CHAPTER FOUR

PRESENTATION OF THE FINDINGS

4.0 Introduction

The study will analyze the findings of the study using SPSS and will be presented in tables and figures.

4.1. Demographic characteristics of respondents

This sections presented the different demographic characteristics of respondents in tables and figures.

4.1.1 Findings on the gender of respondents

The figure below shows the gender of respondents as got from the field, from Kiruddu national referral Hospital

Figure 1: Gender of respondents

The findings in the figure above indicates that majority 56.7% of the respondents were male and the female population was 43.3%, this indicated that all the gender were well represented. this further shows that the findings in the study were not biased opinions of specific gender since there is a fair representation of both.

4.1.2 Findings on age of respondents

The figure below shows the age of respondents who were given questionnaires at Kiruddu National referral Hospital

Figure 2: Age of respondents

Source: Primary Data

According to the figure above Majority of respondents were in the age brackets of 26-35 years of Age with a percentage of 43.3% while respondents in the age brackets of 26-40 years and the percentage was 40% while respondents 18-25 years were 10% while 50 years and above were 6.7%.This findings further shows that all age category of respondents was well represented therefore the research was not biased to a specific age group.

4.2 Finding on the level of education

The Pie-chart below represents the level of education of respondents from Kiruddu Hospital national referral hospital.

Figure 3: level of education

Source: Primary Data

The findings from the Pie-chart above indicates that majority 64% of the respondents were Diploma holders, 23% of the respondents at Kiruddu National referral hospital while 13% were degree holders. These study findings further show that all the respondents are well educated and they were able to answer the questionnaires from an informed perspective.

4.1.4 Findings religion of respondents

The table below shows that the religious denomination of the respondents

The table above shows that majority 43.3% of the respondents were Catholics, while 23.3% were protestants, 20% were Born again while 13.3% were Muslims. This study results also further indicates all the religious denominations were covered and therefore the study results were not a biased opinion of a specific religion. The study further concludes that most of the available religion in Uganda is well represented at kiruddu national referral hospital.

4.1.4 Findings on marital status of respondents

Figure below shows the marital status of respondents

Figure 4: Marital status of respondents

Source: Primary Data

The findings from the figure above indicates that majority of the respondents 63.3% were married , 26.7% were single while only 10% were divorced/separated, this findings further shows that the study included respondents from different marital status and thus it was not segregative which enabled the researcher to get a balanced respondents that can be relied upon.

4.1.5 Department of work

The figure below shows were majority of the respondents worked

Figure 5: Department of work

From the findings in the study majority 46.7% of the respondents at Kiruddu National Referral hospital worked in intensive care unit, 33.3% worked at accident and emergency unit while 20% of the respondents worked at highly dependent unit. This finding further shows that all the departments were the respondents worked was considered further indicating that the study response was not biased towards a specific department.

4.2 Table below shows findings on the level of stress among nurses working in critical care unit

The table below shows the level of stress among nurses working in critical care unit at Kiruddu national referral hospital

Table 1: level of stress among nurses working in critical care unit:

Source: Primary Data

The table results indicate that majority 14(46.7%) of the respondents asserted they did not at all have feelings of Little interest or pleasure in doing things, over the past two weeks, 10(33.3%) of the respondents stated that they have feelings of little interest Several days, 5 (16.6%) of the respondents asserted that Nearly every day, 1 (3.3%) stated that more than half the day.

The findings on the study if the nurses are Feeling down, depressed or hopeless 11(36.7%) stated they do not feel it at all, 5 (16.7%) indicated that they experience the feeling nearly every day, while 3 (10%) indicated that More than half the day they feel depressed.

The study results further show that 14(46.7%) of the respondents indicated that they have Trouble falling or staying asleep, or sleeping to much, the table results further shows that, 8 (26.7%), indicated they did not experience it at all, the results further shows that, 5 (16.7%) of the nurses indicated that they, they feel trouble falling asleep or staying asleep More than half the day and relatedly 3 (10%) indicated that they experience it nearly every day.

