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Chapter I

THE PROBLEM

Introduction

In most nursing programmes, clinical training begins in the first year and

extends until graduation. As clinical training accounts for the majority of the

nursing curriculum, stress has been commonly reported among nursing students,

especially during the initial period. However, depending on how students deal with

stressors, stress could have either advantageous or disadvantageous outcomes;

while some students become more motivated when faced with stressors, others

become anxious and depressed.

Nursing students commonly experience anxiety and stress during their initial

clinical training and practice. Stress during this period can result in several negative

outcomes, such as poor academic performance, elevated burnout levels, and

diminished personal well-being. All these are detrimental to the achievement of the

goal of training, which is to prepare competent nurses. Therefore, it is vital for

clinical teachers to be aware of the factors that may prompt increases in the level

of stress among nursing students and the adaptation techniques they utilise to

overcome stressors. There is evidence to support the idea that helping students

develop positive stress coping abilities is useful for their successful adaptation to

several stressors throughout their learning. Furthermore, a recent integrative

review highlighted the importance of recruiting representative samples to assess

nursing and midwifery students’ stress and coping strategies in various institutions

at specific years during their studies including prior to their clinical practice.( Waled

A.M. Ahmed, PhD* and Badria M.A. Mohammed, PhD, 2019).1

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Coping mechanisms are natural or learned ways of responding to a challenging

environment or specific problem or situation. There are two types of coping

strategies namely; problem-focused coping (taking action) and emotion focused

coping (such as use of anger, avoidance). ( Frank Maureen D1, Robinson-Bassey

Grace C2, Makachi Monica C3, Odum Beatrice2, 2017) 2.

Stress and coping with stress are phenomena closely intertwined with human

life. They relate to all minor and major events in life. Even in our day to day life,

stress is the topic of many conversations, people talk about the stress of balancing

home and work life, the stress of being hard pressed for time, of living in a

mechanical society, dealing with a crying child, getting through traffic jam, etc. We

also come across people who seek to reduce this stress by going to yoga therapies,

faraway beaches and meditation sessions or with use of alcohol, drugs, etc.

Though many people talk about stress in general terms, it is hard to define the

term „stress‟ in a scientific manner. In fact, the phenomenon of stress and the

process of coping is a focal point in various disciplines, such as Medicine,

Psychology, Management, Sociology and Anthropology. Stress and the methods of

coping with it are covered in all branches of psychology, including Health,

Psychology, Environmental Psychology, Developmental Psychology, Neuro-

Psychology, Organizational Behavior, Clinical Psychology etc. (Nayereh

shahmohammadi, 2011).3

Student at the university level experience high level of stress, related to worry

about successes, availability of time, engagement in patient care (Mohamed &

Ahmed, 2012). There are many sources of stress among university student, which

can be related to academic workload, many assignments, and expose to a new

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setting. The rate and level of stress and depression is an alarm among students in

different academic fields (El Ansari, Adetunji, & Oskrochi, 2014).

Nursing students practice a long hour of study and inadequate time for other

activities (Gibbons, Dempster, & Moutray, 2011). In addition, they spend a

substantial time in the clinical areas, with the heavy responsibility of being

accountable for patients (Reeve, Shumaker, Yearwood, Crowell, & Riley, 2013).

Moreover, financial burden, struggling to manage time and using high-tech

machines are all additional stressors in many cases (Seyedfatemi, Tafreshi, &

Hagani ). Many studies found that nursing student have high level of stress

comparing with other students (Gibbons et al., 2011; Goff, 2011; Reeve et al.,

2013).

Coping strategies to manage stress through social care can positively reduce

levels of stress and promote health In Saudi, the students joint the nursing school

in between the ages of 18-20 years (upon completion of high school), and are then

faced with some patient care responsibilities for which they lack the prerequisite

professional knowledge and skills, which is the root of the stress they face. Despite

the universal acknowledgement of the intense stress faced by students, very little

is known in terms of epidemiological figures around stress level and factors.

Largely due to cultural attitudes that affirm the inevitability and normality of major

stress among students, including among nursing researchers who themselves have

gone through such stressful processes, very few studies have explored the

prevalence of stress among students. This study constitutes an effort to illustrate

levels of stress and to identify common stressors among nursing students, describe

the differences in stress levels and coping behaviour related to demographic

variables (age, gender, marital status, education level, smoking habit, Body Mass
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Index (BMI), residence, family income, sleeping hours and Grade Point Average

(GPA)), find out the relation between type of stress and coping strategies and to

find out the coping mechanism used by nursing students.( Emad Shdaifat, Aysar

Jamama & Mohammed AlAmer, 2018).4

The 3rd year nursing students of Naga college foundation, Naga city experience

more stress then the previous two year because of clinical exposure in many

different wards and the most important, tough and broad concepts of nursing is

also included in this year. As researchers, we decided to go into this study to

further understand the effect of this increased workload on the stress level and

coping strategies of the 3rd year nursing students.

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Statement of the problem

The study aims to determine the perceived stress and coping strategies among
3rd year nursing students, of Naga Collage Foundation for school year 2019-2020

Specifically, it will answer the following question:

1. What is the demographic profile of respondents in term of:

a. Age;

b. Gender;

c. Civil status; and

d. Family Monthly income?

