Ife PsychologIA 2017, 25(1), 82 - 103

Copyright (c) 2017 Ife Centre for Psychologial Studies/Services, Ile-Ife, Nigeria ISSN: 1117-1421

STRESS AMONG NURSES: A COMPARATIVE STUDY OF TWO

TERTIARY HEALTH CARE INSTITUTIONS IN JOS, NIGERIA

Edward Mawun Makdet Dachalson, Emmanuel Danja Gyang &

Peace Satzen Azi
Department of General & Applied Psychology
University of Jos, Jos, Nigeria
e-mail: dachalsonmak@yahoo.com

Abstract
The aim of this study was to compare the levels and sources of stress
between nurses working in two tertiary health care settings in Jos,
Nigeria. A total of 192 nurses participated in the study, with 92 from
JUTH and from 100 PSH. The Expanded Nurses Stress Scale (ENSS)
was used to measure the levels of stress and results show that there
was no significant difference between the two samples, where F
(1,191) = .472, p=.493.05 and participants had mean scores of
140.74, SD = 30.76 and 137.80, SD = 28.80 for JUTH and PSH,
respectively. Similarly, there was no significant difference in the
sources of stress for both samples, where F (1,190), p>.05. However,
there were significant differences in the overall sample based on the
dimensions of working environment where the emergency units had
significantly higher levels of stress on the physical dimension with a
mean of 20.00, SD = 8.49 and p=.003; the GOPD had significantly
higher stress on the psychological dimension of the working
environment with a mean score of 51.69, SD = 9.10 and p=.001; and
the SCBU had a significantly higher stress levels on the social
dimension of the working environment with a mean score of 73.60, SD
= 9.29 and p=.005. It was concluded that nurses from the two health
care institutions experienced similar levels of stress and would require
stress prevention and management programs.

Background of the study

Stress is a new-old concept that has recently became one of the most
important contemporary issues in applied research considering the
factors that lead to stress, its consequences, and the necessary
strategies to deal with distress outcomes. It is found in the life of every
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individual, within family relations, at work and in any career, in any

organization, all over the world. Millions of people resort to
medications to reduce the risks of continuous stress in addition to the
huge sums of monies lost annually as a result of decline in productivity
associated with it. Stress has been categorized as an antecedent or
stimulus; as a consequence or response; and as an interaction
(Jennings, 2008) and has been studied from different perspectives
using different approaches. One of the earliest, empirical and most
outstanding postulations about stress supports a physiological model of
association between stress and physical illness (Selye, 1956). Lazarus
(1966), on the other hand, advocated for a psychological model in
which stress is a particular relationship between the person and the
environment that is appraised by the person as taxing or exceeding his
or her resources and endangering his or her well-being. Research
evidence shows that stress is the second in frequency of health
problems associated with the occupational environment and it is
estimated that close to 30% (1 in 3) of people around the world
experience work-related stress (Eleni, Fotini, Maria, Loannis,
Constantina, & Theodoros, 2010; Andoniou, 2007).

Stress, especially as it relates to ones occupation, refers to the adverse

emotional state experienced when the demands due to occupational
factors overcome the ability of an employee to address or control the
situation. It could also be described as the failure of an organism
human or animal to respond appropriately to emotional or physical
threats, whether real or imagined (Varghese, 2012; Eleni et al, 2010).
However, there could be a subjective aspect of stress based on the
discovery that a certain factor(s) may be the source of stress for some
individuals but not for others (Lazarus & Folkman, 1984). The triggers
usually connected with stress are physical, psychological, or social. In
particular, physical symptoms include increased arterial pressure,
allergies, ulcers, cardiovascular conditions, and general health-related
symptoms, while psychological and behavioral symptoms involve lack
of concentration, increased tension/anxiety, boredom, low work
consistency, and some decline in the persons performance and
satisfaction.

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Generally, hospital work often requires coping with some of the most
stressful situations found in any workplace (Etim, Bassey, Ndep, Iyam,
& Nwikekii, 2015). Hospital workers have to deal with patients from
different walks of life, all age groups, and different characteristics with
life-threatening injuries and illnesses which could be further
complicated by tight work schedules and disproportionate staff-patient
ratios. Emergencies also complicate an already stressful work
situation. Brunero, Cowan, Grochinski, & Garvey (2006 as cited in
Etim et al, 2015) add that hospital workers have to accommodate
demanding patients, especially those suffering from chronic
debilitating diseases as well as those experiencing acute or severe
pains.

