A descriptive study to assess the causes of stress and coping strategies used by the newly admitted basic B.Sc. Nursing students Roselin Dhar, Indarjit Walia, Karobi Das Abstract : A descriptive study was conducted in the National Institute of Nursing Education PGIMER, Chandigarh to assess the causes of stress and the ways of coping with stress. Total Forty Three Basic B.Sc Nursing 1st year students were selected purposely for collection of data. The questionnaire consisted of two parts of checklist, 1 st part is for causes of stress and 2nd part is the coping strategies. Result revealed that 21 (48.83%) students were having the mild stress and 5 (11.62%) were having moderate stress. Academic stress ranked highest among the stresses perceived by the nursing students. Factors of little concern were financial area which was perceived as least stressful. Most of the nursing students, perceived "difficulty in participation in social life because of long college hours," as most stressful followed by "shortage of time for self study" and "problems in getting log book completed." Majority of the subject tend to use more of healthy coping strategies as compared to negative or unhealthy ones. " Positive thinking" and listening to music/radio were used frequently. Key words : Stress, coping strategies, newly admitted nursing students Correspondence at : Roselin Dhar National Institute of Nursing Education PGIMER, Chandigarh Introduction From the large number of stresses faced by a adolescents and young adults, academic stress, emerges as significant mental health problem in recent years. It has been estimated that 10% to 30% students experience academic related stress that affects their academic performance. Information load, high expectations, academic burden or pressure, unrealistic ambitions, 31
limited oppor tunities, high competitiveness are some of the sources of stress which create tension, fear and anxiety. 1 Professional preparation of a nurse in the institute of Nursing, is largely determined by her initial adjustment and ability to cope with changes, necessary during her academic preparation. If she can take care of herself, then she will be able to take care of the clients. 2 Nursing students are valuable human resources. Detection of potential stress among nursing students is crucial since stress can lead to low productivity, low quality of life, and suicidal ideas. Identifying factors affecting stress among nursing students can help nursing educators to find ways to decrease stress. 2 Nursing school is very, stressful, students experience increase tension prior to their clinical rotations or their written examinations, especially their finals. Nursing school is very demanding with its paperwork and skill performance. 3 Academic sources of stress include long hours of study during examination assignments and grades, lack of free time, and lack of timely feedback. Clinical sources of stress include working with dying patients, interpersonal conflict with other nurses, insecurity about personal clinical competence, fear of failure, interpersonal problems with patients work overload and concerns about nursing care given to patients. Learning psychomotor skills, e.g. administering injections and performing female catheterization have been associated with high levels of anxiety and a perceived lack of practical skills is a common Worry for many students. 4 The setting in which student nurses are placed may also have an impact on affective well-being Initial ward placements produce greater anxiety for students than for any other period in the early part of training changes in ward allocation have also been shown to be a source of stress for student nurse. 4 Therefore nursing students need to assess their stress levels and determine what will decrease their tension. 5,6 Nursing education is demanding and can be especially stressful during exams, assignment submissions and assessment deadlines around placement schedule and when dealing with difficult or needy people. Other ways of coping with stress might sound like they waste time but they increase ability to think and to concentrate exercise, eating a balanced diet, getting plenty of sleep and spending quality time with friends and family are necessary ingredients for managing stress. 7,8,9 Learning to cope with stress is a useful skill for a nursing career and life ahead. By setting priorities, planning ahead and by organizing, self, one can minimize the impact of stress. 10 Thus the present study was conducted to assess the causes of stress and coping strategies used by the newly admitted basic B.Sc. nursing students. Objectives To identify the causes of stress faced by newly admitted nursing students. 32
