The Influence of Stress On Work Behavior Among Nurses

THE INFLUENCE OF STRESS ON WORK BEHAVIOR AMONG
NURSES
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Every work environment especially within a hospital setup needs to be conducive, friendly and
stress free to promote quality care and wellbeing of health care workers whose job demands are
increasing day by day. This is as a result of advancement in technology and patient’s demand for
quality in response to increasing health care cost. Stress is considered a normal part of life which
is necessary occasionally as a push to increasing functional capacity, but when it is experienced
over a prolonged period it becomes detrimental to health leading to a decline in productivity
(Salleh, M.R., 2008).
Stress can be defined as a particular relationship between the person and the environment that is
assessed by the person as taxing or exceeding his or her resources and endangering his or her
well-being (Irving, J.A. et al., 2009). Stress on its own does not have any damaging effect on an
individual; however, individuals’ assessment of an event, their perceptions and interpretations
give meaning and their coping ability determines whether events are viewed as threatening or
positive. Personality traits also influence individual reaction to stress because what may be
strenuous to one person may be stimulating to another (Robinson, M. D. et al., 2011).
As far back as the mid-1950s, stress was regarded as an occupational hazard and occupational
stress cited as a significant health problem (Jennings, B.M., 2009) while in the 1960s, patient’s
care, decision making, taking responsibility, and change were identified as sources of anxiety
among nurses which predisposed them to work stress (Menzies, 1960). Nurse’s role has long
been regarded as stress-filled based upon the physical labor, human suffering, work hours,
staffing, and interpersonal relationships that are central to what the work nurses do (Lukpata, F.
E. et al., 2013).
This stressful nature of nursing can ultimately lead to job dissatisfaction and burnout (Arafa,
M.A., 2003). This statement is in line with some studies which conclude that the provision of
health care services is demanding both physically and psychologically (Ilhan, M.N., 2005).
Nursing occupies a conspicuous position among the professions that have been identified as the
most stressful worldwide as nurses relate with humans mostly in times of pain, suffering and
death (Lukpata et al., 2013). Nurses work tirelessly rendering care to critically and chronically ill
patients who are between life and death in an environment where there is lack of tolerance for
error (Rowe, J., 2003), all these can exert intense psychological and physical pressures on the
health care giver leading to stress or burn out syndrome.
Among health care professionals, nurses have been found to be most prone to burnout
(Abushaikha, L. and Saca-Hazboun, H., 2009). This is more so because nurses are expected to
deliver humane, empathetic, culturally sensitive, proficient and moral care, in working
environments with limited resources, reduced supply of nurses and increasing responsibilities.
Such imbalance between providing high quality care within an environment of limited resources
leads to stress (Khamisa, N., 2015).
1.2 Statement of the Problem
Job satisfaction and burnout among health care providers are important issues since they affect
turnover rates, staff retention and ultimately the quality of patient care (Atencio, 2003). Burnout
has been defined as “a syndrome of physical and emotional exhaustion, involving the
development of stress which can lead to the development of negative self-concept, negative job
attitudes and loss of concern for clients”. Burnout has also been associated with high
employment turnover, excessive absenteeism, negative job attitudes, low morale and a reduction
in willingness to help others (Abushaikha, L. and Saca-Hazboun, H., 2009).
The way that an individual views and processes stress determines how much stress is felt and
how close the person is to burnout. Perceptions of job stress and burnout are not just a product of
work conditions because not all workers, exposed to the same conditions, develop burnout or
perceive stress (Robinson, M. D. et al., 2011).
An individual can be exposed to few stressors but be unable to process the stress well and thus
experience burnout. Another person, however, can be exposed to a significant amount of
stressors, but process each well, and avoid burnout. How close a person is to a state of burnout is
greatly dependent on individual differences (Truby, B., 2009).
According to psychological theories, stress is determined by the balance between the perceived
demands from the environment and the individual’s resources to meet those demands (Ursin, H.
and Eriksen, H.R., 2004). The International Council of Nurses (ICN) (2008) declares that nurses,
doctors, and laboratory technicians experience the highest job-related stress with 45 percent
reporting that their jobs are quite or extremely stressful. Likewise, the International Labour
Organization has identified nursing as an industry with relatively. These problems make it
necessary to examine the influence of stress on work behavior among Nurses in Federal Medical
Centre Abeokuta.
1.3 Objectives of the Study
The general objective of this study is to investigate the influence of stress on work behavior
among Nurses in Federal Medical Centre Abeokuta. The specific objectives are:
i. To ascertain the causes of work stress among nurses in Federal Medical Centre Abeokuta
ii. To determine the relationship between stress and job dissatisfaction among Nurses in
Federal Medical Centre Abeokuta
iii. To examine the effect of stress among nurses on the safety of patients Federal Medical
Centre Abeokuta
iv. To investigate the impact long working hours on the job performances of Nurses in
Federal Medical Centre Abeokuta.
v. To know if work stress influences negative job attitude among Nurses in Federal Medical
Centre Abeokuta.
1.4 Research Questions
The relevant research questions related to this study are:
i. What are the causes of work stress among nurses in Federal Medical Centre Abeokuta?
ii. What is the relationship between stress and job dissatisfaction among Nurses in Federal
Medical Centre Abeokuta?
iii. What is the effect of stress among nurses on the safety of patients Federal Medical Centre
Abeokuta?
iv. What is the impact long working hours on the job performances of Nurses in Federal
Medical Centre Abeokuta?
v. Does work stress influences negative job attitude among Nurses in Federal Medical
Centre Abeokuta?
1.5 Research Hypotheses
Hypothesis I
H0: There is no significant relationship between stress and job dissatisfaction among nurses.
Hi: There is a significant relationship between stress and job dissatisfaction among nurses.
Hypothesis II
H0: There is no significant relationship between stress among nurses and the safety of patients
Hi: There is a significant relationship between stress among nurses and the safety of patients
Hypothesis III
H0: Work Stress does not have a significant impact on negative job attitude among nurses
Hi: Work Stress has a significant impact on negative job attitude among nurses
1.6 Significance of the Study
This study is very important to medical directors because it elucidates some of the factors that
are responsible for the poor performances of Nurses in hospital. The relationship between stress
and the work behavior among nurses is well examined. Long working hours is one of the causes
of work stress among nurses and its impacts on the productivity of nurses are well investigated.
This study also examines the ways of reducing work stress among nurses in hospital. If these
measures are implemented, it will have impact on improving the safety of patients. Nurses who
are stressed tend to be aggressive on patients and this affects the recuperation of patients.
The finding from this research can also be used as a reference material for other researchers who
will likely carry out a study on a related topic.

This study will be of immense benefit to other researchers who intend to know more on this
study and can also be used by non-researchers to build more on their research work. This study
contributes to knowledge and could serve as a guide for other study.
1.7 Scope of the Study
The scope of this study restricted to examining the influence of stress on work behavior among
nurses in federal medical centre Abeokuta.
1.8 Limitations of the study
Some of the major constraints the researchers encountered in putting up this research include
lack of time, lack of willingness to give information by respondent and also limited resources.
The demanding schedule of respondents at work made it very difficult getting the respondents to
participate in the survey. As a result, retrieving copies of questionnaire in timely fashion was
very challenging. Also, the researcher is a student and therefore has limited time as well as
resources in covering extensive literature available in conducting this research. Information
provided by the researcher may not hold true for all businesses or organizations but is restricted
to the selected organization used as a study in this research especially in the locality where this
study is being conducted. Finally, the researcher is restricted only to the evidence provided by
the participants in the research and therefore cannot determine the reliability and accuracy of the
information provided.
Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in
sourcing for the relevant materials, literature or information and in the process of data collection
(internet, questionnaire and interview).

