1. Department of Adult Nursing, Tribhuvan University, Institute of Medicine, Pokhara Nursing Campus, Pokhara, Nepal.

* Correspondence: munapokhrel423@gmail.com

Keywords: work-related stress, oncology, nursing, working environment, health care institutions

1. INTRODUCTION

The National Occupational Safety Association of America has placed the nursing job in terms of stress at the head of the medical professions [1]. Among which one of the most stressful specialty areas of nursing is oncology [2]. Nursing oncology is a complex working environment as the nurses working in such unit requires greater knowledge, higher skills and competency in caring for the cancer patient. Oncology nurses are also responsible for providing ongoing and continuous support to families through the treatment process, involvement with highly demanding patients and families, administering aggressive cancer treatment and perhaps, death and dying as well [3]. Stress experienced by oncology nurses affects their job satisfaction, desire to remain in the profession and most importantly impact on the physical and psychological wellbeing [4]. Several studies show a strong negative relation between work related stress and job satisfaction resulting in increased turnover rate, causing more and more nurses to leave the nursing profession [5,6,7]. Stress causes significant impact on individual nurses and their ability to accomplish the task and more specifically impaired decision making, apathy, lack of concentration, decreases motivation and anxiety, absenteeism ultimately reducing job performance and errors in the workplace. Nurses experiencing ongoing stress are more vulnerable for poor eating, smoke, alcohol and drugs abuse resulting in negative health conditions and wellbeing [8]. A study done in Ethiopia among nurses working in cancer unit from the selected hospital (52%) of the nurses had job stress whereas (48%) were not stressed identifying dealing with the death, uncertainty of the treatment, and workload as the most stressful sources [9]. Similar findings were observed in Jimma revealing the most common causes of job stress as death (62.94%), uncertainty regarding treatment (57.72%) and workload (57.6%) [10]. Several studies have revealed moderate to high prevalence of stress among oncology nurses with commonly encountered stressful situation as relationship with the patient without any treatment possibilities, patient death, interpersonal conflicts, unexpected and new situation, inadequate preparation for the role they have to perform, shortage of personnel, excessive workload, painful procedure experienced by the patient, lack of equipment and drugs and delay to receive medical care [11,12]. Nurses working in cancer unit may develop stress associated with cytotoxic effects of drugs resulting in headache, depression, hair loss, even cytotoxic drug itself. Thus, signifying more than 70% of the nurses working in the cancer unit with moderate to a high level of job stress [13]. Work related stress is the emerging issue faced by the nurses these days in different work settings, especially those working in the cancer units and the critical care units.  According to the broad set of studies stress is responsible for the reduction in quality performance, well-being, reduction in individual satisfaction, personal stagnation and absenteeism from work [14,15]. A study conducted among oncology nurses of New York city showed the higher prevalence of the stress level among nurses with workload, death and dying as the major stressors [16]. Similar findings were observed in a study conducted in head and neck oncology department of the selected hospital of Portugal which revealed a significant percentage of nurses presented with a high level of pressure and emotional stress identifying the main related stressors as the organizational aspects and work condition [17]. Studies showed the high prevalence of stress among the oncology nurses in Pakistan (62%) [18] and India (63%) [19] experiencing extreme workload and tension associated with patient in terminal phase and families as the main stressors. Several studies reveals work‐related stressors specific to oncology nurses, such as administering aggressive cancer treatments, intensive involvement with highly demanding patients and families, dealing with the death of patients, developing close relationships with patients during long‐term hospitalizations, communication issues, poor relationships with medical staff, ethical and moral issues related to patient care and research, interpersonal staff conflicts, workload, finding a balance between one’s individual and professional life, and lack of in‐service training [20]. Even though several studies have been conducted in developed countries to spot the light on stress level and stressors among oncology nurses; very few studies have been done in critical care areas, however, no studies found specifically among oncology nurses in Nepalese context. So, it is very crucial to conduct a periodic and continuous assessment of work-related stress among nurses especially in cancer units. This study assessed the work-related stress among nurses working in cancer hospitals.

