See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/372175566

Occupational Stress and Its Effects on Nurses at a Health Facility in Ho

Municipality, Ghana

Article in SAGE Open Nursing · July 2023

DOI: 10.1177/23779608231186044

CITATIONS READS
0 128

6 authors, including:

Anita Fafa Dartey Vivian Tackie

University of Health and Allied Sciences University of Health and Allied Sciences
21 PUBLICATIONS 57 CITATIONS 7 PUBLICATIONS 69 CITATIONS

SEE PROFILE SEE PROFILE

Comfort Worna Lotse Emmanuel Dziwornu

University of Health and Allied Sciences University of Health and Allied Sciences
6 PUBLICATIONS 25 CITATIONS 16 PUBLICATIONS 21 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Emmanuel Dziwornu on 27 July 2023.

The user has requested enhancement of the downloaded file.

Original Research Article

SAGE Open Nursing

Volume 9: 1–11
Occupational Stress and Its Effects on Nurses © The Author(s) 2023
Article reuse guidelines:
at a Health Facility in Ho Municipality, Ghana sagepub.com/journals-permissions
DOI: 10.1177/23779608231186044
journals.sagepub.com/home/son

Anita Fafa Dartey, PhD, M Nursing, OHNP, RN1 ,

Vivian Tackie, MPH, BscN, RN1, Comfort Worna Lotse, Mphil, BPH, RN1,
Emmanuel Dziwornu, PhD, MPhil, BA2, Derrick Affrim, BNur3
and Dabi Rejoice Delanyo Akosua, BNur3

Abstract
Introduction: The prevalence of occupational stress among nurses varies significantly around the globe. Nursing is often
considered a stressful occupation and can have negative effects on the mental, physical, family relationships, and quality of
care given to patients. The aim of this study was to explore the experiences, causes, effects, and coping strategies of occu-
pational stress among nurses working at a health facility in Ho Municipality in Ghana.
Methods: The study employed a qualitative research approach with an exploratory design. Data saturation was reached with
18 participants. Purposive sampling was used to select participants, while semistructured interview guide with voice recorders
were used in data collection. Data were manually transcribed and analyzed using thematic analysis.
Results: Overall, four main themes and ten subthemes were developed from this study. The main themes were nurses’ per-
ception of occupational stress, sources of occupational stress, effects of occupational stress, and coping strategies adopted to
cope with occupational stress. The subthemes were as follows: negative and positive stressful feeling, individual level, hospital
level, general body pain and fatigue, mental health problems, ineffective relationships, low work output, diversional therapy,
positive work outcomes, and psychological support from others (family and colleagues).
Discussion: There are more negative effects of occupational stress on nurses. However, most of the nurses adopted coping
strategies to reduce stress with little or no support from the hospital. More support from the hospital will be required to
totally manage occupational stress.
Conclusion: The study findings revealed how stress affects the daily life and work output of nurses. It is crucial to compre-
hend how work-related stress affects nurses and what aspects of their workplace are the most burdensome.

Keywords
occupational stress, nurses, work challenges, Ho Municipality, thematic content analysis
Received 30 March 2023; Revised 22 May 2023; accepted 17 June 2023

Introduction have identified the causes of occupational stress among

nurses. Workload, lack of equipment in caring for patients,
Occupational stress is one of the most reported health challenges
worldwide, with a financial impact of $5.4 billion annually on
productivity due to its negative consequences (Baye et al., 1
School of Nursing and Midwifery, University of Health and Allied Sciences,
2020). The prevalence of occupational stress among nurses Ho, Volta Region, Ghana
2
varies significantly around the globe, from 9.2% to 75.0%, School of Medicine, Department of Psychological Medicine and Mental
where UK- and Nigeria-based studies reported 68% and Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
3
School of Nursing and Midwifery, University of Health and Allied Sciences,
Ghana-based study reported 75% prevalence (Guppy & Tim,
Ho, Volta Region, Ghana
2017; Kassa et al., 2019; Kyreaa, 2014; Mohite et al., 2018).
Corresponding Author:
Nurses are the largest workforce in any healthcare institu- Vivian Tackie, School of Nursing and Midwifery, University of Health and
tion and play a pivotal role. They act as direct caregivers who Allied Sciences, PMB 31, Ho, Volta Region, Ghana.
serve hospitals 24 h a day (Baye et al., 2020). Several studies Email: [email protected]

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-
NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution
of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-
us/nam/open-access-at-sage).
2 SAGE Open Nursing

