TABLE OF CONTENTS
ABSTRACT. ii
TABLE OF CONTENTS. iii
CHAPTER ONE. 1
INTRODUCTION. 1
1.1 Background to the Study. 1
1.2 Statement of the Problem.. 7
1.3 Objectives of the Study. 8
1.4 Research Questions. 8
1.5 Research Hypothesis. 9
1.6 Significance of the Study. 9
1.7 Scope of the Study. 10
1.8 Limitations of the Study. 10
1.9 Organization of the Study. 10
1.10 Definition of Terms. 11
CHAPTER TWO.. 14
REVIEW OF RELATED LITERATURE. 14
2.1 Introduction. 14
2.2 Theoretical Review.. 14
2.2.1 Stress-Strain-Coping Theory. 14
2.2.2 Job Demands-Resources (JD-R) Model Theory. 14
2.2.3 Transactional Model of Stress and Coping. 15
2.2.4 Social Support Theory. 15
2.3 Conceptual Review.. 16
2.3.1 Overview.. 16
2.3.2 The Context of Nursing in Nigeria. 16
2.3.3 Mental Health Challenges. 16
2.3.4 Work Environment Factors. 17
2.3.5 Stigma Surrounding Mental Health. 17
2.3.6 Coping Strategies Employed by Nurses. 17
2.3.7 Role of Professional Support 18
2.3.8 Training and Awareness Programs. 18
2.3.9 Policy Implications. 18
2.3.10 Importance of Research. 19
2.4 Empirical Review.. 19
2.5 Summary of Literature Review.. 21
CHAPTER THREE. 23
RESEARCH METHODOLOGY. 23
3.1 Research Design. 23
3.2 Area of Study. 23
3.3 Population of the Study. 23
3.4 Sample Size and Sampling Technique. 24
3.5 Instrument for Data Collection. 24
3.7 Method of Data Analysis. 25
3.8 Validity and Reliability of the Instrument 25
3.9 Ethical Considerations. 26
3.10 Scope and Limitations of the Study. 26
CHAPTER FOUR. 27
DATA ANALYSIS AND INTERPRETATION. 27
4.1 Preamble. 27
4.2 Socio-Demographic Characteristics of Respondents. 27
4.3 Analysis of the Respondents’ Views on Research Question one: 32
4.4 Testing Hypothesis. 42
4.5 Discussion of Findings. 45
CHAPTER FIVE. 47
SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS 47
5.1 Summary of Findings. 47
5.2 Conclusion. 47
5.3 Recommendations. 48
REFERENCES. 50
APPENDICES. 56
APPENDIX I: RESEARCH QUESTIONNAIRE: INVESTIGATING THE MENTAL HEALTH AND WELL-BEING OF NIGERIAN NURSES. 56
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
The largest and most important part of the healthcare delivery system is the nursing profession (Farhadi et al., 2021). Nurses perform multiple responsibilities as managers, counselors, change agents, and care providers, especially in stressful circumstances (Keykaleh et al., 2018). This makes the mental health of nurses important because of the high level of stress experienced by nurses during their clinical, research, and/or administrative work leading to the syndrome of burnout (Pisanti et al., 2016; Okwaraji & Aguwa, 2014). For example, recently, nurses have had to engage in tedious patient care, yet they have to navigate a rapidly expanding nursing knowledge base, attend to more onerous maintenance of certification requirements, and face an unprecedented level of scrutiny to ensure quality nursing care for their patients (Pisanti et al., 2016).
A 2001 study reported that 43% of nurses in United States hospitals had emotional exhaustion, while 37% providing direct patient care in nursing homes and 33% of hospital nurses had burnout (McHugh et al., 2011). A study of Aiken and co-investigators involving over 43,000 nurses practicing in more than 700 hospitals in five European and North American countries indicates that the design of nursing work, widespread workforce management problems, and inadequate nurse workforce are the most important determinants of burnout among nurses (Aiken et al., 2011). A similar observation was noted in a cross-country comparison involving six countries, namely: the U.S.A., Canada, U.K., Germany, New Zealand, and Japan, where higher levels of burnout were associated with lower ratings of the quality-of-care independent of nurses' ratings of practice environments (Poghosyan et al., 2010).
