Project – Prevalence and Determinants of Occupational Stress Among Healthcare Workers: A Case Study of Selected Public Hospitals in Lagos State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Occupational stress has become an important concern in healthcare because the delivery of medical services requires workers to manage demanding responsibilities, make critical decisions, respond to emergencies, and care for patients experiencing pain, illness, and death. Occupational stress occurs when the demands of a job are perceived to exceed an individual’s ability or available resources to cope effectively. The International Labour Organization (ILO, 2016) identifies excessive workload, long working hours, limited control over work, poor organisational support, and difficult workplace relationships as psychosocial risks that can affect employees’ health and well-being. In healthcare settings, these pressures may be intensified by the need to provide timely and accurate care while working under conditions of uncertainty and emotional strain. The World Health Organization (WHO, 2022) emphasises that protecting healthcare workers’ mental health is an important part of maintaining a healthy workforce and ensuring effective health services. Consequently, occupational stress among healthcare workers is not merely an individual problem; it is also a workplace and public health concern that can affect the quality, safety, and continuity of patient care.

Healthcare workers occupy different professional roles, including doctors, nurses, pharmacists, medical laboratory scientists, physiotherapists, radiographers, and other clinical and allied health personnel. Although their duties differ, they may experience stress arising from high patient volumes, staff shortages, inadequate equipment, demanding schedules, administrative responsibilities, and exposure to suffering. Healthcare workers are also expected to maintain professional judgement, communicate effectively with patients and relatives, and comply with clinical standards even when under considerable pressure. A systematic review and meta-analysis by Odonkor and Adams (2019) found that psychosocial stress was common among healthcare workers in Nigeria, with work overload and inadequate workplace resources among the prominent reported risk factors. The review estimated an overall prevalence of approximately 62% across the included studies, although the estimates varied across studies and settings. These findings indicate that occupational stress deserves attention across different healthcare professions rather than being treated as a challenge affecting only one category of staff. Understanding its prevalence and determinants is therefore necessary for developing interventions that reflect the demands experienced by different groups of healthcare workers.

One major source of occupational stress in hospitals is excessive workload, particularly when the number of patients requiring attention exceeds the available staffing and resources. Healthcare workers may be required to attend to several patients simultaneously, complete documentation, administer treatments, respond to emergencies, and perform other responsibilities within limited periods. When such demands persist without sufficient rest or support, workers may experience fatigue, frustration, reduced concentration, and emotional exhaustion. Faremi et al. (2019), in a study of 183 nurses in two hospitals in southwestern Nigeria, identified inadequate staffing to cover ward workloads as a particularly stressful aspect of nursing practice. The study also highlighted the stress associated with inadequate drugs and equipment and with caring for patients who die. Although the research focused on nurses rather than every healthcare profession, it demonstrates how workload and resource limitations can contribute to stress in Nigerian hospital settings. Examining occupational stress in selected public hospitals in Lagos State can help establish whether similar pressures affect healthcare workers across different professional groups and identify the workplace conditions most closely associated with their stress levels.

Another important determinant of occupational stress is the emotional demand associated with caring for sick, injured, and dying patients. Healthcare workers often witness severe illness, distressing injuries, unsuccessful treatments, bereavement, and difficult conversations with patients and their relatives. They may also encounter patients who are frightened, dissatisfied, aggressive, or unable to understand the limitations of available treatment. These experiences can create emotional pressure, especially when workers are expected to remain calm, compassionate, and professional throughout their shifts. Faremi et al. (2019) reported that death and dying were important sources of stress among nurses in southwestern Nigeria, while the experience of performing painful procedures and working without adequate resources also contributed to occupational pressure. In addition, the COVID-19 pandemic demonstrated how infectious disease emergencies can intensify healthcare workers’ psychological demands through fear of infection, concern for family members, changing clinical procedures, and exposure to patient deaths. Olude et al. (2022), in a study involving doctors and nurses at Lagos State University Teaching Hospital, found that stress was common among the participants during the COVID-19 period. These findings demonstrate the importance of examining both routine workplace pressures and emotionally demanding clinical experiences when assessing occupational stress.