2. MATERIALS & METHOD

The cross-sectional descriptive design was used for the study. The study was conducted in B.P. Koirala Memorial Cancer Hospital, which is located at Bharatpur-7, Chitwan, Bagmati Province, Nepal. The hospital is a tertiary cancer care treatment facility with 500 beds and one of the National Cancer Institute in Nepal entrusted with the responsibilities for high quality services of diagnosis, treatment, rehabilitation, prevention and research in cancer in Nepal. The study population were nurses working in a different department of BP Koirala Memorial Cancer Hospital for more than six months. Total population was 230. Probability, simple random sampling technique was used by listing the sampling frame of total population available during the study period then after that samples were randomly selected from the Excel using lottery method. The sample size was calculated considering 62.9% of prevalence of stress observed among oncology nurses in India.

Confidence interval of 95%

Allowable error of 5 % i.e. 0.05

According to Cochran’s formula

Here p = 63% = 0.63

Then q =1-p = 0.37

n= z²pq/d²

= (1.96) ² × (0.63) ×0.37/ 0.05 ²

 = 305

Having the finite population of 230 nurses in BP Koirala Memorial Cancer Hospital. Sample size was adjusted using the formula:

Finite population size (n) = nₒ/(1+(nₒ-1)/N)

= 305/ (1+ (305-1)/230)

= 131.4 ~ 132

Therefore, the required sample size was132.

After, adding 10% of 131 as non-response rate = 13.1= 13

Total precise sample size obtained = 132+13=145.

A structured self-administered questionnaire was developed to measure the level of work- related stress and its associated factors.  To measure stress, Expanded Nursing Stress Scale (ENSS) was used which was borrowed from Susan French with her permission.  Then it was modified; four relevant items were added, under opportunity for career development and 7 irrelevant items from different subscales were removed after pretesting as per the expert’s suggestion. Finally, the modified ENNS instrument incorporated total 51 items, which could assess the stress level. Four-point Likert scales were there to measure frequency of stress of nurses. The questionnaire consists of two parts. Part I: Socio-demographic related questionnaires which includes (age, marital status, types of family, education level, experience as a nurse, experience as oncology nurse, department of working). Part II: Consists of modified Expanded Nursing stress scale (ENSS) questionnaire. In this modified ENSS contains 51 items with ten subscales. The subscales are Death and dying Patient (6 items), Workload (8 items), Relationship with supervisors (6 items), Relationship with co-workers (3 items), Relationship with physicians (5 items), Inadequate emotional preparation (3 items), Uncertainty concerning treatment (8 items), Patient and family’s stressors (5 items), Opportunity for Carrier development (4 items), Discrimination (3 items). Therefore, modified ENSS consists of 51 items with ten subscales with response options in a Likert like format (0= never stressful, 1 = occasionally stressful, 2 = frequently stressful, 3 = extremely stressful). Validity of the tool was done through extensive literature review, consultation with nursing professionals, experts and peers. Pretesting of the instrument was done in 10% of total sample (15 nurses) who were working in cancer hospital, Bhaktapur. After pretesting Cronbach’s alpha was calculated which was 0.83 and over all 83% reliability of the tool was obtained and necessary modification was done. The Data were collected after getting approval from the research committee of Pokhara Nursing Campus TU, IOM. Then after ethical approval from the Institutional review committee of TU, IOM was obtained. Then formal written permission was taken from B.P. Koirala Memorial Cancer Hospital, Chitwan through the request letter from Pokhara Nursing Campus TU, IOM. The hospital authority and nursing staff were briefed about the objective and process of the study. Introduction to nursing staff was introduced and the purpose of the study was explained to each nurse. Participation of the respondents was voluntary and informed written consent was obtained prior to data collection. Data was collected by researcher herself by using structured self-administered questionnaire in English version, at time convenient for the participants. The average time required to complete a questionnaire was approximately 15-20 minutes. To maintain the quality of the data, clear instructions were given about answering the questionnaire. Precautions were taken throughout the study in every step to safeguard the right and welfare of all respondents in the study. Confidentiality was maintained by putting code number instead of names of participants and collected information was used only for study purposes. The participants were permitted to withdraw from the study at any time without giving reason and without fear. Duration of data collection was four weeks (from 10^th February to 10^th March). Before leaving the participants, the filled instrument was rechecked for completeness and consistency. The respondents who had stress level of moderate to severe were given health teaching on stress management techniques and advised for further psychological counselling. Also, due to COVID-19 pandemic situation, researchers always used Personal Protective equipment’s during the data collection period. Frequent hand washing or sanitization with alcohol-based hand rub (ABHR) with 60-95% alcohol was done. Physical distance of at least 1 meter was maintained. Also, disinfection of questionnaires was done after receiving them back. The obtained data were compiled, edited, and checked to maintain consistency and to find out omission or repetition on the same day. Coding of the data was done and entered the computer using the software Epi-data 3.1 and transferred into Statistical Package for Social sciences (SPSS 16 version) for further analysis. Data was analyzed and interpreted according to the objectives of the study and research questions. Descriptive statistics (frequency, percentage, mean and standard deviation) were used to describe the socio-demographic characteristics. Inferential statistics (Chi square) were used to identify the association between the work-related stress level and selected variables.