Time constraint: The researcher will simultaneously engage in this study with other academic
work. This consequently will cut down on the time devoted for the research work.
1.9 Definition of Terms
Stress: is a state of mental or emotional strain or tension resulting from adverse or demanding
circumstances.
Nurse: A registered nurse is a nurse who has graduated from a nursing program and met the
requirements outlined by a country, state, province or similar government-authorized licensing
body to obtain a nursing license. An RN's scope of practice is determined by legislation, and is
regulated by a professional body or council.
Nursing: Nursing encompasses autonomous and collaborative care of individuals of all ages,
families, groups and communities, sick or well and in all settings. Nursing includes the
promotion of health, prevention of illness, and the care of ill, disabled and dying people.
CHAPTER TWO
LITERATURE REVIEW
2.1 INTRODUCTION
This chapter gives an insight into various studies conducted by outstanding researchers, as well
as explained terminologies with regards to investigating the influence of stress on work behavior
among Nurses in Federal Medical Centre Abeokuta. The chapter also gives a resume of the
history and present status of the problem delineated by a concise review of previous studies into
closely related problems.
2.2 CONCEPTUAL FRAMEWORK
Concept of Stress
Stress is an imprecise term, which is usually defined in terms of the internal and external
stressful conditions. McGrath (1976) suggested that stress is caused when a person thinks that an
environmental condition threatens to stretch the person’s capabilities, and if the person does so,
he/she receives less rewards than the expected ones. Also, McGrath supports that if a person
fears the future and has low self-confidence, stress appears, while Arnold and Feldman (1986)
suggest that stress is different from person to person depending on their reactions to changing
situations. Williams and Huber (1986) support that stress is caused when a stressful situation,
internal or external, lasts for a long time and the person perceives it as a threat irrespective of it
being so, indicating the relativistic characteristic of stress. A more general definition is proposed
by French, Kast and Rosenzweig (1985), who believe that stress is neutral but when we exceed
our limits or we are below them, burnout or rust out, respectively, are caused.
Causes of stress
Working environment: In this field, Gray-Toft and Adderson (1981) focused on specific
stressful situations for nurses, which affect their work performance, when they developed the
Nursing Stress Scale (NSS), identifying three sources of stress from: the physical, psychological
and social environment. The working conditions such as the wrong ventilation, lighting and the
inadequate temperature levels are among the potential work-related stressors. Cooper () support
that difficulties in coping with stress combined with psychological or emotional instability could
lead to violence and there are several studies supporting that the healthcare workers –
specifically nurses and clinic personnel – are especially affected by the risk of physical violence-
particularly in the emergency rooms- which is a source of stress. Interpersonal relationships Blair
and Littlewood (1995) emphasized that work relationships are potential stressors. Two sources of
stress in this field are the conflicts with co-workers and the lack of staff support. Another
assessment showed that lack of social support from colleagues and superiors and less satisfaction
with the head nurses contributed significantly to the appearance of stress (Sveinsdottir et al.,
2006), while the Health and Safety Executive identify the negative effect of lack of
understanding and support from their managers, on workers’ stress (Health and Safety Executive,
2000).
Stress Consequences
Stress can have far reaching consequences for nurses which is why stress management for them
is so important, since occupational stress has been found to be one of the major work-related
health problems for the workers as well as one of the greatest forced cost for the hospitals (Aiken
et al., 2001).
Problems in staff’s behavior

Stress can have a significant impact on individual nurses and their ability to accomplish tasks
and more specifically, poor decision making, lack of concentration, apathy, decreased motivation
and anxiety may impair job performance creating uncharacteristic errors (Jones et al., 2003). All
of the above can directly contribute towards absenteeism, decreased work performance, and
ultimately, burnout. Nurses encountering ongoing stress are more likely to eat poorly, smoke and
abuse alcohol and drugs, all of which can lead to negative health conditions affecting personal
wellbeing errors (Burke, 2000). A strong negative relation between nurses’ occupational stress
and job satisfaction has been found, based on which growing occupational stress results in
increased turnover rate, which causes more and more nurses to leave the nursing profession.
Mental problems
Occupational stress and its consequences on nurses’ behavior can create mental problems such as
anxiety, depression, insomnia and feelings of inadequacy (Wong et al., 2001). Levi points out
that the National Institute for Occupational Safety and Health lists psychological disorders
among the ten leading work-related diseases or injuries and has reported to the World Health
Organization that almost 75% of patients seeking psychiatric consultation face difficulties with
job satisfaction and stress.
Consequences on physical health
Interest in this area has been recently stimulated both by evidence that psychological factors
influence immune function and increasing recognition of the importance of understanding the
role of stress and other psychological factors in the onset and progression of acquired
immunodeficiency syndrome. Only a proportion of people develop clinical disease when