Nursing personnel are usually the largest group of healthcare workers

employed by hospitals and they are faced with the challenge of
providing high quality care at low costs leading to far-reaching
consequences on their physical and mental health. The workload for
nurses has been reported to significantly increase since the last two
decades and the overall stress levels for them increase when more
patients have to be attended to within the same limited working hours
(Azeem, Nazir, Zaidi, & Akhtar, 2014; AbuAlRub, 2004; Hall, 2004;
Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). Several other
sources of stress for nurses have been identified which include nature
of nursing tasks, workload, involvement with death and dying,
uncertainty, responsibility, role conflicts, relationships, the home-work
interface, and fulfilling others expectations of the role of the nurse
(Payne & Firth-Cozens, 1987).

Furthermore, Varghese (2012) shows that stress may produce both

positive (eustress) and negative (distress) consequences. The
workplace for nurses provides a multiplicity of sources of stress and
there are differences in the perceptions of nurses in different healthcare
centers, and even for individuals in the same health center. Thus the
concept of stress is of great importance in healthcare, and especially
nurses are generally considered a high risk group regarding work stress
and burnout. It is paradoxical to note that though nurses are trained to
deal with these factors, chronic stress may take a toll on them where
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there are additional stress factors like home stress, conflicts at work,
inadequate staffing, poor cooperation and teamwork with other
colleagues, inadequate training, and poor supervision. Stress has been
known to cause emotional exhaustion in nurses and lead to negative
feelings toward those in their care (Kerlinger & Pedhadzar, 1973).

Therefore, it is important to investigate the nature of stress and the

extent to which it affects healthcare delivery systems/institutions in
order to find ways to improve stress management strategies that will
help healthcare professionals, especially the nurses who usually bear
the brunt of the intricacies of dealing with patients in hospitals. This is
because stress among nurses affects their health and is seriously
associated with more negative consequences than positive outcomes. It
is important that healthcare management systems understand and
acknowledge the problem in order to take preemptive measures to
tackle the growing impact chronic stress may have so as to avoid the
huge costs to society.

Thus the purpose of this study was to compare the levels of stress
among nurses from two tertiary healthcare institutions, Jos University
Teaching Hospital (JUTH) and the Plateau Specialist Hospital (PSH)
in Jos, Nigeria. These two hospitals are assumed to be the largest
healthcare institutions in Jos and are believed to employ the largest
numbers of nurses who attend to the growing number of patients from
within and outside the state.

Literature review
As mentioned earlier, stress is a new-old concept that was ventured
into by researchers from different perspectives with different
approaches. The research literature includes several studies that
investigated stress among nurses in different places, such as
psychiatric wards, accident and emergency wards, geriatric wards, or
even between public and private healthcare settings. For example, a
recent study conducted by Okwaraji & Aguwa (2014) assessed the
prevalence of stress and burnout among nurses working at a Nigerian
tertiary health care institution, the University of Nigeria Teaching
Hospital (UNTH) in Enugu, South-East Nigeria in which 210 nurses
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were assessed for symptoms of burnout and psychological distress.

High levels of burnout were identified in 43% of the respondents in the
area of emotional exhaustion, 48% in the area of depersonalization,
and 54% in the area of reduced personal accomplishment, while 44%
scored positive in the General Health Questionnaire (GHQ-12)
indicating a presence of psychological distress. The authors concluded
that there was high prevalence of stress and burnout among nurses
which arises when people give too much of their time, energy, and
effort their job over a long time without having much time to recover
physically or emotionally. Their recommendations were that the
government should liaise with the relevant health professionals to
institute regular stress management and stress inoculation programmes
for nurses and other health personnel in the country so as to mitigate
the negative health consequences associated with stress. They also
advised that policy should take into account the plight of female nurses
who face peculiar challenges and newly employed nurses who also
encounter challenges in their workplaces with multiple stressors.

Eleni, Fotini, Maria, Loannis, Costantina, & Theodoros (2010)

conducted a study to identify and compare stress among nursing staff
of capital and regional hospitals in Athens using a sample size of 140
nurses and nursing assistants selected at random. They used the
Occupational Stress Scale (OSS) to obtain measures on workplace
stress in general and found out that there was no significant difference
between the two samples, though increased work overload and conflict
between professional and family roles contribute to the development
of stress. As with previous studies, Eleni et al acknowledged that there
is need for continuous search for factors which potentially harm
employees health as essential for effective prevention. Thus their
bone of contention was that preventive strategies should be an integral
part of management policies and of provisional and safeguarding
procedures for improvement of healthcare quality.

