Title                                                                                                                             i

Approval                                                                                                                     ii

Certification                                                                                                                iii

Dedication                                                                                                                  iv

Acknowledgement                                                                                                      v

Table of Contents                                                                                                       vi

List of Tables                                                                                                              ix

List of Appendices                                                                                                     x

Abstract                                                                                                                   xiii

Chapter One: Introduction

Background of the Study                                                                                           1

Statement of Problem                                                                                                             5

Purpose of the Study                                                                                                  6

Hypotheses                                                                                                                 6

Significance of the Study                                                                                           7

Scope of Study                                                                                                           8

Operational Definition of Terms                                                                8

Chapter Two: Literature Review

The Concept of Stress                                                                                                 9

The Concept of Occupational Stress                                                           9

The Concept of Occupational Stress Management                     19

Age and Career Stage (Rank)                                                                25

Theory Underpinning the Study                                                               28

Application of the Model to the Present Study                                    31

Empirical Review                                                             33

Summary of Literature Review                                                            44

Chapter Three: Research Methods

Research Design                                                                                                         46

Area of Study                                                                                                             46

Population Study                                                                              47

Sample Technique                                                                             48

Instrument for Data Collection                                                                49

Ways of Coping Questionnaire                                                          49

Validity of the Instrument                                                                   51

Reliability of the instrument                                                   51                               

Ethical Consideration                                                                        52

Procedure for Data Collection                                                         52

Method of Data Analysis                                                                     52

Chapter Four: Presentation of Results

Demographic Correlates of Respondents                                                55

Test of Significance                                                                          65

Summary of major Findings                                                                           100

Chapter Five: Discussion of Findings

Discussion of Major Findings                                                                         101

Conclusion                                                                                                     110

Implication for Nursing                                                                                  111

Limitations of the study                                                                                 112

Summary of the study                                                                    112

Suggestion for Further Studies                                                                       114

Recommendation                                                                                            114




Figure 1:         Conceptual Framework of Transactional Model    32                                                                                                       


Table 1:           Demographic Characteristics of Respondents.              56       

Table 2:           Mean and Standard Deviation of the Respondents on

the Level of Stress.                                                                             58       

Table 3a:          Item by Item ANOVA on the level of stress experienced

by the nurses across the four tertiary hospitals.                                  61

Table 3b:         Mean and SD of respondents’ level of stress in the 4

hospitals across the stressors.                                                              65

Table 3c:          Summary of the respondents’ level of stress in the 4 hospitals.         66

Table 4:           Mean and Standard Deviation of the Respondents on the coping strategies by the Nurses in the Tertiary Hospital.     67                   

Table 5:           Item by item analysis of variance of respondents’ mean ratings of coping strategies in the 4 hospitals.                                                71

Table 5b:         Mean and SD of the respondents on the coping strategies used by the nurses across the tertiary hospitals.                                 74

Table 5c:          Summary of the ANOVA of the coping strategies of respondents across the 4 hospitals.                                         75    

Table 5d:         Scheffe and Tamhene multiple comparison analysis.                         76

Table 6:           Item by item T-test of mean ratings of respondents educational status and coping strategies.                                    77

Table 7:           Summary of the T-test analysis of the mean ratings of respondents’ coping strategies with respect to their educational status.                                                                              80

 Table 8:          Item by Item Anova for the Respondents Mean Ratings of

Coping Strategies with Respect to their years of Experience.            81

Table 9:           Summary of the Anova result for difference in the mean ratings of Coping Strategies by Respondents with different Years of Experience.                                                 84                                                       

Table 10:         Item by Item Anova for Respondents Coping Strategies and their Ages.                                                                                           85

Table 11:         Summary of the Anova of the Respondents Ages with their

mean ratings of Coping Strategies.                                                     88

Table 12:         Item by Item T-Test Analysis for the Respondent’s Mean

Rating of Coping Strategies and their Martial Status.                        89

Table 13:         Summary of T-Test for difference between Mean Ratings of

Married and Single respondents on their Coping Strategies.             92

Table 14:         Item by Item analysis of the Respondents Mean Ratings of

Coping Strategies and their Ranks.                                                    93

Table 15:         Summary of ANOVA of the respondent’s mean rating

of coping strategies and their rank.                                                     98

Table 16:         Tamhene Multiple comparison analysis across the ranks.                   99


Appendix I:                 Proportionate determination of sample across the 4 hospitals.                                                            122                                                                                         

Appendix I1:              Determination of the sample across area of work and rank of respondents from   the tertiary hospitals.    123                 

Appendix I11:              Letter of introduction from the Head of Department, Nursing   Sciences.                                 125                                                    

Appendix1V:              Ethical Approval.                                                        126

Appendix V:               Questionnaire.                               127                                  

Appendix VI:              Reliability of instrument.                                            133

Note: All cited material in the study were referenced.