exposed to an infection agent and severity and duration of symptomatology vary widely among
those who do become ill. The reasons for this variability in response are not well understood and
the possibility that psychological factors play a role has received increased attention. Stress-
related physical illnesses include heart disease, migraines, hypertension, irritable bowel
syndrome, muscle, back and joint pain, and duodenal ulcer38, whereas psychologists who are
interested in the role of psychological factors in human diseases have focused primarily on
coronary heart disease and cancer.
Stressors
Stress is derived from the Latin word stringere, meaning ‘to draw tight’. In the 17th century the
word was used to describe affliction. Early definitions of strain and load used in physics and
engineering eventually were adopted in the first psychological theories on the concept of stress
and its effect on individuals. Under the meaning of this concept, external forces are seen as
exerting pressure upon an individual, causing strain (Cartwright & Cooper, 1997). Stimulusbased
definitions of stress have as a central theme to identify potential sources of stress (Goodell, Wolf,
& Rogers, 1986). Theories on occupational stress focus on a range of different stressors. One of
the most well-known occupational stress theories is the job Demand Control Support model
(Karesek, 1979; Johnson, Hall & Theorell, 1988). It states that three job characteristics
(stressors) are crucial in explaining adverse health: high demands, low control, and low social
support. A situation in which work pressure is high, and control and support are low is
hypothesized to be most detrimental for the employee (the iso-strain hypothesis). A category of
other occupational stress models are the Person-Environment (PE) fit models. In these models,
the source of stress defined as a misfit between a person and his environment, such as a misfit of
the individual’s needs with the organization’s or job’s provision of rewards and supplies or a
misfit of the individual’s skills and abilities with the job’s demands and requirements (Harrison,
1985). PE fit models thus define a stressor as a combined effect of personal and environmental
variables. PE fit models generally have an objective fit element as well as a subjective fit
element. The objective fit element contains objective person elements which are attributes of the
person as they exist irrespectively of his or her self-identity or self-concept, and analogously
objective environment elements (Harrison, 1978). These elements can be categorized on the
“stressor” side of Beehrs’ core relationship of occupations stress (Beehr, 1995). A third
influential stress theorist states that “a person is under stress if what happens defeats or
endangers important goal commitment and situational intentions, or violates expectations.”
(Lazarus, 1999, p.60). Here, the impact of the stressor on the individual is totally dependent upon
personal variables: the person’s goals, intentions and expectations. Contemporary definitions
point to the idea that no one variable can be said to be a stressor, because only the person
experiencing the variable or the event can label it as stressful (Lazarus, 1966; 1990).
During nursing education and training, nursing students are frequently exposed to various
stressors which may directly or indirectly impede their learning and performance. The nature of
clinical education presents challenges that may cause students to experience stress. Moreover,
the practical components of the program which is important in preparing students to develop into
professional nurse role by its nature have made the programme even more stressful than other
programmes. The various factors associated with stress among nursing students:
ENVIRONMENTAL FACTORS: Perceived stress due to change in living environment,
inadequate telephone facilities, inadequate provision of safety and security in the world,
inadequate facility of canteen/mess, lack of recreational facilities.
INTRAPERSONAL FACTORS: Change in eating pattern, engagement/marriage, homesickness
in hostel, change in sleeping pattern, new responsibilities of life, personal preoccupations,
parents expectations, decline in personal health, death of significant one, financial problems,
change in religious beliefs
ACADEMIC FACTORS: Less vacations/breaks, Inability to balance study and leisure time, over
burden with study, inability to concentrate on study, poor satisfaction with class room
performance, getting lower grade than anticipated, inability to enjoy study and class
presentations, difficulty to understand language used by teachers while teaching, poor interest in
studies, poor Inter Personal Relationship with teachers, serious argument with teachers, practical
work, missing too many classes. Students experience increased tension prior to their clinical
rotation and written examination especially their final examination.
CLINICAL FACTORS: They also experience stress in clinical area; pressure in procedure
performance, fear of committing a mistake, time pressure, dealing with different and difficult
patients. Lack of experience, fear of making mistakes, discomfort at being evaluated by faculty
members, worrying about giving patients the wrong information or medication and concern
about possibly harming a patient are just a few of the stressors for student nurse.
INTERPERSONAL FACTORS: change in social activities, fight with close ones, lack of
cooperation from friends, lack of close and intimate friends, conflict with roommates. Social
factors can also encompass the fear of public speaking, confrontations, and dealing with
authority figures.
SIGNS AND SYMPTOMS
Furthermore, stress could result to deleterious symptoms such as alcoholism and drug
dependence, eating disorder, indiscriminate use of illegal substances, sleep disorder, suicide,
absenteeism, mental health disorders, and even psychological symptoms. Thus, the
undergraduate nurses is considered as one of the most sensitive period in their lifespan since
learning during these years may be compromised due to stress reactions produced.
THE EFFECTS OF STRESS ON NURSING STUDENTS INCLUDE
The effects of stress extend beyond physical, emotional, and behavioral symptoms as students
may experience difficulty in attaining educational goals. Long-time stress among nursing
students or prolonged stress can cause:
- Memory problems and inability to concentrate in the studies.
- chest pain,
- rapid heartbeat,
- depression or general unhappiness and
- Sleep disturbance, It may even lead to burnout.
PHYSICAL
Physical symptoms include:
- a pounding heart
- elevated blood pressure
- Excessive sweat palms
- Tightness in the chest and pain
- Pain in the neck, jaw and back muscles
- Headache
- Abdominal cramps
- Nausea
- trembling
- Tiredness
- Susceptibility to minor illness
- itching
THOUGHTS
- Lack of attention
- decreased self esteem and confidence
- disorganized thoughts
- diminished sense of meaning in life
- Lack of control or the need for too much control
- Negative self statements and negative evaluation
- Difficulty in making decisions
- Loss of perspective.
BEHAVIOURS
- Withdrawn and not able to socialize
- Alcohol, nicotine or drugs abuse
- under eat or over eat
- Accident prone and careless
- Impatient, aggressive or compulsive –pacing, fidgeting, swearing, blaming, throwing and
hitting!
- Working longer hours – not taking breaks, take work home, procrastinate with important
projects, take the „headless chicken‟ approach when under pressure, and manage time
poorly
- no longer time for leisure activities.
FEELINGS
- Irritable
- Angry
- depressed
- Jealous
- Restless
- Anxious
- Unreal or hyper alert
- Un necessarily guilty.
- Panic
- Mood swings, crying easily.
STRESS MANAGEMENT FOR STUDENTS
Methods to reduce student stress often include effective time management, social support,
positive reappraisal, and engagement in leisure pursuits.
PSYCHOLOGICAL SUPPORT:
Shelton found that psychological support was just as important to student persistence as
functional support.
Two specific types of support were identified – psychological support, directed at facilitating a
sense of competency, self-efficacy, and self-worth and functional support, aimed at the
accomplishment of academic tasks. The coping methods adopted were categorized as healthy
coping strategies and unhealthy coping strategies. While the students reported use of various
methods of coping methods to alleviate stress, the majority of them used positive thinking as a
healthy coping, such as, thinking how similar things were handled in the past, talking to parents,
praying more than usual (relying on religious faith), use of a step by step approach to solve
problem, sharing of problems with friends. The professional support strategies such as "getting
professional counselling" and "talking to a teacher or counsellor" and the humorous strategy.
Whereas self blame was the common unhealthy coping method. The effectiveness of a stress
coping program based on mindfulness meditation approach could be effective in reduction of the
stress and anxiety of the nursing students
STUDENT-CENTERED LEARNING ENVIRONMENTS: A caring, supportive learning
environment transforms faculty–student relationship into a collaborative partnership that
promotes professional socialization and empowerment.
FUTURE DIRECTIONS FOR MANAGING STRESS: Nursing faculty are positioned to create
caring and supportive learning environments that facilitate students‟ coping and persistence,
perceived self- efficacy, and success in nursing.
PEER AND STAFF MENTORSHIPS AND MODELING: Peer support and personal mentoring
can be effective strategies to reduce student anxiety in clinical settings. The support of senior
nursing students in the role of mentors, beginning junior nursing students can be guided in
patient care assignments within the clinical setting. This relationship fosters confidence as
students communicate freely and ask questions without fear of reprisals from nursing instructors.
Nursing students support each other in a student centered, non-threatening learning environment
that minimizes the student‟s anxieties when first entering unfamiliar clinical settings.
CARING LEARNING ENVIRONMENTS: creating a caring environment that demonstrates
value, respect, and support as a collaborative enterprise between faculty and learners; not only
fosters relationships but also promotes learning in a non stressful manner. Caring learning
environment is based on genuine dialog, engagement, and reflection. Further, the development of
formal and informal support systems with faculty, staff, and peers optimizes academic and social
connections and provides essential resources to proactively address stress and positively impact
retention and satisfaction. Watson‟s theory on caring provides a framework for establishing
relationships that support academic success, professional evolution, and collegial relationships.
A caring learning environment actively engages faculty members and students in learning
through mutual respect and genuine presence; this relationship requires a student/faculty
partnership, collaboration, commitment, self-direction, and creativity. Engagement of the learner
and faculty members as equal partners in the learning environment fosters connections, promotes
self-efficacy, and serves to transform participants. This process facilitates meaningful learning
opportunities.
FACULTY ROLE AND BEHAVIOR: Faculty behavior moves into one that embraces teaching
moments and “teaches” rather than critically “evaluates” student performance in the clinical
setting. Focusing on the teaching role while de-emphasizing the evaluator role is one strategy
that can promote an open and supportive learning environment where the instructor is welcomed
as a role model and facilitator of learning. This positive learning environment can result in
enhanced learning and a collaborative relationship for all involved. The student participants in
Del Prato‟s study identified the teachers‟ ability to de-emphasize their evaluative role as an
important dimension of the supportive learning environment that helped students to overcome
feelings of anxiety and stress. Informants explained that supportive teachers recognized when
students felt anxious and worked to put them at ease by establishing rapport and communicating
words of encouragement. Student participants often verbalized appreciation for these caring
teachers who “gave” them confidence and helped them to believe in themselves as future nurses.