dealing with the dying and death were identified as major (2019) in an institutional-based survey among nurses at
causes of occupational stress among nurses (Adenike et al., Salaga Government Hospital in Ghana revealed that a high
2019; Baye et al., 2020; Islam et al., 2021). Also, Tesfaye proportion of the nurses perceived that their psychological
(2018) identified role conflicts and low levels of cooperation well-being was adversely affected by occupational stress. As
from patients and their relatives as causes of occupational per the study by Kaburi et al. (2019), two out of every 10
stress among nurses. Moreover, workplace violence, poor sal- nurses perceive that they are either highly or extremely
aries, and lack of participation by nurses in decision-making stressed by their work. The proportion of nurses who perceive
were also the most common stressors identified by other that work-related stress impacts more adversely on their
researchers (Chatzigiann et al., 2018; Habte et al., 2020; mental health (82.0%) was almost twice than nurses who per-
Kaburi et al., 2019). The repercussions of unmanaged occupa- ceived that work stress affects their physical health (44.3%).
tional stress on nurses cannot be underestimated. In most orga-
nizations, the cost of stress consequences has become a huge Causes of Occupational Stress Among Nurses
burden. Studies at the individual level have shown that occu-
pational stress among nurses can result in psychological, Work-related stress has been recognized as the main challenge
behavioral, and physical reactions. According to a study by for the nursing profession throughout the world (Mehta &
Sarafis et al. (2016), it was found that work-related stress Singh, 2014). Additionally, workload has also been identified
can be associated with many physical health problems such as a cause of occupational stress among nurses. In a qualitative
as migraines, muscle pain, back pain, joint pain, long-term study among 23 nurses in Pakistan, Moustaka et al. (2010)
physical illnesses, hypertension, irritable bowel syndrome, reported that most nurses mentioned the lack of equipment
duodenal ulcer, and immune and endocrine system illnesses. at the workplace as a major cause of occupational stress,
Excessive occupational stress has been found to reduce the causing them to mostly improvise at the ward. In Ghana,
quality of nursing care. For instance, if a nurse is stressed, it Kyreaa (2014) documented in a cross-sectional study of 369
is difficult to give holistic nursing care to patients which nurses in the Greater Accra Region that the lack of working
may increase patient mortality rate (Baye et al., 2020). equipment was the major source of stress for the majority of
Most nurses adopt various coping strategies for managing nurses (85%).
occupational stress (Sarafis et al., 2016). Tesfaye (2018) and
Chang and Chan (2015) found that, the three most commonly Effect of Occupational Stress on Nurses
used coping strategies for Australian nurses were planned
According to Chatzigiann et al. (2018), occupational stress may
problem-solving, self-control, and seeking social support,
affect the overall work performance of nurses. For instance,
while for Chinese nurses, they were positive reappraisal, self-
Kaburi et al. (2019) documented that occupational stress has
control, and planned problem-solving. Nevertheless, nurses
been shown to cause a higher incidence of absenteeism and
who turn to unhealthy coping methods often use food,
presenteeism among nurses leading to low productivity at
alcohol, tobacco, and other drugs, or develop sedentary life-
work. Also, Jordan et al. (2016) in a qualitative study in the
styles as a byproduct of these negative coping techniques
USA revealed that most nurses indicated that occupational
(Alomani, 2016; Scholze et al., 2017).
stress reduces productivity at the workplace as it resulted in
Although there are publications on the experiences, causes,
increased presentism among nurses. Psychological effects,
and effects of occupational stress among nurses in Ghana, the
such as increased arousal, feelings of uneasiness, emotional
literature reviewed showed little report on the effect of occupa-
exhaustion, depression, fatigue, and burnout, are also described
tional stress on nurses in the Ho Municipality. Understanding
in relation to occupational stress among nurses. In Kenya, a
the stress experiences of nurses would help in developing strat-
cross-sectional study among 150 nurses revealed that the
egies and stress management programs which will increase
majority of nurses (84%) indicated that occupational stress
productivity among nurses at large. To gather contemporary
causes depression and feelings of uneasiness.
insights, this study adopted a qualitative design to explore
the experiences of occupational stress among nurses working
at selected hospitals in the Ho Municipality. Coping Mechanisms with Occupational Stress
Among Nurses
Review of Literature In Bangladesh, a study by Adib-Hajbaghery et al. (2012)
revealed that the majority of nurses (64%) cited taking
Nurses’ Experience with Occupational Stress days off duty as a common strategy to cope with stress in
A study by Akweenda and Cassim (2016) and Kurki (2018) on the workplace. More than half (52%) of the nurses said
the experiences of nurses with occupational stress indicated that seeing a patient discharged home without complica-
that nurses experienced psychological distress and intense tions was how they dealt with workplace stress. Also,
workload due to occupational stress and that these had a neg- EL-Jardali et al. (2010) in a qualitative study among 25
ative impact on their quality of health. Also, Kaburi et al. nurses in Saudi Arabia identified that the most common
Dartey et al. 3

strategy adopted by the nurses in the management of stress Research Instrument and Data Collection Techniques
in the workplace was asking a colleague for help. In Ghana,
A semistructured interview guide which consisted of both
Abaa et al. (2013) in a cross-sectional study among nurses
closed-ended and open-ended questions was used based on
found that the major coping strategies for stress were
review of literature. This instrument was chosen because it
expressing their feelings instead of bottling them up and
permits freedom of responses and provides insight into a
time management. The objectives of this study are to
comprehension of an issue. The interview guide was made
explore the experiences, causes, effects, and coping strate-
flexible for interviewer to ask in depth questions in certain
gies of nurses working at selected health facilities in the
areas where new themes were generated. To ensure a
Ho Municipality.
higher degree of rigor of the interview guide for the study,
a pretest was conducted among three nurses at another gov-
ernment hospital. The selected hospital has a 320-bed capac-
Method ity hospital serving as a referral healthcare facility and has a
staff strength of 650 of which 367 are nurses and midwives. It
Study Design is strategically located to provide specialized healthcare ser-
The study employed a qualitative research approach with an vices to the people of the Volta Region and beyond. It has
exploratory design. Exploratory research investigates the full about 20 major wards and units, namely, male medical
nature of phenomena rather than simply observing and ward; female medical ward; male surgical ward; female sur-
explaining the phenomena and provides insight into a gical ward; maternity ward; gynecological ward; labor ward;
better understanding of an issue or situation. This design children’s ward; intensive care unit (ICU); theater, neonatal
would enable the researchers to uncover the experiences, intensive care unit (NICU); ear, nose, and throat (ENT)
causes, effects, and coping strategies of occupational stress unit; eye unit; mental health units; and cardiothoracic unit.
among nurses working at selected health facilities in the This hospital primarily provides curative care, which is
Ho Municipality. mainly clinical and preventive care, in the form of health pro-
motion services, with the following specific services being
rendered: outpatient department (24-h accident and emer-
gency services and consultation) and in-patient services.
Research Questions There are different categories of nurses ranging from
Deputy Director of Nursing to Enrolled Nurse with the edu-
1. What are the experiences of nurses with occupational cation qualification of master’s degree in science to health
stress at a selected health facility in Ho Municipality? assistant certificate, and above all, they are licensed to prac-
2. What are the causes of occupational stress among nurses tice, and they have their professional certificates as well.
working at a selected health facility in the Ho They provide both in-service and outpatient services.
Municipality? The study population included all registered nurses with at
3. What are the effects of occupational stress on the work least 1 year of working experience at the selected hospitals. A
performance among nurses working at a selected health year’s experience was deemed long enough for the nurses to
facility in Ho Municipality? have experienced occupational stress. Informed consent was
4. What coping strategies do nurses adopt in managing obtained from the individual nurses after an explanation of
occupational stress at a selected health facility in Ho the nature of the study. The place and time for face-to-face
Municipality? interviews was scheduled according to the participants’ con-
venience. This study was conducted in December 2022. All
interviews were conducted in English language since it is
Sample and Sampling Technique an official language. Each interview lasted between 30 and
45 min, which was recorded using digital audio recorders
Convenience sampling was employed in this study, and data
as well as detailed field notes.
saturation was reached after the 18th participant when addi-
tional data did not lead to any new emergent theme (Gray
et al., 2017). In qualitative healthcare research, convenience
sampling is a nonprobability sampling in which researchers Data Management and Analysis
recruit participants who are convenient and easily accessible. The outcomes of the interview were analyzed using thematic
This sampling technique was chosen because it allowed the content analysis. A satisfactory thematic content analysis
researchers to subjectively select people have met the inclu- depicts the thematic content of interview transcripts (or
sion criteria and are willing to be approached and become other texts) by detecting common themes in the texts pre-
part of the research. The study focused on nurses working sented for analysis. The data were compared with notes
at the selected facility who willingly consented to take part taken during the interview process to check for possible
in the study. omissions or additions. Using Nvivo software for qualitative
4 SAGE Open Nursing