Organisational conditions can also influence the development and persistence of occupational stress. Factors such as inadequate supervisory support, poor communication, limited participation in workplace decisions, unfair distribution of duties, insufficient recognition, and conflict among colleagues may make work more difficult to manage. The Health and Safety Executive’s Management Standards identify demands, control, support, relationships, role, and organisational change as important areas for assessing and managing work-related stress (Health and Safety Executive, n.d.). These areas are relevant to hospitals because healthcare workers must coordinate their activities across professional groups and follow organisational procedures while responding to rapidly changing patient needs. Where communication is poor or staff feel unsupported, routine clinical demands may become more stressful. Odonkor and Adams (2019) similarly identified poor communication and staff attitudes, alongside work overload and inadequate resources, among the risk factors reported in Nigerian healthcare settings. Assessing occupational stress should therefore include organisational and interpersonal factors, rather than attributing stress exclusively to personal weakness or an individual worker’s inability to cope.

Occupational stress may have consequences for healthcare workers’ physical health, psychological well-being, professional performance, and intention to remain in their jobs. Persistent stress may be associated with sleep difficulties, fatigue, irritability, anxiety symptoms, reduced job satisfaction, and burnout. Burnout is related to occupational stress but is not identical to stress; it is characterised by work-related exhaustion, mental distance or cynicism, and reduced professional efficacy or effectiveness. The WHO (2019) classifies burnout in the International Classification of Diseases, 11th Revision, as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed. In Nigeria, Ogunsuji et al. (2022) examined job satisfaction and psychological health among health workers at Lagos State University Teaching Hospital, demonstrating the relevance of workplace conditions to staff well-being in the Lagos healthcare environment. Moreover, Olude et al. (2022) documented a substantial burden of perceived stress among doctors and nurses during the COVID-19 period. Such evidence matters because a stressed workforce may experience difficulties maintaining concentration, communicating effectively, and sustaining the level of care expected in demanding clinical environments. However, the specific consequences experienced by workers should be established through appropriate assessment rather than assumed for every individual.

Lagos State is an important setting for studying occupational stress because its public hospitals provide healthcare services to a large and diverse population and employ professionals who work in different clinical and support roles. Workers in these hospitals may encounter heavy patient workloads, shift duties, emergency cases, administrative demands, and the emotional challenges of caring for people with serious illnesses. Previous Nigerian studies provide evidence of occupational stress among healthcare workers generally and among specific professional groups. For example, Obasohan and Ayodele (2015) examined job stress among clinical healthcare workers in selected healthcare institutions in Lagos State, while Olude et al. (2022) investigated stress and other mental health outcomes among doctors and nurses at Lagos State University Teaching Hospital during the COVID-19 period. These studies provide a useful foundation, but their findings are tied to their respective samples, settings, and study periods. The prevalence of occupational stress and the factors associated with it should not automatically be assumed to be the same across all public hospitals, professional groups, or working conditions. The present study therefore seeks to determine the prevalence of occupational stress among healthcare workers in selected public hospitals in Lagos State and identify relevant demographic, professional, and workplace determinants. The findings may help hospital administrators and policymakers develop evidence-based strategies for improving staff well-being, workplace conditions, and the sustainability of healthcare services.

1.2 Statement of the Problem

Occupational stress among healthcare workers is a significant concern because hospitals depend on employees who can make sound decisions, communicate effectively, and deliver safe care under demanding conditions. Persistent workplace pressure may affect workers’ psychological well-being, job satisfaction, productivity, and ability to sustain demanding clinical responsibilities. Evidence from Nigeria suggests that occupational stress is not an isolated experience. Odonkor and Adams (2019), in a systematic review and meta-analysis, estimated the pooled prevalence of psychosocial stress among Nigerian healthcare workers at approximately 62%, although the included studies differed in their populations and methods. Similarly, Obasohan and Ayodele (2015) reported that 86.2% of their sample of clinical healthcare workers in selected Lagos healthcare institutions experienced some form of job strain. These figures relate to different study populations and measurement approaches and should not be treated as interchangeable estimates. Nevertheless, they indicate the importance of investigating occupational stress among healthcare workers and establishing its prevalence in the specific public hospitals selected for the present study.

