SHERYL ANN B.

PEDINES BSN-IV
GROUP 1

TITLE: LEVEL OF ANXIETY AND COPING STRATEGIES AMONG NURSING

STUDENT AT NORTHERN CHRISTIAN COLLEGE DURING COVID-19 PANDEMIC
S.Y. 2020-2021

RESEARCH PROBLEM

The coronavirus disease 2019 (COVID-19) pandemic is a substantial health burden

that has major implications for public globally. COVID-19 is a pneumonia-like disease
caused by a novel coronavirus that emerged in the Province of Wuhan in China in November
2019. Affecting nearly all the countries in the world, it is a historic health emergency
condition has ever seen which is even worse than world war II. The rate of contagion and
patterns of transmission is threatening the whole mankind. As the disease is highly
contagious, can be fatal in severe cases, and there are no specific medicines, it poses a huge
threat to the life and leading to a severe impact on their emotional responses and coping
strategies. According to WHO, COV1D-19 was declared in March 2020 as a pandemic in the
Philippines. Moreover, Enhanced Community Quarantine (ECO) was implemented by the
government to help the country' s efforts to curb the adverse impact s of the COVID-19
pandemic (David et al 2020). Pandemic is the outbreak of a disease that occurs over a wide
geographic area and affects an exceptionally high proportion of the population, a pandemic
outbreak of a disease.

Anxiety is highly prevalent among college students. The top three concerns among
students are academic performance, pressure to succeed, and post-graduation plans (Beiter et
al, 2005). Nursing education has consistently been associated with anxiety among students.
Heavy course loads, stringent examinations, continued pressure to attain a high grade point
average (Chernomas and Shapero, 2013)complex interpersonal relationships, challenges of
the clinical environment (Chen et al., 2015), caring for chronic and terminally ill patients (Sancar et al.,
2018
) result in greater anxiety among nursing students than among students from any of the
other healthcare disciplines. During an epidemic/pandemic state, nursing students are
exposed to additional stressful factors, such as fear of being infected. Coping with anxiety
and stress is extremely important regarding the influence anxiety and stress will have on
health.
 Therefore, dealing with the hectic student nursing life the drastic lifestyle changes
imposed due to COVID 19 pandemic can be very challenging. The present study aimed to
assess level of anxiety and ways of coping during the period of covid19 pandemic and
identify association of coping strategies with characteristics of the students among nursing
students in the Northern Christian College.

Statement of the Problem

This study aimed to determine the degree of anxiety and coping mechanisms
among nursing student during the COVID19 pandemic. Specifically, it sought answers to the
following questions

1. The Demographic Profile of the Respondents

1.1 Age
1.2 Gender
1.3 Civil status
1.4 Year level
1.5 Religion
2. The Level of Anxiety adopted by nursing students during pandemic
2.1 Minimal
2.2 Mild
2.3 Moderate
2.4 Severe
3. The Coping of Mechanisms adopted by nursing students during pandemic
3.1 Resilience/Self-esteem
3.2 Seeking information and Consultation
3.3 Mental disengagement
3.4 Spiritual and not Scientific sources of support
3.5 Humor
4. Is There significance relationship between demographic profile and level of anxiety?
5. Is there significance relationship between demographic profile and coping strategies?

Null Hypothesis
 There is no significance relationship of the following level of anxiety and coping
strategies of nursing student during the COVID-19 pandemic, and demographic profile.

Scope and Limitation

The study focused on the Degree of Anxiety and Coping Mechanisms during the
COVID-19 pandemic by first year to fourth year nursing students in Northern Christian
College. Likewise, the researchers also look into the degree of anxiety and coping
mechanisms and arranged them thematically. The data gathered will be limited only through
the use of basic instrument such as questionnaire and interview.

Significance of Study

The generalization of this present study would be a great contribution to the vast
knowledge in relation to the level of anxiety and coping mechanism associated during the
pandemic. Vital results of this investigation could be highly significant and beneficial
specially to the following:

Respondents. The respondents will have a self-awareness of the signs of anxiety so that they
can effectively manage their anxiety.

Professors. The result of the study may contribute to lowering student anxiety by
maintaining a stable educational framework, providing a high-quality distant teaching and
encouraging and supporting students through this challenging period.

Parents. The parents will be able to know their children’s profile during the pandemic and
will be able to coordinate with the teachers to improve and maximize the capacity their
parental guidance’s of their children.

The Researchers. This study will help them to improve their skill, strategy, and knowledge
in engaging research.

The Future Researchers. The findings of the study will serve as a reference material and a
guide for future researchers who wish to conduct the same experimental study or any study
related to the level of anxiety and coping mechanisms among nursing students during the
pandemic.