This study was designed to determine the Occupational Stressors and Coping strategies of nurses in Tertiary Hospitals in Enugu State. The study sought answers to four research objectives and tested seven hypotheses. The population of study consisted of four hundred and twenty-two nurses in tertiary hospitals in Enugu state. They were sampled using stratified proportionate and clustered sampling techniques. Fifty eight (68) question items questionnaire  (demographics variables, level of stress questions and Ways of Coping Questionnaire ) was the instrument used  for the data collection. The instrument was validated by three experts and two personnel managers and Cronbach alpha Reliability coefficient was used to determine the internal consistency of the instrument. The instrument yielded a reliability coefficient of 0.88 and 0.85 respectively. Frequency counts, percentages, mean statistics and standard deviations were used to answer the  research objectives while seven hypotheses were tested using t-test and analysis of variance (ANOVA) at 0.05 level of significance. The major findings of the  study showed that almost all the respondents were females (92.25%), a greater percentage (85.75%) were married, also majority (95%) had no training on occupational stress management. The level of stress experienced by nurses across the four hospitals are the same with work environment as the greatest stressor. The most used strategy by respondents in the 4 hospitals was planful problem solving and problem focused coping while the least used strategy was the escape-avoidance. There is significant difference in the use of coping strategies (EFC and PFC) across the 4 hospitals. Respondents from ESUT Teaching Hospital differed from respondents in the other hospitals in the use of EFC, while respondents from NOHE differed from others in the use of PFC. The use of EFC depends on the respondents’ educational status. The use of coping strategies (PFC and EFC) is same for both the married and single. There is no significant difference in the use of coping strategies (PFC and EFC) by the respondents across their ages and their years of working experience.  Use of EFC is same across the professional ranks while the use of PFC varies across the ranks. Respondents in the rank of ADNs showed the most use of the 2 coping strategies (PFC and EFC) while NO1 showed the least use of EFC and PFC. The study has implication for the nurses, nurse administrators and hospital managers. Work environment should be maintained in such a way that it will be conducive for the nurses to perform their jobs. Nurses should aspire to acquire higher degrees in nursing. Periodic assessment of nurses stress levels should be done and actions put in to reduce, alleviate or aid coping among nurses.  Senior nurse should coach younger ones on better ways of

 coping with stress.



 Background to the Study

Work is an essential need for everyone. It is estimated that over 75% of adult’s non-sleeping time is devoted to job activities and people find satisfaction and personal identity by means of their employment. Among life events the workplace stands out as a potentially important source of stress purely because of the amount of time spent in this setting (Scott, 2012). Employees are exposed to tension, frustration and anxiety as they go about the task assigned to them.  The negative effect of work on an individual is referred to as occupational stress (OS).

 Nakasis and Ouzoni (2008) defined occupational Stress (OS) as the harmful physical and emotional responses that occur when the requirements of the job do not match the resources, capabilities and needs of the worker. Occupational stress is also referred to as a pattern of emotional, cognitive, behavioral and physiological reactions to adverse and noxious aspects of work content, work organization and work environment (European Commission, 2008). Occupational stress is a condition arising from the interaction of people and their job and is characterized by changes within the people that force them to deviate from normal functioning. OS arises when the individual normal coping responses cannot be found (that is, the individual is unable to cope anymore) and as such not able to get along with his job resulting in propensity to leave the organization, absenteeism to mention a few. OS is also seen on a process in which a professional’s attitude and behavior change in negative ways in response to job stressors.

OS is a growing global concern as all countries, profession and all categories of workers, families and societies are affected by occupational stress. Over the past two decades there has been a growing belief that the experience of stress at work has undesirable effects, both on the health of the employee and the effectiveness of the organization. Stress is second in frequency health problem with regards to occupational environment (Moustaka, Antoniadon, Malliarrou, Zanthos, Kiriaki and Constatinidis, 2010). In the UK, occupational stress is estimated to be the largest occupational health problem (Edward & Barnard, 2008). World Health Organization (WHO) has viewed it as a world wide epidemic as it has recently been observed to be associated with 90% of visits to physicians.