The findings in the study further indicates that 13 (43.3%) of the nurses at Kiruddu National Referral Hospital, indicated that in several days they Feel tired or having little energy, 7(23.3%) of the respondents, indicated that they do not feel it at all, 2 (6.7%) indicated that

The study results further show that majority 18 (60%) of the nurses at Kiruddu national referral Hospital they have never felt Poor appetite or overreacting at all, 7 (23.3%) of the nurses asserted that they feel poor appetite or over reacting several days, 3 (10%) of the nurses indicated that more than half day and the remaining 2 (6.7%) asserted that they feel it nearly every day.

The study results further indicate that majority 16 (53.3%) of the nurses asserted that they do not face at all Feeling bad about themselves or that they are a failure or have let their family down, 8 (26.7%) of the respondents stated that they face these feelings for Several days, several days indicated that they face these feelings for more than half a day, while 3 (10%) indicated that they face the feelings for more than half a day.

The study results further show that majority 16 (53.3%) of the nurses at Kiruddu National Referral Hospital indicated that, they do not at all have Trouble concentrating on things, such as reading the newspaper or watching television, the results further in the study further shows that 8 (26.7%), the results further shows that 3 (10%) of the respondents’ assert that, they several days’ experience trouble concentrating on things, such as reading the newspaper or watching television, 3 (10%) of the respondents stated that they nearly feel it every day.

The study results further states that majority 17 (56.7%) of the nurses at National referral hospital Moving or speaking so slowly that other people could have noticed, or being so restless that you have been moving around a lot more than usual, 7 (23.3%) of the nurses indicated that several days, the 3 (10%) of the nurses stated that, more than half the day and the remaining 3 (10%) of the nurses assert that Nearly every day.

The study results indicate that, majority 19 (63.3%) of the Nurses at Kiruddu National Referral Hospital, indicated that they have never developed any thoughts they would better off dead, or of hurting themselves while 6 (20%) of the nurses indicated that More than half the day and more to that 5 (16.7%) indicated that several days.

The data suggest moderate to high levels of psychological distress among nurses working in critical care units. Emotional symptoms such as feeling down or hopeless, fatigue, and sleep disturbances are particularly prevalent. Although some symptoms like poor appetite and psychomotor issues are less frequent, the presence of suicidal ideation in a significant portion of the population is especially concerning and warrants immediate attention. These findings underscore the need for targeted mental health interventions, stress management programs, and ongoing psychosocial support for critical care nurses to safeguard their well-being and enhance patient care outcomes.

4.3 Findings on the causes of stress

The figure below presents the findings if the respondent works in shifts

Figure 6 : Findings if the respondents works in shifts:

Source: Primary Data

The study results show that majority 86.7% of the nurses working in Kiruddu national referral Hospital are working in shifts while 26% are not working in shifts. This study results further shows that majority of nurses in Kiruddu national referral hospital are working in shifts.

4.3.1 Findings on the shifts the nurses work

The table below indicates the shifts that the nurses in Kiruddu national referral hospital work at.

Table 2:  Findings on the shifts nurses work at at Kiruddu National referral hospital

Source: Primary Data

According to the findings in the study 40% of the nurses indicated that they work Day and night while 33.3% asserted that they work Day shift only and only 26.7% work Morning, Evening and night.

4.3.2 Findings on the number of hours’ people work per shift

The table below shows the number of hours’ nurses at kiruddu national referral hospital work

Table 3: Findings on the hours nurses work at in Kiruddu National Refferal Hospital

Source: Primary Data

The study results indicates that 76.6% of the Nurses at kiruddu National referral Hospital asserted that they work for 12 hours while 20% work for 8 hours and the remaining 3.3% work for 24 hours. This results further shows that actually majority of the nurses at kiruddu national referral Hospital work for 12 hours.

4.3.3 Findings on the shift nurses find hectic

The figure below indicates the shift nurses at kiruddu national referral hospital

Table 4: Findings on the shift the nurses find hectic at Kiruddu National Referral Hospital

Source: Primary Data

The study findings show that the Majority 53.4% of the nurses at Kiruddu National Referral Hospital find night shift so hectic, only 20% find Day shift hectic while 16.7% find evening shift (6 hours) hectic and 10% of the nurses stated that morning shift 8 hours is hectic.

4.3 Causes of stress in critical care units

The section below indicates the findings from the respondents response on , Causes of stress in critical care units, Nurses at Kiruddu National referral Hospital, were presented with items and requested to either agree or disagree basing on a five Likert scale of; Strongly Agree(SA) =5, Agree(A) =4, Neutral (N)=3, Disagree(D)=2, Strongly Disagree(SD) =1. The mean above 3 implied that majority agreed, and that below 3 means disagreed while 3 imply undecided/neutral.

