CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Occupational stress has been a long-standing concern of the health care system.

Studies indicate that health care workers have high rates of depression and anxiety linked

to job stress. Stress is an important psychological concept that can affect health,

wellbeing and job performance in negative dimensions (Mojoyinola, and Olaleye, 2002).

Work itself can have a positive effect on human mental and physical health. However,

occupational-related stress generated through certain adverse working conditions can

have negative effects on individual’s health.

Stress-related disorders involve enormous human suffering and huge cost to

society in terms of mental strain, stress related diseases, such as depression and heart

disease, and absenteeism. Long term exposure of health workers to occupational stress

has been linked to an increased risk of musculoskeletal disorders and depression as well

as syndromes such as burnout, and may contribute to a range of other debilitating

diseases (Park, 2005). Recent research data from the World Health Organization (WHO)

global burden of disease studies shows that 8% of depression can be attributed globally to

environmental factors in occupational stress (WHO, 2006).

Stressful working conditions may also interfere with an employee’s ability to

work safety, contributing to work injuries and illnesses. The International Labour

Organization (ILO) reports that in the work place of the 1990s, the most highly ranked

and frequently reported organizational stressors were potential job loss, technological

innovation, change and ineffective top management. At the work unit level, work

overload, poor supervision and inadequate training were the top ranking stressors.

1
 Hospital work often requires coping with some of the most stressful situations

found in any workplace. Health workers have to deal with patients with life threatening

injuries and illness which could be further complicated by their tight work schedules and

disproportionate staff/patient ratios. Emergencies further complicate an already stressful

work situation. Additionally, health workers have to accommodate demanding patients,

especially those suffering from chronic debilitating diseases as well as those experiencing

acute or severe pains (Bruno, Cowan, Grochulski & Garvey, 2006).

According to the Health Advocates (2013), occupational stress-related distraction

or sleepiness account for estimated 60% to 80% of accidents on the job and near misses.

According to the National Institution for Occupational Safety and Health (NIOSH) in

2008, 60% to 90% of health care provider’s poor attitude to clients is attributed to stress

response. The Nigeria health system is bedeviled with chronic underfunding, dilapidated

health facilities, poor staffing and inadequate working tools which has been sources of

stress on health workers. Most health care provided especially at the secondary and

primary levels of care in Nigeria have to work under harsh and unconducive conditions.

Stress is a worldwide phenomenon and unfortunately, well-known to health workers in

different parts of the world. Occupational stress as the harmful physical and emotional

occurs when the requirements of the job do not match the resources, capabilities and

needs of the worker. It is a condition arising from the interaction of people and their job

and is characterized by changes within the people that force them to deviate from normal

functioning (Nakasis and Ouzoni, 2008).

Over the past two decades, there has been a growing belief that the experience of

stress among health workers and other organizations at work has undesirable effects, both

on the health of the employee and the effectiveness of the organization. Stress is second

2
in frequency health problems with regards to occupational environment (Moustaka,

2010). In the United Kingdom, occupational stress is estimated to be the largest

occupational health problem (Edward & Barnard, 2008). World Health Organization

(WHO) has viewed it is a worldwide epidemic as it has recently been observed to be

associated with 90% of visits to physicians.

Significantly, it reduced brain functions such as memory, concentration and

learning and also impairs the immune system, all of which are central to effective

performance at work. Work is an essential need for everyone. It is estimated that over

75% of adult’s non-sleeping time is devoted to job activities and people find satisfaction

and personal identity by means of their employment. Among life events the workplace

stands out as a potentially important source of stress purely because of the amount of

time spent in this setting (Scott, 2012). Health workers are exposed to tension, frustration

and anxiety as they go about their assigned duties. The negative effect of their work is

what is referred to as occupational stress.

However, it is possible to take this situation under control. Many researchers

every year try to learn more about stress and burnout and ways of helping and preventing.

The American Psychological Association suggests a range of ways that a working

environment can be changed to help reduce stress: workloads in a same line as a worker’s

capabilities and resources, clearly defined worker’s role and responsibilities,

communication and opportunities for social interaction among workers. Each

organization could have own stress reducing programme, according to the policy of

resources (APA, 2012). Moreover, healthcare professionals, who experience stress or

have symptoms of burnout, have possibility to help themselves by using psychological

methods and coping techniques, such as mediation, relaxation and art-therapy.

3
 Occupations in the field of human services are considered to be high stress

occupations dealing with diverse social as well as individual problems. Occupational

stress is a major occupational health problem for health care professionals especially

nurses. Nurses provide care for three (3) types of clients: individuals, families and

communities. This involves, promoting health and wellness, preventing illness, restoring

health and caring for the dying. Nizamd et al. (2006) stated that caring for individuals,

families, groups, population or entire communities with multiple complex and distressing

problems can be overwhelming for even the most experienced practitioner. Nurses

encounter complex and stressful conditions due to special demands of their profession

which enhances their vulnerability to occupational stress. Stress among nurses is an

endemic problem and nursing is known to be stressful throughout the world (Onasoga,

Ogbebor and Ojo, 2013).

Stress among health workers is an endemic problem. This is because health sector

is emotionally, physically and psychologically demanding. In order to fill this gap in

knowledge, the study therefore intends to provide useful measures towards the prevention

of stress and provide convivial working environments for health workers, thereby

alleviating the stress on them and by extension improve or consolidate service delivery.

