions.

5.2 Recommendation

From the findings and conclusions of the study, the following

recommendations are made:

1. Management of Federal Medical Center Abeokuta organizes seminars,

workshops, fora for nurses that are targeted at specific sources of stress like

conflict management, work load and others. This would aid staff of Federal

Medical Center Abeokuta to plan measures to reduce stress among nurses.

2. Stress reduction programmes that target some of the prevalent

stressors could be organized for the supervisors in order to equip them to

assist the nurses.

3. Nurses should be equipped with stress coping skills, and introduced to

other non-nursing related activities.

4. Improving safe and secure environment at the hospital by providing

adequate and good facilities.

41
5.3 Implications for counselling

1. From the findings of the study it implies that being male or female does

not really matter so far as stress is concerned. Counsellors are therefore to

put in techniques that treat both sexes with equal attention in stress

management.

2. It was again deduced from the study that nurses of different age groups

assume the same of stress or their stress types do not differ significantly.

Counsellors should intensify their efforts at giving psycho-education to nurses

on stress related issues.

3. Counselling and training of supervisors in the field of administration as

well as planning measures to improving interpersonal relationship among

nurses in the hospital.

4. Education of nurses for stress management and skilled training for

conflict resolution and assertiveness will help to reduce stress among workers.

5. Stress management programmes can be included in the curriculum of

nursing training so that nurses who come out could manage their own stress

in the future.

42
6. Training in proper time management skills is important to enhance

planning of work to avoid work-overload.

43
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Cox, T., Cox, S. and Griffiths, A. (1996), Work related stress in nursing:
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Payne, N. (2001), Occupational stressors and coping as determinants of
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45
 QUESTIONNAIRE

Dear Sir /Madam,

The researcher is an undergraduate student of …………………………….. conducting

aresearchtitled:"The influence of stress on work behavior among nurses”. This
questionnaire is an integral part of the study and it is designed to seek your opinion on the
subject under investigation as one of the requirements for the award of ….
………………………………………

The researcher assures you that the information you will give is purely for academicpurpose
and will be treated as confidential. Your kind cooperation and honesty is
greatlyappreciated.

Thank you for your anticipated cooperation and kind consideration.

Yours faithfully

46
Fill the questionnaire by putting a tick √ in the appropriate box or by writing your
response in the provided spaces.

PART A: PERSONAL INFORMATION

Please indicate your age?

A. 18-23 B. 24-29 C. 30-35 D. 36-41 E. 42 and above

Indicate your Gender. Male Female

What is your level of education?

A. Certificate. B. Diploma C. Degree. D. Masters and Above

E. Any other please specify

PART B: QUESTIONNAIRE QUESTIONS

1. Causes of stress among nurses

A. Workload B. Supervisor C. Lack of logistics D. conflict with colleagues E. Others

2. Frequencies of stress among nurses

A. Daily B. Weekly C. Monthly D. Yearly E. Others

3. Influence of stress on performance of nurses

A. Strongly agree B. Agree C. Disagree D. Strongly disagree

4. Impact of stress on performance of nurses

A. Output B. Quality of work C. Client satisfaction D. Output, Quality of work and

Client satisfaction E. Others

5. Is there any relationship between stress and performance of nurses in FMCA?

A. Yes B. No

6. How is stress managed by nurses in FMCA?

Management of
Stress
Get a reality check
Reflect on your
situation
Seek out professionals
Regularrecreational
exercisefortension
reduction
Enough rest

Days off from work

Discuss concerns with

sympathetic person