In 2003, Cocco, Gatti, Lima, and Camus conducted a comparative

study to compare levels of stress and burnout among nursing staff
from nursing homes and acute geriatric wards in Northern Italy. Their
sample comprised of 172 nurses from 3 different nursing homes and
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183 from 9 general hospital geriatric wards. The result of the study
revealed that more stressful events were reported by nurses from the
general hospital wards, particularly from events related to patients
behavioural disorders than by nurses from the nursing homes. Cocco
and associates suggested that increasing the rate of trained nursing
staff and improving staff support could be needed mostly in general
geriatric wards.

Another study by Mojoyinola (2008) compared stress among nurses

from two public hospitals in Ibadan, South-West Nigeria using a
sample size of 154 nurses and the Stress Assessment Questionnaire for
Hospital Nurses (SAQFHN) to measure job stress, state of health,
personal and work behaviours. The nurses were randomly selected
from 5 units or wards, where the tasks are highly demanding, and were
asked to assess the level of stress they experienced at work in the last 6
months. They were also asked to assess the effect such stress has had
on their physical and mental health, as well as on their personal and
work behaviour. The results helped to establish that nurses in public
health settings generally experience stress, irrespective of the wards or
units they work in, and this has significant impact on their physical
and mental health. Mojoyinola, like other researchers, called on
governments and hospital managements to improve on the welfare of
nurses as a part of overall strategies to help alleviate the stress
experienced by nurses. Mojoyinola also appealed that nurses should be
involved in policy or decision-making concerning their welfare and
working conditions, especially as this is expected to significantly
affect patient care.

Another comparative study using a cross-sectional survey design was

conducted in two different hospitals in Ghana by Rita, Atindanbila,
Portia, & Abepouring (2013). Rita and associates suspected that there
might be significant differences in the levels of stress experienced by
nurses working in the psychiatric hospitals and those that are working
in general hospitals. So they selected 105 nurses from a psychiatric
hospital and a general hospital, where a good representative of the
nursing population in Ghana, including the general nurses and
psychiatric nurses, could be accessible. The Expanded Nurses Stress
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Scale (ENSS) was used to obtain measures on stress from participants

and the results did not show any significant difference on the causes of
stress among nurses in the two hospitals, except workload which was
higher in the general hospital. The study went further to test the level
of job satisfaction of the participants and correlated it with the level of
stress and found a weak negative correlation between stress and job
satisfaction in the two hospitals. Rita and co. recommended that the
Ministry of Health and the various hospitals managements recruit
more nurses and teach them stress management techniques.

In South Africa, Khamisa, Oldenburg, Peltzer, & Ilic (2015) invited a

total of 1200 nurses from 4 hospitals (2 private and 2 public) who
completed the Nursing Stress Inventory (NSI), Maslach Burnout
Inventory-Human Services (MBI-HSS), Job Satisfaction Survey (JSS),
and the General Health Questionnaire (GHQ-28). Of the 5 types of
stressors experienced by nurses in the study, staff issues was found to
be most associated with burnout as well as job satisfaction which
corroborates existing research that staff issues, including excessive
administration, stock control, and colleagues not doing their job,
influences the levels of stress experienced by nurses which are
explained by the overburdened South African health system where
nurses may be unable to meet the demands of their job due to poor
staff management which may negatively affect morale; lack of
resources which may negatively affect patient care; and security issues
owing to high levels of crime in the country. Rita and associates also
found out that stress related to staff issues in particular was associated
with all 3 dimensions of burnout, explaining 16% variance in
emotional exhaustion, 13% variance in depersonalization, and 10%
variance in personal accomplishment.

This literature review is by no means exhaustive. However, it has

helped to capture the current state-of-the-science in the direction of
comparative research on stress among health workers, especially
among nurses from different types of hospitals and wards, and from
different countries across the world. It also reveals the beauty of
research where different investigators approach the same phenomenon

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with different approaches and different methods but arriving at similar

conclusions.