Table 5: Causes of stress in critical care units

Source : primary data

A significant majority of respondents agreed (46.7%) or strongly agreed (30%) that they face a high workload, with only a small proportion disagreeing (6.7%) or strongly disagreeing (3.3%). Similarly, nurse-to-patient ratio was perceived as too high, with 46.7% strongly agreeing and 26.7% agreeing. These findings suggest that staff shortages and excessive workload are among the most prominent stressors in critical care units. This is consistent with existing literature that links staffing challenges to burnout, reduced quality of care, and high turnover rates in healthcare settings.

Approximately 66.6% of respondents either agreed or strongly agreed that they do not receive adequate rest between shifts. The unexpected death of patients, a common occurrence in critical care, was reported to be a significant stressor, with 33.3% strongly agreeing and another 20% agreeing. Continuous exposure to death and dying was also confirmed as a major cause of stress (33.3% agree, 33.3% strongly agree). These results reflect the emotional and physical exhaustion faced by healthcare workers and emphasize the need for psychological support mechanisms in these settings.

Respondents indicated that a lack of appropriate knowledge about specialized equipment was a concern, with 40% agreeing and 13.3% strongly agreeing. Similarly, lack of practice and inadequate skills was acknowledged as a source of stress by 33.3% of participants. This underlines the necessity for ongoing professional development, simulation training, and mentoring to ensure that nurses are confident and competent in handling complex medical technologies.

Lack of equipment and resources, such as ventilators, was another major cause of stress, with 46.7% agreeing and 30% strongly agreeing. A shortage of staff was similarly recognized, with over half of the respondents (53.3%) agreeing and 30% strongly agreeing. An improper work environment, including noisy surroundings, also contributed to stress, though responses were more varied. These findings suggest that infrastructural and logistical deficiencies severely hinder effective service delivery and contribute to mental strain.

The study also revealed stress arising from interpersonal conflicts and organizational culture. Around 50% of respondents agreed that lack of motivation and recognition was a stressor, and another 50% agreed that lack of support from supervisors or managers contributed to their stress. Conflict with doctors, lack of cooperation among nurses, and aggressive family members were also perceived as significant sources of distress. These results indicate a need to foster a supportive and collaborative work environment through effective leadership and communication training.Concerns over cross-infection (e.g., tuberculosis, hepatitis B/C) were reported by 40% of respondents, pointing to the stress of working in a high-risk environment. Furthermore, difficult patient behavior and aggressive family members were also recognized as contributing factors, highlighting the psychosocial challenges faced by nurses beyond clinical duties.

 CHAPTER FIVE

DISCUSSION, CONCLUSIONS AND RECOMMENDATION

Introduction

This chapter comprises of, discussion of findings, limitations, conclusions and recommendations.

5.1.5 a) Discussion

This section presents the discussion of the study findings as per objectives in relation to the findings in chapter four.

5.1.5 To determine the causes of stress among nurses working in critical care units at Kiruddu National Referral Hospital, Kampala Uganda

In the study it was revealed that Kiruddu National Referral Hospital there is multifaceted set of stressors affecting staff in the critical care units, in the analysis it was revealed that the majority of respondents perceived high levels of occupational stress related to workload, resource constraints, and workplace conditions, in another response it was also further revealed that insufficiency or unavailability of equipment and resources was one of the other causes of stress among health workers in kiruddu national referral hospital , this view was also in line with the findings of , Johan, Sarwar, & Majeed (2017)  who 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 identified that Lack of resources and lack of practice and inadequate skills as one of the causes of stress among the health workers.

The study results further revealed that another factor that stressed the nurses more at Kiruddu National Referral Hospital was consistent with global literature that associates staff burnout with excessive responsibilities in high-pressure environments like intensive care, inadequate rest between shifts and further Lack of knowledge about specialized was also identified as stress-inducing factors, these indicate gaps in professional development and infrastructure that may undermine nurses’ confidence and competence. Meanwhile, inappropriate communication between nurses and doctors reflects interpersonal and interprofessional tensions, which, if unaddressed, can impede collaboration and patient safety, these results were also in line with Sarwar, & Majeed (2017)  who 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 who stated that, the major determinant  of stress among nurses includes inappropriate communication between nurses and doctors  and lack of appropriate knowledge about specialized equipment.