1.2 Statement of the Problem

The Nigerian health system is bedeviled with chronic underfunding, dilapidated

health facilities, poor staffing and inadequate working tools which has been sources of

stress to healthcare providers. Most healthcares provided especially at the secondary and

primary levels of care in Nigeria have to work under very harsh and unconducive

4
 atmosphere which contribute to the increase of work-related stress of hospital staff

(Onasogba, Ogbebor and Ojo, 2013). Stress in the workplace impairs both quality and

quantity of work and has been a strong contributing factor to accident or near misses in

the health care settings (i.e. Affecting service delivery) (Cotton & Hart, 2003).

Occupational stress among health workers is associated with a number of health problems

in employees. It has been linked to low job satisfaction, reduced productivity and an

increase in occupational accidents.

Health occupation is a job that requires expenditure of energy on many levels.

Physical demands of the job could result in many aches, strains and pains. Mentally,

health practitioners are required to make calculations for medications and to respond

professionally to questions of patients and relatives. Emotionally, they are expected to be

clothed with empathy to provide the needed care of their clients. The physiological,

mental and emotional harm caused by stress can adversely affect their performance

(example in medication errors). A health worker under stress will be indifferent to

patient’s demand. What are the causes of occupational stress among health workers and

how can such stress be controlled in the Nigeria’s health system? How do health workers

cope or handle stress at the work place? This study seeks to find answers to the above

questions.

1.3 Objectives of the Study

The study is anchored on the following objectives:

i. To examine the causes of occupation stress among health workers in

general Hospital Wannune, Tarka Local Government Area of Benue State.

ii. To examine the adverse health effects of occupational stress on health

workers.

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 iii. To determine the level of stress experienced by health workers in carrying

out their jobs satisfactorily.

iv. To suggest possible ways by which stress can be managed among health

workers.

1.4 Research Questions

The study is devoted to answer the following research questions:

1. What are the causes of occupation stress among health workers in general

Hospital Wannune, Tarka Local Government Area of Benue State?

2. What are the adverse health effects of occupational stress on health workers?
3. What is the level of stress experience by health workers in carrying out their jobs

satisfactorily?
4. What are the possible ways to manage stress among health workers in General

Hospital Wannune?

1.5 Significance of the Study

Research is the best way to find solutions to problematic issues. This study is of

utmost importance because it will provide valid information on how stress can be

managed among health workers. The study will also equip the health institutions,

government, non-governmental organizations and other relevant stakeholders in the

health sectors with the right information to enable them organize training, seminars,

workshops on interventions to handle stress at work both at the organizational and

individual level.
These interventions will assist health workers to be more effective in managing

stress at work, improving and promoting their health job satisfaction while reducing the

physiological, psychological and behavioral consequences of occupational stress, thereby

ensuring the delivery of quality care with an enhanced patient outcome.

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 Finally, the findings from this study will serve as a guide to scientists, researchers

and students who would like to carry out further research in the same area.

1.6 Scope of the Study

The study was delimitated to occupational stress among health workers in General

Hospital Wannune of Tarka Local Government Area of Benue State. The study was

focused on the causes of occupational stress among health workers in the General

Hospital, the adverse effects of such stress on its health workers, the level of stress

experienced by health workers in carrying their jobs and the possible ways of controlling

such stress among its workers. The study covers the entire health workers of General

Hospital Wannune of Tarka Local Government Area of Benue State.

1.7 Definition of Concepts

i. Stress: Stress can be defined as a great worry caused by difficult situation of something

that causes the situation. It is a non-specific response of the body to any demand

made upon it, which results in symptoms such as rise in the blood pressure,

release of hormones, and quickness of breath, tightening of muscles, perspiration

and increased cardiac activity.

ii. Occupational Stress: Occupational stress can be defined as the harmful and emotional

response that occurs when the requirements of the job do not match the

capabilities, resources, or needs of the worker.

iii. Health Workers: Health workers are the employees to both public and private

hospitals whose primary aim is to carter for patients (the sick) in such hospitals in

order to strengthen the health system. They include doctors, nurses, pharmacists,

psychologists etc.

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 CHAPTER TWO

LITERATURE REVIEW AND THEORETICAL FRAMEWORK

2.1 Introduction

This chapter explores the various views of scholars concerning occupational stress

among health workers in Nigeria with particular reference to Tarkaa Local Government

Area of Benue State and further adopts the theoretical framework that best capture this

reality.

2.2 Concept of Stress

The term stress is enshrouded by a thick veil of conceptual confusion and

divergence of opinion (Anbazhagan & Soundarrajan, 2013). It is derived from the Latin

word “Stringere” which means to be drawn tight (Mojoyinola, 2013). Krohea (2002),

showed that the term stress was first used in physics in order to analyze the problem of

how man-made structures must be designed to carry heavy loads and resist deformation

by external force. This implies that stress refers to external pressure or force applied to a

structure while strain denotes the resulting internal distortion of the object.

The term stress has come into wide usage in the behavioral study only within the

past two decades. In the biological sciences, the term was first employed by Hans Selye

in the 1936 (Anbazhagan & Soundarrajan, 2013). In the behavioral and biological

sciences, it designates body processes created by circumstances that place physical or

psychological demands on an individual. Stressors are used to describe the external

forces that impinge on the body. Hans Selye described it as an inappropriate

physiological response to any demand (Anbazhagan & Soundarrajan, 2013). This implies

8
that stress is a condition and the stimulus causing it is called stressor. Stress could be

viewed as an internal state which can be caused by physical demands, for example

disease condition, exercise and the likes or by the environment and social situation which

are evaluated as potentially harmful, uncontrollable or exceeding ones resources of

coping. These physical, environmental and social causes of stress are called stressors.