research, codes were developed into themes and subthemes

for the write-up. This software allows for coding, sorting Table 1. Demographic Characteristics of Study Participants.
and retrieval of data. Three researchers were involved in car-
Frequency Percentage
rying out coding. Deductive approach was applied in this Demographics (n) (100%)
study. The researchers studied what others have done, read
existing theories, and then tests hypotheses that emerge Age 20–24 1 5.6
from those theories. In order to minimize interobserver 25–29 4 22.2
bias, all authors were trained to make sure data are consis- 30–34 8 33.3
tently recorded ensuring interrater reliability. Also, all obser- 35–39 2 22.2
Anonymous 3 16.7
vation procedures were standardized making sure they were
well structured and clear. The researchers reviewed and dis- Marital status Married 9 50.0
cussed the categories and themes to ensure that participants’ Single (never 9 50.0
views were represented. married)
Sony ICD-PX470 Digital Voice Recorder was used in Divorced/separated 0 0
audio recording. The researchers transcribed all the audio Widowed 0 0
tape-recorded information verbatim into readable texts after Qualification Master’s degree 4 22.2
listening to the audios severally. Direct quotations from par- Degree 9 44.4
ticipants were presented to ensure that the participants’ Diploma 4 22.2
responses were reflected in the study. Field notes were also Certificate 1 5.5
reviewed to add depth to the analysis. Rank Deputy Director 2 11.1
Nursing Service
Principal nursing 3 16.6
Ethical Approval officer
Senior nurse officer 3 16.6
The study was approved by an Ethical Review Committee. Nurse officer 6 33.3
Approval was also obtained from the selected hospital, and Staff nurse 4 22.2
individual participants signed the consent form as appropri- Enrolled nurse 1 5.5
ate. The nature, purpose, and procedure of the study were
Years of 1–3 8 44.4
explained to the participants. A written consent was obtained
working 4–6 5 27.8
from participants who partook in this study. These individual experience 7–9 3 16.7
participants and witnesses signed a consent form as appropri- 10–12 2 11.1
ate. Participants were informed that participation in the study
was completely voluntary and that they might. Years of serving 1–3 7 38.8
in study 4–6 7 38.8
hospital 7–9 2 11.1
10–12 2 11.1
Results
Role Nurse matron 2 11.1
Sociodemographic Characteristics organogram ICU nurse 5 27.7
of nurses in OPD nurse 4 22.2
The table provides a detailed information on the sociodemo- study Theater nurse 2 11.1
graphic characteristics of all 18 participants in this study hospital Peri-/postoperative 2 11.1
(Table 1). nurse
ENT nurse 3 16.6
Sex Female 12 66.7
Research Question Results Male 6 33.3

All 18 participants in this study affirmed that they suffer from Note: ENT = ear, nose, and throat; ICU = intensive care unit; OPD=Out-
patient Department.
stress as a result of the nursing related work. Four themes and
10 subthemes emerged from the analysis of this study
(Table 2).
Subtheme A1: Feelings of Occupational Stress
Seventeen of the participants stated that they feel bad about
occupational stress. Quotes from participants to support
Theme A: Nurses’ Perception on Occupational Stress these are:
Seventeen out of the 18 participants had a negative feeling
about occupational stress. Only one among the 18 participants … I feel bad about occupational stress, if something can be
mentioned that she felt positive about occupational stress. done about it, it will be good. To me, occupational stress
Dartey et al. 5

Table 2. Summary of the Themes and Their Subthemes.