Research hypothesis
Based on the literature review, the following research hypotheses are
formulated to guide the conduct of the study:
There will likely be a significant difference in the level of
stress experienced between nurses in JUTH and nurses in
PSH.
There will likely be a significant difference in the sources
of stress between nurses in JUTH and nurses in PSH.
There will likely be a significant difference between the
dimensions of working environment at the various nursing
units in JUTH and PSH.

Method
Participants
Participants for this study consisted of a total of 192 nurses selected
from nurses in the various wards and units of JUTH and PSH in Jos.
Ninety-two participants were from JUTH while 100 were from PSH,
respectively. The general descriptive details of the participants is
shown in Figure 1 and Table 1 below where the Obstetrics and
Gynecology (O&G) and the Male/Female Surgical wards were most
represented in the study with 9.4% from each. The majority of
participants were between the age range of 40-49, with more females
than males (66.1% and 33.9%, respectively). Respondents with 1-10
years nursing experience were most represented (35.4%) and nurses
with a diploma qualification outnumbered other qualifications. There
were more registered nurses and midwives (RN/RM) than any other
group of participants (63.5%). Participants with 1-10 years length of
employment in were most represented than the rest (48.4%) while
those who have been employed in their present units for 1-10 years
formed the majority of respondents for the study (81.8%). Majority of
the participants (97.4%) were employed on full-time basis while
80.7% are married with a total of 81.8% of them having children, with
the majority of those with children being 19.8%.

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Figure 1: Demographics for Participants Units and Wards

UNIT
20
18
16
14
12
10
8
6 UNIT
4
2
0

Table 1: Participants Demographic Characteristics

Variables Frequency Percentage
Hospital
JUTH 92 47.9%
PSH 100 52.1%

Unit

ICU 13 6.8%
Theatre 5 2.6%
O&G 18 9.4%
M/F Medical 10 5.2%
M/F Surgical 18 9.4%
B/F Orthopedic 15 7.8%
Eye/ENT 13 6.8%
EPU 6 3.1%
SCBU 5 2.6%
Labour 4 2.1%
Maternity 7 3.6%
Emergency 2 1.0%
GOPD 16 8.3%
Pediatrics 11 5.7%
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ART 3 1.6%
Anesthesia 6 3.1%
Psychiatric 16 8.3%
Amenity 6 3.1%

Age

20-29 31 16.1%
30-39 47 24.5%
40-49 78 40.6%
50 & Above 22 11.5%
Gender
Male 65 33.9%
Female 127 66.1%
Years in Nursing

1-10 68 35.4%
11-20 53 27.6%
21-30 48 25.0%
31 & Above 11 5.7%
Education

Diploma 163 84.9%

Associates 1 0.5%
Bachelor 20 10.4%
Others 7 3.6%
Nursing Certificate

Registered Nurse (RN) 62 32.3%

Registered Midwife (RM) 4 2.1%
RN/RM 122 63.5%
Length of Employment in Hospital
1-10 93 48.4%
11-20 62 32.3%
21-30 26 13.5%
31 & Above 4 2.1%
Length of Employment to Unit
1-10 157 81.8%
11-20 14 7.3%
21-30 9 4.7%

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Work Status

Full-time 187 97.4%

Others 5 2.6%
Marital Status

Married 155 80.7%

Single 28 14.6%
Widowed 9 4.7%
Have Children

Yes 157 81.8%

No 34 17.7%
Number of Children
1 18 9.4%
2 32 16.7%
3 38 19.8%
4 33 17.2%
5 23 12.0%
6 10 5.2%
7 2 1.0%

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Dachalson E.M.M., Gyang E.D. & Azi P. S.: Stress among Nurses