Stress could be defined as a stimulus, a response or as a transaction (Anbazhagan

& Soundarragan, 2013). A stimulus definition treats stress as some characteristic or event

that may result in a disruptive consequence. As a response, it is a nonspecific response of

the body to any demand made upon it. As a transaction, stressful experiences are

construed as person – environment transaction. The consequence of the interaction

between an environmental stimulus (a stressor) and the individual’s response. This

implies that stress is the result or outcome of the unique interaction between stimulus

conditions in the environment and the individual’s predisposition to respond in a

particular way. This is the opinion of this work.

Stress can be negative or positive. This depends on the level of one’s response to

the stressor encountered. Negative stress refers to stress that is beyond the individual’s

control. The negative impact of stress, most times manifest in physical or physiological

signs and symptoms. On the other hand, positive stress is what people refer to when they

say “a little bit of stress is good for you”. Positive stress makes for improved creativity,

learning, efficiency at work, a higher level of self-esteem that could help one to be able to

withstand a higher level of stress in future (Sincero, 2012).

The term stress according to (Hans Selye 2009) defined stress as “a non-specific

re-sponse of the body to any demand for change” different authors have defined the term

9
 stress in several ways as an automatic physical response to any Stimuli that require you to

adjust to change” (Benson and Casey 2006); as a state of mental or emotional strain or

tension resulting from adverse or demanding circumstances; as a state of tension one

experiences when one’s side of coping are insufficient as a dynamic condition in which

an individual is confronted with opportunity, constraint or demand related to which he or

she desired and for which outcome is perceived to be both uncertain and important

(Robbins and De Cenzo 2008).

Stress most thus results from an imbalance between demands being made upon an

individual and the resources available to help that individual cope with the demands, this

luring us to the definition of stress as “ any condition in which there is a marked

discrepancy between demands placed on worker’s capacity or perceived capacity to

respond” (Howard .F. 2008, p.105).

Since healthcare environment requires changing continuously, stress is common

in the life of the healthcare professionals work, environment is not derived of this

imbalance between demands being made upon an individual and the resources available

to help them cope with the demands. But if the demand is seen as overwhelming and

exceeds the individual’s capacities or resources they become stressors and this will

trigger mental and physical stress (Howard. F.2008, p 106) the emotional and physical

demand involved within the healthcare environment can strain even the resilient

healthcare professional.

2.3 Concept of Occupational Stress

Occupational Stress is a major health issue in many organizations today. It has

become the buzz word of the 1990’s for Human Resource Department and in particular is

10
the human service industry. Anbazhagan and Soundarrajan (2013) showed that National

Institute for Occupational Safety and Health reported that one quarter of the employee

view their job as the number one stressor in their lives while three quarter of the

employees believe the worker has more on the job stress than a generation ago. In a study

of American workers by the American Psychological Association (2012), two in five

(41%) reported feeling stress on the job, nearly half said they needed help in managing

stress. Any factor in the occupational environment that an individual finds threatening

which also exceeds the individual’s ability to address it result to stress.

Occupational Stress could be referred to as a condition arising from the

interaction of people and their jobs and characterized by change within people that force

them to deviate from the normal functioning (Anbazhagan & Soundarragan, 2013). It

could also be defined as the interaction of the work conditions with the characteristics of

the worker such that the demands of the work exceed the ability of the worker to cope

with them.

Occupational stress could be seen as a process in which a professional’s attitude

and behavior change in negative ways in response to job stressors. When conditions at

work interact with the employee’s characteristics to disrupt psychological or

physiological homeostasis, this is referred to as occupational stress. The implication of

the above definitions is that Occupational stress involves a relationship in which there is a

deficit of resources available to meet the demand posed by the relationship. Common

constituent of the above definition of Occupational stress include, a domain of the

environment and its constituent, a domain of the individual employee, an interaction

between the two (2) domains, an appraisal of the demand of the interaction exceeding the

11
resources within domain of the individual resulting in a disruption of psychological and

physiological homeostasis.

Within the occupational environment, stress arises because a threat is present and

is perceived by the individual; the homeostasis of the individual is involved. The

individual is affected psychologically (anxiety, depression, frustration, disorganized

thought etc) and physiologically (muscle and joint aches, heart disease, migraines etc).

His personal needs are shattered, the normal coping response cannot be found (ie), the

individual is unable to cope anymore and as such not able to get along with his job. This

results in ineffective performance, propensity to leave the organization, absenteeism to

mention a few.

Occupational stress is strongly associated with low productivity, high absenteeism

and poor job performance, (Mcshane & VonGlinow, 2005). Employees with high levels

of stress have significantly higher rates of productivity loss than their counterparts.

Likewise medical cost to the organization and the individual attributed to stress are higher

in this population. Employee’s exp-Occupational Stressed to prolonged stress typically

suffer from psychological and physiological symptoms.

Occupational stressors are those factors or stimuli that generate stress response in

the occupational environment. These factors could also be referred to as causes of stress

or threats. Several classifications of occupational stress exist in literature. The

classification used in this study is an adaptation from several papers (Wong, 2001;

Moustaka & Constantinidis 2010; Thomson, 2006).

Task Related Stressor: At the workplace, elements of the tasks that are carried out could

be initiators of the stress process as interaction takes place with the individual. This

12
involves issues like task completion pace, time pressure, task ambiguity and task

complexity (Wong, 2001).

Physical/Environmental Stressors: These are elements of the workplace environment

that are inherent to the nature of work like excessive vibration from equipment, excessive

noise and heat, inadequate lighting and temperature, unavoidable exposure to weather

elements, wrong ventilation to mention a few (Wong,2001; Moustaka & Constantinidis,

2010).