3. RESULTS & DISCUSSION

Table 01: Socio-Demographic Characteristic of Respondents

Characteristics	Number	Percent
Age in Years
≤30	95	65.5
31 – 40	35	24.1
>41	15	10.4
Mean± SD (30.30±6.70)
Marital Status
Married	106	73.1
Unmarried	39	26.9
Types of Family
Nuclear	89	61.4
Joint	56	38.6
Qualification
PCL	36	24.8
Bachelor	101	69.7
Masters	8	5.5
Experience as Nurse
≤10 years	103	71.0
˃10 years	42	29.0
Oncology Experience
≤5 years	84	57.9
˃5 years	61	42.1
Working Department
Critical Unit	46	31.7
General Unit	81	55.9
Others	18	12.4

 

Table 01 shows that 66 percent of respondents were from age 30 and below 30 years, and only 9.7 percent were from 40-50 years with mean age (30.3±6.70). In considering marital status majority 73.1 percent were married. 61.4 percent were from nuclear families. Similarly, 69.7 percent of the respondents were bachelor’s degrees and 5.5 percent completed master’s degree. Likewise, majority of the respondents (71%) had up to 10 years of experience in nursing profession while 57.9 percent had an experience in oncology field up to 5 years. In considering the working department 31.7 percent of the respondents were working in critical unit and 55.9 percent were from general unit.

Table 02: Respondents Responses on Death and Dying

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
Performing procedures patients experience as painful	6(4.1)	68(46.9)	49(33.8)	22(15.2)	1.60±0.79
When a patient health deteriorates	4(2.8)	52(35.9)	62(42.8)	27(18.6)	1.77±0.77
The death of the patient	2(1.4)	42(29.0)	42(29.0)	59(40.7)	2.09±0.86
Death of patient with whom you developed closed relationship	2(1.4)	26(17.9)	48(33.1)	69(47.6)	2.27±0.80
Physician not being present when a patient dies	5(3.4)	43(29.7)	42(29.0)	55(37.9)	2.01±0.90
Watching a patient suffered due to pain and other aggressive treatment modality	6(4.1)	46(31.7)	54(37.2)	39(26.9)	1.87±0.86

 

NS-Never Stressful, OS- Occasionally Stressful, FS-Frequently Stressful, ES- Extremely Stressful

Table 02 shows responses of respondents on death and dying subscale where majority (47.6%) perceived extremely stressful during death of the patient with whom you developed closed relationship whereas only 1.4 percent perceived as never stressful situation. Likewise, majority (46.9%) of respondents perceived occasionally stress while performing painful procedures where as 15.2 percent perceived as extremely stressful factor.