In further finding out on the factors that cause stress to nurses the findings revealed that lack of practice and inadequate skills revealed that some nurses experience stress due to training gaps, this underlines the need for targeted professional development tailored to individual needs, this view was also further indicated by Sarwar, & Majeed (2017) who asserted that lack of practice and inadequate skills is one of the major causes of tress among the nurses.

In the study in further finding out the factors that cause stress it was further revealed that resource shortages, poor remuneration, operational and emotional exposure to death, contribute to stress among critical care nurses, this finding further indicated that it is imperative to address these factors, this study results were also in line with Mwinga, & Mugala (2015) who stressed that working environment like overcrowding and death exposure are among the factors that cause nurses stress and therefore addressing these issues is imperative for improving the working environment of the nurses.

It was further revealed that the most significant source of stress, was shortage of staff, this results further indicated that the presence of few staff at Kiruddu National Referral Hospital has few staff and as such the few who exist  are burnt out due to much work and this findings further reveals that human resource is in critical care environments where the nurse-to-patient ratio is crucial for quality care and patient safety, an understaffed unit not only increases individual workload but also compromises the ability to respond effectively to emergencies, this factors was also supplemented by the fact that lack of motivation and recognition led to stress among the nurses of Kiruddu National Referral Hospital, this view was also further in line with Johan, Sarwar, & Majeed, (2017), who stated that in 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, it was revealed that lack of breaks , due to shortage of staff and improper work environment as one of the cause of stress among the nurses.

The findings in the study also revealed that conflict with doctors during duty hours had the lowest mean score among the listed items, indicating a relatively lower but still notable source of stress,  Although not as prevalent, this interprofessional tension can affect communication and collaborative decision-making, ultimately impacting patient outcomes, the findings demonstrate that stress in critical care units is multifactorial, arising from both organizational and interpersonal factors, this view was also shared by Ullah et al., (2022) who asserted that stress among nurses included conflict with coworkers and doctors and lack of support from seniors.

5.1.5 The levels of stress among nurses working in critical care at Kiruddu National Referral Hospital, Kampala Uganda.

The findings indicated the nurses at kiruddu national referral hospital asserted they did not at all have feelings of Little interest or pleasure in doing thing that they were doing, this indicated that the stress level was high among the Nurses this results was also in line with Bolado et al., (2024), who stated that in assessing 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, there results that the stress levels among nurses was moderate at 55.9%

The study results indicated that a considerable number of nurses stated that a considerable number of nurses indicated that they are Feeling down and depressed or hopeless in addition to that a large of nurses at Kiruddu National Referral Hospital also asserted that they having trouble falling or staying asleep, this view was also in line with Awan et al (2023) who carried out a quantitative study in Pakistan to assess the level of stress and associated factors among nurses working in critical care units, the level of stress was found at a moderate level of 80.2%, this view further reveals that nurses in Kiruddu National Referral Hospital face mild stress level.

The findings in the study further indicates that a large number of the nurses at Kiruddu National Referral Hospital, indicated that in several days they Feel tired or having little energy, this results was also further highlighted by Kumar, Pore, Gupta & Wani, (2016) who asserted that 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 majority 48.78% were mildly stressed.

The study results further indicate that majority of the nurses asserted that they do not face at all Feeling bad about themselves or that they are a failure or have let their family down, this indicated that the nurses are proud of their professions and more to that some nurses also stressed that some nurses indicated that they have trouble concentrating on things, such as reading the newspaper or watching television, this view was also in line with Salameh, Abdallah, Alkubati, & ALBashtawy, 2024), who asserts that 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.

The study results further states that majority of the nurses at National referral hospital Moving or speaking so slowly that other people could have noticed, or being so restless that you that they move around a lot more than usual, this view was also further shared by Podvorica, Rrmoku, Metaj, & Gashi, 2020) who indicated that regarding the  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 results indicates that a vast majority of participants reported moderate to high levels of stress (81%).

5.1.5 b) Limitations

The following were some of the limitations faced by the researcher in the course of data collection and the study in general.

