Amole BB.1A-E,, Adebiyi SO.2A-E, Dakare O.3D-F*
A-Conceptionandstudydesign;B-Collectionofdata; C-Dataanalysis; D-Writingthepaper;
E-Reviewarticle; F -Approvalofthefinalversionofthearticle
Introduction:Stress among healthcare professionals has become a major issue in healthcare organizations operating at the domestic, international and global fronts. This profession however, requires people to be physically, emotionally and mentally alert, in order to care for other people.
Purpose:To ascertain stress factors among healthcare professional in Nigeria. In order to rank and establish causal relationships among the various stress factors using the Multi-Criteria Decision Making methods (MCDM).
Materials and methods:A validated AHP-based questionnaires was used to conduct a survey of 386 healthcare professionals from two tertiary teaching hospitals in South-west, Nigeria, using proportional quota sampling procedure.
Results:The results reveal that relationship factor has the most significant impact on the stress of healthcare professionals with an Eigen vector of 0.3531. It finds also that the role factor has the least significant criterion, having an Eigen vector of 0.0778. At the global level of ranking the alternative decision occupational stress factor, speed of change has the highest priority, the least being financial problems.
Conclusions:In comparison with others, the health care profession is highly stressful, due mainly to the fact that it has a higher rate of psychological distress. Keeping this in mind, this study has examined what determines occupational stress among healthcare professionals in teaching hospitals in Nigeria.
Keywords:Occupational stress, Health care professionals, MCDA, AHP, Healthcare service delivery, Nigeria
Dakare Olamitunji, Ph.D., Department of Business Administration, School of Management and Social Sciences,
Pan-Atlantic University, Lagos, Nigeria, e-mail: firstname.lastname@example.org, Tel: 234 8023600188
Progress in Health Sciences
Vol. 8(1) 2018 pp 113-125
© Medical University of Białystok, Poland
The pressure at the workplace is unavoidable, due to the demands of the contemporary work environment. However, work environment pressures may be positive or negative, considering the degree of pressure. Pressure may be acceptable to an individual or not depending on the situations, magnitude and the capacity to cope. Often times, it may keep workers on the alert, even motivates them to achieve what they would not achieve ordinarily or learn in the process depending on the availability of resources and personal characteristics. Nevertheless, when pressure becomes excessive or otherwise unmanageable, it may become negative, thereby leading to stress .
Stress among healthcare professionals has become a major issue in healthcare organizations operating at the domestic, international and global fronts. This profession however, requires people to be physically, emotionally and mentally alert, in order to care for other people. Mistakes by healthcare professionals are hardly allowed, because they may be disastrous and irreversible. Healthcare professionals are therefore required to be in a stable and perfect state of mind, with no worries and anxieties .
Meanwhile, the causes and effects of job-related stress have been widely acknowledged within the extant literature and academic researchers. The reason for this acknowledgement is that most workers, in their line of duties, may have experienced stress in one way or another . Much of the extantresearch studies on occupational stresshave also demonstrated that healthcare-related professions can result in excessive stress levels [4,5]. Upon the recognition that healthcare profession is a stressful one, Somaz and Tuglan  however, pointed out workload, job duplications, inadequate resources, physical environment, inadequate allocation of job, psychological environment, among others, as responsible for stress. Nonetheless, much of the prolific research on occupational stressamong healthcare professionalshas concentrated on developed and developing countries, using different methodology. However, this phenomenon has global appeal as evidenced in studies within Delhi , Iran , Ghana , Taiwan , India ,Ghana , Dubai . The aforementioned empirical review however, shows that studies have been undertaken to assess stress factors among healthcare professionals across developed and developing countries, using different methodology, however, similar studies do not exist in Nigeria and also no study has sought to rank and establish causal relationships among the various stress factors affecting the healthcare professional.
Consequently, this research study is necessary because it provided evidence that stress factors among healthcare professional are numerous but they are all treated with equal importance in prior research. The study also represents one of the few formal research studies to focus on West Africa region and the ﬁrst one to focus on pairwise comparison for ranking and establishing causal relationships among the various occupational stressfactors affecting the healthcare professionals in Nigeria using theMulti-Criteria Decision Making methods (MCDM). Hence, the study proposed a framework based on cause and effect relationship among occupational stress factors. It thus offers a novel perspective.Similarly, this study has also provided empirical evidence that, in practice, prioritization of stress factors among healthcare professional will advance the understanding of both practitioners and academics to know which stress factors act as causes to other stress factors, or which stress factors lead to other stress factors in order to stimulate research driven policy for its management.
Ultimately, the purpose of this research study is to ascertain the influence of stress factors among healthcare professionals in Nigeria and to rank and establish causal relationships among the various stress factors using the Multi-Criteria Decision Making methods (MCDM).