Table 03: Respondents Response on Workload

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
Not enough time to provide emotional support to the patient	6(4.1)	55(37.9)	58(40.0)	26(17.9)	1.72±0.80
Not enough time to respond to the need of patient’s families	3(2.1)	62(42.8)	58(40.0)	22(15.2)	1.68±0.75
Not enough staff to adequately cover the unit	3(2.1)	33(22.8)	50(34.5)	59(40.7)	2.14±0.83
Too many non-nursing tasks required, such as clerical work	12(8.3)	57(39.3)	39(26.9)	37(25.5)	1.70±0.94
Not enough time to complete all of my nursing task	6(4.1)	52(35.9)	48(33.1)	39(26.9)	2.03±2.6
Having to work through breaks	18(12.4)	61(42.1)	41(28.3)	25(17.2)	1.50±0.92
Not enough equipment supplies/not functioning well	10(6.9)	43(29.7)	47(32.4)	45(31.0)	1.88±0.93
When need to balance between work and home	20(13.8)	55(37.9)	44(30.3)	26(17.9)	1.52±0.92

 

Table 03 shows responses of the respondents on workload subscale where 40.7 percent of respondents perceived not enough staff to adequately cover the unit as extremely stressful whereas only 2.1 percent respondents perceived it has never stressful situation. Likewise, majority (42.8%) perceived not enough time to respond to the need of the patient’s families as occasionally stressful situation whereas 40 percent of respondents perceived it as frequently stressful situation.

Table 04: Respondents Response on Relationship with Supervisors

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
When my supervisor does not accept my decision	17(11.7)	73(50.3)	36(24.8)	19(13.1)	1.39±0.86
Lack of support from immediate supervisor	12(8.3)	64(44.1)	37(25.5)	32(22.1)	1.61±0.92
Criticism by nursing administration	20(13.8)	40(27.6)	39(26.9)	46(31.7)	1.77±1.04
Lack of support from nursing administration	11(7.6)	47(32.4)	42(29.0)	45(31.0)	1.83±0.95
When I am accountable for things over which I do not have any control	9(6.2)	67(46.2)	28(19.3)	41(28.3)	1.70±0.95
Lack of support from other health care administrations	14(9.7)	53(36.6)	36(24.8)	42(29.0)	1.73±0.98

 

Table 04 shows respondents’ responses on relationship with supervisors’ subscale where half (50.3%) of the respondents perceived when supervisor do not accept my decision as extremely stressful. Likewise, nearly half (46.2%) perceived being accountable for things over which I do not have any control as occasionally stressful whereas 28.3 percent perceived it as extremely stressful factor.

Table 05: Respondents Response on Relationship with Co-Workers

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
Lack of opportunity to share experience and feelings with other personnel in the work setting	25(17.2)	70(48.3)	36(24.8)	14(9.7)	1.27±0.86
Lack of opportunity to express to other personnel in the unit regarding my negative feelings towards patients	33(22.8)	71(49.0)	28(19.3)	13(9.0)	1.14±0.87
Difficulty in working with a particular nurse outside my immediate work setting	32(22.1)	63(43.4)	38(26.2)	12(8.3)	1.21±0.88

 

Table 05 shows respondents’ responses on relationship with co-workers’ subscale where majority (49.0%) of the respondents perceived lack of opportunity to express to other personnel in the unit regarding negative feelings towards patients as occasionally stressful where only 9 percent perceived it as extremely stressful. Considering difficulty in working with the particular nurse outside my immediate work setting 43.4 percent of respondents perceived as occasionally stressful whereas only 8.3 percent of respondents as extremely stressful.

Table 06: Respondents Response on Relationship with Physician

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
Criticism/scold by physician	19(13.1)	48(33.1)	33(22.8)	45(31.0)	1.72±1.04
Conflict with a physician	27(18.6)	59(40.7)	32(22.1)	27(18.6)	1.41±0.99
Disagreement concerning the treatment of a patient	12(8.3)	76(52.4)	43(29.7)	14(9.7)	1.41±0.77
Making a decision concerning a treatment of patient when the physician is unavailable	24(16.6)	60(41.4)	36(24.8)	25(17.2)	1.43±0.96
Having to organize doctors work	27(18.6)	48(33.1)	47(32.4)	23(15.9)	1.46±0.97

 

Table 06 shows respondents’ responses on relationship with physician subscale where more than half (52.4%) perceived disagreement concerning the treatment of the patient as occasionally stressful whereas only 9.7 percent of respondents considered as extremely stressful. Considering criticism/scold by physician 33.1 percent of respondents perceived it as occasionally stressful and 31 percent of respondents perceived it as extremely stressful.