Objectives Themes Subthemes

Occupational stress experiences of nurses Theme A: A1. Feelings of stress

Perceptions of nurses on
occupational stress
Causes of occupational stress among nurses Theme B: B1. Individual level sources
Sources of occupational stress B2. Hospital level sources
Effects of occupational stress among nurses Theme C: C1. General body pain and fatigue
Effect of occupational stress on C2. Mental health issues
work life C3. Ineffective relationships
C4. Low work output
Coping strategies adopted by nurses to cope with Theme D: D1. Diversional therapy
occupational stress Adaptive mechanisms used by D2. Positive work outcomes
nurses D3. Psychological support from others (family
and colleagues)

doesn’t have any positive side. So, my opinion on stress is Another participant was of the same view:
something that makes you uncomfortable. Today for instance
I’m tired, I want to rest but because of the profession I have … I think the work load is part… there are unexpected
chosen I can’t rest…. (Participant N6, 33 years old) patients that come… As I said we are managing orthopaedic
and urology together. Imagine I came for morning shift and
… I don’t think occupational stress has much positive sides I’m supposed to close at 2 and maybe by 1:00 pm I’ve
as compared to the negative side, because when you are in some admission or transfer in like 3,4,5. The afternoon
the house you don’t experience them but the job will make staff are not yet in, I have to receive all those cases so that
you experience those things…. (Participant N8, 27 years old) I can hand over to them when they come. And before that
time too, I have to administer medication, empty bedpans
One participant mentioned that she has a positive feeling and when there is the need to bath patients… Performing
about occupational stress because she learned something these duties can be stressful… (Participant N4, 34 years old)
new. She explained:
Five of the participants mentioned death and dying as the
… Even despite the fact that you will be stressed, you will source of occupational stress to them as participants explained:
end up learning something new. That will be positive….
(Participant N12, 26 years old)
… Patient dying will stress you because we are all humans,
someone going just like that is a kind of a stress. You even
Theme B: Sources of Occupational Stress finish doing the last office but within you, you don’t feel
okay. You even go home and still be thinking about this
This theme represents participants’ views on the sources of
patient… (Participant N12, 26 years old)
occupational stress. Two subthemes, that is, at the individual
level and hospital level, emerged from this theme.
… A patient dying is stressful because at times you wish your
client will recover but the client has passed out so you will be
Subtheme B1: Individual-Level Sources stressed and all your effort is wasted, it’s a bit of stress to
This subtheme describes the causes of occupational stress at me.… (Participant N13, 37 years old)
individual level. Work overload, death and dying, attitude
from colleagues, behavior and pressure from patients and rel- Four of the participants said that behavior, pressure, and
atives, and ergonomics were sources identified by the expectation from patients and relatives were the sources of
participants. occupational stress among them. This was what the partici-
Six of the participants mentioned work overload to be the pants had to say:
source of occupational stress. Some participants explained:
… The patients give us pressure; someone will intentionally
… So, at individual level, well first of all I think it has to do do that to see if you will get annoyed at them. Bone pain is
with the work overload. Truth be told, sometimes the burden more severe than that of the skin, so at times too it’s not
is unbearable. The workload especially during the day is just them, it’s the pain that they go through, they want to displace
too much. (Participant N18, 31 years old) that anger on the nurse. I remember one day, I was
6 SAGE Open Nursing

administering some drugs which was painful. I said sorry Eight of the participants mentioned lack of logistics to be
alongside but the patient said oh! Why are you telling me the source of occupational stress at the hospital level. Some
that, will sorry heal me? Will it cater for the pain? So as participants explained:
for the patients’, they give us stress…. (Participant N4, 34
years old)
… At hospital level, when things are not put in place, for
instance, let’s say equipment to work with are not there, as
… Patient’s relatives also stress us a lot, example is, when I’m talking currently, we have shortage of syringes, and
you admit a patient you tell them about the protocols, we ori- you’re supposed to serve medications, you know all these
entate them, but they still tell their relatives to come at odd contribute to it, so if management does not provide the equip-
times and when you tell them it is not visiting time, they ment required or logistics for us to use it causes us so much
don’t understand because some of the patients might need frustration and stress…. (Participant N18, 31 years old)
rest at that moment. And when they come and the person is
even sleeping, they will wake the patient up which is very
bad. That one too is stressful…. (Participant N6, 33 years old) … If I want to perform a procedure and the equipment are
not available it stresses me up. Maybe you want to pass
catheter urgently but there is no gel and you need to go to
Two of the participants mentioned ergonomics (bad other wards to and beg for some. Maybe there is suturing
posture) to be the source of occupational stress to them at to be done yet suturing set is not available. The client’s rel-
the individual level. Some participants explained: ative may not understand why you’re delaying, they’ll say
they’ve brought their patient and after 2 h nothing has
… That is what I said posture, body mechanics, the way you been done meanwhile it is not my fault…. (Participant
lift patient, and you are supposed to position yourself before N6, 33 years old)
you do the lifting and if you don’t get it right you end up
exposing yourself and its stressful. Standing for long hours,
even pushing patient to x ray, you get to x ray and they
will ask you to lift the patient up from the bed, that’s my Theme C: Effect of Occupational Stress
major problem…. (Participant N11, 30 years)
This theme describes the outcomes occupational stress had
on participants’ physical health, mental health, family rela-
… So, for me personally, if you want to look at some of the tionship, and quality of nursing care.
causes of stress, I’ll say it has to do with the kind of work that
I do on the ward. Mostly you have to be busy throughout the
entire shift standing, writing, bending and that’s stressful….
(Participant N1, 25 years old) Subtheme C1: Effect of Occupational Stress on
Physical Health
Participants stated that they experienced fatigue and pain at
different parts of the body and contracted other diseases as a
Subtheme B2: Hospital-Level Sources result of occupational stress. Seventeen participants men-
At the hospital level, participants stated lack of logistics, tioned that they experience pain at different parts of the
unfavorable shift schedules, and low staff strength, as the body.
sources of occupational stress to them. Seven of the participants had waist and back pains as an
Six of the participants mentioned unfavorable shift sched- outcome on their physical health. Participants explained:
ules and low staff strength to be the sources of their occupa-
tional stress. Some participants explained: … Physically it affects you, like headache, joint pain, back
pain, fatigue all stem out as a result of standing for longs
… Hmm! I will say the time table is a major cause, yes, it is hours and lifting of patients…. (Participant N18, 31years old)
done based on the strength of the staff. So maybe, I may have
an agenda but because of my shift I can’t go and if I’m too
… One of the effects that I have experienced from stress is, it
tired I can’t rest unless I’m given excuse duty. This is
can cause you to have, waist pain, back pain…. (Participant
really stressful…. (Participant N6, 33 years)
N6, 33 years old)