Instruments
The Expanded Nursing Stress Scale (ENSS) was used to measure
sources and frequency of stress perceived by nurses. The ENSS is
made up of 57 items in 9 subscales death and dying, conflict with
physicians, inadequate preparation, problems with peers, problems
with supervisors, workload, uncertainty concerning treatment, patients
and their families, and discrimination and there is empirical evidence
to support its reliability and validity (see French, Lenton, Walters, &
Eyles (2000). The empirical evaluation of the 9-factor (57-item) ENSS
shows data that support the original subscales of the original Nurses
Stress Scale (NSS) with 7-subscales of 34 items formulated by Gray-
Toft and Anderson (1981). The psychometric assessment of the ENSS
factors reports Cronbachs alpha for Factor 1, death and dying (a=.84)
on 7 items; Factor 2, conflict with physicians (a=.78) on 5 items;
Factor 3, inadequate preparation (a=.74) on 3 items; Factor 4,
problems with peers (a=.70) on 6 items; Factor 5, problems with
supervisors (a=.88) on 7 items; Factor 6, workload (a=.86) on 9 items;
Factor 7, uncertainty concerning treatment (a=83) on 9 items; Factor 8,
patients and their families (a=.87) on 8 items; and Factor 9,
discrimination (a=.65) on 3 items. The ENSS is structured such that
Factors 1, 3, and 7 refer to psychological environment, Factor 6 refers
to the physical environment, and Factors 2, 4, 5, 8, and 9 refer to the
social environment. The factor correlations provided in the analysis
show moderate to moderate strong associations among the stress
subscales supporting the argument that the subscales are measuring
unique, but related, dimensions of stress. There is also considerable
support for the validity of the 57-item ENSS among nurses in different
specialties and work settings. While further work is needed to refine
the ENSS subscales, they are an important step toward providing a
more comprehensive range of stressors experienced by nurses in
different units and care settings.

Procedure
Permission to conduct the study was obtained from the relevant ethical
committees of the two sampled hospitals, even though as at the time of
the study ethical approval was not required because no patients or
clients were involved as participants. Participants were approached
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individually and briefed about the purpose and requirements of the

study as the questionnaires also including introductory letters.
Participants were also assured of confidentiality and anonymity as they
were informed that the results of the study would be expressed in
general terms only and used for research purposes only.

Results
Table 2: Participants Overall Mean Scores for all Stress
Situations
Scale N Mean SD
STRESS 191 139.21 29.52
Subscales & Number of Items N Mean SD
Death & dying (DD) 7 items 190 16.66 3.63
Conflict with Physicians (CP) 5 items 191 14.31 3.21
Inadequate preparation (IP) 4 items 191 7.08 2.58
Problems with peers (PP) 6 items 191 16.50 3.99
Problems with supervisors (PS) 7 items 191 9.59 2.81
Work load (WL) 9 items 191 16.77 4.72
Uncertainty about treatment (UT) 8 188 19.78 5.34
items
Patients and their families (PF) 8 items 190 18.27 4.86
Discrimination (D) 3 items 191 6.89 2.53
Dimensions of Work Environment & N Mean SD
Number of Subscales Contained

Physical Environment 1 subscale 191 16.77 4.72

Psychological Environment 3 subscales 187 43.49 9.92
Social Environment 5 subscales 190 65.54 14.09
*Physical (WL); Psychological (DD,IP, &
UT); Social (CP, PP, PS, PF, & D)

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Inferential statistics
Three hypotheses were tested in this study using One-Way Analysis of
Variance (ANOVA). The results for each hypothesis are presented
below.

Hypothesis One: There will likely be a significant difference

between the levels of stress experienced by
nurses in JUTH and nurses in PSH.
Table 3: Mean Difference in Stress Levels of Nurses from JUTH
and PSH
Stress N Mean SD df F Sig.
JUTH 92 140.74 30.76 1 .472 .493
PSH 99 137.80 28.40
Total 191 139.21 29.52
*a=.05
Table 3 shows that there was no significant difference in the levels of
stress experienced between nurses from JUTH (mean 140.74, SD =
30.76) and nurses from PSH (mean 137.80, SD = 28.40), where F(1,
191) = .472, p > .05.

Hypothesis two: There will likely be a significant difference in

the sources of stress between nurses in JUTH
and nurses in PSH.
Table 4: Mean Difference for Sources of Stress between Nurses in
JUTH and PSH.
Sources of Stress JUTH PSH df F Sig.
Death and Dying 16.89 16.45 1,188 .683 .410
Conflict with Physicians 14.41 14.21 1,189 .186 .667
Inadequate Preparation 7.13 7.03 1,189 .072 .789
Problems with Peers 17.05 15.98 1,189 3.505 .063
Problems with Supervisors 9.34 9.82 1,189 1.405 .237
Workload 17.03 16.54 1,189 .528 .468
Uncertainty concerning 19.83 19.73 1,186 .016 .900
Treatment
Patients & their Families 18.47 18.08 1,188 .298 .586
Discrimination 7.23 6.58 1,189 3.213 .075
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Table 4 shows the computed F ratios for the 9 stressors measured. The
results revealed that there were no significant difference in the sources
of stress measured in both hospitals, where F (1,190), p >.05.
Hypothesis three: There will likely be a significant difference in
the dimensions of work environment at the
various nursing units in JUTH and PSH.
The overall mean scores for participants were obtained to compute the
F ratios for the various nursing units across the three primary
dimensions of work environment in both hospitals and the table of
means and ANOVA results are shown in Table 5 below.