Occupational stress has been associated with chronic health problems like cardiovascular diseases, musculoskeletal disorders, physical injuries and cancers (Alves, 2005). Significantly, it reduces brain functions such as memory, concentration and learning and also impairs the immune system, all of which are central to effective performance at work. Occupational stress adversely affects performance in the workplace due to factors such as absenteeism, lower productivity, employees’ turnover and industrial accidents. Figure given by the Health and Safety Executive (2001) in the UK suggests that stress related medical problems are responsible for the loss of 6.5 million working days each year which in turn cost organizations in UK around three hundred and seventy (370) million dollars (about five hundred and eighteen million US dollars) (Sutherland & Cooper, 2002). US business and industry lose about five hundred and fifty (550) million working days annually because of absenteeism and 54% of these cases are stress – related (Lin, 2007).

The problem of occupational stress is not limited to these regions. Although, there is paucity of data as regards the impact of occupational stress in the sub-region of Africa and Nigeria to be precise, it has been defined as a “global epidemic” by the United Nations International Labor Organization.

Occupations in the field of human services are considered to be high stress occupations dealing with diverse social as well as individual problems. OS is a major occupational health problem for health care professionals especially nurses. Nurses provide care for three (3) types of clients: individuals, families and communities. This involves, promoting health and wellness, preventing illness, restoring health and caring for the dying.  Nizamd et al (2006) stated that caring for individuals, families, groups, population or entire communities with multiple, complex and distressing problems can be overwhelming for even the most experienced practitioner. Nurses encounter complex and stressful conditions due to special demands of their profession which enhances their vulnerability to occupational stress (OS). Stress among nurses is an endemic problem and nursing is known to be stressful through out the world (Onasoga, Ogbebor and Ojo, 2013). Nad (2009), stated that nursing is emotionally, physically and psychologically demanding. Many nursing tasks are by normal standards distasteful and disgusting, others are often degrading while some are simply frightening.

Most studies on occupational stress management have viewed it as a response to a stressor. Occupational stress management strategies refer to measures initiated by an individual or organization that aim at reducing the presence of work related stressor or assisting individuals to minimize negative outcomes of exposure to these stressors. It could be referred to as physical and psychological resources used to counter the effects of occupational stress or to cope with the stress. In the present study, coping is synonymous to occupational stress management. Coping has been considered as a very crucial element in the stress literature as individuals under stress can use various coping strategies to buffer, minimize or tolerate the effects of the stressor (Lin, 2007). It could also be seen as effort, whether cognition or action that people use to cope with environmental stressors. Such efforts could be problem focused or emotion focused strategies. The strategies include; confrontive coping, distancing, self-controlling, seeking social support ,accepting responsibility, escape-avoidance, planful–problem solving and positive reappraisal (Lambert and Lambert,2008).Problem focused strategies are highly action focused and involve altering or managing the problem that is causing the stress while emotion focused strategies refer to those strategies that help the individual reduce the negative emotional response associated with stress such as embarrassment, fear, anxiety to mention a few. Studies have shown evidence that use of coping strategies can have beneficial effect on both the employer and the employees, enhancing work satisfaction, reducing rate of absenteeism and turn over and also workplace related tension (Lin, 2007; Lambert & Lambert,2008).

In the previous studies, it was reported that nurses used mostly problem-focused coping rather than emotion-focused coping strategies and that nurses used a variety of coping strategies in order to deal with numerous workplace stressors (Chang et al., 2006; Tyson & Pongruengphant, 2004; Xianyu & Lambert, 2006; Welbourne et al., 2007).

Studies have shown that some demographic variables have significant association with coping strategies adopted by nurses (Jose & Bhat, 2013; Payne, 2001). Some of these variables are age, marital status, married status, years of working experience, experience in current area, area of work and daily working hours. Each coping strategy function independently in stressful situations, the type of strategy adopted largely depends on the specific profile of the individual’s stress perception and demographic characteristics (kariv & Heiman, 2013).

It has been established that nursing is stressful (Nad,2009; Papageorgiou, Karabetsou, Nikolakou & Paylakou, 2007)  but work on how nurses cope or manage occupational stress and the demographic determinants are rather few and inconclusive. In order to fill this gap in knowledge, this study, therefore, investigated the coping behavior of nurses to work-related stress in tertiary hospitals in Enugu State.

Statement of Problem