… the nurse to patient ratio is very low so most at times the … If I’m in pain and I come to work, I’m not able to concen-
number of patients outweigh the nurses caring for them and trate on the work because my concentration is all on the
we are overburdened…. (Participant N9, 31 years old) pain…. (Participant N5,30 years old)
Dartey et al. 7

Subtheme C2: Mental Health Problems One participant said occupational stress causes her to dis-
place anger she got from work on family. She explained:
In terms of the outcome occupational stress had on the mental
health of the participants, depression, anxiety, inability to
… at times the stress from work makes you displace your
concentrate, frustrations, and posttraumatic stress disorder
anger on your children and your wife. It does happen in
(PTSD) were the effects mentioned by the participants in
my case…. (Participant N9, 31 years)
this subtheme.
Four of the participants mentioned that they are unable to
concentrate as a result of occupational stress on their mental Subtheme C4: Low Work Output
health. Some participants explained: All the participants stated low productivity and poor-quality
service delivery as a result of stress from their nursing work.
when you have a stress-free environment, you can give your Quotes from participants to support these are:
all. But when you are stressed out mentally, then it means,
you will be lacking at some point… the decision you make … It does affect the quality of nursing care, very much,
for your patient may not be from a concentrated mind because we normally accumulate stress from a previous
hence may not be correct…. (Participant N15, 32 years old) shift and it does affect the subsequent ones. For instance, I
was very stressed up the previous day, yet I’m supposed to
One participant mentioned frustration as an impact on her come to work early today and relieve my colleagues to go
mental health. She explained: home but because of the stress from the previous day, I
was not able to wake up early. Even as I’m here, I’m so
… You become frustrated, imagine there’s a patient gasping much fatigued, I cannot work effectively as I’m supposed
or a patient’s condition is not good and you need to give to. Because of that patients may see me to be lazy or pretend-
oxygen and there’s no oxygen anywhere, then the patient ing to be tired and this leads to low productivity….
passes on just like that. You may go home and you are like (Participant N18, 31years old)
“This man paa”, relatives come and they are crying. You
will have some emotional stuff on you. Sometimes you will … When I’m stressed up I’m not really able to render the
go and talk to yourself but at least you did your best. It nursing care as expected. Anytime I’m under stress, there
was just beyond your capabilities…. (Participant N2, will be one or two incomplete jobs, because you can’t do
Anonymous age) all…. (Participant N14, 37 years)

One of the participants said the impact of occupational

stress had on his mental health was PTSD. He explained: Theme D: Strategies Adopted by Nurses
This theme describes the various coping strategies adopted by
… I have suffered post-traumatic stress disorder before, as a
participants to cope with occupational stress. Diversional
result of this work but I just kept it at personal level. There
therapy, expressing anger on patients and others, seeing
were points at work where I lost some patients under my
patients discharged, time management, and receiving support
care. It wasn’t easy, it really affected me psychologically
from the hospital, family, and other colleagues were some of
for some time. (Participant N18, 31years old)
the coping strategies adopted by the participants.
Subtheme C3: Ineffective Family Life and Relationships
This theme represents the outcome that occupational stress Subtheme D1: Diversional Therapy
had on the participants in terms of their family relationships. Fifteen of the participants said they use diversional therapy as
Twelve of the participants mentioned that stress from way of coping with occupational stress. Some participants
work prevented them from having enough time for their fam- shared their strategies:
ilies. Some participants explained:
…. So, when it comes to the coping strategies, what I do is, I
… Yes, it has an effect on family relationships, you don’t watch football games a lot, normally when I go home, I just
have time for your family especially when you’re on night tune in and watch my football matches and then listen to
shift…. (Participant N7, 30 years old) music. I also do some indoor press ups to gain small muscles
or maybe go for a trip…. (Participant N18, 21 years old)
… maybe let’s say that I’m stressed at the work place, I can
even get home and not feel like talking to anybody, I don’t … For me I like watching movies, then music once in a while,
talk to friends, I don’t talk to family, so it doesn’t build when I come to the workplace, I talk with my colleagues, in
cordial relationships, it rather destroys it…. (Participant the house I talk to my husband and my kids…. (Participation
N17, Anonymous age) N14, 37 years)
8 SAGE Open Nursing

