DETERMINANTS OF STRESS AMONG NURSES WORKING IN CRITICAL CARE UNITS AT KIRUDDU NATIONAL REFERRAL HOSPITAL, KAMPALA UGANDA

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

1. To determine the causes of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda.
2. To identify the levels of stress among nurses working in critical care at Kiruddu National Referral Hospital, Kampala Uganda.

1.5 Research questions

1. What is the determionants of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda?
2. 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.

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).

CHAPTER THREE: METHODOLOGY

3.0 Introduction

This chapter contains the study design and rationale, study setting and rationale, study population, sample size determination, sampling procedure, inclusion criteria, definitions of variables, research instruments, data collection procedure, data management, data analysis, ethical considerations and dissemination of results.

3.1 Study design and rationale

The study will use a descriptive cross-sectional study design employing a quantitative approach. This method will help in collecting my data in one place at one point in time using questionnaires (Wang & Cheng, 2020). Additionally, examining the level of stress among nurses working in critical care units and the causes of stress among nurses working in critical care at Kiruddu National Referral Hospital, Kampala Uganda.