Individual/Social Stressors: These type of stressors originate from the domain of the

individual and or interactions with other individuals. It could be objective stressors as

well as perceived stressors in the workplace. It involves issues like lack of co – worker

support, discrimination and sexual harassment (Thomson, 2006).

Organizational Stressors: They can also be called management stress. They include

issues like low level of decision latitude, lack of adequate remuneration or compensation,

poor communication networks in the organization to mention a few (Moustaka &

Constantinidis, 2010).

Occupation-Specific–Stressors: These are stressors characteristic of a particular

profession that generate the stress response. They are usually unique to that particular

profession. For example, a professor - an academic teaching staff may not experience

trauma with the same frequency and duration as that of nurses or police officers.

(Thomson, 2006).

Safety Stressors: Stressors dealing with safety sometimes overlap with task –related

stressor and organizational stressors. They include emergency response tasks, medical

13
 emergencies, inadequate emergency training response, poor provision of safety gadgets

etc (Moustaka & Constantinidis, 2010).

Career and Achievement Stressors: These could be grouped as individual and

organizational stressors (Wong, 2001). They include issues like perceived limited

promotion opportunities, under utilization of skills to mention a few.

2.4 Types of Stress

According to Australian Psychological Society and American Psychological

Association (2015), there are three types of stress: acute, episodic and chronic stress.

2.4.1 Acute Stress

The most common type of stress that may come from demands and pressures of

the recent past and the nearest future. Because of the short-term, acute stress does not do

the extensive damage.

2.4.2 Episodic Stress

Acute stress that comes frequently and often observed in people with “Type A”

personality – too competitive, aggressive and demanding.

2.4.3 Chronic Stress

Chronic stress destroys bodies, minds and lives. It is the stress of poverty, of

dysfunctional families, of being trapped in an unhappy marriage or in a despised job or

career, of the never-ending "troubles"”.

One more type of stress is Post-traumatic Stress (PTSD) – it can occur in people

“who have experienced or witnessed a life-threatening event, such as a natural disaster,

serious accident, terrorist incident, sudden death of a loved one; war; or rape or other

violent personal assault”. These people can relive traumatic events through nightmares

and flashbacks. (ADAA).

14
 Thomas W. Colligan and Eileen M. Higgins (2005) state that stress is divided into

two categories: Eustress and Distress. Eustress is also known as positive or good stress

and distress – negative or bad stress. The main idea of discussing these two types of stress

is to show that stress can help people to reach their objectives and increases the

productivity; however, stress also can lead to emotional confusion, burnout and illness.

(Calligan & Higgins, 2005).

2.5 Causes and Consequences of Occupational Stress

The reasons why healthcare professionals are faced with stress daily is due to

their work environment, this stresses are also known as work related (occupation) stress,

the work related stress is caused by a number of inherent factor called stressors. Work

related stressors have been defined as “any work situation perceived by the participants

as threatening the situation and individuals coping abilities (Abu Alrub and Al-zaru

2008).

The inherent factors include long working hours, excessive work load, dealing

with death and dying, inter personal conflict with other staff, patient’s expectation, and

threat of malpractice litigation this factors lead to the classification of work place

stressors of-ten faced by healthcare professionals in the healthcare environment into three

classes or categories namely organization stressor, task characteristics, and social factors,

the above classification were made by (Sardiwalla., et al 2007).

Organization stressors as noted by (Sardiwalla 2007) include communication

problems between workers and higher authorities, problems with team worker, role

antiquity and administrative factor. Interpersonal conflict with other staff in the

healthcare environment, roles of professionals may not be properly spelled out especially

where hierarchy is observed. If orders are not properly is observed there may be
15
communication problems and thus stress situations may arise (Sardiwalla et al., 2007).

Since healthcare professionals deal with death and dying, thus has become a

characteristic of their occupation, this gives rise to task characteristics. Healthcare

professionals usually develop an anxiety that could affect their positive attitudes towards

their patients, resulting in poor care and socials factors usually arise from environment of

multidisciplinary teams, where one part of the team feels superior to the other or

differences arising from one healthcare professional feeling that his or her role is more

important than the other in the survival of their organization, such differences may

contribute to stress (Sardiwalla et al 2007).

Exposures to the above classes of stressors by healthcare professionals usually

results in burnout if they are not adequately dealt with. Burnout has been defined as a

work related syndrome caused by a long –term exposure to high levels of stress. Burnout

is a role Stress reaction and behavioral rejection of the jobs (Howard 2008, P.105).

American Psychological Association (David Ballard 2009) describes job burnout

as” an extended period of time where someone experiences exhaustation and a lack of

interests in things, resulting in a decline in their Job performance”. A lot of burnout really

has to do with experiencing chronic stress. In those situations, the demands being placed

on you exceed the resources you have available to deal with stressors. Left unchecked

burnout can wreck havoc in your health happiness, relationships and job performance.

According to (David Ballard 2009) says 10 signs are experienced during burnout,

these are: Exhaustation – A clear sign of burnout is when you feel tired, exhaustation can

be emotional, mental or physical, lack of motivation – when you don’t feel enthusiastic

about anything anymore or you no longer have that normal motivation for your work,

16
 frustration, cynicism – you may fell like what you are doing does not matter that much

any-more, or you may be disillusion with everything, cognitive problems – burnout and

chronic stress may interfere with your ability to pay attention or concentrate when you

are stressed up, our attention narrows to focus on the negative element that will percent as

a threat. Slipping job performance – there is decrease in job performance in people

experiencing burnout. This tends to play out in one of two ways, you are having more

conflicts with other people, such as getting into arguments or you withdraw (David

Ballard 2009).