REFLECTIVE LEARNING MODEL: Reflection builds upon sharing one‟s personal knowledge
and experience to better understand the implications of one‟s care and explore alternatives.
Promoting a supportive learning environment can readily become incorporated into the
educational experience within the classroom and clinical settings by implementing reflection.
This strategy integrates personal knowledge, clinical practice, and faculty–student engagement
within a structured learning environment. The reflective learning model allows the student to
critically examine one‟s practice by reflecting on one‟s interactions and interventions. Bevis and
Watson support this and suggest the sharing of one‟s learning experiences promotes
collaboration, fosters interpersonal relationships, and creates new knowledge.
SOCIAL SUPPORT AND PROFESSIONAL NETWORKS: Social support in conjunction with
coping strategies and identification of personality styles can lead to effective management of
stressors. The provision of academic, social, and behavioral support systems and networks are
effective for reducing distress and preventing unhealthy levels of stress. Further, teaching stress
identification and stress reduction techniques provides learners with an effective tool for use
personally and in the clinical area. Finally, utilization of innovative teaching methodologies and
stress reduction interventions in all learning environments can optimize learning while
decreasing stress.
EMPOWERING STUDENTS: One strategy that shows promise for reducing the stress for
nursing students is mindfulness based stress reduction (MBSR). Mindfulness requires the
individual to attend to his/her conscious experience with a detached, objective, and open attitude.
As a result, the individual gains insight into the nature and frequency of their thoughts and
feelings along with the ability to separate the thought from the feeling and/or behavior, and a
more balanced emotional state leading to decreased stress.
PROACTIVE LEARNING STRATEGIES: Nursing faculty members can take a proactive
approach by providing timely and constructive feedback on assignments, establishing reasonable
and purposeful course requirements, exploring innovative strategies for instruction and
evaluation of learning, and by preparing students for the clinical experience and supporting them
as they administer care. Implementation of traditional and innovative academic strategies can be
effective for reducing stress among nursing students. In this regard, numerous interventions have
been recommended to support students in the learning environment. Peer and professional
tutoring can assist students to master course content, which improves confidence, self-esteem,
and satisfaction. Faculty availability, approachability, and fairness have been identified as
sources of support and reassurance for students. Informal faculty support has been identified as
being as significant and as effective as that received from family and peers in empowering
students to cope with stress.
Stress reaction
The work of Cannon introduced the idea that environmental pressures can cause disease rather
than just short time ill effects and that people have a natural tendency to resist such forces
(Cannon, 1929). Cannon studied the effects of stress on animals and people and, in particular,
studied the fight-or-flight reaction (the physical reaction to either fight or flight when confronted
with a stressor). He saw that people react physically to stressors: when confronted with a
stressor, their physiological balance changes, for example, they show increased adrenaline
secretions. Cannon described these individuals as being “under stress”. Hans Selye (1946)
distinguished three stages in a stress reaction in his description of the General Adaptation
Syndrome (GAS). The first stage is that of an alarm reaction: the initial phase of lowered
resistance, followed by countershock, during which the individual’s defence mechanisms
become active. The second stage is that of resistance: maximum adaptation and, ideally,
successful return to equilibrium for the individual. If adaptation mechanisms are not effective or
stress continues, the individual moves to the last phase of exhaustion, where adaptive
mechanisms collapse. Critique on this model has to do with its simplicity. The model does not
account for the fact that different stressors evoke different physical reactions. For example,
anxiety producing situations are associated with adrenalin-secretion, whereas aggression
producing events are associated with noradrenalin secretion. Also, the GAS does not address the
issue of psychological responses to stress (Cooper, Dewe, & O Driscoll, 2001). In the 1970s and
’80s stress researchers started to study the emotional responses to stress by examining burnout
and emotional exhaustion. It has long been recognized that health care workers by definition are
at high risk of becoming ill or burned out. Burnout is a response to the chronic stress of dealing
with individuals, particularly when these individuals are troubled or having problems (Maslach
& Zimbardo, 1982). When people describe themselves as experiencing burnout, they are most
often referring to the experience of emotional exhaustion (Maslach, Schaufeli, & Leiter, 2001).
Emotional exhaustion refers to feelings of being emotionally overloaded and depleted of one’s
emotional resources. In occupational stress research, stress reactions are often categorized into
psychological, physical (health) and behavioural responses. Examples of psychological
responses include anxiety and depression (House and Rizzo, 1972; Kaufman & Beehr, 1989) and
burnout (Maslach & Zimbardo, 1982). The most cited critique on stimulus and response based
models of stress is that they are too simplistic. They do not account for individual differences in
6 responses to stressors. Two individuals exposed to exactly the same stressor might have
completely different stress reactions. Stimulus and response based models of stress however are
important in identifying and categorizing events that have the potential for causing stress and
their responses, in order to provide optimal working conditions.
Individual differences, interaction and transaction: the process facet
Over time, stress theorists began to investigate the individual differences in the impact of outside
stressors. Next to the nature and strength of the stressor and the stress reaction, cognitive
processes that account for individual differences in the strength of the stressor-stress reaction
relationship became of importance. There is great variability in theoretical outlines of this
process facet. One of the chief proponents of the psychological view of stress was Lazarus, who
introduced the psychological concepts of appraisal and coping (Lazarus & Folkman, 1984).
Lazarus (1966) suggested that an individual’s stress reaction depends on how that person
interprets or appraises the significance of a harmful, threatening or challenging event. After the
first appraisal of the event, the individual makes a secondary appraisal in which one’s coping
resources and options to overcome the possible harm and threat are evaluated. By taking into
account these personal variables, scientists began to understand why one person seems to
flourish in a certain setting, while another suffers. The so-called transactional stress models are
concerned with the dynamics of the psychological mechanisms that underpin a stressful
encounter. The term “transaction” implies that stress is neither in the person, nor in the
environment, but in the dynamic transaction between the two (Lazarus, 1990). The transactional
definition points to three important themes: a dynamic cognitive state, a disruption or imbalance
in normal functioning, and the resolution of that disruption or imbalance. P-E fit models of stress
have defined the process facet as the subjective misfit between the person (abilities or values)
and the environment (demands, supplies). The individual perceives the encounter in the light of
his or her abilities to manage the encounter. This perception is conceptualized in terms of values,
supplies, demands and abilities. However, the definition of the exact nature of misfit and
appropriate measure of the constructs is problematic in empirical research (Edwards & Cooper,
1988). 7 Because of this difficulty with defining and measuring psychological processes,
empirical research on occupational stress has predominantly been conducted from an
interactional perspective. The interactional approach focuses on the statistical interaction
between stimulus and response. Work stress models that best characterize the interactional
framework postulate that the perceived presence of certain stressors may be associated with a
number of stress responses. Various organizational characteristics, situational factors, and
individual differences can influence (moderate) the strength of stimulus-response relationship.
Although with the interactional approach differences in reactions to stimuli can be partly
explained, these attempts to explain the complexity of such a relationship are limited to structural
manipulations such as the influence of a third (moderator) variable, which again do not provide
an explanation of the psychological process associated with stress (Cooper, Dewe, O Driscoll,
2001). The gap between transacional theory and interactional empirical research could be due to
a lack of detail in which psychological processes are defined. Recently, these processes
associated with stress are described more and more detailed. Self Regulation Theory refers to the
process in which people seek to align their behavior and self-conceptions with appropriate goals
and standards and stress results from difficulties in the achievement of goals. Higgins (1997,
1998) proposed two distinct self-regulatory systems, one in which people have a promotion
focus, and the other in which they have a prevention focus. Peoples’ regulatory foci are
composed of three factors which serve to illustrate the differences between a promotion focus
and a prevention focus: (a) the needs that people are seeking to satisfy, (b) the nature of the goal
or standard that people are trying to achieve or match, and (c) the psychological situations that
matter to people. In people that are promotion focused, the needs of growth and development
predominate; they seek to attain goals that are associated with their ideal self, and positive
outcomes are salient for them. People that are prevention focused are driven by security needs;
they seek to attain goals or standards associated with the ought self, and salient emotions center
around the presence or absence of negative outcomes. The use of Self Regulation frameworks
seems to be promising in the context of empirical occupational stress research as it can help to
define the process facet that explains the stressor-stress reaction relationship.
Nature of nursing
In many cases 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 is not what they thought it would
be19 considering the nature of nursing tasks and the involvement with death and dying people20.
Healthcare institutions are different in size and nature, and nurses are confronted with different
work tasks and working hours - nightshifts-, working conditions – understaffing and stress
related situations – the suffering and death of patients15. Another serious stressor is that the
health professionals have always paid a heavy price concerning infectious diseases because due
to the nature of their work they come into contact with biological dangers people21 as they use
sharp equipment like needles and through skin contact are exposed to the same active infection
dangers as the patients by handling patients’ blood and bodily liquids22. Except these, the
chemical substances in the hospital along with the use of dangerous medication, such as those
used in chemotherapy, expose nurses to health dangers23.
Organizational factors
Studies indicate that, in addition to nursing itself, organizational and management characteristics
influence the stress nurses experience at work24. With regard to previous research, a large part
of potential sources of stress for nurses appear to be organizational in nature including stress-
generating nursing work situations, which can be of physical, psychological or social
nature24,25. Besides responses to patients’ physical and psychological status, increased job