Table 07: Respondents Response on Inadequate Emotional Preparation

Items	NS	OS	FS		ES	Mean± S. D
	No. (%)	No. (%)	No. (%)		No. (%)
Feeling inadequately prepared to help the emotional need of a patient	23(15.9)	75(51.7)	39(26.9)	8(5.5)		1.22±0.77
When I do not have a satisfactory answer while patient ask a question	7(4.8)	80(55.2)	40(27.6)	18(12.4)		1.48±0.77
Feeling inadequately prepared to help the emotional need of a patient’s family	14(9.7)	88(60.7)	33(22.8)	10(6.9)		1.27±0.72

 

Table 07 shows respondent’s responses on inadequate emotional preparation subscale where majority (60.7%) of respondents perceived feeling inadequately prepared to help the emotional need of a patient’s family as occasionally stressful. Likewise, 55.2 percent of the respondents perceived not having satisfactory answer while patients ask a question as occasionally stressful.

Table 08: Respondents Response on Uncertainty Regarding Treatment

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
Inadequate information from a physician regarding the medical condition of a patient	8(5.5)	57(39.3)	55(37.9)	25(17.2)	1.67±0.82
A physician ordering what appears to be inappropriate treatment for a patient	4(2.8)	59(40.7)	57(39.3)	25(17.2)	1.71±0.78
Fear of making a mistake in treating a patient	24(16.6)	61(42.1)	35(24.1)	25(17.2)	1.42±0.96
Absence of physician during medical emergency	3(2.1)	43(29.7)	44(30.3)	55(37.9)	2.04±0.87
Lack of competency for what I have to do	18(12.4)	66(45.5)	38(26.2)	23(15.9)	1.46±0.90
Unable to answer the question of patient or patient’s family about patient’s condition and their treatment	22(15.2)	75(51.7)	29(20.0)	19(13.1)	1.31±0.88
Uncertainty regarding the operation and functioning of specialized equipment	13(9.0)	70(48.3)	45(31.0)	17(11.7)	1.46±0.81
Being exposed to health and safety hazards	13(9.0)	36(24.8)	53(36.6)	43(29.7)	1.87±0.94

 

Table 08 shows respondents’ responses on uncertainty regarding treatment where 51 .5 percent of respondents are occasionally stressed for unable to answer the question of patients and their families regarding patient’s condition and their treatment. Likewise, 48.3 percent of the respondents are occasionally stressed regarding uncertainty regarding the operation and functioning of specialized equipment.

Table 09: Respondents Response on Patients and Family Stressors

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
Patient’s families making unreasonable demands	12(8.3)	44(30.3)	55(37.9)	34(23.4)	1.77±0.90
Being blamed for anything that goes wrong	8(5.5)	41(28.3)	41(28.3)	55(37.9)	1.99±0.94
Being the one that has to deal with patient’s families	24(16.6)	68(46.9)	37(25.5)	16(11.0)	1.31±0.87
Having to deal with misbehave from patient’s families	8(5.5)	67(46.2)	40(27.6)	30(20.7)	1.63±0.87
Not knowing whether patient’s families will report you for inadequate/improper care	19(13.1)	72(49.7)	34(23.4)	20(13.8)	1.38±0.88

 

Table 09 shows respondent’s responses on patients and family stressors where majority 49.7 percent respondents perceived occasionally stressful for not knowing whether patient’s families will report for inadequate /improper care. Considering being blamed for anything that goes wrong 37.9 percent respondents perceived it as extremely stressful whereas only 5.5 percent perceived it as never stressful.

