Stress level among nurses that work in ER department in Nigeria and their work life balance.

Abstract
It is undeniable that stress within the nursing profession has become increasingly concerning over the years, which is why is it is imperative to understand the effects this can have upon nurses. Accordingly, stress not only affects nurses mentally but it can also have an effect upon their performance and the care they provide to patients. This is a serious matter and unless stress is dealt with effectively, the nursing profession will be in a state of discontent. The burnout syndrome is widespread amongst Nigerian nurses; though the stress levels amongst Nigerian nurses working within emergency departments is evidently more prevalent than the stress levels of other departments. This signifies the importance of tackling stress by documenting the causes and extent of stress, in order for successful interventions to take place.
Proposed Plan of Work

Introduction
It is vital that all nurses have a work-life balance in order to ensure that stress levels are significantly reduced. Yet it is very difficult to achieve this in practice and nurses are often being subjected to the burnout syndrome, which results from the chronic exposure to work-related stresses. Thus, burnout is defined as “a state of continual physical and mental exhaustion” (Simmons, 2012, p. 25), which leads to a disconnection from both work and home life. This can have serious consequences if not dealt with effectively, which is why more needs to be done to tackle workplace stresses. This is especially the case when it comes to emergency departments since nurses are under a lot more pressure in the job and are subjected to greater physical demands than other departments. Consequently, it is believed that “emergency departments should be screened regularly on job and organisational characteristics to identify determinants of stress-health outcomes that can be the target of preventive interventions” (Adriaenssens, 2011, p. 1). Essentially, it is therefore important that the stress level among nurses that work in Emergency departments in Nigeria are reduced and that a work-life balance is being attained by all nurses.
Research Aims and Objectives
The aims and objectives of this research are to determine the stress levels amongst Nigerian nurses in order to determine whether they are receiving a work-life balance. This will enable a determination to be made as to whether interventions are needed to reduce the stress levels and whether Nigerian nurses working in emergency departments are more prone to stress than those working in other departments. Consideration as to how these nurses cope with stress will also be established, followed by an assessment as to what improvements need to be made in order to prevent nurse shortage ensuing within the emergency department.
Research Questions
Is stress prevalent amongst nurses in general?
What are the levels of stress nurses within emergency departments subjected to and how does this compare with other departments?
Are nurses working within emergency departments in Nigeria more likely to suffer from stress than those working in other departments?
How do nurses cope with stress?
What is nurse burnout?
How serious is nurse burnout and in what ways can it be tackled?
Are poor working conditions one of the main factors causing stress?
Do Nigerian nurses working in emergency departments have a work-life balance?
What interventions are needed to reduce the stress levels of Nigerian nurses?
Is stress likely to result in nurse shortage?
Predictions
The underlying objective of this study is to determine the effect stress has upon nurses in Nigerian emergency departments and to consider present stress levels, whilst also analysing the work-life balance of these nurses.
H1. Stress levels amongst Nigerian nurses are increased in emergency departments.
H2. Nurse burnout is one of the main causes of stress.
H3. Poor working conditions ultimately lead to stress.
H4. Stress is likely to result in nurse shortage.
H5. Nurses within emergency departments are subjected to higher levels of stress than nurses working in other departments.
H6. It is important that stress amongst nurses is being sufficiently tackled.
H7. Improvements to the working conditions of nurses would allow a work-life balance to be achieved.
Key Words
Nigerian Nurses
Stress Levels
Burnout
Nigerian Emergency Departments
Working Conditions
Work-Life Balance
Intervention
Methodology
Design
A quantitative research approach will be utilised for this assignment in order to develop theories and hypotheses pertinent to the observations being made about the stress levels of Nigerian nurses working in emergency departments. Measurement is one of the main aspects of quantitative research and for this reason it is important that definitive comparisons between empirical observation and mathematical expression of quantitative connections are made throughout this study. Data collected under this type of research consists of any data in numerical form such as statistics. Furthermore, quantitative data will also be collected from the use of questionnaires by asking participants various questions that are relevant to the hypothesis. Numerical data will then be collected and statistically analysed to answer the question using the data received. It is hoped that the data collected will help to determine the correlation between stress and health in nurses that work in emergency departments, whilst also considering how nurses cope with their personal life and the effects stress has on their work-life balance. The data that is to be analysed will be collected from applicable text books, journal articles, online databases and governmental reports. These will consist of both primary and secondary resources which will ensure that a deeper understanding of the subject matter can be acquired, whilst also obtaining an overall assessment of the stress levels amongst Nigerian nurses in emergency departments. An objective and subjective approach will be employed in doing so, as this will ensure that divergent viewpoints are incorporated into the study which will enable a critical evaluation to be made. The collection of immediate data will thus allow a proper assessment to be made as to the impact stress has upon nurses and an overview as to what changes ought to be made will be provided. The secondary data will enable the current phenomena surrounding the stress levels of Nigerian nurses to be analysed which will allow the requirements of the study to be satisfied. Although secondary data is considered to be less reliable than primary data, it is important that the study includes existing observations of the hypotheses.