2. What are the perceived internal and external stressors of respondents?

3. What are the possible coping strategies of the 3rd year nursing students in
terms of:

a) Physiological;
b) Psychological;
c) Spiritual;
d) Social; and
e) Emotional?

4. Is there a significant relationship between the demographic profile; perceived

internal and external stressors and coping strategies?

5. What intervention program can be recommended to enhance coping

strategies of the respondents?
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Assumption

This study is guided by the following assumption that:

1. The demographic profile of the respondent differs.

2. The perceived internal and external stressors of the respondent are different.

3. The coping strategies of the respondent are unique to themselves.

4. There is intervention program that can be recommended to improve the

coping strategies of respondents.

Hypothesis

There is no significant relationship between the demographic profile; perceive

internal and external stressors and coping strategies of respondents.

Scope and delimitation of study

This study was focuses on the perceived internal and external stressors and

coping strategies of nursing 3rd year student of Naga College Foundation, Naga City.

It likewise will to find out the relationship between the demographic profile as to

perceived internal and external stressors and coping strategies of respondents. This

study is exclusively for the nursing student of Naga College Foundation, Naga City.

Specifically, this research is targeted at the 3rd year nursing students due to the extra

burden of clinical exposure and hospital duties.

Significance of the study

This study is deemed important to the following:

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Students: They will be given information on the different possible stressors that

they might encounter in third year nursing school and on the different coping

strategies available that can be utilised to deal with them.

College of Health Sciences: This study helps the nursing department to be aware

of the possible outcomes if experienced suffered by the students who could not

manage stressors. The department will have further information about their students

when it comes to grade and performances.

School Administrators: This study will provide information on creating school

policies that will be helpful to reduce the effect of stress on its students.

Guidance Counsellor: This study will help them to provide more focused and

factual knowledge of the factors impairing student stress management. The

increased understanding of the guidance counsellor on the interplay of variables

studied in this research such as knowledge, hope to help the guidance and

counselling practitioners towards the development and implementation of the more

effective programs in consideration to these variables.

Clinical Instructors: This study will help them in understanding better the diversity

of learning their students and provide them to give appropriate adjustments go

improve their methods and standards of teaching.

Other Researchers/Future Researcher: This study will provide valuable

information and data in regards to the internal and external stressors and coping

strategies on selected regular Nursing students. This will serve as an inspiration for

future researchers to look into it and continue the study of this matter.
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Definition of terms

The following term were defined conceptually and operationally for classification

purpose:

Perceive: To come to an opinion about something, or have a belief about

something.

Stressor: A stressor is a chemical or biological agent, environmental condition,

external stimulus or an event that causes stress to an organism. Psychologically

speaking, a stressor can be events or environments that an individual would consider

demanding, challenging, and or threaten the individual's safety.

Internal Stressor: It is the stress that originates inside the individuals, it is caused

by the things surrounding us that could stress, such as pressure from school or

family, large crowds, or excessive noise, internal stress also generated by your mind,

both unconscious and conscious, it may be triggered by past experiences, present

conditions or future situations.

External stressors: Refers to the stress on the human system caused by an aspect

outside of the body, such as physical environment, work, rest schedules, and social

relationships.

Coping Strategies: Coping strategies are psychological patterns that individuals

use to manage thoughts, feelings, and actions encountered during various stages of

ill health and treatments.

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NOTES

A.M. Waled Ahmed, PhD* and M.A. Badria Mohammed, PhD, 2019 Nursing

students' stress and coping strategies during clinical training in KSA.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.sciencedir

ect.com/science/article/pii/S165836121930023X&ved=2ahUKEwiTz9-

05eHjAhUFHXAKHW00BcEQFjAAegQIBhAC&usg=AOvVaw023B9wj4Va7tPH5Xsvyxd

m&cshid=1564666672238

D. Frank Maureen, R-B. Grace , M. Monica , O. Beatrice2,2017) Coping Mechanisms

Utilised for Stressors among Nursing Students

on Clinical Posting at University of Port Harcourt Teaching Hospital,

Rivers State.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.ijcmr.com

/uploads/7/7/4/6/77464738/ijcmr_1606.pdf&ved=2ahUKEwjG2Iep4uHjAhWNZt4KH

TNAB00QFjABegQIAxAB&usg=AOvVaw2GsprJxa1EagAV5Lb9cjhH

N. shahmohammadi, 2011 Students’ coping with Stress.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.sciencedir

ect.com/science/article/pii/S1877042811019033&ved=2ahUKEwiw09Os5uHjAhVRfd

4KHSIdDYoQFjAIegQIAxAB&usg=AOvVaw1_QlGbnb9Mn2sBpWirwzRt&cshid=1564

666895287

E. Shdaifat, A. Jamama & M. AlAmer, 2018

Stress_and_Coping_Strategies_Among_Nursing_Student.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.researchg

ate.net/publication/323869280_Stress_and_Coping_Strategies_Among_Nursing_St
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udents&ved=2ahUKEwi1wojc5uHjAhWJad4KHQLFCV8QFjAAegQIAxAB&usg=AOvVa

w0GxMpQQ1n8EptlOi3JKZka&cshid=1564667117004