DETERMINANTS OF STRESS AMONG NURSES WORKING IN CRITICAL CARE UNITS AT KIRUDDU NATIONAL REFERRAL HOSPITAL, KAMPALA UGANDA
A&E: Accident and Emergency unit
CCU: Critical Care Unit
EAC: East African Community
HDU: Highly Dependant Unit
ICU: Intensive Care Unit
REC: Research Ethic Committee
SSA: Sub Saharan Africa
UAE: United Arabs Emirates
WHO: World Health Organization
OPERATIONAL TERMS
Stress: a physical or psychological stimulus that can produce mental tension or physiological reactions that may lead to illness (Chu et al., 2024)
Critical care nursing: is a specialized field of nursing that involves providing advanced care to patients with life-threatening conditions. Critical care nurses, also known as ICU nurses, work in high-intensity environments, such as intensive care units (ICUs), emergency rooms (A&E) (bestnursingschools, 2023).
An intensive care unit (ICU): Intensive care unit refers to a place where specialized treatment is given to patients who acutely un well and need special attention and support. It provides critical care and life support for acutely ill and injured patients. (Apollo Hospitals, 2024).
Critical care unit: department Critical care is medical care for people who have life threatening injuries and illnesses. It usually takes place in an intensive care (ICU),high dependency units(HDU) and emergency units (Christensen & Liang, 2023).
Highly dependent unit: a department of a hospital where patients who are seriously ill but do not require intensive care receive special medical treatment (Gupta, 2023).
A nurse: is a professional licensed person who has undergone professional training to provide patient-centered care.
ABSTRACT
The purpose of the study was to Identify the determinants of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda while the study was guided by the following specific objectives; to determine the causes of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda and to identify the levels of stress among nurses working in critical care at Kiruddu National Referral Hospital, Kampala Uganda.
The study used a descriptive cross-sectional study design employing a quantitative approach, the study was carried out at Kiruddu National Referral Hospital, the study considered a sample size of 32 nurses considering who qualify and are willing to consent and participate in the study. the researcher used simple random sampling to collect data until the required number of participants are achieved. All nurses working in critical care unit for a period of 1 year and above who are willing to be part of the study and have consented to participate in the study were included.
In the study it was revealed that majority of respondents perceived high levels of occupational stress related to workload, resource constraints, and workplace conditions, and in appropriate communication between nurses and doctors.
The study concluded that nurses working in the critical care units of Kiruddu National Referral Hospital experience high levels of occupational stress due to a combination of organizational, interpersonal, and resource-related factors.
The study recommended that there is need to increase the staffing levels, Kiruddu National Referral Hospital administration and further the high levels of stress resulting from inadequate staffing and excessive workload highlight the urgent need for healthcare administrators to implement staffing policies that ensure optimal nurse-to-patient ratios.
CHAPTER ONE: INTRODUCTION
1.0 Introduction
Stress is a pervasive occurrence within certain professions, including nurses working in Critical Care Units, which include Accidents and Emergency Units (A&E), Intensive Care Units (ICU) and High-Density Units (HDU) (Bolado et al., 2024). These units are highly specialized unit designed to handle emergency care and care for critically ill patients. It provides advanced monitoring, life support systems, and intensive medical and nursing interventions to sustain life during periods of organ failure (Marshell et al., 2017).
The United Kingdom National Institute for Occupational Safety and Health says occupational stress consist of harmful physical and emotional responses which occur when job requirements do not match the capabilities, resources, or needs of the worker (Ageel & Shbeer, 2022).
Nurses working in critical care units face significant levels of occupational stress due to the demanding nature of their work arising from physical, cognitive, and emotional factors, leading to negative consequences such as increased absenteeism, turnover, and decreased job satisfaction (Lamb et al., 2024). To address this issue, it is essential to identify the underlying determinants of stress and develop effective strategies for mitigation. This paper will explore the various determinants of stress among nurses working on critical care units and provide insights for improving their well-being and patient outcomes.
1.1 Background
Work-related stress a widespread global health challenge, results in a substantial annual financial burden of $5.4 billion on productivity due to its detrimental effects (Baye, Demeke, Birhan & Semahegn, 2020). Globally, the prevalence of stress among nurses varies significantly, ranging from 9.2% to 75.0% (Kassa, Afenigus, Meteku, 2019). It is known to be associated with physical and psychological illnesses, decreased performance, absenteeism, high staff turnover and decreased job satisfaction (Okuhara et al., 2021).
Nurses are the cornerstone and the largest workforce of healthcare institutions providing direct patient care (Baye, Demeke, Birhan & Semahegn, 2020) and are subjected to high levels of stress as they manage the emotional and physical demands of caring for complex patients (Al-Yaqoubi, & Arulappan, 2023).