Table 5: Overall Means Scores and ANOVA Results for

Dimensions of Work.
Dimensions of Work Environment
Physical Psychological Social
Units Mean (SD) Mean (SD) Mean (SD)
ICU 16.54 (5.35) 41.92 (12.79) 63.30 (16.51)
Theatre 14.00 (5.79) 40.40 (13.69) 56.40 (20.49)
O&G 15.11 (3.64) 38.24 (6.90) 58.11 (10.74)
M/F Medical 17.80 (2.20) 43.70 (6.34) 68.10 (7.52)
M/F Surgical 19.22 (3.28) 45.59 (11.64) 69.33 (14.46)
M/F Orthopedic 17.93 (4.59) 49.29 (7.61) 73.40 (13.26)
ENT 15.92 (5.12) 39.61 (11.42) 56.30 (15.87)
EPU 11.83 (1.47) 31.17 (8.57) 55.50 (4.51)
SCBU 18.40 (5.13) 46.80 (5.54) 73.60 (9.29)
Labour 19.00 (2.16) 45.50 (1.73) 69.50 (9.15)
Maternity 15.14 (3.24) 44.43 (7.84) 67.57 (11.25)
Emergency 20.00 (8.49) 44.50 (3.53) 73.50 (6.36)
GOPD 19.94 (4.89) 51.69 (9.10) 72.56 (15.83)
Pediatrics 13.30 (4.59) 42.50 (8.30) 63.22 (14.39)
ART 19.67 (1.52) 45.33 (5.51) 63.33 (12.70)
Anesthetics 18.50 (2.81) 49.17 (8.18) 72.50 (10.61)
Psychiatric 17.06 (6.12) 42.69 (9.45) 67.06 (14.27)
Amenity 14.86 (4.85) 38.29 (8.44) 55.29 (13.09)

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Dachalson E.M.M., Gyang E.D. & Azi P. S.: Stress among Nurses

ANOVA
Work Environments Df F Sig.
PHYSICAL 17,156 2.344 .003
PSYCHOLOGICAL 17,153 2.565 .001
SOCIAL 17,155 2.236 .005

The overall findings indicates that participants from the emergency

units (Mean = 20.00, SD = 8.49) at both JUTH and PSH together have
a significantly higher mean on the dimension of physical work
environment, where F (1,156) = 2.344, p =.003. Participants from the
GOPD unit (Mean = 51.69, SD = 9.10) have significantly higher mean
on dimension of psychological work environment, where F (1,153) =
2.565, p =.001. Finally, participants from the SCBU units (Mean =
73.60, SD = 9.29) have significantly higher mean on dimensions of
social work environment, where F (1,155) = 2.236, p = .005.

Discussion
The primary aim of this study was to compare levels of stress between
nurses in JUTH and PSH in Jos, Nigeria and three hypotheses were
tested for differences among the participants based on levels of stress,
sources of stress, and their differences based on working units of the
hospitals. The first hypothesis (which compared levels of stress
between the two groups) yielded a significance of no difference
between the two groups which implies that both groups experienced
significantly similar levels of stress. This finding generally tangles
with earlier evidence such as the evidence found by The Health
Education Authority (1988) suggesting that nursing is a potentially
stressful occupation, and recent reports like Okwaraji and Aguwa
(2014) who reported high levels of burnout and psychological distress
among nurses, especially in the areas of emotional exhaustion,
depersonalization, and reduced personal accomplishment when people
give too much of their time, energy, and effort on their job over a long
period of time without having much chance to recover physically or
emotionally.

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Particularly, this finding also tallies with similar comparative analysis

conducted by Eleni et al, (2010) which showed that there was no
significant difference in workplace stress between nurses in state and
regional hospitals, though increased workload and conflict between
professional and family roles contribute to the development of stress.

The second hypothesis was designed to compare sources of stress

between the two samples and the results were not significantly
different, which also implies that nurses from both hospitals have
similar working experiences that generate similar levels of stress. This
result agrees with Mojoyinola, (2008) whose study in comparing
nurses from two tertiary health care institutions in Ibadan helped to
establish that nurses in public health care settings generally experience
similar stressors, irrespective of their wards or units where they work.
The result also tallies with Rita et al, (2013) in Ghana which did not
show any significant difference in the sources of stress between nurses
in two different tertiary health care institutions, except in workload
where one hospital had higher workload than the other.