demands, because of the use of sophisticated technologies, competition among hospitals, nursing
shortage, work overload, and lack of task autonomy and feedback, as well as reduced
advancement opportunities, appear to be major determinants of emotional exhaustion26,27.
Occupational stress among nurses is associated with a variety of personal and institutional
factors. For example, Lee and Wang28 found that a high level of occupational stress is related to
workload and responsibility, while for someone else workload is the best independent predictor
of health and well-being status29.
Role characteristics
Since 1964 Kahn has recognized ambiguity and role conflict as stressful characteristics of the
working role. Ambiguity can be defined as the lack of clarity concerning the employee’s targets
and duties, while role conflict as the conflict among professional roles30. Stress in individuals or
groups occurs when their situation is overly complex, ambiguous and unclear, as well as highly
demanding regarding competence or when structural means to deal with the demands are not
present31. According to a study, the lack of opportunities to practice the professional role of
nursing significantly contributed to the production of stress17 which is consistent with the
findings of a study done on 43,000 nurses in USA, Canada, England, Scotland and Germany32.
According to another study completed by Kahn et al., (1964) approximately 50% or more of the
groups of nurses studied, stated that they could not either at all or to some extent practice the
professional role of nursing, which might indicate that nurses experience a conflict between their
expectations of their professional role and the reality of their work. This conflict is supported by
the findings that too much work produces the greatest stress. Taken together, these findings
might indicate a need to reorganize the content of nurses’ work and give higher priority to the
professional role of the nurse Germany (Kahn et al., 1964). These findings are consistent with a
study conducted in Greek Hospitals which showed that occupational stress of nursing
professionals is connected with the wish to modify the professional role of nursing tasks and the
reduced social acknowledgment of the profession (Moustaka et al., 2009). Marshal identified the
home/work interface and fulfilling others’ expectations for the role of the nurse as elements of
potential stress related to nursing (Marshall, 1980). A higher risk of the employees suffering a
psychiatric disorder exists when employees are stressed because they need to resolve conflicting
priorities, or have a lack of recognition. Helping people who experience major health problems,
although personally rewarding, can be a stressful situation when patients are not cognizant of the
efforts made by nurses to assist them.
2.3 THEORETICAL FRAMEWORK
This study is based within the frame work of Selye (1976), theory of General adaptation
syndrome (GAS) and Herzberg‟ s two-factor theory of Motivation. Selye (1976) physiological
stress theory, popular referred to as General Adaptation syndrome theory of stress (GAS),
stipulates that response to stress is non-specific and -it occurs regardless- of the nature of stress,
and that disease occurs when there is failure of the resistive mechanism. Selye‟s physiological
theory of stress is of much relevance to nurses' work stress and job satisfaction. The theory
exposes that the optimal point of intervention to promote health is during the stage when a
person‟s own compensatory processes are still functioning effectively. The role of nurses
therefore is the early identification of both physiologic and psychological stressors. Nurses
should be able to relate the presenting signs and symptoms of distress to the physiology they
represent and identify a person‟s position on the continuum of function, from health and
compensation to pathophysiology and disease. This will help the nurse initiate the appropriate
intervention at that particular stage on the continuum of function.
Herzberg’ s two-factor Theory Within the frame work of job satisfaction, Herzberg‟s Theory of
Motivation, a two-dimensional paradigm of factors affecting work attitudes can be regarded as
theory base for job satisfaction (Okoronkwo, 2005). Factors such as supervision, interpersonal
relationships, working conditions and salary are hygiene factors rather motivating factors related
to overall job satisfaction. Motivating factors such as achievement, recognition, responsibility
and advancement are considered to be strong determinants of job satisfaction. Motivating factors
are the direct stimulating factors that give a person job satisfaction in his work and kindle
positive attitude to like and love the job. The strength of these factors will affect feelings of
satisfaction or no satisfaction, but not dissatisfaction. Hygiene or maintenance factors serve to
prevent dissatisfaction. Herzberg's theory bears credence in this study because it exposes both the
hospital management and nurses to those factors that can bring about job satisfaction and those
that do not. It is expected to serve as a guide in the re-organization of nurses' duty schedule to
enrich the job contents that can bring about increased job satisfaction among the nurses. The
various studies reviewed point to the fact that job stress has adverse effects on physical and
mental health, personal and work behavior of nurses. It is imperative therefore that government,
hospital management boards or employees of nurses be committed to the prevention or reduction
of high job stress experienced by the nurses. The provision a conducive organizational climate to
reduce job stress, enhance nurses‟ job satisfaction cannot be over emphasized, it is a task that
must be given considerable attention to curb further brain drain in Ogun State.
2.4 EMPIRICAL REVIEW
Work Hazard (Physical environment) and Nurses' Job Satisfaction
In this study hazard is synonymous with physical work environment. A work hazard carries the
potential for harm. Exposure to hazard may threaten psychological and physical health (Clancy
& Mcvicar, 2014); the authors also suggests that effects of work hazard may be mediated by
direct physio-chemical mechanism and that organic solvents may have a psychological effect on
the nurse through their direct effects on the brain and through fear that such exposure might be
harmful. Several studies have tried to determine the link between stress and job satisfaction and
also identified some factors such as physical environment, role conflict and workload as stressors
(Mansoor, Fida, Nasir, and Ahmed 2011; McCann, Hughes, Adair and Cardwell 2009; Lui, Ngo
and Tsang 2010, Srivastava, 2008 and Ella, 1992) Physical work environment can be defined in
terms of lightening, noise, temperature, humidity, clean air, exposure to dangerous substances
( Mansoor et al 2011). A study of managers of Chinese restaurant in Honkong showed that the
physical work environment is one of the important determinants of job satisfaction. Furthermore
Srivastava‟s (2008) study of 360 technical supervisors showed that employees who perceived
their physical work environment as adequate are more satisfied with their jobs. A study by
Bailey, Steffen, and Grout (2014) on work hazard and job satisfaction among nurses in North
Carolina also revealed low level of job satisfaction as a result of work hazards. Poor working
environments are hazardous and very stressful and were believed to result in lack of job
satisfaction among the nurses.
Role Conflict and Nurses Job Satisfaction
Role conflict is generally defined as the simultaneous occurrence of two or more sets of
pressures, such that compliance with one would make compliance with the other more difficult
(Fie, Alarm, Abdullah and Ahsan, 2009 Ella 1992). Researchers have found that role conflict has
a significant negative impact on job satisfaction. (Mansoor, Fida, Nasir and Zubair 2011, Ella
1992). A study on role conflict among head nurses in Birmingham also revealed that role conflict
was associated with low job satisfaction and high propensity to leave (Lui, Hang-Yue, Wing-
Ngar & Tsang, 2010). Another study by McGillis (2013) on role conflict and nurses job
satisfaction using a random sample of 30 Registered Nurses selected from eight (8) hospitals
located in Toronto, Canada, showed that Registered Nurses in the study experienced high levels
of role conflict majorly due to lack of resources and differing perceptions of how work should be
carried out. Furthermore Dewe‟s (2014) study with 1,800 nurses in 29 hospitals in New Zealand,
identified role conflict as a major cause of job dissatisfaction among nurses. Dewe then made an
important point about the finding, that nursing role is associated with multiple and conflicting
demands imposed by nurse supervisors and managers, and by medical and administrative staff.
This kind of a situation appears to lead to role conflict which may be most obvious when dealing
with patients who are critically ill and dying, although perhaps less so when dealing with their
families. However, the study of Ella, (1992) on Role conflict and job satisfaction of nurse
educators in Cross River and Akwa Ibom states revealed no significant relationship between
nurse educators‟ role conflict and their job satisfaction.
Workload and Nurses' Job Satisfaction
Work load could be quantitative and could lead to boredom, apathy anxiety and tension, break
down, low morale and low self esteem. Nurses in Cross River State are often too overloaded with
work. A situation where one nurse on night duty attends to 20-30 patients in a ward can cause
frustration, anxiety low morale and conflict. This for sure is not an ideal climate in which a nurse
is expected to give her best; she may thus end up stressed with resultant lack of job satisfaction.
Albar Marin and Garcia-Ramirez (2012) in their study examined the effect of workload on
nurses‟ job satisfaction among hospital nursing staff in Serville, South of Spain. They found that
workload had significant effect on the level of stress and emotional exhaustion experienced by
the nurses at work. Nurses that have more work load have job stress and emotional exhaustion
than those who did not. Another study by Academy for Nursing Studies, (Claudio, 2014) for
Training Division, Ministry of Health and Family Welfare, Government of India, India, found
that the critical factors which affect the Indian nursing systems are shortage of staff and work
load Healy and McKay (2009) examined the impact of nursing work-related stressors and coping
strategies on levels of job satisfaction and mood disturbance in urban and regional medical
institutions in Australia. Result indicated that `workload' was the highest perceived stressor in
the nurses' working environment, which closely accords with the findings of (Tyler 2010 and
Cushway 2012). Effiom, Ejue and Eworo (2007) conducted a comparative study of occupational
stress among nurses and nonnurses in the University of Calabar Teaching Hospital (UCTH),
Calabar, Nigeria. The subjects consisted of sixty (60) nurses and sixty (60) non-nurses selected
through stratified random sampling. The study revealed that nurses of UCTH perceived heavy
workload as significant stress factor intrinsically more related to their work than their non-nurses
colleagues who perceived too much supervision as a significant stress factor more than nurses.
CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Introduction
This chapter covers the description and discussion on the various techniques and procedures used
in the study to collect and analyze the data as it is deemed appropriate
3.2 Research Design
For this study, the survey research design was adopted. The choice of the design was informed
by the objectives of the study as outlined in chapter one. This research design provides a quickly
efficient and accurate means of assessing information about a population of interest. It intends to
study the influence of stress on working behaviour of nurses. The study will be conducted in
Ogun state.
3.3 Population of the Study
The population for this study were nurses in federal medical centre abeokuta, Ogun state,
Nigeria. A total of 134 respondents were selected from the population figure out of which the
sample size was determined. The reason for choosing Ogun state is because of its proximity to
the researcher.
3.4 Sample and Sampling Techniques
The researcher used Taro Yamane’s formula to determine the sample size from the population.
Taro Yamane’s formula is given as;