A second problem is that healthcare workers face multiple workplace demands that may contribute to stress, but the relative importance of these factors may differ between hospitals and professional groups. High patient loads, inadequate staffing, long working hours, limited equipment, emotionally difficult patient encounters, and insufficient rest may combine to create sustained pressure. Faremi et al. (2019) found that inadequate staffing and shortages of drugs and equipment were prominent sources of stress among nurses in two southwestern Nigerian hospitals. These findings suggest that occupational stress may be connected not only to the nature of healthcare work but also to the resources available for performing it. However, findings from a study focused on nurses cannot automatically explain the experiences of doctors, laboratory scientists, pharmacists, radiographers, and other healthcare workers. There is therefore a need to assess the prevalence of stress among different categories of healthcare personnel in the selected public hospitals and identify the workplace demands most commonly associated with it.

A further concern is that occupational stress is influenced by a combination of personal, professional, and organisational factors. Age, marital status, professional cadre, years of experience, shift patterns, and weekly working hours may be associated with how workers experience workplace demands. Organisational factors, including supervisory support, communication, workplace relationships, access to equipment, and opportunities to participate in decisions, may also influence stress levels. Olude et al. (2022) found that 62.4% of the doctors and nurses studied at Lagos State University Teaching Hospital experienced stress during the COVID-19 period, with associations involving factors such as age, professional group, and previous mental health history. The pandemic context is important when interpreting those results, and they do not necessarily represent current stress levels in other hospitals or under ordinary working conditions. Nevertheless, the findings demonstrate the need to investigate potential determinants within the specific context of the proposed study. Without such evidence, interventions may address general symptoms of stress while overlooking the workplace factors contributing to them.

Finally, although previous studies have examined job stress among clinical workers in Lagos and mental health outcomes among healthcare professionals at a Lagos tertiary hospital, their findings do not establish the current prevalence and determinants of occupational stress across the particular public hospitals included in this research (Obasohan & Ayodele, 2015; Olude et al., 2022). Differences in study periods, professional composition, measurement instruments, and hospital conditions make it necessary to collect data that directly address the present study population. If the extent of occupational stress and its associated factors are not adequately assessed, hospital administrators may lack the local evidence needed to prioritise staff-support programmes, review workload distribution, strengthen supervisory practices, and improve working conditions. This study therefore seeks to determine the prevalence of occupational stress among healthcare workers in selected public hospitals in Lagos State and examine the demographic, professional, and workplace factors associated with it. Its findings are intended to contribute evidence for practical measures to support healthcare workers’ well-being and the effective delivery of patient care.

1.3 Aim and Objectives of the Study

The main aim of this study is to assess the prevalence and determinants of occupational stress among healthcare workers in selected public hospitals in Lagos State.

The specific objectives are to:

1. Determine the prevalence and level of occupational stress among healthcare workers in selected public hospitals in Lagos State.

2. Identify the major occupational and workplace factors contributing to stress among healthcare workers in the selected hospitals.

3. Examine the relationship between selected sociodemographic and professional characteristics and occupational stress among healthcare workers.

4. Assess the relationship between selected organisational factors, including workload, working hours, staffing adequacy, availability of work resources, and workplace support, and occupational stress among healthcare workers.

1.4 Research Questions

The study will answer the following questions:

1. What is the prevalence and level of occupational stress among healthcare workers in selected public hospitals in Lagos State?

2. What major occupational and workplace factors contribute to stress among healthcare workers in the selected hospitals?

3. What relationship exists between selected sociodemographic and professional characteristics and occupational stress among healthcare workers?

4. What relationship exists between selected organisational factors and occupational stress among healthcare workers in the selected hospitals?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no statistically significant relationship between selected organisational factors and occupational stress among healthcare workers in selected public hospitals in Lagos State.

1.6 Significance of the Study

The findings of this study are expected to be beneficial to healthcare workers, hospital administrators, policymakers, patients, and future researchers.

Healthcare workers: The study may help healthcare workers recognise the common sources and effects of occupational stress in their professional environment. Understanding the factors associated with stress may encourage workers to adopt appropriate coping strategies, seek support when necessary, and participate in workplace initiatives designed to improve their well-being.

Hospital administrators: The findings may provide useful information for reviewing working conditions in the selected public hospitals. By identifying important stressors, such as excessive workload, long working hours, inadequate staffing, insufficient resources, and poor workplace support, administrators may be better positioned to improve staff scheduling, distribute duties more fairly, and strengthen supervisory support.

