THE IMPACT OF POST TRAUMATIC STRESS DISORDER ONNURSING CARE DELIVERY AMONG NURSES AT. FEDERALNEUROPSYCHIATRIC HOSPITAL, KADUNA

Abstract

This study examined the impact of Post-Traumatic Stress Disorder (PTSD) on nursing care delivery among nurses at the Federal Neuro-Psychiatric Hospital, Kaduna. A cross-sectional survey research design was adopted, and a structured questionnaire was designed to collect data from a sample of 333 nurses. The questionnaire assessed PTSD prevalence, its effects on clinical performance, and coping mechanisms used by nurses. Data were analyzed using SPSS version 27, with descriptive statistics and one-sample t-tests employed to test three hypotheses: (1) no significant PTSD prevalence among nurses, (2) no significant effect of PTSD symptoms on care delivery, and (3) no significant relationship between coping mechanisms and PTSD severity. The findings revealed a statistically significant prevalence of PTSD (t=12.37, p<0.001), with over 50% of nurses reporting trauma-related distress. PTSD symptoms negatively affected clinical performance, including reduced focus (55.56%), increased errors (50.45%), and emotional withdrawal (53.16%), rejecting the second hypothesis (t=8.50, p<0.001). Coping strategies significantly influenced PTSD severity (t=7.12, p<0.001), with adaptive techniques like relaxation (55.56%) proving more effective than avoidance (37.54%). The study concluded that PTSD is a critical occupational hazard for psychiatric nurses, impairing both their wellbeing and patient care quality. Recommendations include routine mental health screenings, trauma-informed counseling, and institutional support programs to mitigate PTSD’s impact. These findings underscore the need for healthcare systems to prioritize nurse mental health as a fundamental component of quality care delivery.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Post-Traumatic Stress Disorder (PTSD) is a complex psychological condition that arises from exposure to highly stressful or traumatic events such as violence, abuse, natural disasters, serious accidents, or life-threatening experiences. Historically, research into PTSD has largely centered on military personnel and survivors of catastrophic events. However, there is a growing body of literature recognizing the prevalence of PTSD among healthcare workers, especially nurses, due to the emotionally intensive and trauma-laden nature of their work environments (Li et al., 2021). Nurses, by virtue of their frontline roles in patient care, are persistently exposed to distressing medical conditions, patient suffering, and life-and-death scenarios, all of which cumulatively place them at increased risk of developing PTSD (Liu et al., 2020).

The emergence of global crises such as the COVID-19 pandemic has further accentuated the psychological burden on nurses. During the pandemic, healthcare systems worldwide were overwhelmed, and nurses were compelled to work under extreme conditions involving long hours, limited protective resources, and a constant threat to personal safety. Such conditions have been directly linked to elevated incidences of anxiety, depression, burnout, and PTSD among health workers (Tan et al., 2020). A systematic review by Li et al. (2021) affirmed that the prevalence of PTSD symptoms among health professionals significantly increased during the COVID-19 crisis, especially among those with direct patient contact. These findings reinforce the need to explore how high-stress healthcare environments, such as psychiatric hospitals, can become grounds for psychological trauma among nursing staff.

In psychiatric facilities such as the Federal Neuro-Psychiatric Hospital, Kaduna, nurses encounter uniquely challenging work dynamics. Here, nurses are routinely exposed to patients suffering from severe mental health conditions, including schizophrenia, bipolar disorder, psychosis, and major depressive disorders. These patients may exhibit unpredictable behavior, aggression, or self-harm tendencies, making psychiatric nursing a high-risk profession in terms of occupational stress and trauma exposure (Si et al., 2020). The constant engagement with emotionally volatile situations, including witnessing suicide attempts or managing violent patients, can significantly contribute to the development of PTSD symptoms among psychiatric nurses (Heir et al., 2019).