n = N
1+N (e)2
Where N = Population of study (134)
n = Sample size (?)
e = Level of significance at 5% (0.05)
1 = Constant
.: n = 134 = 134 = 134
1 + 134 (0.05)2 1+134(0.0025) 1+0.335
n = 134 = 100
1.335
The sample size therefore is 100 respondents.
3.5 Research Instrument and Instrumentation
Data for this study was collected from primary and secondary sources. The primary source of
data collected was mainly the use of a structured questionnaire which was designed to elicit
information on the influence of stress on working behaviour of nurses. The secondary source of
data collections were textbooks, journals and scholarly materials.

3.6 Validity of Instrument
The instrument of this study was subjected to face validation. Face validation tests the
appropriateness of the questionnaire items. This is because face validation is often used to
indicate whether an instrument on the face of it appears to measures what it contains. Face
validations therefore aims at determining the extent to which the questionnaire is relevant to the
objectives of the study. In subjecting the instrument for face validation, copies of the initial draft
of the questionnaire will be validated by supervisor. The supervisor is expected to critically
examine the items of the instrument with specific objectives of the study and make useful
suggestions to improve the quality of the instrument. Based on his recommendations the
instrument will be adjusted and re-adjusted before being administered for the study.
3.7 Reliability of Instrument
The coefficient of 0.81 was considered a reliability coefficient because according to Etuk (1990),
a test-retest coefficient of 0.5 will be enough to justify the use of a research instrument.
3.8 Method of Data Collection
This study is based on the two possible sources of data which are the primary and secondary
source.
a. Primary Source of Data: The primary data for this study consist of raw data
generated from responses to questionnaires and interview by the respondents.
b. Secondary Source of Data: The secondary data includes information obtained through
the review of literature that is journals, monographs, textbooks and other periodicals.
3.9 Method of Data Analysis
Data collected will be analyzed using frequency table, percentage and mean score analysis while
the nonparametric statistical test (Chi- square) was used to test the formulated hypothesis using
SPSS (statistical package for social sciences). Haven gathered the data through the
administration of questionnaire, the collected data will be coded, tabulated and analyzed using
SPSS statistical software according to the research question and hypothesis. In order to
effectively analyze the data collected for easy management and accuracy, the chi square method
will be used for test of independence. Chi square is given as
X2 = ∑ (o-e)2
Where X2 = chi square
o = observed frequency
e = expected frequency
Level of confidence / degree of freedom
When employing the chi – square test, a certain level of confidence or margin of error has to be
assumed. More also, the degree of freedom in the table has to be determined in simple variable,
row and column distribution, degree of freedom is: df = (r-1) (c-1)
Where; df = degree of freedom
r = number of rows
c = number of columns.
In determining the critical chi _ square value, the value of confidence is assumed to be at 95% or
0.95. a margin of 5% or 0.05 is allowed for judgment error.