Not taking care of yourself – when suffering from burnout, some people engage in

un-healthy coping strategies like drinking too much, smoking, being too sedentary, eating

too much, not eating enough or not getting enough sleep. Being preoccupied with work

when you are not at work – even though you might not be working at a given moment, if

you’re expending mental energy mulling over your Job, then your work is interfering

with your ability to recover from the stresses of your day. Generally decreased

satisfaction; this is the tendency to feel less happy and satisfied with your career and your

home like health problems over long period of time, serious chronic stress can create real

health problems like digestive issues, heart diseases, depression and obesity (David

Ballard 2009).

2.6 Occupational Stress Management among Health Workers

To be able to cope with stress and manage it, it is important to know how stress

influences ones performance, having self-awareness and recognition of the symptoms of

stress it helps us to use it constructively and avoid its destructive aspect. It is also good to

17
know when people might be getting into the unproductive and destructive end of the

stress curve (Afsaneh Nahavandi et al., 2015).

Although, it is not possible to eliminate stress entirely, people can learn to manage

it. Stress could be managed at the individual or organizational levels. The present study

looked at the individual management of stress which is synonymous to coping. Coping

has been considered as a very crucial element in stress literature as individual under stress

can use various coping strategies to buffer, minimize or tolerate the effects of the

stressors. Bhagat (2001) stated that the level of stress experienced and the extent to which

adverse psychological and physiological effects of stress occur depend on how well the

individual utilizes coping strategies in the work setting. Lazarus (1991) in Scott (2012)

defined coping as a cognitive and behavioral efforts that individuals make to manage

situations appraised as potentially harmful or stressful. It involves efforts to change

circumstances or our interpretations of them to make them more favorable and less

threatening. Coping could be seen as a strategy or a result. As a result, it refers to the

eventual outcome of the chosen strategy for the individual. As a strategy, it refers to

different methods that individuals employ to manage their specific circumstances.

Individuals engage in coping when they are under stress or want to manage a

taxing situation. This could be approach oriented or avoidance oriented coping strategies.

Consequently, coping could be viewed as either active or passive. Movement or actions

geared towards the stressor is regarded as active coping while actions away from the

stressor is seen as passive coping. Lazarus and Folkman (1984) in Mcleod (2009)

suggested that there are two (2) types of coping responses; emotion focused and problem

focused.

18
Emotion Focused: This involves trying to reduce the negative emotional response

associated with stress such as embarrassment, fear, anxiety, depression, excitement and

frustration. It aims at reducing and managing intensity of the negative and distressing

emotions that a stressful situation has caused rather than solving the problematic

situation. The strategies help individuals to feel better but do not solve the source of the

distress or stressor. It is often utilized when the problem is out of the individual’s control,

or is perceived to be too great for solving or the individual is not up to using problem

solving strategies. It increases the sense of pleasure, positivity and contentment in a

person’s life and thus enables the individual to increase the ability to focus on things that

can be changed. It is a common reaction to initially react in an emotionally focused

manner especially to trauma events. When used in a short term, it is an adaptive coping.

However, after a while, problems become complicated and less controllable. Emotionally

focused coping strategy is useful if it creates a pause or a break which the individual

takes for himself or herself, which enables him/her to have the time to gather strength and

to look at the problem from different perspectives (Mcleod, 2008). This strategy should

be a short term solution because it does not fix the core of the problem. It is most useful

when circumstance will not change and the individual needs to learn to accept the

situation as it is and to learn to live with its after math. Women tend to use more emotion

focused coping than men.

The strategies include: keeping yourself busy to take your mind off the stressor,

ignoring the problem in the hope that it will go away, distracting yourself (Watching TV,

eating), praying for guidance and strength, letting off steam to other people, building

yourself up to expect the worse, drug therapy (Mcleod, 2009). Scott (2012), stated that

19
emotional focused coping involves strategies for regulating emotional distress;

Avoidance, distancing oneself from the emotion, acceptance, seeking social support,

selective attention, venting anger demands, and alcohol emotional state or appraisal.

Galor (2012) identified some emotional focused coping strategies as listening to music,

massage, meditation, getting physical exercise, going out with a friend, writing a journal

or diary, taking a hot bath, expressing emotions creatively,(e.g painting) use of humour,

positive self-thoughts, seeking social support to provide understanding and support, use

of religion and spirituality, denial, day dreaming, self-blame (Shifting blame to self or

others), substance abuse (drugs, alcohol, over eating) and just giving up on the situation.

Wong (2008) identified the following emotion focused coping strategies; Escape –

avoidance: trying to escape from the stressor, Distancing: minimize the impact of the

stressor, Denial: refusing to acknowledge problem exists, Wishful thinking: Imagining

stressor is magically gone, Seeking social support: turning to friends or support people,

Positive reappraisal: minimize negative while emphasizing positive side of the situation,

and then Downward comparison: comparing oneself to those seen as less fortunate.

Problem Focused Coping Strategy (PFC): This is highly action focused as it involves

altering or managing the problem that is causing the stress. Scott (2012), asserts that PFC

is used while the individual feels he has control of the situation and thus can manage

source of the problem. It involves strategies like defining the problems, generating and

evaluating alternative solutions, learning new skills to manage stressor and lastly

reappraisal (involves attempts to change or reduce ego involvement in the circumstance).