Healthcare policymakers: The study may provide local evidence to support the development and implementation of policies that protect healthcare workers’ psychological well-being. Its findings may assist policymakers in considering occupational stress as part of broader efforts to improve healthcare workforce management and service delivery.

Patients: Patients may benefit indirectly from interventions informed by the findings. Healthcare workers who receive adequate organisational support and have manageable workloads may be better positioned to maintain concentration, communicate effectively, and provide consistent care. However, the study will assess occupational stress and its determinants rather than directly measure patient outcomes.

Human resource and occupational health departments: The findings may help these departments identify groups of workers who may require additional support and develop appropriate workplace wellness programmes, counselling services, stress-management training, and referral procedures.

Researchers and students: The study may contribute to existing knowledge on occupational stress in Nigeria and serve as a reference for future investigations involving healthcare professionals in other hospitals, states, or healthcare systems.

1.7 Scope of the Study

The study focuses on the prevalence and determinants of occupational stress among healthcare workers in selected public hospitals in Lagos State, Nigeria.

The geographical scope covers the public hospitals selected for the research. The names of the participating hospitals will be specified in the methodology after the study sites have been determined and the necessary permissions obtained.

The content scope covers the prevalence and level of occupational stress, common workplace stressors, and the relationships between stress and selected sociodemographic, professional, and organisational factors. These factors may include age, sex, marital status, professional cadre, years of work experience, workload, working hours, staffing adequacy, availability of work resources, and workplace support.

The population scope includes eligible healthcare workers employed in the selected hospitals. Depending on the staffing structure and inclusion criteria, participants may include doctors, nurses, pharmacists, medical laboratory scientists, radiographers, and other relevant healthcare professionals.

The study will assess occupational stress using an appropriate, clearly specified measurement instrument. It will not assume that all psychological distress, anxiety, depression, or burnout is equivalent to occupational stress.

1.8 Limitations of the Study

The study may encounter limitations that should be considered when interpreting its findings.

First, the study will involve selected public hospitals rather than every public hospital in Lagos State. Consequently, the findings may not be generalisable to all healthcare facilities or healthcare workers in the state.

Second, if data are collected through self-administered questionnaires, respondents may overestimate or underestimate their stress levels because of recall difficulties, concerns about confidentiality, or reluctance to disclose personal experiences.

Third, occupational stress may fluctuate according to workload, emergencies, staffing levels, and other temporary workplace conditions. A cross-sectional study captures participants’ experiences within a particular period and may not fully represent changes in stress over time.

Fourth, healthcare workers from different professional groups may experience different job demands. The study will need to account for these differences when comparing results across professional categories.

Finally, limited time and financial resources may affect the number of hospitals and participants that can be included. These limitations may be reduced through appropriate sampling, use of a validated measurement instrument, protection of respondents’ confidentiality, and careful interpretation of the results.

1.9 Operational Definition of Terms

Occupational stress: The psychological and physical strain associated with perceived difficulties in meeting the demands of one’s job. In this study, it refers to stress assessed among healthcare workers using the selected research instrument.

Prevalence: The proportion of healthcare workers in the study population who meet the study’s defined criteria for occupational stress during the specified assessment period.

Determinants: The personal, professional, and workplace characteristics examined for their statistical association with occupational stress. Unless a causal research design is used, these factors will be described as associated factors rather than proven causes.

Healthcare workers: Professionals engaged in the provision of healthcare services in the selected hospitals, including eligible clinical and allied healthcare personnel.

Public hospitals: Healthcare facilities owned or operated by government authorities.

Workload: The amount and complexity of work assigned to or performed by a healthcare worker within a specified period.

Working hours: The amount of time a healthcare worker spends performing official duties during a specified period, including relevant shift and overtime arrangements.

Workplace support: The practical, professional, and interpersonal assistance available to healthcare workers from supervisors, colleagues, and hospital management.

Burnout: A work-related phenomenon associated with chronic workplace stress that has not been successfully managed, characterised by exhaustion, mental distance or cynicism toward work, and reduced professional efficacy. Burnout is related to, but distinct from, occupational stress (World Health Organization, 2019).

Coping strategies: The behavioural and psychological approaches used by healthcare workers to manage stressful experiences and workplace demands.

Project – Prevalence and Determinants of Occupational Stress Among Healthcare Workers: A Case Study of Selected Public Hospitals in Lagos State.