In the United Kingdom (UK), the National Health Service (NHS) revealed that over over 38% of its nursing staff experience job-related stress (N. H. S, 2018). Studies from Australia show that 41.2% experience stress related to work including depression among 32.4% of nurses and anxiety in 41.2% (Maharaj, Lees, & Lal, 2018).
In the Middle East, nurses are known to experience high levels of occupational stress among all health workers (Chegini, 2019). Up to 75% of the nurses in Iran experience average and high levels of stress at work, this was linked to some factor of both hospital and individual factors (Asefzadeh, Kalhor, & Tir, 2017).
A comprehensive review study done in the United Arab Emirates (UAE) among nurses shows that 69% of nurses in the Intensive Care Unit (ICU) experiences work-related stress (Gheshlagh et al., 2017). The primary causes of this job stress in healthcare are excessive workload, interactions with colleagues, leadership style, unfavourable patient outcomes, and exposure to death and dying among other factors (Mengist et al., 2021).
In Africa, the healthcare systems comprise of only 3% of global healthcare workers and face severe financial constraints, are burdened with addressing 24% of the world’s most substantial disease burden which has subjected health-workers to poor wages, low socioeconomic status, high workload, role ambiguity, and challenging working conditions (Selamu, Thornicroft, Fekadu, & Hanlon, 2017). This has contributed to occupational stress among nurses working in critical care units and health care providers in the African countries at large.
In Sub-Saharan Africa (SSA), a recent comprehensive study was carried out among health workers and the findings indicated that nurses working in critical units experience a significantly high level of occupational stress than doctors (Dubale et al., 2019). It is particularly prevalent among nurses working in intensive care unit and those working in reproductive health services at a rate of 37% to 89% respectively (Poku, Donkor, & Naab, 2020).
Studies conducted across various regions of Ethiopia have revealed a significant prevalence of work-related stress among nurses working in critical units, with reported rates ranging from a substantial 37.8% to a concerning 66.2% (Godifay, Worku, Kebede, Tafese, & Gondar, 2018). These findings highlight the urgent need for targeted interventions to address this critical issue and improve the well-being of nurses.
The EAC countries are either low- or lower-middle-income developing countries, with most populations living in the rural areas. The EAC state health systems have been described as resource-limited settings, severely weakened and fragile hence job stress (Muthuri, Senkubuge, & Hongoro, 2020).
In Kenya, about 79.8% of nurses working in critical care units reported to be affected by job stress and this has negatively influenced their output at work (Lewa, Kioko, & Lewa P, 2023).
In Uganda, the number of registered nurses and midwives far exceeds the number employed, creating a significant strain on the healthcare system (Luyima, 2022). This shortage, coupled with the rising physical and mental demands of the profession, increases the likelihood of chronic stress among nurses working in critical care units (Luyima, 2022).
Studies that provide a comprehensive overview of stress are needed to accumulate data and synthesize results into generalizable knowledge that is common and applicable to large populations, which can be used by organizations and governments in making policies and taking measures to mitigate stress (Okuhara et al., 2021). It is therefore on this ground that this study aims to identify determinants of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda.
1.2 Problem statement
Nurses working in critical care units often experience high levels of stress due to the demanding nature of their roles, which can negatively impact their job satisfaction, mental health, and overall well-being (Bolado et al., 2024). Nurses’ well-being is directly linked to the quality of care they provide and when nurses experience a high quality of life, they are more likely to deliver effective nursing care (Layali, Ghajar, Abedini, & Emadian, 2019).
While stress is common among nurses in critical care units , the specific determinants can vary. Nurses in kiruddu National referral hospital, who handle complex cases often have limited resources, face unique challenges that contribute to their stress and given the escalating demands and complexities within healthcare systems. Addressing the determinants of stress among nurses working in critical care units is paramount to maintaining a sustainable and high-quality nursing workforce (Tsegaw, Getachew, & Tegegne, 2022). This is why this study aims to Identify determinants of stress among nurses working in critical units at Kiruddu National Referral Hospital, Kampala Uganda.
1.3 Purpose of the study
To Identify the determinants of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda.
1.4 Specific objectives
- To determine the causes of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda.
- To identify the levels of stress among nurses working in critical care at Kiruddu National Referral Hospital, Kampala Uganda.
1.5 Research questions
- What is the determionants of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda?
- What are the levels of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda?
1.6 Justification of the study
This research would be useful in the following ways;
To the Ministry of Health: This study will provide valuable insights into the challenges faced by nurses working in critical care units, allowing the ministry to develop targeted interventions to improve their well-being and job satisfaction.
To Nurses: This study can provide evidence to support the concerns of nurses working in critical care units and advocate for improvements in working conditions and support systems.
To Kiruddu National Referral Hospital: Addressing the determinants of stress can help to improve job satisfaction and reduce turnover rates among nurses.
To the researcher: Through this research, I will attain an award of diploma in Nursing extension as it is a partial requirement.
