CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This chapter reviewed the literature on the determinants of stress among nurses working in critical care units from various published literature.

2.1 The level of stress among nurses working in critical care units

A facility-based cross-sectional study was done to assess the level of stress and associated factors among nurses working in critical care units in Ethiopia. Using a purposive sampling method, a total population of 236 nurses was obtained. The findings state that level of stress among nurses in the emergency and intensive care units was low (19.3%), moderate (55.9%), and high (24.8%) (Bolado et al., 2024).

Awan et al (2023) carried out a quantitative study in Pakistan to assess the level of stress and associated factors among nurses working in critical care units. The study used a simple random sampling method to obtain a population of 217 nurses working in critical care units. The level of stress was found at a moderate level of 80.2%, 12.4% had high level of stress and the rest of the nurses had as low as 7.4% stress level.

A cross-sectional study was conducted in the ICU of various Hospitals in Pune city to identify the prevalence of stress and its level among intensive care unit staff (doctors and nurses). A simple random sampling was used to get a total population of 82 study participants. The results show that out of 68.29% of nurses, 48.78% were mildly stressed and 19.51% were moderately stressed (Kumar, Pore, Gupta & Wani, 2016).

In northern and central regions of the West Bank, Palestine, a descriptive cross-sectional study was carried out among 187 Intensive Care Unit (ICU) nurses who were obtained randomly. It was determined that 69.5% of nurses experience averagely high levels of stress (Salameh, Abdallah, Alkubati, & ALBashtawy, 2024).

A cross-sectional survey was done with an aim of assessing the level of stress among nurses working in the Emergency Clinic and nurses working in the Central Intensive Care Kosovo University Clinical Center. The study included 90 nurses who were randomly sampled to participate in the study. Results indicates that a vast majority of participants reported moderate to high levels of stress (81%) (Podvorica, Rrmoku, Metaj, & Gashi, 2020).

2.2 The causes of stress among nurses working in critical care units

Johan, Sarwar, & Majeed (2017) carried out a cross sectional study to identify the causes of stress amongst daily routine of nurses working in the ICU unit of Ittefaq Hospital Lahore. The study employed convenient sampling method to obtain 92 study ,participants. The major determinant  of stress among nurses includes inappropriate communication between nurses and doctors (57.6%), possibility or fear of cross-infection (57.6%), unexpected death of patients (56.2%), and lack of appropriate knowledge about specialized equipment (53.3%). Lack of resources (46.1%) and lack of practice and inadequate skills (44.6%) are also among causes of the moderate stress.

Mwinga, & Mugala (2015) carried out a cross-sectional descriptive study with a purpose of determining the prevalence and causes of stress amongst nurses in critical care units at Ndola Central Hospital. The study used a simple random sampling to obtain 183 nurses to participate in the study. The results of this study shows that nurse-patient ration (92.3%), working pattern where night shift is the most stressing shift (83.1%), working environment like overcrowding (82.5%), poor ventilation (90.7%) and death exposure (55.7%) are the major factors causing stress among nurses in critical care unit.

A descriptive cross-sectional study with the aim of assessing of factors that determine stress among nurses working in the critical care unit in Khartoum was carried out. The study used a simple random sampling technique to select 56 critical care nurses from the study population. It was determined that lack of practice and skills (62.5%), the effect of workload (100%), shortage of staff (100%), lack of motivation and recognition (100%), and improper work environment (80%) were the causes of stress among nurses (Mohamed, 2015).

A cross-sectional descriptive study was carried out in the ICU unit of Ittefaq Hospital Lahore among nurses to identify the causes of stress in the daily routine of nurses working in the ICU. A convenient sampling technique was used to obtain a total sample of 92 study participants. The results determined the causes of stress as patients undergoing painful procedures (53.3%) , lack of breaks (52.2%)  including patients themselves sources of stress for example their aggressive family members (43.5%) as well as improper work environment (82.3%) (Johan, Sarwar, & Majeed, 2017).

In a cross-sectional study conducted among ICU nurses of the PIMS hospital Islamabad to assess the causes, and interpret the effects of stress and strategic methods for reducing the stress among nurses, working in the Intensive care unit of PIMS hospital, 150 nurses were sampled using a convenient sampling method. The study found that the causes of stress among nurses included conflict with coworkers and doctors at 95.8%, lack of support from seniors at 52.0% and prolonged shift at 46.7% (Ullah et al., 2022).