PFC refers to strategies that target modification of the individual’s behavior (Sincero,

2012). Mcleod (2009) said that PFC targets the causes of stress in practical ways which

20
tackles the problem or stressful situation that is causing stress, consequently directly

reducing the stress. The strategies include; taking control (changing the relationship

between oneself and the stressor), seeking information (a cognitive response to the stress,

the individual tries to understand the situation by reading books or using the internet and

putting into place cognitive strategies to avoid it in future ) and evaluating the pro and

cons of different options for dealing with the stressor. Lazarus (1984) in Harley (2009)

stated that individuals who utilize PFC focus their attention on gathering the required

resources (skills, tools and knowledge) necessary to deal with the stressor, utilizing

strategies like gathering information, resolving conflict, planning and making decision.

Problem focused coping involves strategies that attempt to change the person-

environment realities behind negative emotion or stress (Krohnea, 2002).

There are different strategies identified by (Afsaneh Nahavandi et al 2015) that

might be useful in managing and controlling stress and they are as follows:

Personal strategies lifestyle Adjustment: The personal decision of our lifestyle, go a

long way to determine our physical health and well-being as well as our ability to cope

with the demand, challenges and stress of work, therefore to handle stress very well, we

need to be healthy to be able to cope with the demand and challenges we face and to deal

with the physical manifestation of stress when we experience them. (Nahavandi, 2015) In

other to have good health it is important to eat balanced diet, get enough sleep, and

exercise regularly, these help to prevent some of the negative manifestations of stress and

to cope with stress related symptoms (Afsaneh Nahavandi et al., 2015).

Attitude Adjustment, Positivity and Resilience: Healthy attitude help people to

increase their tolerance for stress, this result were got from the survey organized of

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human resources managers. This might seem ironic given that stress is a bodily response

and not all in your head, our thinking and attitudes can make difference in how we

respond to potentially to stressful situation as well as our subjective experience of stress

when it happened. (Afsaneh Nahavandi et al., 2015).

Furthermore, stress can be good for you and better able to handle future

challenges, depending on how you handle it. The only way to psychological recovery is

that individuals do not survive or recover, but that they can adapt, learn and change, and

as a result become more recover over time. People can recover more by facing the

realities of a particular situation or problem by thinking positively, and also having a

strong value system that helps us set priorities, and make sense of the challenges we face,

enhance resilience. (Afsaneh Nahavandi et al., 2015).

However (Coutu 2015) suggested that ingenuity foresters resiliencies by

improvising and being creative with the resources that are available to us. Core resilient

people ‘turn challenges into opportunities, how can we think about problems as

challenges or about demand as opportunities, we can consciously ask ourselves how we

might see a potentially stressful situation in a more positive light, most people conclude

that they could indeed survive it, ironically, doing so might even take away some of the

fear and lead them to take constructive action to avoid the worst outcome. (Afsaneh

Nahavandi et al., 2015).

Social support: Social isolation is a major risk factor in human morbidity and mortality.

Our personal relationships are linked to our immune function and our ability to fight

disease. How well people cope with stress is the amount and quality of social support that

they receive. Positive relationships with and support from the people we work with can

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act as a mediator to job – related stress. Structural social support comes from being

embedded in and connected to a network of people whom we know can potentially

provide support. (Rollinson, 2008).

More so, laughter and positive humor is an effective tool that help people handle

stress, laughter in the work place can result in a significant and long – lasting increase in

several different aspect of self – efficacy, including self-regulation , optimism, positive ,

emotion and social identification. Conclusively, making social connections with others at

work can help us to do a better job and cope with stress as they arise. At the same time, it

is import to understand how our support, be it emotional, tangible functional can strongly

influence other people’s capacity to cope with the stresses and strains of organizational

life. We all need a little of help from friends (Nahavandi et al., 2015).

Time management: The major source of stress in time management, coupled with too

much to do. Effective time management involves establishing and reconfirming priori-

ties, taking note of how you spend time, and organizing time to better reflect your goals,

plans and commitments. It is not just a matter of completing all of the tasks presented to

us, but at the end of the day, after we have done everything expected of us to do; we still

experience stress, if we have not made time to do things that we think to be more

important. (Rollinson, 2008).

The step is to determine what your priorities are, people can list all your tasks and

responsibilities, and use an “A B C” system in which high priority items are assigned an

A and moderate or low priority item are assigned B or C. Either way of making your

priorities known, one can evaluate how one spend their time. People might as well

discover that the actual time allocation of time does not always match their priorities and

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 the degree of importance they assign to each of their responsibilities. In planning time,

there should be allocation of some part of the day for rest, reflection creativity, and social

contact (Afsaneh, 2015).

2.7 Occupational Stress and Nursing

Occupational Stress is a recognized concept prominent in the health care sector.

Among healthcare staff, occupational stress is becoming a common occurrence in most

public health service. According to Munn – Giddings (2005), if left untreated, it could

negatively impact the delivery of care by healthcare workers.

Within the health sector, nurses form the largest group with the principal mission

of nurturing and caring for people in the human health experience. Nurses provide around

– the – clock service to the patient in hospitals, nursing homes, long term care facilities

as well as clients using supportive or preventive programmes and related community

services (Kipping, 2000). Nurses in practicing their profession follow a holistic approach,

taking account the person in totality in his or her environment. They provide presence

(always with the client twenty-four hours of the day and seven days of the week),

comfort, help and support for people confronted with loneliness, pain, incapacity, disease

and even death. These unique roles of the nurse have made nursing to be regarded as a

caring profession. It is not surprising that nursing has been known to be stressful

throughout the world (Nad, 2009).