In Africa, a cross-sectional survey of 309 female nurses in private and public hospitals in Kenya, Tanzania, and Uganda indicated that about a third of the sample had burnout (van der Doef et al., 2012). In a systematic review of 12 studies from seven African countries, using the Maslach Burnout Inventory, the prevalence of emotional exhaustion was 66%, depersonalization was 37%, and low personal achievement was 49% (Owuor et al., 2020).
In Nigeria, where healthcare providers face numerous challenges, the mental health of nurses is of paramount importance. The demanding nature of their work, coupled with limited resources and high patient-to-nurse ratios, contributes to elevated stress levels and potential mental health issues (Udo et al., 2021). Recent studies indicate that nurses in Nigeria often grapple with emotional exhaustion, burnout, and compassion fatigue, which can significantly impair their professional efficacy and personal lives (Adeyemo et al., 2020; Abimbola et al., 2021).
The challenges faced by Nigerian nurses are exacerbated by systemic issues within the healthcare sector. Insufficient staffing, inadequate training, and poor working conditions contribute to a hostile work environment that can detrimentally affect mental health (Adebayo et al., 2020). Additionally, socio-cultural factors and stigma surrounding mental health issues further complicate their willingness to seek help (Ibrahim et al., 2022). The intersection of these factors not only impacts the individual nurses but also affects patient care and overall healthcare delivery in Nigeria (Ojo et al., 2023).
The largest and most important part of the health care system is the nursing profession (Farhadi et al., 2021). Nurses take on a variety of roles as managers, consultants, change agents and care providers, particularly under stressful conditions (Keykaleh et al., 2018). Therefore, mental health of nurses is important because nurses face high levels of stress during their clinical, research, and/or administrative work, leading to burnout syndrome (Pisanti et al., 2016; Okwaraji & Aguwa, 2014). For example, nurses have recently had to deal with tedious patient care, but must navigate a rapidly expanding nursing knowledge base, deal with the more burdensome maintenance of certification requirements, and face unprecedented levels of scrutiny to provide quality care for them ensure patients (Pisanti et al., 2016).
A 2001 study found that 43% of nurses in U.S. hospitals suffered from emotional exhaustion, while 37% in nursing homes providing direct patient care and 33% of hospital nurses suffered from burnout (McHugh et al., 2011). A study conducted by Aiken and co-investigators of over 43,000 nurses working in more than 700 hospitals in five European and North American countries shows that nursing work design, widespread human resource management problems, and inadequate nursing staff are the most important determinants of nurse burnout ( Aiken et al., 2011).
A similar observation was found in a cross-country comparison that included six countries, namely the United States, Canada, the United Kingdom, Germany, New Zealand and Japan, where higher burnout rates were associated with lower ratings of quality of care independent of nurses' ratings of practice environments (Poghosyan et al., 2010).
In Africa, a cross-sectional survey of 309 female nurses in private and public hospitals in Kenya, Tanzania and Uganda found that about a third of the sample had experienced burnout (van der Doef et al., 2012). In a systematic review of 12 studies from seven African countries using the Maslach Burnout Inventory, the prevalence of emotional exhaustion was 66%, depersonalization 37%, and low personal achievement 49% (Owuor et al., 2020).
In Nigeria, healthcare providers face numerous challenges the mental health of nurses is of utmost importance. The demanding nature of their work, coupled with limited resources and a high patient-to-nurse ratio, contributes to increased levels of stress and potential psychological problems (Udo et al., 2021). Recent studies show that nurses in Nigeria often struggle with emotional exhaustion, burnout and compassion fatigue, which can significantly impact their professional performance and personal life (Adeyemo et al., 2020; Abimbola et al., 2021).