Participants
Since it would be unrealistic to study every nurse working within an emergency department in Nigeria, it is essential that only a pool of participants is selected. Furthermore, whilst it must be ensured that this pool is small, because of the impracticalities that would arise from studying a large pool, it is important that the amount of nurses studied is sufficient enough for the research question to be answered appropriately. Accordingly, approximately 100 voluntary participants will be used for this study and will consist of nurses from a specialist governmental hospital in Nigeria namely; Gwagwalada clinic and maternity in Abuja. In considering whether this sample size is appropriate, a power and sample size estimation will need to be undertaken. Therefore, it will need to be assessed whether “there is the possibility of harmful effects from participating in the study” (Taylor and Kermode, 2006, p. 207). Consequently, it will need to be shown that the study will achieve the desired outcome (power) and that the number of people participating will help to achieve this (sample size). In addition, the data being collected must be measurable on the same scale and the sample size must not be too high. This is because, unnecessary time and expense would otherwise be utilised which would be detrimental to the study overall. Here, the power and sample size estimation has been satisfied since the data is of the same scale and measurement and the sample size does appear reasonable.
Materials
A questionnaire will be used for this study in order to determine the personal effects in which stress has upon the participants. In doing so, the Hospital Anxiety & Depression Scale (HADS) will be utilised so that the levels of anxiety and depression can easily be determined. The HADS was originally developed by Zigmond and Snaith (1983, pp. 361-370) and has been considered an effective way of measuring health (McDowell, 2006, p. 297) by looking at items on the questionnaire that relate to anxiety and depression. Once each item has been identified a score of 0-3 will then be given, which will allow a decision to be made as to the level of anxiety and depression that is prevalent amongst these nurses. The use of questionnaires is highly beneficial to this study as the impact in which stress has upon individual nurses in Nigeria will be more easily determined. In addition, the information that is gathered will be more applicable to the study and will help to address the concerns raised in the studies aims and objectives. Furthermore, the answers received will also be relevant to the hypotheses and a detailed account of the existing stress levels amongst nurses will be provided.
Procedure
Steps to be taken in the research process;
Step 1: Determine the purpose of the research and identify the problem
Step 2: Determine who the research project is aimed and review current literature surrounding the issue
Step 3: Consider the requirements of the study and any limitations
Step 4: Investigate the topic by gathering relevant information to be analysed
Step 5: Consider what elements of the topic are the most important to the study
Step 6: Define the population that is to be studied
Step 7: Develop a data plan
Step 8: Collect the applicable data
Step 9: Analyse the data that has been collected
Step 10: Compare the data collected with existing data in order to determine whether hypotheses has been answered
Literature Review Summary
Nurses generally deal with life threatening conditions in all emergency departments and so are often faced with medical dilemmas which need to be dealt with immediately. Consequently, it is thus unsurprising that the working conditions can become rather strenuous, which ultimately leads to nurse burnout (Masters, 2009, p. 320). As a result of this, it is vital that various measures are implemented in all emergency departments so that the stress levels of nurses can be reduced. This will prevent nurse burnout from taking place and a work-life balance will be more easily ascertained. Whilst nurses are trained to deal with the difficulties they may face, it is important that the health and safety of nurses is also being given due consideration because “chronic stress takes a toll when there are additional stress factors like home stress, conflict at work, inadequate staffing, poor teamwork and poor supervision” (Kane, 2009, p. 28). Therefore, in order to avoid nurse burnout, it is necessary that all of these factors are avoided from the outset, since this would otherwise lead to inadequate care being provided to patients. Hence, it is therefore imperative that nurses have a work-life balance since this guarantees optimum performance (Nursing Times, 2011, p. 1). In order for a work–life balance to be achieved, it is important to firstly identify the causes of stress. This will allow effective changes to be implemented, which will help to avoid nurse burnout from being instigated in the first place.