The term “stress” has become an amorphous term since there are numbers of research studies on the subject with different definitions of stress. The implication of this, that stress is a multidimensional concept, its definition then depends largely on the focus of the particular research study undertaken. For instance, The National Institute of Occupational Safety and Health , Health and Safety Executive , Howard , Moustaka & Constantinidis , Radhakrishnan & Jins  among others, defined stress to encompass the physical, mental, psychological and emotional pressures on the individual(s) which result from the interaction with the environment which they live, that are alleged as hurting and/or beyond their adaptive aptitude and having threats to human wellbeing.
However, as earlier mentioned in this study, numerous empirical studies have been conducted on stress factors among healthcare professionals in various contexts. Bhatia et al.  in their study on comparative analysis of occupational stress among nurses in two tertiary care hospitals in Delhi found that the most significant stressors in the case of the
causes of stress were high level of skill requirement of the job, while the least significant stressor was the helpfulness of the supervisors. In the same way, Saranbadi et al.  conducted a study on employee occupational stress among Military hospital personnel in Iran. The Cross-sectional survey design was employed. The results of the study show that there is a higher stress level among healthcare employees compared to their administrative counterparts, which depicts that working conditions in military health settings are even more stressful for clinical staff. Also, from the findings of the study, no significant effect was identified for other demographic and professional characteristics, including age, sex, marital status, educational level, and work experience either between entire employees, or between clinicians.
Rita et al.  also carried out a comparative study at Ridge and Pantang hospitals in Ghana, in order to find out the main causes of stress among nurses in both hospitals and their level of job satisfaction. The results of study reveal that the main causes of stress are the same for both sampled, except workload which is higher in Ridge hospital. It also found out that there was a weak negative correlation relationship between work stress and job satisfaction in the two Hospitals. In Taiwan, Pan  also conducted a study to identify the determinant of nurses’ capabilities of stress using the Analytic Hierarchy Process model (AHP) in two regional hospitals in southern Taiwan. This study identified stress factors and classified them according to their order of importance. Four factors were identified as the second level of hierarchy. Of these, family factor was considered the most important, followed by personal attributes. The top three sub-criteria that enhanced nurse’s stress-coping capability are children’s education, good career plan, and healthy family.
For Gulavani and Shinde  the results of their study show that there is no significant relationship between occupational stress,job satisfaction and age, sex, professional education, and year of experience.Yeboah et al.  also examined the relationships between six key organizational factors, namely: demand, control, support, relationships, change, and role conditions. To do this, they analyzed the data collected from 453 healthcare professionals working in a teaching hospital in Ghana, using the three sequential steps in linear regression analysis. This helped to identify the causes of stress among human resource personnel sampled. The overwhelming finding in their study is that six elements significantly impact on employee stress with differential influences. They called for a model like the AHP, which will not only estimate the influence of major factors (criteria), but contribute to each component (sub-criteria). In the long run, this helped to arrive at a comprehensive assessment of occupational stress influences of health professionals.
Furthermore, Khan and Khurshid  conducted an empirical study on the impact of workplace stress of employees among hospitals’ staff in Dubai. A total of 150 employees working in various healthcare centers and hospitals in UAE were surveyed. The results of the study show that workplace has negative impact on employees’ well-being and the impact was found to be weak. The findings of the study suggested that an increase in workplace stresses will reduce wellbeing of employees. Also, the researchers recommend that in order to reduce the impact of stress on employees’ well-being, organizational support, family support and social support are essential.
Although, in the above empirical review, studies have been undertaken to assess stress factors among healthcare professional across developed and developing countries, using different methodology, similar studies do not exist in Nigeria. To be precise, there has not been any know study that mobilize the Multi-Criteria Decision Making methods in order to assess occupational stress among healthcare professionals in Nigerian teaching hospitals. It can thus be said that the interest of this paper in situating the MCDM model within the context of Nigerian healthcare experience is seminal. Since, little stress situation can have positive effects by energizing employees towards achieving both personal and organizational goal, conversely unnecessary stress can seriously and undesirably impact an employee’s health and job performance from time to time .
MATERIALS AND METHODS
The cross-sectional design was used in the selected teaching hospitals in South-west, Nigeria. The Lagos University Teaching Hospital (LUTH), Lagos, Nigeria, and Olabisi Onabanjo University Teaching Hospital (OOUTH), Ogun-state, Nigeria were purposively selected to guarantee easily access to information. The population of this study comprises all doctors and nurses in the selected teaching hospitals in South-west, Nigeria. The total population of the healthcare professional in the selected teaching hospitals is 5917. The choice of the healthcare professionals (doctors, nurses and other healthcare professionals) for the study is necessitated by the fact that they are recognized as the closest tertiary caregiver to numerous patients and patient relatives in the teaching hospital. Additionally, the quota sampling technique was used. This helped to determine the percentage of respondents from each of the hospitals, so as to ensure effective representation.
Meanwhile, 16% (975) of the total respondents were healthcare professional of OOUTH while 84% 4,942) of the respondents were healthcare professional of LUTH.
The researchers depended on the widely adopted formula developed by Cocharan  to determine appropriate sample size, based on the population from 5, 917 health professionals.