Table 10: Respondents’ Response on Opportunity for Career Development

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
When I feel hindering for continuing my further education	7(4.8)	45(31.0)	57(39.3)	36(24.8)	1.84±0.85
When I feel uncertainty regarding promotional activity	9(6.2)	46(31.7)	46(31.7)	44(30.3)	1.86±0.92
When my organization do not provide me regular in- service training and refreshment opportunity	9(6.2)	43(29.7)	44(30.3)	49(33.8)	1.92±0.93
When I do not get regular opportunity for self-evaluation and feedback	11(7.6)	50(34.5)	51(35.2)	33(22.8)	1.73±0.89

 

Table 10 shows respondents’ responses on opportunity for career development where 33 .8 percent of respondents perceived not having regular in-service training and refreshment opportunity as extremely stressful whereas only 6.2 percent of respondents perceived as never stressful. Likewise, 30.3 percent of respondents perceived uncertainty regarding promotional activities as extremely stressful whereas only 4.8 percent respondents perceived as never stressful.

Table 11: Respondents Response on Discrimination

Items	NS	OS	FS	ES	Mean± S. D
	No. (%)	No. (%)	No. (%)	No. (%)
Being felt sexually harassed by the co- workers	50(34.5)	26(17.9)	15(10.3)	54(37.2)	1.50±1.30
Experiencing discrimination because of race or ethnicity	49(33.8)	25(17.2)	26(17.9)	45(31.0)	1.46±1.24
Experiencing discrimination on the basis of gender by co-workers	51(35.2)	28(19.3)	27(18.6)	39(26.9)	1.37±1.21

 

Table 11 shows respondent’s responses on discrimination subscale where 37.2 percent of respondents perceived extremely stressful for being felt sexually harassed by co- workers. Considering discrimination because of race and ethnicity 33.8% respondents perceived as never stressful whereas 31 percent respondents perceived as extremely stressful. Similarly, for discrimination on basis of gender by co-worker’s majority (35.2%) respondents perceived as never stressful.

Table 12: Distribution of Stress Subscale by Ascending Mean Score

Subscales	Minimum	Maximum	Mean	S. D
Death and dying	16.67	100.00	64.52	19.03
Carrier development	8.33	100.00	61.26	23.74
Workload	12.50	100.00	59.02	23.27
Supervisor relation	00	100.00	55.74	24.70
Uncertainty regarding treatment	4.17	95.83	53.87	19.62
Patient and families’ stressors	00	100.00	53.83	20.92
Physician Relation	00	100.00	49.42	23.19
Discrimination	00	100.00	48.19	38.71
Emotional preparation	00	100.00	44.06	21.57
Co-workers’ relation	00	100.00	40.22	24.04
Minimum Score: 26
Maximum Score: 135
Mean ± SD (83.5±24.4)

 

Table 12 shows that the highest sources of stress among the respondents were death and dying of the patient with mean ± SD (64.52 ± 19.03). Likewise, the least stressful source among the respondents were relationship with co-workers with mean ± SD (40.22 ±24.04).

Table 13: Level of Work-related Stress among Nurses

Level of Stress	Number	Percent
Mild Stress	60	41.4
Moderate-severe Stress	85	58.6
Mean ± SD (83.5±24.4)

 

Table 13 shows that 58.6 percent of the respondents perceived moderate to severe stress level while only 41.4 percent of the respondents had mild level of stress with mean ± SD (83.5 ± 24.4).

Table 14: Association between Level of Work-related Stress and Selected Variables

Variables	Level of Stress		χ2	P- value
	Mild No. (%)	Moderate to Severe No. (%)	Value
Age
≤30	39(41.0)	56(59.0)	0.012	0.912
˃ 30	21(42.0)	29(58.0)
Marital Status
Married	39(36.8)	67(63.2)	3.418	0.064
Unmarried	21(53.8)	18(46.2)
Types of family
Nuclear	38(42.7)	51(57.3)	0.165	0.685
Joint	22(39.3)	34(60.7)
Qualification
PCL	14(38.9)	22(61.1)	0.122	0.726
Bachelor and               above	46(42.2)	63(57.8)
Department
Critical	25(54.3)	21(45.7)	4.758	0.091
General	28(34.6)	53(65.4)
Others	7(38.9)	11(61.1)
Experience as nurse
	44(42.7)	59(57.3)	0.263	0.608
˃10	16(38.1)	26(61.9)
Oncology Experience
≤5	39(46.4)	45(53.6)	2.099	0.147
˃5	21(34.4)	40(65.6)