To ascer tain the coping strategies adopted by them in response to the stress they faced. Materials and Methods The study was conducted at the National Institute of Nursing Education PGIMER, Chandigarh, during the month of January. This Institute is affiliated with Panjab University and presently running three programmes in nursing viz. B.Sc. Nursing (4 years), B.Sc. Nursing (Post Basic) of two years and M.Sc. Nursing of two years. Except B.Sc. Nursing (4 years), rest candidates, are having the experience of Clinical, administrative or teaching, whereas B.Sc. Nursing (4 years) students directly enter into the programme after 10+2 with medical stream, but all the students are to qualify an entrance test before getting admission into each course. The target population consisted of all the B.Sc. Nursing (4 years) first year students. Study sample comprised of 43 nursing students. Data was collected after seeking permission from the principal, NINE and the class coordinator was contacted to fix up the time for data collection. The purpose of the study was explained to the subject and verbal consent was sought from them. Data was collected by using the self administered questionnaire. It was comprised of sociodemographic profile, and checklist of the causes of stress of four areas, (academic, personal, psychosocial, financial) and coping strategies. A numerical rating scale from 0-3 scores in which 0 score indicated never, 1 sometime, 2 Most of the time and 3 Always, No Stress = 0-58, Mild = 59-88, Moderate =89-118, Severe = 119-117, this scale was used to assess the level of stress experienced by the subjects regarding different life events. For content validity and reliability, suggestions were received from five experts in the field of psychology, nursing education and research. The data was analyzed as per the objectives by applying both descriptive and inferential statistics. Results Mean age of the subjects was 18.32 years, ranging between 17to 20 years. Table 1 depicts that 62.79% study subjects were between the age range of 17-18 years and the rest 37.20%, were between age range of 19-20 years. 62.8% subjects were belonging to nuclear families and 30.23% were from the joint families. Majority of the subjects 86.04% were residing in the hostel of the institute and rest of them were residing either at their own house (11.63%), or rented accommodation (02.32%). It was also observed that majority of the subjects, (72.10%) were from families having parental income more than Rs. 10,000/- month. 33
Table -1: Socio-Demographic profile of Subject. N = 43 S.No. (f) (%) 1 Age (in years) 17-18 27 62.80 Mean =18.32Yrs 19-20 16 37.20 Range =17-20 yrs 2 Type of Family Nuclear 30 69.76 Joint 13 30.23 3 Residence Hostel 37 86.04 Own House 05 11.63 Rented 01 02.33 Accommodation 4 Parents Income < 5,000 04 09.30 5001-10,000 08 18.60 > 10000 31 72.10 Regarding the level of stress 11.62% subjects experienced moderate stress. 48.83% experienced mild stress and 39.53% did not experienced any stress. There were no subjects with severe stress (Table 2) Table - 2: Frequency of Perceived Stress Level of 59 Life events by 43 subjects. N = 43 S.No. Level of (f) % Score Mean Stress Range 1. Moderate 5 11.62 90-106 99.2 2. Mild 21 48.83 59.84 72.33 3. No Stress 17 39.53 35-52 46.41 Range Score = 35-106 65.20 : SD = 18.52 Table 3: Revealed the first three ranking items of coping strategies depending upon their extent of use are: positive thinking (96), listening to music (85), Indulge in creative activities (84). On the contrary items like release tension on others/objects (31), curse and blame others (19) are some of the strategies not commonly used by the nursing students 34
Table - 3.1 : Healthy Coping Strategies used by Subject given in Rank Order Maximum score = 129 Rank How Often Order Description of life events Never Some Most of Always Total times the time Score 0 1 2 3 I. Positive thinking -- 9 15 19 96 2. Listen to music/ radio 3 9 17 14 85 3. Indulge in creative activities 2 22 13 6 84 4. Talk to parents 3 14 13 13 79 5. Pray more 3 14 14 12 78 6. Handle problem in bits -- 19 16 8 75 7. Self discipline 1 20 15 7 71 8. Set goals in order to be 5 15 17 6 67 prepared for life stresses 9. Overcome short comings by 4 18 15 6 66 self discipline 10. Discuss problem with friends 2 25 10 6 63 11 Discuss problem/ seek help 3 25 10 5 60 from elders/teachers 12. Consider sleep as best solution 9 17 13 4 55 13. Devoting more time to study 8 13 9 4 52 14. Saying that its fate "I deserve it 8 22 12 1 49 15. Put the problem aside and 11 21 10 1 44 participate in other activities 16. Watch television 15 18 6 4 42 17. Laugh it out/joke about the 13 27 2 1 32 problem when confronted with it. Mean = 64.70 35