Unless the problems surrounding stress are acknowledged by emergency departments, it will not be tackled effectively. Emergency departments within underdeveloped countries, such as Nigeria, do appear to have greater stress levels than those within developed countries. This illustrates how a lack of resources will ultimately lead to inadequate conditions for nurses and as put by (Lasebikan and Oyetunde, 2012, pp. 1-2); “A growing recognition of job stress leading to dissatisfaction among registered nurses in Nigerian hospitals has contributed to current problems with recruitment and retention of nurses.” In accordance with this, it is likely that stress within emergency departments will result in nurse shortages. This is because; nurses will not want to be subjected to stressful conditions, which is why the causes of stress need to be dealt with efficiently. Despite the awareness surrounding these issues, it is clear that nurse burnout does commonly occur throughout Nigerian hospitals. As absurd as this may seem, it is evident that stress is being insufficiently dealt with. Consequently, various measures therefore need to be implemented in order to reduce the levels of stress that occur within Nigerian emergency departments, yet it remains to be seen what measures will in fact be implemented.
Conclusion
Overall, it is evident that stress levels are prevalent amongst nurses within Nigerian emergency departments, which is largely due to the added pressure that nurses within these departments are being subjected to. Regardless of this, it seems as though stress can in fact be reduced provided that the problems associated with stress are properly dealt with. Whether this will ever be attained is questionable since it seems as though there has been an awareness of this problem for some time, yet Nigerian hospitals have still failed to implement adequate measures dealing with nurse burnout. Essentially, it is important that something is done to reduce the stress that currently persists as this may ultimately lead to nurse shortages within emergency departments. This would substantially affect the care that is currently provided to Nigerians and the emergency departments would be significantly affected as a result.
Data Analysis
Subsequent to all of the relevant data being collected, it will then need to be analysed so that a determination can be made as to whether stress levels within Nigerian emergency departments are high. In doing so, however, the data will first need to be cleaned through the inspection of each source so that a decision can be made as to whether the data should be used for the study: “the quality of the research should be judged in relation to the resources available and the effectiveness with which those resources have been used to investigate the particular topic in question” (Denscombe, 2009, p. 53). Once a thorough investigation of the collected data has been made, it can then be determined what data is most applicable to this particular study.
Ethics
There are a number of ethical issues that will need to be addressed when undertaking this study since the fundamental issues surrounding this topic are extremely sensitive. As such, it is necessary to ensure that the confidentiality and anonymity of the participants of the study are maintained and that permission to use the data collected is first obtained (Dawson, 2009, p. 150). The ethical rules of conduct will also need to be conformed to, which means that any data collected must be used in a way that is “honest, unbiased, sincere, free from errors or negligence, open to critique and it must protect confidential communications” (Rensik, 2011, p. 1). This can be achieved by adopting a risk-analysis approach and by conforming to the BPS guidelines. A letter of introduction and an ethics checklist will also be completed and provided to the hospital in order to gain their consent to carry out the research.
References
Adriaenssens, J. (2011) A&E Staff Need Regular Stress Screening, Nursing Times, [Online] Available: http://www.nursingtimes.net/nursing-practice/clinical-zones/accident-and-emergency/ae-staff-need-regular-stress-screening/5027021.article [13 January 2013].
Dawson, C. (2009) Introduction to Research Methods: A Practical Guide for Anyone Undertaking a Research Project, How to Books Ltd, 4th Edition.
Denscombe, M. (2009) Ground Rules for Social Research: Guidelines for Good Practice. 2nd edn. McGraw-Hill International.
Kane, P. P. (2009) Stress Causing Psychosomatic Illness Among Nurses, Indian Journal of Occupational Environment Medicine, vol. 13, no. 1.
Lasebikan, V. O. and Oyetunde, M. O. (2012) Burnout among Nurses in a Nigerian General Hospital: Prevalence and Associated Factors, US National Library of Medicine National Institutes of Health, [Online] Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3350958/#B7 [14 January 2013].
Masters, K. (2009) Role Development in Professional Nursing Practice, Jones & Bartlett Publishers, 2nd Edition.
McDowell, I. (2006) Measuring Health: A Guide to Rating Scales and Questionnaires, Oxford University Press.
Nursing Times. (2011) How’s Your Work-Life Balance[Online] Available: http://www.nursingtimes.net/nursing-practice/clinical-zones/educators/hows-your-work-life-balance/5030453.article [14 January 2013].
Resnik, D. B. (2011) What is Ethics in Research and Why is it Important?’ [Online] Available: http://www.niehs.nih.gov/research/resources/bioethics/whatis/ [14 January 2013].
Simmons, S. (2012) Striving for Work-Life Balance, American Journal of Nursing, vol. 112, no. 1.
Taylor, B. and Kermode, S. (2006) Nursing Research 3e, Cengage Learning in Australia, 3rd Edition.
Zigmond, A. S. and Snaith, R. P. (1983) The Hospital Anxiety and Depression Scale, Acta Psychiatrica Scandinavica, vol. 67, no. 6.