 

Table 14 shows there is not any significant association between socio-demographic variables and the stress level. (p value = 0.05). This study was conducted to identify the level of work-related stress among oncology nurses working in BP Koirala Memorial Cancer Hospital, Chitwan. The study population consisted of 145 nurses, among them 73.1% were married. The mean age of respondents was 30 years. Majority 69.75% were bachelor’s degrees. 57.9% of respondents have had their experiences in oncology nursing up to 5 years. In considering the working department, 31.7% of the respondents were working in critical unit and 55.9% were from general unit. Present study revealed that 58.6% of the respondents perceived moderate to severe work-related stress and 42.4% perceived mild work-related stress. This finding is supported by the study done in Ethiopia that showed an average overall stress of 58.46% [21]. This finding is also consistent with the study done in Sanford that showed 54.55% of nurses reported moderate to extreme stress [22] and with study done in Iran that showed 55.3% of study respondents develop moderate level of job stress [23]. The possible reason for the differences may be study setting or sample size. The present study indicated that death and dying, career development, workload were the major sources of work-related stress with mean ± SD (64.52 ±19.03, 61.26 ±23.74, 59.02 ±23.27) respectively and lowest sources of stress perceived was relationship with co-workers with mean ± SD (40.23 ±24.04). This finding is supported by the study done in Jimma, [24] and another study done in Ethiopia [25] that showed the death and dying, workload as the major sources of stress situation perceived by the nurses. In contrast, a study done in North-Dakota State University and Sanford (USA) revealed that the main causes of work-related stress were workload and lack of support [26] and another study done in Portugal revealed organizational aspects and working conditions as the main stressful event [27]. Present study revealed second source of work-related stress was lack of career development opportunity with the mean score of 61.26. In contrast, the study done among 254 nurses in Lalitpur, Nepal showed lack of career facilities as the major factor causing most frequent and severe stress. In the current study the socio demographic variables (age, marital status, family status, qualification, experience as nurse, oncology experience, working department) were not significantly associated with overall work-related stress. This finding is supported by the study done in India that reported there was no significant relationship between age, marital status, family types, oncology experience, working department and stress levels [28]. In contrary, other studies done in India showed that younger and single Nurses were more stressful as compared to the married Nurses with higher age [29] and significant positive impact in the level of stress and the nurses posted in emergency and ICU department than the surgery and medicine department [30]. The possible reason for the difference may be study setting or sample size.

4. CONCLUSIONS

Result showed 58.6% of the respondents perceived moderate to severe work-related stress and 42.4% perceived mild work-related stress. The mean age of the respondents were 30 years. Death and dying, career development, workload were the major sources of work-related stress with mean 64.52±19.03, 61.26±23.74, 59.02±23.27 respectively and lowest sources of stress perceived was co-worker’s relation with mean 40.23±24.04. No statistically significant association were found between the level of work-related stress and selected variables. Based on the findings it was concluded that majority of the respondents had moderate to severe stress level. Death and dying, career development, workload, were the major sources of work-related stress among oncology nurses. So, need to provide periodical in-service training for all oncology nurses to reduce the work-related stress and to create awareness as well as a supportive administrative working environment in the health care institutions. The findings of the study concludes that majority of the respondents had moderate to severe stress level. There was no significant association between the level of work- related stress and selected variables. Death and dying, career development, workload, were the major sources of work-related stress among oncology nurses whereas discriminations, emotional preparation and co- workers relation were the least affecting sources identified in this study.

5. RECOMMENDATIONS

The administration of health institutions should develop standards for job prospects, clear working ladder, establish professional conflict management systems and safety working systems. Job reform activities should be carried out to avoid heavy workloads/burden. Health institutions should provide ongoing in-service training regarding stress management techniques. Supportive administrative working environment should be created in health care institutions. More sample size can be taken from other settings as well for more generalizability. Additional research can be done more precisely considering other different factors that may directly or indirectly contribute to stress level.

 

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