Anxiety and depression are one of the most common mental health issues. Several research reports on the prevalence of depression and anxiety on medical, nursing students. [1] The high intensity of training, high targets to achieve are some of the important reasons for the depression and anxiety in them.
The formal nursing education in Nepal has started only during 1950s before which there was no single health institution involved in nursing or other medical education. [2] Today, nursing education system has entered the maturity in Nepal. Several universities and numerous affiliated colleges at both government and private sectors in different regions of Nepal run nursing education. In Nepal, there are various categories of nursing education and the degrees are awarded accordingly. Among the various categories, there are two formal nursing degrees.
1. The proficiency certificate level in nursing (PCL) or staff nurse which was started in 1999. PCL nursing is one of the prominent and popular disciplines within the Nursing profession. It is taught for 3 years and is given equivalence to the diploma in nursing internationally. This curriculum is designed with the purpose of producing middle level technical nursing workforce equipped with knowledge and skills related to the field of nursing to meet the demand of such workforce in the country to contribute in the national economic and health development of Nepal. In total three years; the first-year course is focused on basic nursing care in hospital and in the community: foundation nursing practices; the second-year course is focused on preventive, promotive as well as therapeutic nursing care of sick adult and elderly individual as well as mentally ill individual. Similarly, the third-year course comprise of the pediatric, midwifery and gynecology as well as leadership and management.
2. The other popular formal nursing course is Bachelor of science in nursing (B.Sc. Nursing). This is a 4 years course. The Program aims to prepare professional nurse with the highest possible technical and managerial competence in respective level of health programs, including problem identification, planning, implementing, training, health education, evaluation and research. This program is equivalent to international BSc Nursing. The salary and pay are a major issue in Nepal’s nursing profession. The average salary of a junior nurse is around $ 100 a month. With the bachelor’s degree, the pay could rise as high as $ 200, which is still a meagre amount in comparison to the developed nations. To get a nursing education, the expenditure on average involves paying $ 3000 for PCL and $12000 or more for B.Sc. Nursing (according to the admission section of a parent University).
Demand of nurses is another major issue in the country. The nurse to patient ratio should be according to workload and nurses' specialization. [2] This ratio is very low in Nepal. Usually 20-30 occupant (patients) in a unit is covered by only 1-2 nurses in most hospitals. Usually, they also must carry out non-nursing jobs which are time consuming and distract them from their work. Overload and overwork are one of the challenges facing nurses in Nepal.
Anxiety and depression in nurses have been quite dreadful than perceived. Systematic reviews and meta-analyses indicated that the prevalence of anxiety and depression among medical students worldwide was around 28%, and suicidal ideation was 11.1%.[3-5] However, not many papers report the prevalence of anxiety and depression among nurses employed in hospitals.[6] However each papers from around the world on depression symptoms indicate the prevalence of anxiety symptom from 18% to 40% in nurses in United States, 11% to 80% in Iranian nurses,[7] 35% in Chinese nurses[8] while 41.2% in Australian nurses. [9] A survey done in Vietnam showed that the prevalence of depression and anxiety is higher than the prevalence of anxiety and depression in general population of that country.[10, 11] The low socio-economic status, longer working period, uncertainty for the future and low earning than the counterparts working in abroad countries add the fuel to the fire of anxiety and depression.
Depression in nursing profession should be addressed as it may significantly impact the quality of care they provide to the consumers. In this study we have attempted to see the prevalence of anxiety and depression among nurses who are working in different hospitals in Nepal. Nurses regularly face a various types of stressors including but not limited to : work hours, meeting patient’s needs, and the patient attendant’s expectations, lack of professional support.[9] The greatest concern is that the depressed staff often exhibit low mood, difficulty focusing and as a result are accident prone and lower total work output and decreased efficiency. [12, 13] The accurate measurement and identification of depression and anxiety is challenging because of frequent overlapping or co-occurrence of these conditions.