However, there is a slight discrepancy between the result of this study

and that of Cocco et al, (2003) which reported significant difference in
sources of stress between nurses of a general hospital (like the case of
JUTH) and a specialist hospital (like PSH is expected to be though, in
the real sense, PSH also offers general services to some reasonable
extent) whereby nurses from general hospital wards report more
stressful events than nurses from specialist hospitals, particularly from
events related to patients behavioural problems. One possible
explanation for this discrepancy may be attributed to cultural factors
where Cocco and associates study was conducted in a different land
and time (Northern Italy, a first world country) while this present study
was conducted in North-Central Nigeria (a third world country).
Again, one reason for the discrepancy observed may be that specialist
hospitals in Italy may only offer specialist services while specialist
hospitals in Nigeria (as the PSH is expected to be) may go beyond
specialist services and also offer general services, as the case actually
is in the PSH.

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The third hypotheses, however, did not exclusively compare between

nurses in the two samples of this study but went ahead to do general
comparison to test for significant differences based on dimensions of
work according to the various units and wards of the two hospitals put
together and the results showed that the emergency units report a
significantly higher level of stress based on the physical dimensions of
the working environment while the GOPD reported significantly
higher levels of stress based on the psychological dimension. The
SCBU reported higher levels of stress based on the social dimensions
of the working environment. This, however, does not compare the
units in one hospital versus the other.

Conclusion
The results of this study help us to generalize that there are significant
levels and sources of stress that nurses from both JUTH and PSH
experience, though there may be slight differences where the workload
is higher. While some stressors were common to nurses in all the units
and wards explored, there variability based on the dimensions of
working environment which presents some peculiarities for different
units: The emergency units experience more stressors based on the
physical working environment; the GOPD experiences higher degree
of stress based on the psychological environment; while the SCBU
experiences higher degree of stress based on the social environment,
due to the impact that the stressors have on these three different
dimensions. The results, however, cautions further research to avoid
the temptation to treat stress among nurses as being different in one
hospital than the other because there were no significant differences
observed between nurses from the two different hospitals, except for
where there is significant difference in the working environments and
higher workloads.

In the analysis of this study, there were no attempts to compare levels

and sources of stress between males and females and this call for
gender considerations in future studies that seek to understand more
about stress between two different health care institutions. Similarly,
the analysis of this study on the dimensions of work environment did
not exclusively compare between the sources of stress in the various
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units of the two samples, only an overall comparison was made.

Therefore, future comparative studies may explore further potential
differences when the units of the samples are compared against each
other.

As the results of this study proves that there is significantly high levels
of stress and similar sources of stress among nurses in the two samples
studied, it is recommended that authorities of the hospitals, especially
Plateau State Government and the Federal Government who control
the administrations of both hospitals, to collaborate with relevant
professionals (clinical and occupational psychologists, psychiatric
doctors and nurses, etc.) to implement stress management and stress
inoculation programs for nurses in these hospitals. Particular attention
should also be paid to nurses based on gender grounds or newly
employed nurses who face challenges of multiple stressors even
though the investigations of this study were limited to comparisons
between the various units of the two hospitals.

There is need for continuous research into factors that have potential to
harm employees health for the purpose of prevention, first, before
treatment when the need arises. Prevention programs and strategies
should be incorporated or integrated into the welfare package of
nurses. We recommend also that there is need for increased training
and re-training of nurses with improved staff support and consultation
with relevant mental health professionals for continuous stress
education and management programs. Regular (and, if possible,
compulsory) psychological or stress assessment of all nursing staff
should be carried out in order to identify and manage the impact that
stress may have or costs it may incur on the general health care
delivery system.
Finally, the welfare of nurses must be emphasized as part of the
general strategies adopted by the authorities. For example, there
should be the inclusion and involvement of nurses using total quality
management approaches that will involve nurses in policy-making and
decision-taking concerning their welfare and working conditions.
Similarly, recruitment of more nurses would be necessary to help
cushion and reduce the effects of heavy workload which will in turn
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help provide more employment for qualified nurses who are

unemployed in the state and nation at large, thereby improving general
health care delivery.

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