Many studies have examined OCCUPATIONAL STRESS among nurses

especially in clinical setting (Nizami, Rafique, Aslam, Minhas & Najam, 2006; Moustaka

& Constantinidis, 2010; Wong & Chang, 2012; Onasoga, Ogbebor & Ojo, 2013). Results

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of these studies show that stressors are many and varied. Frequently cited occupational

stressors among clinical nursing professionals include;

Workload: Two aspects of workload include; quality and quantity. Quality of workload

refers to the intensity and time allotted to the work. When there is work overload in terms

of quality, there is a feeling that job is complex, difficult and hard to finish. Quantitative

work overload arises when the number of activities to be performed in the prescribed

time is many. This will make the employee feel burdened under the long term highly

intensified work. This leads to stress as it puts a person under tremendous pressure.

Role Characteristic: Role ambiguity and conflict have been recognized as stressful

characteristic of the working role. Role ambiguity can be defined as the lacking clarity

concerning the employee’s target and duties. This occurs when the person does not know

what he is supposed to do on the job. His tasks and responsibilities are not clear. The

nurse is not sure what she is expected to do. This creates anxiety and confusion in the

mind of the nurse and result to stress.

On the other hand, role conflict refers to conflict among professional roles. Cope

(2003) says it occurs when the individual is torn by conflicting job demands or doing

things he or she does not want to do or does not feel are part of the job specification. This

occurs most times when a person is expected to perform in different ways by different

individuals. Studies have linked role conflict to lower job satisfaction and high job-

related tension. Also the more power and authority the person(s) sending the message has

the greater the job dissatisfaction due to role conflict.

Career Concern: This could be seen when the nurse feels that she is very much behind

in the corporate ladder. The nurse may experience stress if she perceives that there is no

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 opportunity for self-development or growth. Unfulfilled career expectations are a major

source of stress (Cope, 2003).

Interpersonal Relationship: Interpersonal conflict occurs due to difference in

perceptions, attitudes, values and beliefs between two (2) or more individuals and groups.

Moustaka and Constantinidis (2010) showed that work relationships are potential

stressors. Two sources of stress in this area are conflicts with co–workers and lack of staff

support. Lack of social support from colleagues and superiors and less satisfaction with

the head nurse contributed significantly to the appearance of stress among nurses

(Sveintdottir, Bierring & Ramel, 2006). Relationship with superior is the most important

factor among all the factors influencing the employee’s health at the workplace. (Wong &

Chang, 2012). When an employee realizes that she is neglected by her supervisor or that

she can hardly communicate smoothly with her supervisor/colleagues. She would feel the

stress (Moustaka & Constantinidis, 2010).

2.7.1 Nature of Nursing

Hudgins (2008) in Moustaka & Constantindis (2010) said that most times someone

becomes a nurse because they want to help people but when they are confronted with the

reality of the job, they soon realize that it is not what they thought it would be

considering the nature of nursing task and the involvement with death and dying people.

Health care organizations are different in size and nature. Hence, nurses are confronted

with different work tasks, workload, working period (rotating shifts), working conditions,

and issues like working under time pressure, monotonous and repetitive nature of nursing

jobs, frequent encounter with suffering and death of patients, dealing with difficult

patients and relatives.

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 Nurses in carrying out nursing procedures are exposed to a lot of hazards, some of

which are cuts and wounds from sharp instrument, exposure to secretion/body fluids from

the patients. Even some chemical substance used in the hospitals especially those used in

chemotherapy expose the nurse to health danger. The shift nature of nursing job makes

nurses vulnerable to stress. The alternation of day and night shifts may create problems in

adjusting to the shift timings and it can affect not only personal life but also family life

and they are made to sacrifice their time with their family members, friends and others.

Globally, shift work is generally acknowledged as a source of stress (Admi, Tzischinsky,

Epstein, Herer & Lavie, 2008; Price, 2011). Shift work could cause sleep problems such

as lacking sleep, inversion of sleep rhythm to mention a few. (Costa, 2000; Price, 2011).

Shift workers have been identified to face the problem of absent mindedness, slow

reaction and higher possibility for making mistake.

Work Environment: A major source of stress is derived from the occupational

environment, which implies that irrespective of individual differences among role holders

in same profession, they are much more likely to experience stress (Cope 2003). This

could be referred to as the environment directly related to the employee, most especially

the specific environment at the work place (Moustake & Constantinidis 2010). When

nurses are subjected to poor working conditions, poor lighting and ventilations,

unhygienic sanitation facilities, excessive noise, dust, inadequate safety measures to

mention a few. These unpleasant conditions have the tendency to create physiological and

psychological imbalance in the nurse resulting to stress.

Wong and Chang (2012) opined that unfavorable chemical or physical condition

such as noise, poisonous gas, high temperature and strange light can on the one hand

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 directly influence the physical health of workers; on the other hand, it could disturb their

psychological activities. Comfortable and pleasant environment, suitable tools for

ergonomics and reasonable methods and the elimination of risk factors in the

environment could be of vital significance in ameliorating and improving the mood,

confidence and productivity of workers (Moustaka & Constantinidis, 2010).

Organizational Factor: Researchers indicate that in addition to nursing itself,

organizational and management characteristics influence the stress nurses experience at

work (Santos, Carroll, Cox, Teasley, Simon & Bainbridge, 2003). Some of these factors

inherent in the organization or management practices include, lack of or poor

advancement opportunities, nursing shortage or understaffing, lack of task autonomy,

change management, staff compensation/remuneration, poor communication network to

mention a few.