The challenges facing Nigerians nurses are compounded by systemic problems in the health sector. Inadequate staffing, inadequate training, and poor working conditions contribute to a hostile work environment that can adversely affect mental health (Adebayo et al., 2020). In addition, sociocultural factors and the stigmatization of mental health problems complicate their willingness to seek help (Ibrahim et al., 2022). The intersection of these factors not only impacts individual nurses but also impacts patient care and overall healthcare delivery in Nigeria (Ojo et al., 2023).
This highlights the need for nurses to develop resilient characteristics in their various areas of expertise. In her study of nursing students, Stephens (2013) suggested that developing, promoting, or enhancing resilience can be achieved through targeted interventions and educational efforts to strengthen protective factors (p. 130). Failing to support nurses in developing these characteristics can lead to disruption in their work, which can have a negative impact on current retention rates as well as future recruitment (Gillespie et al. 2007). Individual resilience skills ensure that nurses are successful in their nursing careers and can thrive in challenging and difficult work environments (McGowan & Murray 2016).
However, the coping strategies that caregivers use to mitigate the effects of stress and maintain mental well-being are varied. Some rely on personal resilience and peer support, while others may engage in physical activities or mindfulness practices (Ogunyemi et al., 2021). Understanding these coping mechanisms is critical to developing targeted interventions and support systems to promote caregiver mental health.
Current literature emphasizes the need for organizational changes and policy reforms to create a supportive environment that promotes well-being (Adeyemo et al., 2020; Udo et al., 2021). The aim of this study is to examine the psychological challenges faced by Nigerian nurses and the coping strategies they use. By examining both the systemic factors that contribute to mental health problems and personal strategies for coping with these problems, this research attempts to provide a comprehensive understanding of the situation. This research is critical not only to improving the lives of nurses but also to improving the overall quality of healthcare in Nigeria (Abimbola et al., 2021; Ibrahim et al., 2022).
Bottom of Form
1.2 Statement of the Problem
The mental health and well-being of Nigerian nurses are increasingly recognized as critical factors influencing both their quality of life and the effectiveness of healthcare delivery in the country. Despite their vital role in the healthcare system, Nigerian nurses face numerous challenges, including high patient-to-nurse ratios, inadequate staffing, and insufficient resources, which contribute to elevated stress levels and burnout (Adeyemo et al., 2020). These conditions not only compromise their mental health but also negatively impact patient care outcomes, creating a cycle of stress and diminished quality of service (Udo et al., 2021). Moreover, the stigma surrounding mental health issues often prevents nurses from seeking help, leading to untreated psychological distress that can further exacerbate their situation.
Understanding the coping strategies employed by Nigerian nurses is essential for developing effective interventions to support their mental health. Many nurses resort to informal coping mechanisms, which may not be sufficient to mitigate the adverse effects of their work environment (Ogunyemi et al., 2021). The lack of institutional support and mental health resources further complicates their ability to cope effectively. This investigation aims to highlight the specific challenges faced by Nigerian nurses and explore their coping strategies, providing insights that could inform policy changes and improve mental health support within the nursing profession (Abimbola et al., 2021).
1.3 Objectives of the Study
The main objective of the study is to examine Investigating the Mental Health and Well-being of Nigerian Nurses: Challenges and Coping Strategies. Specific objectives of the study are:
- To identify the primary sources of stress and mental health challenges experienced by Nigerian nurses.
- To explore the coping strategies employed by Nigerian nurses to manage stress and maintain their mental health.
- To examine the availability and accessibility of mental health support resources for Nigerian nurses.
1.4 Research Questions
To guide the study and achieve the objectives of the study, the following research questions were formulated:
- What are the most common stressors faced by Nigerian nurses in their work environment?
- What coping strategies do Nigerian nurses commonly use to deal with work-related stress?
- What mental health support resources are currently available to Nigerian nurses?