Subtheme D2: Positive Work Outcomes and Amarakoon (2015) defined stress as either good stress
or negative stress, which is consistent with this line of reason-
Four participants mentioned that positive work outcomes
ing. While good stress is positive and it motivates employees
such as seeing their patients discharged are the way they
to perform, bad stress brings negative consequences.
cope with occupational stress. Participants explained:
Occupational stress results from various worker environ-
ment interactions (Tan & Yip, 2018). The current study
… The joy in seeing a patient discharged. Patients come with
found that patient and their relative’s behavior, pressure
stroke, and not able to swallow yet they go back home with
and expectation, work overload, and colleague’s attitude
some improvement even though they may not be fully recov-
are sources of occupational stress consistent with Hasan
ered. Anytime a patient is discharged, and we hear words like
and Tumah (2019), Adenike et al. (2019), and Godwin
“akpe loo” (thank you), we are happy…. (Participant N2,
et al. (2016). It was observed that participants’ experience
Anonymous age)
of helplessness during a patient end-of-life processes
(dying) exerts stress for the nurse, similar to the findings of
… When the ward is full, and within a short time patient’s
Dartey and Phuma-Ngaiyaye (2020), Kassa et al. (2019),
condition improves and they are discharged, it brings relief
and Starc (2018), who identified dealing with patient death
and joy. So, once they discharge them, that stress is off….
as a source of occupational stress among nurses. Maybe,
(Participant N3, 28 years)
the stress associated with caring for dying patients could be
because nurses have traditionally focused on providing care
Subtheme D3: Psychological Support from Others to the living, with often dramatic efforts to preserve life.
(Family and Colleagues) Attitude from colleagues was another major cause of stress
to nurses in the current study. At the hospital level, lack of
Eight of the nurses mentioned that receiving support from logistics, unfavorable shift schedules, and low staff strength
their families and other colleagues was a way they coped were mentioned by the participants as source of occupational
with occupational stress. The following participants shared stress. These factors have been reported in others studies
this view: including Rivaz et al. (2017), Yuwanich et al. (2015), and
Adib-Hajbaghery et al. (2012).
… My husband supports and encourages me, cools my In terms of the effects of occupational stress on partici-
temper, at times my children also do same. Sometimes too pants’ physical health, pain (waist, back, body, and head-
if your colleagues see that you’re stressed, they calm you aches) was experienced, and this concurs with Bryndal
down…. (Participant N4, 34 years) et al. (2022), who demonstrated that excessive strain of the
spine associated with occupational activities has a strong
… We sometimes get support from colleagues. When you impact on the intensity and frequency of spinal pain episodes
report to work and you’re not feeling well, like I said, they and that physiotherapists and nurses mainly suffer from low
sometimes work in your stead and when any of them is back pain. Adhikari and Dhakal (2015) observed 50% absen-
also in similar situation, we do same for them…. teeism among nurses by sick leave due to low back pain,
(Participant N7, 30 years old) many of them and many more could not perform their job
properly because of low back pain.
Occupational stress had an effect on participants’ mental
Discussion health, resulting in anxiety, depression, frustrations, poor
These findings revealed that nurses’ perception of occupa- concentration and PTSD. Participants in this study suffer
tional stress was predominantly negative. Based on their per- depression and anxiety as a result occupational stress. This
sonal feelings, majority of the participants claimed that finding is consistent with the finding of Chhabra (2022)
occupational stress is bad. In a study conducted in the UK, and Yang et al. (2018), which stated that depression and
one of the three occupations with the most stress is nursing anxiety are the most common mental health problems in
(Health & Safety Executive, 2020). This is consistent with the nursing community. Bowen et al. (2021) reported that
findings from a correlational study conducted among nurses experience “frustration, fatigue, strain on personal
nurses in public and private facilities in Greece (2013). It and professional relationships, and anger/irritability.”
was concluded that while it can be viewed as having an Again, Liu et al. (2022) also showed that mental health
effect on patient outcomes, occupational stress negatively nurses experience symptoms of PTSD. All these are demon-
affects nurses’ quality of life (Sarafis et al., 2016). strated in the current findings.
Additionally, Kaburi et al. (2019) and Akweenda and Another effect of stress identified in this study is ineffec-
Cassim (2016) revealed that a high proportion of the nurses tive family life and relationships. Less time for the family and
perceived that their psychological well-being was adversely displacement of anger on family were some outcomes men-
affected by occupational stress. One participant stated that tioned by majority of the participants. These finding agree
he has a positive feeling about occupational stress. Simon with Repetti and Wang (2017), who stated that daily job
Dartey et al. 9

stressors influence family interactions through their impact Conclusion

on the employee’ mood, thoughts, and coping behaviors. In
The study findings revealed how stress affects the daily life
the long term, family relationships can be shaped by those
and work output of nurses. It is crucial to comprehend how
experiences in both positive and negative ways. Some
work-related stresses affect nurses and what aspects of their
spouse “cross-over” effects appear to represent accommoda-
workplace are the most burdensome. It is also crucial to
tions of the employed partner under stress. For instance, a
learn more about the working environment, occupational
spouse’s increased provision of social support and involve-
stress, and job satisfaction of nurses because this information
ment with children are evidence of dynamics that go
could help them reduce occupational stress and boost job sat-
beyond a simple and direct transfer of stress from work to
isfaction and productivity. Moreover, workplace stress is not
home (Repetti & Wang, 2017). All the participants in this
just a result of organizational issues and obligations. It is rea-
study reported job dissatisfaction and low productivity as
sonable to infer that occupational stress varies between cul-
effects of occupational stress. Sarafis et al. (2016) found
tures and countries due to differences in working
that occupational stress may affect significantly nurses’
conditions, education, social position, and the autonomy of
quality of life and simultaneously reduce the quality of
nurses in various cultures. As a result, research on work-
care, staff truancy, and low levels of productivity.
related stress among nurses in many nations is necessary,
Participants reported diverse coping strategies among
and the results of such studies must be evaluated in light of
which are diversional therapy (listening to music, watching
the sociocultural contexts in which they were done.
movies, enough sleep, indoor press ups, going for trips,
taking a warm bath and relax, and leaving the house to a
calm environment), positive work outcomes (seeing patients Acknowledgments
discharged), and receiving psychological support from col- The researchers wish to thank the participants: Challa Yasmine
leagues and family. This is supported by Baral and Subedi Edem Akosua, Gyimah Salomey Ayaka, Mensah Sandra, and our
(2021), who found that nurses adopted different activities able research assistant John Yesuohene Ofori who took part and
to keep themselves busy based on comfort and situation: lis- supported the study.
tening to music; playing indoor and outdoor games; watching
television, films, or movies; surfing the internet; engaging in Declaration of Conflicting Interests
household chores; sharing events and incidents; calming The author(s) declared no potential conflicts of interest with respect
down; crying; and going through newspapers. One partici- to the research, authorship, and/or publication of this article.
pant stated that he attends stress management workshops as
a way of coping with occupational stress and this is in line
Funding
with Craigie et al. (2016), who explained that these educa-
tional workshops have significant positive impact on stress, The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: The study
depression, burnout, and trait negative affect, as well as
was self-funded by the researchers.
improving levels of compassion, satisfaction, self-
compassion, and subjective quality of life.
ORCID iD
Anita Fafa Dartey https://orcid.org/0000-0002-8263-4562
Strengths and Limitations of the Study
This study is one of the few that specifically examines how Supplemental Material
stress affects nurses. The exploratory character of the study
Supplemental material for this article is available online.
contributed to a broader and more contextual knowledge of
the phenomenon. However, because this study is qualitative,
it cannot be generalized. Ethical Consideration
The study was approved by the Ethical Review Committee at the
University of Health and Allied Sciences, Ho, Ghana with reference
Implications for Nursing Practice (UHAS-REC A.11[168] 21-22). Approval was also obtained from
Nurses play an important role in the provision of timely and the selected hospital and individual participants signed the consent
quality services. Findings from this study would influence form as appropriate. The nature, purpose, and procedure of the
study were explained to the participants. A written consent was
new policies, improve on existing policies, and remove non-
obtained from participants who partook in this study. These individ-
working policies in relation to occupational stress among ual participants and witnesses signed a consent form as appropriate.
nurses. This study could also serve as a reference manual for Participants were informed that participation in the study was
nurses in dealing with work-related stress. Additionally, find- completely voluntary and that they might drop out at any time
ings from this study would help hospital administrators, without consequence. Confidentiality and anonymity were ensured
nursing managers, and other relevant stakeholders in develop- by assigning pseudonyms to participants’ names (Participant 1,
ing strategies in managing occupational stress among nurses. Participant 2, etc.).
10 SAGE Open Nursing