CHAPTER FOUR
DATA ANALYSIS AND INTERPRETATION
4.1 Introduction
This chapter deals with the presentation and analysis of the result obtained from questionnaires.
The data gathered were presented according to the order in which they were arranged in the
research questions and simple percentage were used to analyze the demographic information of
the respondents while the chi square test was adopted to test the research hypothesis.
4.2 Analysis of Demographic Data of Respondents
Table 1: Gender of Respondents
Frequency Percent Cumulative Percent

Valid Male 65 65.0 65.0
Female 35 35.0 100.0
Total 100 100.0

Source: Field Survey.
Table 1 above shows the gender distribution of the respondents used for this study. Out of the
total number of 100 respondents, 65respondents which represent 65.0percent of the population
are male. 35 which represent 35.0 percent of the population are female.
Table 2: Age range of Respondents
Cumulative
Frequency Percent Percent
Valid 20-30years 15 15.0 15.0
31-40years 10 10.0 25.0
41-50years 25 25.0 50.0
51-60years 20 20.0 70.0
above 60years 30 30.0 100.0
Total 100 100.0
Table 2 above shows the age grade of the respondents used for this study. Out of the total
number of 100 respondents, 15 respondents which represent 15.0percent of the population are
between 20-30years. 10respondents which represent 10.0percent of the population are between
31-40years. 25respondents which represent 25.0percent of the population are between 41-
50years. 20respondents which represent 20.0percent of the population are between 51-60years.
30respondents which represent 30.0percent of the population are above 60years.
Table 3: Educational Background of Respondents
Cumulative
Valid FSLC 20 20.0 20.0
WASSCE/GCE/NECO 25 25.0 45.0
OND/HND/BSC 35 35.0 80.0
MSC/PGD/PHD 15 15.0 95.0
OTHERS 5 5.0 100.0
Total 100 100.0
Table 3 above shows the educational background of the respondents used for this study. Out of
the total number of 100 respondents, 20 respondents which represent 20.0percent of the
population are FSLC holders. 25 which represent 25.0percent of the population are
SSCE/GCE/WASSCE holders. 35 which represent 35.0percent of the population are
OND/HND/BSC holders. 15 which represent 15.0percent of the population are MSC/PGD/PHD
holders. 5 which represent 5.0percent of the population had other type of educational
qualifications.
Table 4: Marital Status
Cumulative
Valid Single 30 30.0 30.0
Married 55 15.0 45.0
Divorced 5 20.0 65.0
Widowed 10 15.0 80.0
Total 100 100.0
Table 4 above shows the marital status of the respondents used for this study. 30 which represent
30.0percent of the population are single. 55 which represent 55.0percent of the population are
married. 5 which represent 5.0percent of the population are divorced. 10 which represent
10.0percent of the population are widowed.

4.3 Analysis of Psychographic Data
Table 5: There is a relationship between stress and job dissatisfaction among nurses
Cumulative
Valid Strongly agree 30 30.0 30.0
Agree 42 42.0 72.0
Undecided 10 10.0 82.0
Disagree 10 10.0 92.0
Strongly disagree 8 8.0 100.0
Total 100 100.0
Table 5 shows the responses of respondents if there is a relationship between stress and job
dissatisfaction among nurses. 30 respondents representing 30.0percent strongly agreed that there
is a relationship between stress and job dissatisfaction among nurses. 42 respondents
representing 42.0percent agreed that there is a relationship between stress and job dissatisfaction
among nurses. 10 respondents representing 10.0 percent were undecided. 10 respondents
representing 10.0percent disagreed that there is a relationship between stress and job
dissatisfaction among nurses. 8 respondents representing 8.0percent strongly disagreed that there
is a relationship between stress and job dissatisfaction among nurses.

Table 6: There is no relationship between stress among nurses and the safety of patients
Cumulative
Agree 15 15.0 25.0
Disagree 40 40.0 70.0
Total 100 100.0
Table 6 show the responses of respondents if there is no relationship between stress among
nurses and the safety of patients. 10 of the respondents representing 10.0percent strongly agree
that there is no relationship between stress among nurses and the safety of patients. 15 of the
respondents representing 15.0percent agree that there is no relationship between stress among
nurses and the safety of patients. 5 of them representing 5.0percent were undecided. 40 of the
respondents representing 40.0percent disagree that there is no relationship between stress among
nurses and the safety of patients. 30 of the respondents representing 30.0percent strongly
disagree that there is no relationship between stress among nurses and the safety of patients.
Table 7: Work stress has an impact on negative job attitude among nurses
Cumulative
Agree 25 25.0 85.0
Disagree 5 5.0 100.0
Total 100 100.0
Table 7 show the responses of respondents if work stress has an impact on negative job attitude
among nurses. 60 of the respondents representing 60.0percent strongly agree that work stress has
an impact on negative job attitude among nurses. 25 of the respondents representing 25.0percent
agree that work stress has an impact on negative job attitude among nurses. 10 of them
representing 10.0percent were undecided. 5 of the respondents representing 5.0percent disagree
that work stress has an impact on negative job attitude among nurses.
Table 8: Long working hours have a positive impact on the job performances of nurses in
federal medical centre abeokuta
Cumulative
Agree 32 32.0 57.0
Disagree 15 15.0 85.0
Total 100 100.0
Table 8 shows the responses of respondents if long working hours have a positive impact on the
job performances of nurses in federal medical centre abeokuta. 25 of the respondents
representing 25.0percent strongly agree that long working hours have a positive impact on the
job performances of nurses in federal medical centre abeokuta. 32 of the respondents
representing 32.0percent agree that long working hours have a positive impact on the job
performances of nurses in federal medical centre abeokuta. 13 of the respondents representing
13.0percent were undecided. 15 of the respondents representing 15.0percent disagree that long
working hours have a positive impact on the job performances of nurses in federal medical
centre abeokuta. 15 of the respondents representing 15.0percent strongly disagree that long
working hours have a positive impact on the job performances of nurses in federal medical
centre abeokuta.
Table 9: There are causes of work stress among nurses in federal medical centre abeokuta
Cumulative
Agree 30 30.0 95.0
Disagree 3 3.0 98.0
Total 100 100.0
Table 9 show the responses of respondents if there are causes of work stress among nurses in
federal medical centre abeokuta. 65 of the respondents representing 65.0percent strongly agree
that there are causes of work stress among nurses in federal medical centre abeokuta. 30 of the
respondents representing 30.0percent agree that there are causes of work stress among nurses in
federal medical centre abeokuta. 3 respondents representing 3.0percent were undecided. 3 of the
respondents representing 3.0percent disagree that there are causes of work stress among nurses in
federal medical centre abeokuta. 2 of the respondents representing 2.0percent strongly disagree
that there are causes of work stress among nurses in federal medical centre abeokuta.
Table 10: The senior health workers in federal medical centre abeokuta increases the stress
nurse go through
Cumulative
Agree 42 42.0 72.0
Disagree 10 10.0 92.0
Total 100 100.0
Table 10 shows the responses of respondents if the senior health workers in federal medical
centre abeokuta increases the stress nurse go through. 30 respondents representing 30.0percent
strongly agreed that the senior health workers in federal medical centre abeokuta increases the
stress nurse go through. 42 respondents representing 42.0percent agreed that the senior health
workers in federal medical centre abeokuta increases the stress nurse go through. 10 respondents
representing 10.0 percent were undecided. 10 respondents representing 10.0percent disagreed
that the senior health workers in federal medical centre abeokuta increases the stress nurse go
through. 8 respondents representing 8.0percent strongly disagreed that the senior health workers
in federal medical centre abeokuta increases the stress nurse go through.
4.4 Test of Hypothesis

Hypothesis I
H0: There is no significant relationship between stress and job dissatisfaction among nurses.
Hi: There is a significant relationship between stress and job dissatisfaction among nurses.
Level of significance: 0.05
Decision rule: reject the null hypothesis H0 if the p value is less than the level of significance.
Accept the null hypothesis if otherwise.
Table 11 Test Statistics
There is a significant relationship between stress and job

dissatisfaction among nurses
Chi-Square 105.520a
Df 3
Asymp. Sig. .000
a. 0 cells (.0%) have expected frequencies less than 5. The minimum expected cell frequency is 25.0.
Conclusions based on decision rule:

Since the p-value= 0.000 is less than the level of significance (0.05), we reject the null
hypothesis and conclude that there is a significant relationship between stress and job
dissatisfaction among nurses.
Hypothesis II
H0: There is no significant relationship between stress among nurses and the safety of patients.
Hi: There is a significant relationship between stress among nurses and the safety of patients.

