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 used a descriptive cross-sectional study design employing a quantitative approach. This method was 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.

3.2 Study setting and rationale

The study will be carried out at Kiruddu National Referral Hospital. Kiruddu National Referral Hospital is located on Buziga Hill, in Makindye division along Salaama – Munyonyo road, one of the five administrative units of the Kampala Capital City Authority. It is approximately 13.5 kilometers (8 mi), by road, south-east of the Mulago National Referral Hospital. Kiruddu National Referral Hospital is approximately 10 kilometers (6 mi), southeast of the central business district of the city.  The coordinates of Kiruddu General Hospital are 0°14’53.0″N, 32°36’45.0″E (Latitude: 0.248056; Longitude: 32.612500). Kiruddu National Referral Hospital has a total number of 120 permanently employed nurses of all cadres; certificate level, diploma and degree level. Kiruddu offers has critical care units like accident and emergency, highly dependent unit, and intensive care unit with cardiology, pulmonary, renal, burns and plastic, dental services, burns and plastics and psychiatric services which will be able to meet the study need of nurses working in critical care unit.

3.3 Study population

The study population included 35 nurses working in critical care units ICU,HDU and Emmergency units at Kiruddu National Referral Hospital.

3.4 Sample size determination

The study considered a sample size of 32 nurses considering who qualify and are willing to consent and participate in the study considering the Krejcie and Morgan table.

3.4.1 Sampling procedure

The researcher used simple random sampling to collect data until the required number of participants are achieved. The researcher assigned numbers to all available nurses working in critical care unit. All those who will pick number one to thirty qualified for the study.

3.4.2 Inclusion criteria

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 was included.

3.4.3 Exclusion criteria

Nurses working in critical care units but are not willing to consent was excluded from the study.

Nurses working in critical care units who were on leave excluded from the study.

3.5 Definition of variables

 3.5.1 Independent variable

The determinants of stress among nurses working in critical care units.

3.5.2 Dependent variables

Stress among nurses working in critical care units

3.6 Research instruments

The researcher collected data using 2 questionnaires. The first questionnaire tested for the determinants of stress and that will consist of a set of closed ended questions on the study objectives. This helped to obtain firsthand information and a quick and easy way to record and identify data and requirements for the study.

Secondly to collect data for the levels of stress the researcher used the Patient Health Questionnaire (PHQ9). Patient Health Questionnaire-9 is a self-administered tool used to screen, diagnose, monitor, and measure depression severity. It consists of nine items assessing depressive symptoms frequency over two weeks, with higher scores indicating greater severity(Sun et al., 2020).  The PHQ-9, designed to assess depression, can also be used to evaluate stress levels among nursing staff, as elevated scores may indicate underlying stress-related issues. Research in Kenya demonstrated its reliability and validity(Odero et al., 2023). In practice, the PHQ-9 can be administered to nursing staff to identify those experiencing depressive symptoms, which may be indicative of high stress levels.

3. 7 Data collection procedures

The researcher obtained an introductory letter from the school to seek permission to carry out the study from the Director of Kiruddu National Referral Hospital. The director of Kiruddu National Referral Hospital is expected to write to the ward in charges of all critical care units to give all the necessary help to the researcher regarding this study especially with data collection.

The ward in charges assigned any healthcare worker the duty of introducing the researcher to nurses in critical care units. The researcher then sought consent from the able nurses to participate in the study and they enrolled into the study upon their consent to participate by answering the questions in the questionnaires and they shall be appreciated for their participation.

3.7.1 Data management

Data was managed by the researcher to ensure accuracy, confidentiality and security. The researcher will also check for the completeness of the data and was hand-coded and entered into Microsoft Excel. The data was then exported to Stata 15 version software for further cleaning. Cleaning of the data will be done by running frequencies on each variable. This checked inconsistently coded data. Inconsistently coded data was double-checked with raw data from the check list, and all inconsistencies and errors were resolved. A completed check list was stored in safety lockers under lock and key. They was only accessed by the researcher so that the acquired information isn’t manipulated by other people for selfish interests.

3.7.2 Data Analysis

Data was first cleaned, coded and categorized according to the specific objectives. This data was manually be entered into Statistical Package for Social Scientists (SPSS) software version. Descriptive data will be run in this program to develop graphs and charts for better interpretation of the findings. These was transferred to Microsoft word where data was interpreted in a narrative form to illustrate the basic meaning of the results.

3.8 Ethical Consideration

The research proposal was reviewed by the supervisor and was then submitted to the Research ethics committee for approval. An introductory letter was written from the school introducing the researcher to the study area managers. The researcher took the introductory letter and the approved proposal to the health facility director to seek permission to carry out the research data collection in their facility. The area managers, ward in charges and the nurses of the respective critical care unit was also notified about the study. The collected data was kept under lock and key only accessible by the researchers.

3.9 Limitation of the Study

The study faced;

• Critical care nurses are often overworked and were hesitant to participate in research studies however, as the researcher, clearly communicated the purpose and benefits of the study and be flexible with the participants’ busy schedules.
• The researcher also expected to get inadequate information which was due to the sensitivity of the study topic but explained properly to the participants and reassure them of full confidentiality, no harm, blame or even identity.

3.09 Dissemination of results

The findings of this research study was made into a research dissertation where copies were produced and submitted to different stakeholders as follows;

• Uganda nurses and midwives’ examination board as partial fulfillment for the award of a Diploma in Nursing
• Aga Khan University for future reference by other researcher, scholars and students.
• Kiruddu National Referral Hospital management in order to plan on how to create solutions for the identified gaps.
• The researcher will also have a copy for personal references.
• Presentation in conferences especially the Nurse’s led conferences.