Moreover, nurses in mental health settings often face the dual burden of clinical responsibilities and emotional labor. They are expected not only to manage medication, treatment, and observation protocols but also to provide emotional support to patients and their families. This emotional labor, when sustained without adequate psychological support or institutional buffers, can predispose nurses to compassion fatigue, emotional exhaustion, and eventually PTSD (Mukhtar, 2020). McLaughlin et al. (2023) observed that even subthreshold PTSD where individuals do not meet the full diagnostic criteria can impair occupational functioning and lead to long-term psychological dysfunction if left unaddressed.

The effects of PTSD on nurses are not just personal but extend into professional practice. Symptoms such as flashbacks, hypervigilance, emotional numbness, and sleep disturbances can hinder cognitive processing, clinical decision-making, and effective communication all of which are vital for safe and efficient patient care (Lazarus & Folkman, 2021). When nurses are mentally distressed, their ability to empathize, maintain therapeutic relationships, and respond swiftly to patient needs diminishes significantly, thereby compromising the quality of care delivered (Hardler, 2021). In a study conducted by Wong et al. (2020), nurses reported feelings of emotional disconnection, irritability, and anxiety, which interfered with their professional conduct and interpersonal interactions.

In northern Nigeria, including Kaduna State, the issue of PTSD among healthcare workers remains under-researched despite growing anecdotal and clinical observations of psychological distress in this demographic. Cultural stigmas associated with mental illness, combined with insufficient mental health infrastructure, often discourage healthcare professionals from seeking psychological support (WHO, 2020). As a result, nurses silently grapple with trauma-induced stressors, which may lead to burnout, absenteeism, high turnover rates, and even exit from the profession (ICN, 2021). According to Lazarus (1966), the stress-coping process is influenced by individual perceptions of stress and the resources available for coping. When nurses perceive their work environment as threatening but lack coping mechanisms or institutional support, the risk of PTSD is significantly heightened.

Evidence from other low- and middle-income countries supports this concern. For instance, in Indonesia, Marthoenis et al. (2021) documented significant levels of mental distress among nurses working in COVID-19 referral hospitals, citing workload, patient deaths, and fear of infection as major stressors. Similarly, in Spain, Luceño-Moreno et al. (2020) found that healthcare workers exhibited high levels of PTSD, anxiety, and burnout, especially among those who lacked personal protective equipment or psychological counseling services. These international findings mirror the likely realities of nurses in Nigeria’s underfunded psychiatric institutions, where similar stressors are prevalent and support systems ar e limited.

The situation is further complicated by the persistent shortage of mental health professionals and limited access to occupational health services. In Nigeria, there is a significant disparity between the growing mental health needs of the population and the capacity of healthcare institutions to provide specialized care (WHO, 2022). Nurses are frequently tasked with responsibilities that exceed their formal training, leading to role strain and increased vulnerability to psychological breakdown. Xiao et al. (2020) noted that survivors of high-stress environments, including healthcare workers, are at an elevated risk of developing PTSD when there is a lack of psychosocial support, peer counseling, and mental health education.

From a theoretical standpoint, the Transactional Model of Stress and Coping by Lazarus and Folkman (2021) provides a valuable lens through which to examine the relationship between psychiatric nursing and PTSD. The model posits that stress results from an imbalance between perceived demands and coping resources. Nurses at the Federal Neuro-Psychiatric Hospital, Kaduna, often face a mismatch between the overwhelming demands of psychiatric care and the limited institutional resources—be it staffing, safety protocols, or mental health support systems. This mismatch intensifies their susceptibility to chronic stress and trauma-related disorders.

Furthermore, research by Perna and Caldirola (2021) illustrates that PTSD in healthcare settings may also co-exist with panic disorders, especially among individuals exposed to persistent fear and helplessness. Such dual diagnoses not only complicate treatment but also prolong recovery periods, thereby affecting workforce sustainability. Nurses struggling with untreated PTSD may also resort to maladaptive coping mechanisms such as substance use, emotional withdrawal, or avoidance behaviors, which can adversely affect team collaboration and patient satisfaction (Moon et al., 2021).