Table - 3.2 Unhealthy coping strategies (7 Items Used by Subjects given in Rank Order. Maximum score = 129 Rank How Often Order Description of life events Never Some Most of Always Total times the time Score 0 1 2 3 1. Believe in supernatural Power 5 15 6 17 78 2. Isolate Self 12 14 13 4 52 3. Eat less 16 16 6 5 43 4. Eat more 21 13 3 6 37 5. Release tension on others 18 20 4 1 31 6. Release tension on objects 21 16 3 3 31 7. Curse and blame others 24 19 -- -- 19 Mean = 41.57 Discussion This study was conducted on the newly admitted nursing students at NINE, PGIMER, Chandigarh. The findings revealed that they were from the age group of 17-20yrs with a mean age of 18.32 yrs. It was also seen that 86.04% were residing in the hostel of the Institute and about 39.76% were from nuclear families. Majority of the subjects, 72.10% were from families where parental income was more than Rs 10,000 per month, which is one of the factors that the financial area was least stressful for the students. The study also revealed that 48.83% were having mild stress and only 11.62% had moderate stress. Majority of them perceived, Difficulty in participation in social life, due to long college hours, as the most stressful event, followed by shortage of time for self-study and the third being is problems in getting log book completed, and strict rules and regulations in the hostel, with few picnics and outing. A study conducted at the college of nursing, Ireland on 70 student, showed that factors related to writing assignment, fulfilling personal needs and academic demands were perceived as major stressors by the students. Factors of little concern were financial issues and attendance on the programme. 9 The present study also revealed that majority of the students tend to use more of the healthy coping strategies. The five most frequently used coping strategies were positive thinking, listening to the music/radio, 36
Indulging in creative activities, talk to parents and pray more. The findings of the study are supported by similar findings, among Nursing students at Chiang Mai University which revealed that the three most frequently used coping strategies were seeking social suppor t (62.25%), planful problem solving (23.73%) and accepting responsibility (8.47%). 11 Stress has become a chronic and pervasive condition in the world today. Present era is marked as an era of stress. Every person experience different forms of stress throughout their life, therefore a student nurse is no exception as she has to adjust to an entirely new environment on joining a training course in nursing. Coping with stress for a student nurse is a dynamic and ongoing process, aimed at survival, growth and maintenance of the individual integrity. She tries to restore the imbalance or disequilibrium within herself by attempted adjustment and this attempted adjustment is by the use of various coping strategies which can be healthy or unhealthy. References 1. Sinha K. Uday Sharma Vibha, Development of A Scale of Assessing Academic Stress. Joumal of Mental Health and Human Behavior 2002; 7: 47-48. 2. Davis E Maureen. Stress Management is Key during Nursing School. The Student Voice, 2004; 4: 2-3. Available from http:// onsopcontent.ons.orgl Publications 1 Student Voice 1Nov041 artic1e5.html 3. Ratchneewan Ross, Depression, Stress, Emotional Support, and Self- Esteem among Nursing Students. Imitational Journal of Nursing Education Scholarship 2005; 2: 10-11. 4. Jones MC, Johnston. Stress and Coping in First-Year Student Nurses. Journal of Advanced nursing distress 1997; 8: 10-12. Available from http:jjwww.sdps. worc.ac.ukj subjects_ and_challenges j nursingj nursing...anxiety.html 5. Wiley A. Causes of Stress. Journal of Clinical Psychology 2006; 37 (2): 284-290. Available from http://ww.interscience.willey.com /cgi-bin/ abstract 1 1124576581 ABSTRACT? CRETRY=Pubmed. 6. Anthikad Jacob. Stress and its Management. Psychology for Graduate Nurses, 1 st Edi, Jaypee Brothers; 74-81 7. Stoppler Conrad Melissa Shiel C, William. Medical Reference, Stress Management. 8. Townsend C Mary. The Concept of Stress Adaptation. Psychiatric Mental Health Nursing, Fifth Edition, Jaypee Brothers 2007; 4-8. 9. Honor Nichell. Related Stressors among par t time undergraduate nursing students. Joumals of Advanced Nursing Programme 2005; 50: 93-100. 10. Pitts Patty. Research helps nursing Students reduces Stress levels. The Ring, The University of Victoria's Community Newspaper, 2000; 14: 2-3. Available from http:j jring.uvicj 00july14 jyoung.html 11. W ongchai Lonsri, Niwatchai Ubol. Stress and ways of coping among third year Nursing Student. Faculty of Nursing Chiang Mai University. A Clinical study available from http:j jwww.grad.cmu.ac.th/abstract/1999/nur/ abstract nur990032.html 37