There is a significant relationship between stress among

nurses and the safety of patients
Chi-Square 74.520a
Df 2
Asymp. Sig. .000
hypothesis and conclude that there is a significant relationship between stress among nurses and
the safety of patients.
Hypothesis III
H0: Work Stress does not have a significant impact on negative job attitude among nurses.
Hi: Work Stress has a significant impact on negative job attitude among nurses.
Work Stress has a significant impact on negative job attitude

among nurses
Chi-Square 74.520a
Df 2
Asymp. Sig. .000

hypothesis and conclude that work Stress has a significant impact on negative job attitude among
nurses.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 SUMMARY OF FINDINGS
The purpose of this study was to investigate the influence of stress on work behavior among
Nurses in Federal Medical Centre Abeokuta. Three hypotheses were formulated (generated) to
guide the researcher. The first was meant to find out if There is a significant relationship between
stress and job dissatisfaction among Nurses. The research also sought to uncover whether There
is a significant relationship between stress among nurses and the safety of patients. The third
hypothesis sought to find out whether Work Stress has a significant impact on negative job
attitude among nurses.
To attain these goals, a test questionnaire was randomly administered to nurses in federal
medical centre Abeokuta Ogun State. During data analysis, the student t-test analysis was
employed.
The analyses of collected data revealed that a significant relationship between stress and job
dissatisfaction among Nurses. The analysis also revealed a significant relationship between stress
among nurses and the safety of patients. More so, the analysis of work Stress has a significant
impact on negative job attitude among nurses. Hence, the null hypotheses were rejected.
5.2 CONCLUSION
Job stress has potentials to determine nurses‟ job satisfaction in a hospital. Some of their
intrinsic or extrinsic needs may be thwarted or not be met sufficiently. The findings imply that
nurses experience job stress in the form of workload, multiple conflicting roles and physical
work environment experienced lower job satisfaction and vice versa. Nurses who are exposed to
conducive work environment usually perform their job effectively and easily attain satisfaction
in the performance of their job.
It is widely accepted that nurses are exposed to various stress sources from physical
psychological and social working environment. It seems imperative that nurses are identifying
the perceived sources of stress and are assisted in applying knowledge to practice. Such a
positive approach will motivate and nurture the confidence in the nurses, creating a positive
socialization which in turn will increase job satisfaction and will reduce the level of stress. This
will allow the modifications of the stress management programme for the policy maker and
organizations to address specific factors rated as most stressful. As revealed in this study, the
presence of stress among the nurses also make them to engage in withdrawal, displaced or hostile
aggressive behaviour to their patients and other people alike. Hence, under stressful working
conditions, they could not give humane treatment to their patients.
5.3 RECOMMENDATIONS
To ensure that efficient nursing care is given to the patients, the government (Federal, State) the
Ministries of Health or the hospital management boards should help in reducing sources of stress
in the nurses. Their working conditions need to be quickly improved by giving them adequate
salary that commensurate with the demands of their jobs. Their promotion should be done as at
when due to boost their morale. They should also be involved in vital decisions concerning their
jobs and their patients. In-service training, workshops and seminars should be organized for
nurses to update their knowledge and skills. They should be sent for courses on human
behaviour, resource management, interpersonal relation, stress management and crisis

interventions. It is hoped that when nurses are given adequate support by their employers or
when their needs are adequately met many of them will experience less tension or stress at work.
They will become less aggressive or hostile to the patients or their families. The patients will
also receive better and adequate nursing care from them.
Other recommendations include the following:
 The Nurse Managers should ensure the suitability of individual nurses for each job before
assigning tasks, and the challenge of task should be based on the objective of each nurse in order
to maintain good mental health among nurses
 Psychological counseling and therapy should be easily assessable and available for troubled
staff members
 Clear work practices and policies, for both the physicians and nurses, can help reduce conflict
among health workers
 Employing more nurses is an obvious potential remedy for reducing workload

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APPENDIX I
QUESTIONNAIRE
INSTRUCTION: Please endeavor to complete the questionnaire by ticking the correct
answer (s) from the options or supply the information where necessary.
1. Gender
a. Male
b. Female
2. Age range
a. 20-30
b. 31-40
c. 41-50
d. 51-60
e. Above 60
3. Educational qualification
a. FSLC
b. WASSCE/GCE/NECO
c. OND/HND/BSC
d. MSC/PGD/MBA/PHD
e. Others
4. Marital Status
a. Single
b. Married
c. Divorced
d. Widowed
SECTION B
QUESTIONS ON THE INFLUENCE OF STRESS ON WORKING BEHAVIOUR OF
NURSES.
5. There is a relationship between stress and job dissatisfaction among nurses.
a. Strongly agreed
b. Agreed
c. Undecided
d. Disagreed
e. Strongly disagreed
6. There is no relationship between stress among nurses and the safety of patients.
a. Strongly agreed
b. Agreed
c. Undecided
d. Disagreed
7. Work stress has an impact on negative job attitude among nurses.
a. Strongly agreed
b. Agreed
c. Undecided
d. Disagreed
8. Long working hours have a positive impact on the job performances of nurses in
federal medical centre abeokuta.
a. Strongly agreed
b. Agreed
c. Undecided
d. Disagreed
9. There are causes of work stress among nurses in federal medical centre abeokuta.
a. Strongly agreed
b. Agreed
c. Undecided
d. Disagreed
10. The senior health workers in federal medical centre abeokuta increases the stress nurse
go through.
a. Strongly agreed
b. Agreed
c. Undecided
d. Disagreed

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THE INFLUENCE OF STRESS ON WORK BEHAVIOR AMONG

1.1 Background of the Study

is necessary occasionally as a push to increasing functional capacity, but when it is experienced

over a prolonged period it becomes detrimental to health leading to a decline in productivity

(Salleh, M.R., 2008).

individual; however, individuals’ assessment of an event, their perceptions and interpretations

strenuous to one person may be stimulating to another (Robinson, M. D. et al., 2011).

health care giver leading to stress or burn out syndrome.

leads to stress (Khamisa, N., 2015).

1.2 Statement of the Problem

in willingness to help others (Abushaikha, L. and Saca-Hazboun, H., 2009).

perceive stress (Robinson, M. D. et al., 2011).

experience burnout. Another person, however, can be exposed to a significant amount of

greatly dependent on individual differences (Truby, B., 2009).

1.3 Objectives of the Study

Federal Medical Centre Abeokuta

Federal Medical Centre Abeokuta.

1.4 Research Questions

The relevant research questions related to this study are:

Medical Centre Abeokuta?

Medical Centre Abeokuta?

1.6 Significance of the Study

will likely carry out a study on a related topic.

contributes to knowledge and could serve as a guide for other study.

1.7 Scope of the Study

nurses in federal medical centre Abeokuta.

1.8 Limitations of the study

resources in covering extensive literature available in conducting this research. Information

(internet, questionnaire and interview).

1.9 Definition of Terms

requirements outlined by a country, state, province or similar government-authorized licensing

regulated by a professional body or council.

closely related problems.

2.2 CONCEPTUAL FRAMEWORK

Problems in staff’s behavior

job satisfaction and stress.

Consequences on physical health

immunodeficiency syndrome. Only a proportion of people develop clinical disease when

coronary heart disease and cancer.

endangers important goal commitment and situational intentions, or violates expectations.”

inadequate facility of canteen/mess, lack of recreational facilities.

INTRAPERSONAL FACTORS: Change in eating pattern, engagement/marriage, homesickness

in hostel, change in sleeping pattern, new responsibilities of life, personal preoccupations,

change in religious beliefs

rotation and written examination especially their final examination.

THE EFFECTS OF STRESS ON NURSING STUDENTS INCLUDE

students or prolonged stress can cause:

- Memory problems and inability to concentrate in the studies.

- depression or general unhappiness and

- Sleep disturbance, It may even lead to burnout.

Physical symptoms include:

- elevated blood pressure

- Excessive sweat palms

- Tightness in the chest and pain

- Pain in the neck, jaw and back muscles

- Susceptibility to minor illness

- decreased self esteem and confidence

- diminished sense of meaning in life

- Lack of control or the need for too much control