Addressing the issue of PTSD among psychiatric nurses requires a comprehensive and multi-dimensional approach. Early identification of symptoms, continuous mental health screening, institutional support systems, professional counseling services, and peer support groups are essential strategies for mitigating the impact of PTSD. According to WHO (2022), investing in healthcare workers’ mental health is not merely a humanitarian obligation but a strategic imperative for national health development. Healthy nurses are more productive, more compassionate, and more likely to contribute to sustainable healthcare outcomes.

1.2 Statement of the Problem

Post-Traumatic Stress Disorder (PTSD) among healthcare professionals, particularly nurses, is an emerging global health concern, yet it remains significantly under-researched in low- and middle-income countries like Nigeria. While international studies have established the psychological toll of frontline caregiving roles, particularly during crises like the COVID-19 pandemic (Li et al., 2021; Tan et al., 2020), most of these studies are concentrated in high-income countries and in general hospital settings. There is a paucity of context-specific research that examines how PTSD manifests among nurses in psychiatric hospitals, especially within northern Nigeria where mental health services are already under-resourced (WHO, 2022).

Although studies have examined PTSD in healthcare workers broadly, few have isolated the psychiatric nursing subgroup despite their high exposure to patient aggression, suicide attempts, and emotionally disturbing behavior (Si et al., 2020). The unique stressors encountered in psychiatric environments, including the high emotional demands and unpredictable patient conduct, are rarely the focal point in PTSD research conducted in sub-Saharan Africa. This lack of targeted research creates a critical gap in understanding the occupational hazards specific to psychiatric nurses and the cumulative psychological effects of working in such settings (Heir et al., 2019).

Moreover, studies that have examined PTSD in Nigerian healthcare contexts often lack a focus on institutional and environmental contributors to stress, such as insufficient staffing, lack of mental health support, and cultural stigma associated with psychological help-seeking (Mukhtar, 2020; WHO, 2020). This results in a knowledge gap regarding how systemic and organizational deficiencies exacerbate PTSD symptoms among nurses, and how these symptoms in turn affect patient care outcomes. Furthermore, much of the existing literature tends to measure PTSD using general stress indicators, failing to apply validated trauma-specific assessment tools in the Nigerian nursing context (Lazarus & Folkman, 2021).

Another critical gap is the absence of empirical data from northern Nigerian institutions like the Federal Neuro-Psychiatric Hospital, Kaduna. Without localized evidence, healthcare policymakers and hospital administrators lack the necessary insights to develop effective mental health interventions for their workforce (ICN, 2021). As such, the lived experiences of psychiatric nurses in this region remain undocumented and their mental health needs unaddressed.

This study aims to fill these significant gaps by examining the prevalence, causes, and consequences of PTSD among nurses in a psychiatric setting in Kaduna, thereby contributing to both academic literature and evidence-based policy formulation.

1.3 Objectives of the Study

The broad objective of this study is to examine the impact of Post-Traumatic Stress Disorder on nursing care delivery among nurses at the Federal Neuro-Psychiatric Hospital, Kaduna. The specific objectives are:

1. To assess the prevalence of Post-Traumatic Stress Disorder among nurses at Federal Neuro-Psychiatric Hospital, Kaduna.
2. To evaluate the effects of PTSD symptoms on nurses’ clinical performance and patient care delivery.
3. To determine the relationship between coping mechanisms and the level of PTSD symptoms among psychiatric nurses.

1.4 Research Questions

1. What is the prevalence of PTSD among nurses at Federal Neuro-Psychiatric Hospital, Kaduna?
2. How do PTSD symptoms affect the clinical performance and care delivery of nurses in the hospital?
3. What coping mechanisms are used by nurses, and how do these relate to the severity of PTSD symptoms?

