Maternal Stress and its Associated Factors among Working Nurses in Public Sector Tertiary Care Teaching Hospitals, Karachi

productivity and personal and professional growth. Objectives: To determine maternal stress and its associated factors among working nurses in public sector tertiary care teaching hospitals in Karachi, Sindh. Methods: The analytical cross-sectional study was accomplished at Dr. Ruth K.M Pfau Civil Hospital Karachi and Dow University Hospital Karachi. A total of 131 nurses were approached by a convenient non-probability sampling method. The Parental Stress Scale was used for data collection. Data were entered and analyzed by using SPSS version 24.0. Chi-square test was applied out to �nd an association between maternal stress and associated factors. Results: Nurses reported 72 (55%) mild parental stress, 58 (44.3%) parental moderate stress, and 1 (1%) severe parental stress. Nurses belonging to the younger age group, widowed or divorced, had mild parental stress, while nurses who lived with their husbands had lesser moderate stress. Female participants with one child of either gender, whose more family members were earning, had less tendency to have mild parental stress. A statistically signi�cant association was found between working nurses' parental stress level and age group (p-value=0.005). Conclusions: It was concluded that nurses reported mild, moderate, and severe maternal stress. Hence, it is increasingly imperative to create facilities like daycare centers and offer them the �exibility to perform their job effectively.

shifts that may serve similarity of standard timing and additional scheduled working hours and, therefore, might also possess high maternal stress [13].
There is a lack of data on maternal stress and its associated factors among nurses in Pakistan.Therefore, the study aimed to determine maternal stress and its associated factors among working nurses in public Sector Tertiary Care Teaching Hospitals in Karachi, Pakistan.

M E T H O D S
An analytical cross-sectional study was accomplished at Dr. Ruth K.M Pfau Civil Hospital, Karachi and Dow Hospital, Karachi.Both hospitals are public sector tertiary care hospitals in Karachi, Pakistan.The study was employed for three months, from August 2019 to October 2019.Female married registered nurses with one or more children at least 18 years or below who might also be expecting a baby at the time of data collection (Being pregnant) were included in the study.The selection of participants was made through a non-probability convenient sampling method.The sample was calculated by taking the prevalence of parental stress in working women (P) =79%, [14] margin of error (d) =7%, and level of signi cance %, the calculated sample size is 131 patients with the help of Open Epi 3.0.online software for sample size calculation.Written informed consent was obtained from all participants before the data collection.Respondents participated voluntarily.The research study was conducted according to the declaration of Helsinki 2000.Data were collected by a validated, adopted tool named PSS (Parental Stress Scale), which measures maternal stress among working nurses.The PSS has an internal reliability of 0.83 and a testretest reliability of 0.81.PSS was developed by Berry and Jones and established in August 1995.Its reliability was 0.79 measured by using Cronbach's alpha test.PSS tool was rstly established by Cohen et al., in 1983 [15].Study protocols were approved by the IRC (Institutional Review Committee) of Dow University of Health Sciences, Karachi, Ref-ION/MSN/2019-7/18-420. Data collection permission was taken from the medical superintendent of both hospitals.The con dentiality of participants was assured.The data were entered and analyzed by using SPSS version 24.0.Descriptive measures, like percentage and frequency, were reported to describe categorical variables such as age group, marital status, income level, number of children, gender of children, current pregnancy, nature of family, number of earning members, position at the job, nature of duty and working hours.Additionally, range, mean, standard deviation (SD), median, and interquartile range (IQR) were reported to describe the continuous variable, parental stress score.The Chi-square test and Fisher's exact test were used to assess the association between all independent covariates and parental stress Table 1 exhibits working nurses' demographic, family, and workplace characteristics.A total of 131 female nurses were included in this study.Among all the participants, 61(46.6%)were less than thirty-one years old, and 47 (35.9%) were aged between 31 and 40 years, whereas only 23(17.6%)participants were more than forty years old.Most female nurses were married and lived with their husbands 125(95.4%).Nearly 120(92%) of the participants were earning a satisfactory level of income (> 30,000 PKR).A high proportion of the female nurses had two children 59 (45.0%), whereas only 9 (6.9%) of nurses had several children.72 (55%) of the participants had both-gender children, whereas almost an equal proportion of the female nurses had boys only 31(23.7%) or girls only 28(21.4%).Nearly half of the female participants lived in nuclear families 64(48.9%)and half in extended families 67(51.1%).Around 96 (73%) earned with their husbands.At the workplace, 110(84.0%) of participants had job positions as bedside nurses, whereas a de cient proportion of nurses were team leaders 13 (9.9%) and head nurses 8 (6.1%).Female nurses allotted xed duty timings were 58(44.3%),whereas 73 (55.7%) nurses worked in different shifts.Nearly 47 (36%) worked for six hours, and around 84 (64%) had a working duration of eight hours at their respective workplaces.None of the participants withdrew from the study.

C O N C L U S I O N S
It is concluded that working nurses experience higher level of maternal stress.Younger age group of nurses had greater level of maternal stress.Strong family support was identi ed as preventive factor from maternal stress among working nurses.

Table 1 :
scores categories among nurses.First, the normality of the continuous variable was checked using the Shapiro-Wilk test.Then, Mann-Whitney U and Kruskal-Wallis tests were applied to study the mean differences between groups of all independent factors.All test results having p-values less than or equal to a 0.05 level of signi cance were considered statistically signi cant.

Table 2
describes parental stress scores among working nurses.According to the Parenting Stress Scale (PSS), which was used to assess parental stress among working nurses, it was found that the average stress score of female nurses was 42.74 with SD ± 9.56, and scores

Table 3
and the tests, as mentioned earlier, were run on a sample of 130 participants.It was found that most of the female nurses who belonged to the younger age group had mild parental stress 43 (70.5%).Female nurses who were widowed or divorced had more chances of being moderately stressed 4(66.7%),whereasthosewholived with their husbands had lesser chances of having moderate stress 54 (43.5%).It was noted that female participants who had one child only of either gender were less likely to have mild stress 15 (35.7%).Similarly, in the current study, nurses were supported by either joint family.If not, at least they had arranged their duties shifts according to the availability of their spouse.Consequently, their children are better cared for in their absence.Hence, none of the mothers in this study suffered severe stress.However, there was a prevalence of mild to moderate maternal stress levels.Another study by Juin, Jaafar, and Ghazali titled 'The relationship between maternal stress and perceived children's social problems behavior among Chinese working mothers[19], examined the relationship between maternal stress and social behavior problem.The study ndings revealed that parenting stress among working mothers was highly associated with children's behavior problems, the income of the family, and the number of children.Present study ndings exhibited that female nurses having more than eight working hours and on shift duty had shown a far larger level of maternal stress among nurses.These study results are congruent with a study accomplished in Portugal, which demonstrated a much higher level of maternal stress in those who had long working hours and on-shift duty[20].
PBMJ VOL. 7 Issue.3 March 2024 D I S C U S S I O N