1.5 Research Hypothesis
The following research hypothesis was developed and tested for the study:
Ho: There is no significant difference in the mental health and well-being of Nigerian nurses based on the challenges they face and the coping strategies they employ.
1.6 Significance of the Study
The study is important for many reasons. The following are the major stakeholders this paper through its practical and theoretical implications and findings will be of great significance:
Firstly, the paper will benefit major stakeholders and policy makers in the Nursing Science sector. The various analysis, findings and discussions outlined in this paper will serve as a guide in enabling major positive changes in the industry and sub-sectors.
Secondly, the paper is also beneficial to the organizations used for the research. Since first hand data was gotten and analyzed from the organization, they stand a chance to benefit directly from the findings of the study in respect to their various organizations. These findings will fast track growth and enable productivity in the organizations used as a case study.
Finally, the paper will serve as a guide to other researchers willing to research further into the subject matter. Through the conclusions, limitations and gaps identified in the subject matter, other student and independent researchers can have a well laid foundation to conduct further studies.
1.7 Scope of the Study
The study is delimited to UUTH, Uyo. Findings and recommendations from the study reflects the views and opinions of respondents sampled in the area. It may not reflect the entire picture in the population.
1.8 Limitations of the Study
The major limitations of the research study are time, financial constraints and delays from respondents. The researcher had difficulties combining lectures with field work. Financial constraints in form of getting adequate funds and sponsors to print questionnaires, hold Focus group discussions and logistics was recorded. Finally, respondents were a bit reluctant in filling questionnaires and submitting them on time. This delayed the project work a bit.
1.9 Organization of the Study
The study is made up of five (5) Chapters. Chapter one of the study gives a general introduction to the subject matter, background to the problem as well as a detailed problem statement of the research. This chapter also sets the objectives of the paper in motion detailing out the significance and scope of the paper.
Chapter Two of the paper entails the review of related literature with regards to corporate governance and integrated reporting. This chapter outlines the conceptual reviews, theoretical reviews and empirical reviews of the study.
Chapter Three centers on the methodologies applied in the study. A more detailed explanation of the research design, population of the study, sample size and technique, data collection method and analysis is discussed in this chapter.
Chapter Four highlights data analysis and interpretation giving the readers a thorough room for the discussion of the practical and theoretical implications of data analyzed in the study.
Chapter Five outlines the findings, conclusions and recommendations of the study. Based on objectives set out, the researcher concludes the paper by answering all research questions set out in the study.
1.10 Definition of Terms
1. Mental Health
A state of emotional, psychological, and social well-being in which individuals can cope with stress, work productively, and contribute to their community. It encompasses conditions such as depression, anxiety, and stress disorders.
2. Well-being
A holistic concept that includes emotional, physical, and social dimensions, reflecting an individual's overall quality of life and satisfaction. In the context of nurses, it refers to their ability to thrive in both personal and professional spheres.
3. Challenges
Various stressors and obstacles faced by nurses in their professional roles, including high workloads, emotional exhaustion, workplace violence, and inadequate support systems. These challenges can significantly impact their mental health.
4. Coping Strategies
Techniques and methods employed by individuals to manage stress and navigate challenges. These can be adaptive (healthy) strategies, such as seeking social support or practicing mindfulness, or maladaptive (unhealthy), such as substance abuse.
5. Burnout
A state of chronic physical and emotional exhaustion, often resulting from prolonged stress and job-related pressures. It manifests in feelings of detachment, cynicism, and reduced personal accomplishment, particularly common in nursing professionals.
6. Resilience
The capacity to recover quickly from difficulties or adapt to challenging situations. In nursing, resilience can play a crucial role in maintaining mental health and well-being despite the demands of the profession.
7. Support Systems
Networks of individuals or organizations that provide emotional, social, or professional assistance to nurses. This can include family, friends, colleagues, supervisors, and institutional resources aimed at promoting mental health and coping mechanisms.