Individual Factors: Occupational Stress among nurses is to a great extent determined by

how successfully each individual nurse copes with the job-related stress factors in his or

her workplace (Moustaka & Constantinidis, 2010). One of the greatest causes of stress

for nurses is the lack of preparation in handling the emotional needs of the patients which

causes anxiety within the nursing staff. (Sveintdottir, Bierring & Ramel, 2006).

2.7.2 Individual Differences in Coping with Occupational Stress

Despite disagreement over several conceptual and definitional issues in stress research,

there seems to be a consensus in the importance of individual differences. Many

individual differences might be correlates of occupational stress. Factors that contribute

to these differences include; age, gender, motivation, years of experience, past

experience, skills, personality to mention a few (Cope, 2003; Nayak, 2008). Most

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 research into the individual differences has focused on personality difference between

high and low stress individuals (Cope, 2003). Hence, the present study restricts attention

to personality. It has been established that some personalities respond to stressors

negatively than others. This includes; type ‘A’ personality and neurotics (Aamodt, 2007).

These individuals are characterized by achievement, striving, impatience, urgency,

hostility and anger. They tend to be multi-tasking, fast paced individuals (who talk and

walk fast) seem to always be on the go, achievement oriented, competitive, place work

before pleasure. These features become exaggerated when the person is experiencing

stress. (Aamodt, 2007). Type ‘A’ employees are more likely than others to exhibit high

blood pressure and high levels of stress-related hormones and are slower to recover after

stressor is removed. Type ‘B’ personalities are more laid back. When they encounter a

stressor, they are better at keeping things in perspective and use positive ways to deal

with it. Type ‘B’ personalities are more relaxed and more agreeable.

2.8 Theoretical Framework

Coleman (1973) identified three basic forces; pressure, conflict and frustration as

emotional stress process. The study is leaning onto this model for the causes of

occupational stress. Pressure comes with environment demands especially with regard to

time (Ogundele, 2006) high work load and perfectionism (Marzabadi and Tarkhorani,

2007) frustration such as low work control; low employee participation in decision

making, boring and repetitive work, lack of training lack of meaningfulness or knowledge

of how the individual contributes to the organization goals and then conflict stress such as

depression and aggression, especially in union grievances and mistrust. Conflict arises

because of competing alternatives which require us to make the right choice and

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decisions. Frustration is imposed because of our inability to meet the objectives or

achieve the goals. Under a stressful situation, conflict arises between the demands being

made by our industrial organization workplace and our individual ability as a worker to

meet the challenge of work or no work, or conflict before us. It is this discrepancy that

reacts to stressful feelings and subsequent responses to stress by the worker affected. This

feeling usually must go through three processes. These are the psychological,

physiological behavioral. It is the psychological (feeling, judgment motivation, job

dissatisfaction that informs the internal body reactions) which in turn informs the

behavioral responses or action.

The three most prevalent theories of occupational stress include:

The Person-Environment (PE) Fit Theory

According to this theory, stress appears from an inconsistency between person and

environment. Individuals feel that their work environment do not fit well with their

needs, wants, and desires. Environmental demands include job requirements, role

expectations, rules and norms.

The Framework of Occupational Stress

In its view, occupational stress is a total process including the environmental

sources of stress and the individual s perception of them. Recognized stress and the

resulting strains are explained as a snowball effect negative feelings increase level of

stress. Acute depression, alcoholism, unemployment, and diseases may follow the

accumulation of physiological, psychological and behavioral strains.

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The Demand-Control-Support Model

Occupational stress depends on the work content, which is divided into two

components: job demands and job control. In situations where there are high demands,

very low control and strong level of strain, the great level of occupational stress will

occur (Bickford 2005). Stress can be provoked by any type of situation at the work place

and any type of person can suffer from it.

Applied to occupational this study, these models best capture the reality in

analyzing the stress working conditions among health workers as they point out the

relevant schemes that leads to stress and eventually suggests how such conditions of

stress can be effectively controlled and managed to produce job satisfaction, health care

and adequate service delivery within the health sector.

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 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

This aspect of the study deals with the procedures and processes which will be

applied for the purpose of the study. The processes include Research design, population

of the study, sample and sampling size, method and instrument of data collection,

Technique of data analysis and limitation of the methodology.

3.2 Research Design

The research design for the study is based on survey method. A survey method is

a sample of opinion s, attitudes or perception of respondents about the problem under

study. The choice of this method is aimed at providing an avenue to the sampled

population to articulate their views about occupational stress among health workers in

Nigeria with particular reference to General Hospital Wannune, Tarkaa Local

Government Area of Benue State.

3.3 Population of the Study

The population of the study is the entire health workers of General Hospital

Wannune, Tarkaa Local Government of Benue State

3.4 Sample and Sampling Size

 The study considers a sample of 200 respondents for the purpose of data

collection about occupational stress among health worker. Thus, the sampling technique

employed for the study is the simple random technique of data collection.

3.5 Method and Instrument of Data Collection

The data used for this study will be derived from primary and secondary sources.

In its primary sources, the use of questionnaire instrument will be employed as well as

personal observation. Thus, secondary source will be derived from the use of journals,

internet, textbooks, newspapers, magazines, government publication and unpublished

documents.

3.6 Technique of Data Analysis

The data collected for the purpose of this study will be quantified and analyzed in

tables using simple percentage.

3.7 Limitations of the Methodology

The study is limited by time constraints due largely to delay in processing of

application to obtain information, finance and inability of the respondents to return

questionnaires in good time. Consequently, these limitations might have affected the

quality of data obtained. But notwithstanding, data collected have been carefully

scrutinized and interpreted in a concise manner to suit the aim of the study.