The nurses at kiruddu national referral hospital were generally very busy and this mainly affected the performance, the time for data collections, it was very tricky as nurses had to be clearly explained to before they could accept to participate in the study.

The study further faced a challenge of as some nurses were fearing that disclosing their challenge may lead them to losing jobs this was also further, emphasized by the researcher to the respondents that they information and identity will be kept secret and therefore no one will follow up on them regarding their responses.

Getting the literature for the study was quite one of the challenges that limited the study, most of the literature review was from other countries that was not specifically from Uganda, therefore though this is good but some conditions may not specifically apply to Uganda as each country has its own unique culture and aspirations.

5.1.5 C) Conclusions

The following are the conclusions of the study;

5.1.1 Conclusion on the Causes of Stress Among Nurses Working in Critical Care Units at Kiruddu National Referral Hospital, Kampala, Uganda

The study established 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. Key stressors identified included excessive workload, inadequate staffing, insufficient equipment and resources, and poor remuneration, the results further emphasized that a lack of specialized knowledge and inadequate training contribute to stress by reducing nurses’ confidence and competence in handling critical situations.

Inappropriate communication and occasional conflict between nurses and doctors emerged as significant interpersonal sources of stress, which can hinder teamwork and patient care.

The psychological burden resulting from frequent exposure to patient deaths and the emotional toll of high-pressure responsibilities with little rest between shifts. The most prominent source of stress was the persistent shortage of staff, and a lack of motivation and recognition further compounded this issue, contributing to burnout and diminished morale.

5.1.2 Conclusion: The Levels of Stress Among Nurses Working in Critical Care at Kiruddu National Referral Hospital, Kampala, Uganda

The study concluded that nurses working in critical care units at Kiruddu National Referral Hospital experience moderate to high levels of stress. The findings revealed that many nurses reported symptoms such as low interest or pleasure in daily activities, persistent feelings of fatigue, trouble sleeping, and feelings of hopelessness all of which are indicators of psychological distress.

Although most nurses did not report feeling like failures or expressing negative self-worth, which suggests a level of professional pride and resilience, other stress indicators such as difficulty concentrating, restlessness, or lethargy were prevalent. Overall, the study highlights that the demanding nature of critical care work, combined with the emotional and physical toll, contributes significantly to nurse stress.

5.1.5 d) Recommendations of the study

The study recommendations are highlighted below;

There is need to increase the staffing levels, Kiruddu National Referral Hospital administration, in collaboration with the Ministry of Health, should prioritize the recruitment and deployment of additional qualified nurses to critical care units as this will be imperative in reducing the high nurse to patient ration and alleviate excessive workloads.

The study further recommends that there is need to Improve Working Conditions and Resource Availability at Kirruddu National Referral Hospital and also ensure that there is adequate supply of essential medical equipment and resources should be ensured to enable nurses to perform their duties effectively and reduce stress caused by resource constraints. Regular audits of resource availability should be implemented to identify and address gaps.

5.2.2 Study Recommendations Based on the Conclusion on Levels of Stress Among Nurses Working in Critical Care Units at Kiruddu National Referral Hospital

The following are some of the recommendations to the fact that nurses in critical care units’ experience moderate to high levels of stress, the following recommendations are proposed to mitigate stress and improve nurse well-being and performance:

The study also recommends that there is need to implement regular mental health screening and counselling services and also there is need to increase Staffing Levels and Workload Distribution to reduce fatigue and burnout from the staff and more importantly there is need to promote stress management training among the staff.

5.1.5 e) Implications to the nursing practice

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. This would help reduce burnout, enhance quality of care, and improve patient outcomes.

The reported shortage of essential equipment and supplies underscores the importance of proper resource planning and budget allocation. Ensuring the availability of adequate tools and materials is crucial for enabling nurses to deliver efficient and safe patient care.

The study indicates that a lack of specialized knowledge and inadequate training significantly contribute to nurse stress. Therefore, continuous professional development, including targeted training in critical care procedures and the use of specialized equipment, should be prioritized to build competence and confidence among nursing staff.

Interpersonal stress arising from poor communication and conflict between nurses and doctors suggests a need for structured communication protocols and interprofessional collaboration training. Promoting mutual respect and teamwork is essential for reducing conflict and improving patient care coordination.

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