References Dartey, A. F., & Phuma-Ngaiyaye, E. (2020). Physical effects of

Abaa, A. R., Atindanbila, S., Mwini-Nyaledzigbor, P. P., & maternal deaths on Midwives’ health: A qualitative approach.
Abepuoring, P. (2013). Causes of stress and job satisfaction Journal of Pregnancy, 2020, 1–6.
among nurses at Ridge and Pantang hospitals in Ghana. EL-Jardali, F., Dimassi, H., Dumit, N., Jamal, D., & Mouro, G.
International Journal of Asian Social Science, 3(3), 762–771. (2010). A national cross- sectional study on nurses’ intent to
Adenike, F., Idowu, M., & Grace, K. (2019). Assessment of leave and job stisfaction in Lebanon: Implications for policy
occupational-related stress among nurses in two selected hospi- and practice. BMC Nursing. https://doi.org/10.1186/1472-
tals in a city in southwestern Nigeria. International Journal of 6955-8-3
Africa Nursing Sciences, 10, 68–73. Godwin, A., Suuk, L. A., & Selorm, F. H. (2016). Occupational
Adhikari, S., & Dhakal, G. (2015). Prevalent causes of low back stress and its management among nurses at St. Dominic demo-
pain and its impact among nurses working in Sahid Gangalal graphic characteristics of study subjects research methodology.
national heart centre. Journal of Nepal Health Research Council. Health Science Journal, 10(6), 1–80.
Adib-Hajbaghery, M., Khamechian, M., & Alavi, N. M. (2012). Guppy, A., & Tim, G. (2017). Job satisfaction and occupational
Nurses’ perception of occupational stress and its influencing stress in UK general hospital nursing staff. International
factors: A qualitative study. Iranian Journal of Nursing and Journal of Works, Health & Organization, 5(4), 315–323.
Midwifery Research, 17(5), 352–352. Habte, T., Amduka, R., & Mengistu, D. (2020). A job stress, coping
Akbar, A., Eshgh, Z. M., Peyman, A., & Chehrehgosha, M. (2016). strategy and associated factors among nurses working in cancer
Prevalence of occupational stressors from the perspective of pre- unit of selected governmental hospitals of Addis Ababa. J Prim
hospital personnel in disaster and emergency medical manage- Care Gen Pract, 3(3), 53–58.
ment center. Advances Environment Biology, 4(2), 73–80. Hanson, V. F., Onasoga, O. A., & Babalola, C. O. (2017). Self-reported
Akweenda, F. M., & Cassim, N. (2016)). Investigating work related occupational stress, environment, working conditions, on pro-
stress and its impact on the performances of registered nurses ductivity, and organizational impact among of nursing staff in
employed at Katutura state hospital in Windhoek. Kuwawait Nigerian hospitals. International Journal of Translational
Chapter of Arabian Journal of Business and Management Medical Research and Public Health, 1(2), 29–35.
Review, 5(10), 50–78. Hasan, A. A., & Tumah, H. (2019). The correlation between occu-
Alomani, Q. (2016). Causes and effects of occupational stress in pational stress, coping strategies, and the levels of psychological
nursing. International Conference, Istanbul, 978(72), 12–18. distress among nurses working in mental health hospital in
Baral, S., & Subedi, S. (2021). Stress: How is it affecting service Jordan. Perspectives in Psychiatric Care, 55(2), 153–160.
delivery and health of nurses? A qualitative study from Health and Safety Executive (2020). Work-related stress, anxiety or
pokhara metropolitan, Nepal. Journal of Health and Allied depression statistics in Great Britain. https://www.hse.gov.uk/
Sciences, 11(1), 24–29. statistics/causdis/stress.pdf.
Baye, Y., Demeke, T., Birhan, N., & Semahegn, A. (2020). Nurses ‘ Islam, M. I., Alam, K. M. W., Keramat, S. A., Murshid, M. E.,
work-related stress and associated factors in governmental hos- Haque, R., Kabir, E., & Khan, M. E. (2021). Working conditions
pitals in Harar, Eastern Ethiopia: A cross-sectional study. Plos and occupational stress among nurses in Bangladeshh: A cross
One, 15(8), 1–12. sectional pilot study. Journal Of Public Health, 1–9.
Bengtsson, M. (2016). How to plan and perform a qualitative study Jordan, T. R., Khubchandani, J., & Wiblishauser, M. (2016). The
using content analysis. Nursing Plus Open, 2, 8–14. impact of perceived stress and coping adequacy on the health
Bowen, P., Peihua Zhang, R., & Edwards, P. (2021). An investiga- of nurses: A pilot investigation. Nursing Research and
tion of work-related strain effects and coping mechanisms Practice, 20(12), 10–20.
among South African construction professionals. Construction Kaburi, B. B., Bio, F. Y., Kubio, C., Ameme, D. K., Kenu, E.,
Management and Economics, 39(4), 298–322. Sackey, S. O., & Afari, E. A. (2019). Psychological working
Bryndal, A., Glowinski, S., & Grochulska, A. (2022). Influence conditions and predictors of occupational stress among nurses,
of occupation on the prevalence of spinal pain among physio- Salaga government hospital, Ghana. The Pan African Medical
therapists and nurses. Journal of Clinical Medicine, 11(19), Journal, 33, 1–15.
5600. Kassa, D. H., Afenigus, A. D., & Meteku, B. T. (2019). Assessment
Chang, E., & Chan, B. (2015). A survey of role stress, coping of occupational stress and associated factors among nurses in
and health in Australian and New Zealand hospital East Gojjam zone public hospitals. Clinical Medicine
nurses. International Journal of Nursing Studies, 44(8), Research, 6(2), 43–48.
1354–1362. Kurki, R. (2018). Stress Management among Nurses: Literature
Chatzigiann, D., Tsounis, A., Markopoulos, N., & Sarafis, P. Review of Causes and Coping Strategies.
(2018). Occupational stress experienced by nurses working in Kyreaa, D. A. (2014). Causes of stress among nurses in the Greater
a Greek regional hospital: A cross-sectional study. Journal of Accra Region. International Journal of Research in Social
Nursing and Midwifery Research, 23(10), 450–457. Sciences, 3, 8.
Chhabra, B. (2022). Work role stress and employee outcomes: Legg, J. T. (2018). Everything You Need to Know About Stress.
Mediating role of job satisfaction. In Research anthology on https://www.healthline.com/health/stress.
changing dynamics of diversity and safety in the workforce Leon, A. C., Davis, L. L., & Kraemer, H. C. (2011). The role and
(pp. 1324–1338). IGI Global. interpretation of pilot studies in clinical research. Journal of
Craigie, M., Slatyer, S., Hegney, D., et al. (2016). A pilot evaluation Psychiatric Research, 45(5), 626–629.
of a mindful self-care and resiliency (MSCR) intervention for Liu, W., Sun, L., Yin, X., Zhao, H., Zhu, G., Lian, B., & Sun, H.
nurses. Mindfulness, 7, 764–774. (2022). Relationship between job stress, thinking style and
 Dartey et al. 11