1.5 Research Hypotheses

1. There is no significant prevalence of PTSD among nurses at Federal Neuro-Psychiatric Hospital, Kaduna.
2. PTSD symptoms have no significant effect on nursing care delivery among nurses in the hospital.
3. There is no significant relationship between coping mechanisms and PTSD severity among nurses.
   1.6 Significance of the Study

This study holds critical significance for multiple stakeholders across the healthcare system, academic institutions, and broader mental health advocacy networks. Primarily, it offers valuable empirical evidence to hospital administrators, health ministry officials, and policymakers regarding the psychological challenges nurses face, particularly in psychiatric institutions such as the Federal Neuro-Psychiatric Hospital, Kaduna. The findings of this study will help illuminate the extent and impact of Post-Traumatic Stress Disorder (PTSD) among psychiatric nurses, a group often exposed to traumatic and high-stress clinical environments. With this data, health administrators can develop and implement targeted mental health support services such as trauma counseling, stress management training, and employee assistance programs tailored to improve nurse well-being and healthcare service quality.

Secondly, this study makes a vital academic contribution by addressing a significant gap in existing literature, especially within the Nigerian context. While PTSD in military and emergency responders is well-documented, there remains limited scholarly focus on its prevalence and implications among nurses, particularly those working in psychiatric settings in sub-Saharan Africa. By focusing on this unique demographic and setting, the study contributes new insights that can serve as a foundation for future research. Academic institutions offering nursing and mental health programs can incorporate the findings into their curricula, thereby equipping future healthcare professionals with trauma-informed care approaches and self-care strategies essential for handling emotionally intense clinical roles.

Furthermore, this study has the potential to empower nurses by increasing their self-awareness about the psychological burden inherent in their work. Through the dissemination of research findings, nurses may gain better recognition of PTSD symptoms, understand the importance of early intervention, and be encouraged to adopt healthier coping mechanisms or seek professional psychological support. Such awareness can enhance resilience, reduce burnout, and ultimately improve patient care outcomes.

Lastly, the research will benefit mental health advocacy organizations, civil society groups, and non-governmental organizations (NGOs) working to promote workplace mental health. The data generated can serve as a basis for advocacy campaigns and policy dialogues aimed at instituting safer, more supportive, and psychologically responsive work environments for healthcare professionals. These organizations can leverage the evidence to push for reforms in mental health policy and ensure that healthcare workers, particularly in high-risk specialties like psychiatric nursing, are adequately protected and supported.

1.7 Scope of the Study

This study is delimited to the Federal Neuro-Psychiatric Hospital, Kaduna, and focuses specifically on registered nurses working in the facility. It investigates the prevalence of PTSD, its effects on nursing care delivery, and the coping strategies employed by the nurses. The study will not include other categories of healthcare workers such as doctors, social workers, or administrative staff. Furthermore, while PTSD can be caused by external life events, the study limits its focus to work-related PTSD experienced within the context of the hospital environment.

1.8 Operational Definition of Key Terms

Post-Traumatic Stress Disorder (PTSD): A mental health disorder triggered by experiencing or witnessing traumatic events, characterized by flashbacks, nightmares, hyper-vigilance, emotional numbness, and avoidance behaviors.

Nursing Care Delivery: The process through which nurses provide health services to patients, including assessments, interventions, patient monitoring, and emotional support.

Federal Neuro-Psychiatric Hospital, Kaduna: A specialized psychiatric health facility in Kaduna State, Nigeria, providing mental health services and serving as the study location for this research.

Prevalence: The proportion or rate of a population that is affected by a specific condition in this case, PTSD among nurses within a given period.

Coping Mechanisms: Psychological strategies or behavioral methods used by individuals to manage stress and reduce the emotional impact of traumatic experiences.

Clinical Performance: The efficiency, accuracy, and competency with which nurses perform their duties and responsibilities in a healthcare setting.

Psychiatric Nursing: A specialized field of nursing focused on the care of individuals with mental health disorders, emotional disturbances, and behavioral problems.

Workplace Trauma: Emotional or psychological distress experienced due to traumatic events occurring in a professional environment, including violence, patient death, or witnessing suffering.