Definition of Terms

The following terms are defined according to how they were used in study.
1. COVID-19- is an infectious disease caused by a new strain of coronavirus that can
spread from person-to-person and throughout the world.
2. Nursing student- All students undergoing I, II, III, IV BS Nursing course in various
Northern Christian College.
3. Pandemic- this refers to the occurring over a wide geographic area, such as multiple
countries or continents and typically affecting a significant proportion of
the population.
4. Anxiety- this refers to the emotional aspects of a person which characterized by
feelings of tension, worried thoughts and physical changes and recurring intrusive
thoughts or concerns.
5. Coping mechanism- this refers to the specific efforts, both behavioral and
psychological, that the nursing students are employing to master, tolerate, reduce, or
minimize stressful events during pandemic.
6. Mild anxiety- this refers to the level of anxiety which a person experiencing on a
day-to-day basis during certain situations. It may feel uneasy in the stomach, and
pulse increase slightly. Likewise, it may feel complete attention on the thing or
situation that's making feel anxious and ignore everything else around us.
7. Moderate anxiety- this refer to the level of anxiety which is similar to mild
anxiety but can become more severe and overwhelming, when a person is making
more nervous and agitated.
8. Severe anxiety- this refers to the level of anxiety when a person is not able to think
rationally and experience severe panic. This characterized by feelings of afraid and
confused, agitated, withdrawn and find it difficult to think clearly. The breathing may
quicken and start to perspire while the muscles will feel very tense.
9. Resilience- this refers to the capability of students by dealing with challenges.
10. Seeking information or consultation- this refers to the process of attempting by the
students to seek advice and using consultations with professionals about the
situations.
11. Mental Disengagement- this refers to the usage of the coping strategies by the
students such eating, consuming sedative drugs and alcohol.
12. Spiritual support and not scientific sources of support - this refers to the beliefs in
God and usage of social networks by the students to get information.
13. Humor- this refers to the usage of humor by the students to deal with the situations.
 CHAPTER II
REVIEW OF RELATED LITERATURE

This chapter present the Review of Literature on Anxiety and Coping Mechanisms
during COVID-19 Pandemic among Nursing Students.

COVID-19 PANDEMIC

The corona (covid-19) pandemic is defining as a global health crisis of our time and
greatest challenge we have faced since World War II (UNDP, United Nations Develop
Program). In early December 2019, caused by a novel severe acute respiratory syndrome
coronavirus 2 (SARS_CoV-2), occurred in Wuhan, Hubei Province, China. On 7 th of January
2020, the authorities in China declared the isolation of the new CoV type. On 12 th of January
2019-nCoV was designated by WHO, aid on 11th of February 2020 was assigned COVID-19
name (WHO, World Health Organization).

The first case was identified, the infection was possible spread from animal to human
a zoonotic agent. A record human to human route by transfer confirmed a surge in cases in
Wuhan and globally after the shutdown of the Wuhan market and relocation of cases in
China. Although, china declared that this is a f—of new cases but have been reported at the
beginning of April of 2020 of viral re-emergence (John Hopkins Coronavirus, Resource
Center).

This COVID-19 associated with person to person through droplet in contact

transmission is flack of stringent infection control and prevention or no proper protective
equipment, and it is danger to extreme highest level. Since, it is emergence in Asia, the virus
has spread all over the world infecting millions of people and causing hundreds pf thousands
of deaths. Every people are losing jobs, income within way of knowing when normality will
return (WHO, World Health Organization).

ANXIETY

Anxiety is an emotion characterized by feelings of tension, worried, thoughts, and

physical change like increase blood pressure. People with anxiety disorder usually have
recurring intrusive thoughts or concerns. They may avoid certain situations out of worry.
They may also have physical symptoms such as sweating, trembling, dizziness, or a rapid
heartbeat (APA, American Psychological Association).

Most worrisome is that nursing student who experience anxiety may be unable to
perform safety and effectively (Cook,2005). Anxiety is highly prevalent among College
Student. The main source of anxiety in nursing student during COVID-19 pandemic was
heavy loads, stringent examinations, continued pressure to attain a high-grade point average
(ChernomasandShapiro,2003), complex interpersonal relationships, challenges of the clinical
environment (Chenetal,2015). Anxiety has a negative effect on the equality of student’s life,
their education and clinical practices (Sanad,2019).

During pandemic state, nursing student are exposed to additional stressful factors,
such as fear of being infected. A study conducted among nursing students during the SARS
outbreak (2003) showed that nursing students perceived themselves to beat higher risk of
infection (Wongetal,2004).