symptoms of post-traumatic stress disorder in mental health nurses’ caring behaviors and their health-related quality of life.
nurses. Frontiers in Public Health, 10, 979138. BMC Nursing, 15(56), 1–9.
Mehta, R., & Singh, I. (2014). Stress among nurses working in crit- Scholze, A. R., Martins, J. T., Lucia, M., Robazzi, C., Carmo, M.,
ical care areas at a tertiary care hospital. Journal of Chitwan Haddad, F. L., José, M., Galdino, Q., & Ribeiro, R. P. (2017).
Medical College, 4(10), 42–48. Occupational stress and associated factors among nurses at
Mohite, N., Shinde, M., & Gulavani, A. (2018). Occupational stress public hospit. Cogitare Enferm, 22(3), 10–20.
among nurses working at selected tertiary care hospitals. Simon, N., & Amarakoon, U. A. (2015). Impact of occupational
International Journal of Science and Research (IJSR), 3(6), stress on employee engagement. 12th International Conference
999–1005. on Business Management (ICBM).
Moustaka, E., Antoniadou, F., Maliarou, M., Zantzos, I., Kyriaki, Starc, J. (2018). Stress factors among nurses at the primary and
K., & Constantinidis, T. (2010). Research in occupational secondary level of public sector health care: The case of
stress among nursing staff–a comparative study in capital and Slovenia. Open Access Macedonian Journal of Medical
regional hospitals. Hellenic J Nurs Sci, 3, 79–84. Sciences, 6(2), 416.
Onasoga Olayinka, A., Osamudiamen, O. S., & Ojo, A. (2013). Tan, S. Y., & Yip, A. (2018). Hans Selye (1907-1982):
Occupational stress management among nurses in selected hos- Founder of the stress theory. Singapore Medical Jornal,
pital in Benin City, Edo state, Nigeria. European Journal of 59(4), 170–171.
Experimental Biology, 3(1), 473–481. Tesfaye, T. D. (2018). Coping strategies among nurses in south-
Poursadeghiyan, M., Abbasi, M., Mehri, A., Hami, M., Raei, M., & west Ethiopia: Descriptive, institution-based cross-sectional
Ebrahimi, M. H. (2016). Relationship between job stress and study. BMC Research Notes, 11(421), 1–6.
anxiety, depression and job satisfaction in nurses in Iran. The Wu, H., Chi, T., & Wang, L. (2017). Occupational stress among
Social Sciences, 11(9), 2349–2355. hospital nurses: Cross-sectional survey. Journal of Advanced
Repetti, R., & Wang, S. W. (2017). Effects of job stress on family Nursing, 66(3), 627–634.
relationships. Current Opinion in Psychology, 13, 15–18. Yang, J., Tang, S., & Zhou, W. (2018). Effect of mindfulness-based
Rivaz, M., Momennasab, M., Yektatalab, S., & Ebadi, A. (2017). stress reduction therapy on work stress and mental health of psy-
Adequate resources as essential component in the nursing prac- chiatric nurses. Psychiatria Danubina, 30(2), 189–196.
tice environment: A qualitative study. Journal of Clinical and Yuwanich, N., Sandmark, H., & Akhavan, S. (2015). Emergency
Diagnostic Research: JCDR, 11(6), IC01–IC04. department nurses’ experiences of occupational stress: A quali-
Sarafis, P., Rousaki, E., Tsounis, A., Malliarou, M., Lahana, L., & tative study from a public hospital in Bangkok, Thailand.
Bamidis, P. (2016). The impact of occupational stress on Work (Reading, Mass.), 53(4), 885–897.

View publication stats