While a low level of anxiety is helpful to motivate and generate excitement in an

individual, persistent exposure to anxiety may have negative consequences on them
physiological and psychological health and academic performance. Avast number of studies
highlighted the negative effects of a higher of anxiety, including loss of desire to eat,
dizziness, sleep disturbance and vomiting or nausea (Lee,2020; Leeetal.,2020). Higher
anxiety levels were also associated with impairment in some bodily functions, negative
coping mechanism (such as increased intake of alcohol or drugs) stress and depression and
increased suicidal ideation (Leeetal.,2018a; Leeetal.,2020). Further unmanaged anxiety may
lead to long term effects on nursing student’s academic performance and job satisfaction,
leading to frequent absenteeism (Labragueetal.,2018a; Leeetal.,2020). Implementing
measures to reduce anxiety among nursing student may prevent its adverse consequences.

Coping with anxiety and stress is extremely important regarding the influence anxiety
and stress will have on health. Coping mechanism area necessity when dealing with anxiety
and accompanying stressors. (Lazarus&Folkman,1987) classified coping ways as problem-
solving approaches the most coping behaviors in nursing student. Coping as any behavior or
thought process unconsciously brought into use by an individual to protect himself/herself
against painful or anxiety provoking feelings, impulses and perception
(Muersing(1996),PuhlandBrownell(2003).

Coping strategies and students' characteristics

As to the resilience factor, stronger resilience and self-esteem were associated with
the lowest anxiety levels (moderate and severe). The people with high resilience and self-
esteem presumably engage in positive, active attempts to cope with stressors (Carver and
Scheier, 1989). Nursing students who showed that a positive coping style is significantly
correlated with a higher level of self-esteem (Ni et al., 2010, 2012). In this study mental
disengagement (usage of alcohol, sedative drugs and excessive eating) was associated with a
higher state of anxiety. Consistent with what is known about alcohol and drugs to cope with
anxiety, this coping strategy is ineffective and may worsen the level of anxiety (Carver and
Scheier, 1989). Maladaptive coping strategies are more likely to lead to eating disorders
(Zheng et al., 2020.Usage of humor was associated in this study with lower levels of anxiety.
Freud's psychodynamic viewpoint described humor as one of the strongest defense
mechanisms that allow individuals to face problems and avoid negative emotions and
researchers believe that humor has a stress-moderating effect (Penson et al., 2007).. The
authors believe that in the particular case of the covid-19 pandemic, seeking for information
might increase anxiety by overflow and multiple sources of information, sometimes
broadcasting contradicting information.
Theoretical Framework

This quantitative study is mainly anchored on the Selye’s Theory of stress which was
first developed in the 1930’s. He explained his stress model based on physiology and
psychobiology as General Adaptation Syndrome. According to Selye, stress is a non-specific
physiological response pattern of the body to any demand which focuses on the achievement
or maintenance of homeostasis or stability of physiological systems that maintain life (e.g.,
body temperature, heart rate, glucose levels). This idea is elaborated in his General
Adaptation Syndrome (GAS) model which is based on the observation that all living
organisms respond to stress as a basic reaction pattern, and this is always the case,
irrespective of the agent used to produce the stress.

The model states that an event that threatens an organism’s well-being (a stressor)
leads to a three-stage bodily response. The first stage is the Alarm/Reaction Phase, in this
phase the rate of all bodily functions of the autonomic nervous system increases dramatically,
known as the “fight-or-flight” response, to give physical strength and mobilize internal
forces. In some instances, its duration may only be a few seconds, though it may last longer.
The second stage is the Resistance/Adaptation Phase, the body begin to repair itself and
returns many physiological functions to normal levels of a stressful event or a fight-or-flight
response. If the resistance/ adaptation phase continues for a prolonged period of time without
periods of relaxation, sufferers become prone to fatigue, poor concentration, irritability,
frustration, and lethargy, leading to the third stage known as exhaustion phase. The
exhaustion phase, in the stressor environment is chronic. With this, struggling with the stress
for long periods can exhaust an organism’s physical, emotional, and mental resources, which
results to signs of adaptation failure. Systems begin to break down, and the person becomes
more susceptible to a range of biopsychosocial signs and symptoms. Such as, fatigue,
burnout, depression, anxiety, and decreased stress tolerance. This may even lead to death.

Later, Selye introduced the idea that a stress response can result to positive or
negative outcomes based on cognitive interpretations of the physical symptoms or
physiological experience. When a person tolerates stress and uses it to overcome lethargy or
enhance performance, the stress is positive, healthy, and challenging; this is known as
eustress. On the other hand, when stress is negative and it exceeds one's ability to cope,
fatigues body systems, and causes behavioral or physical problems, it is known as distress.

However, the stress as stimulus model ignores important variables such as prior
learning, environment, support networks, personality, and life experience. Subsequently, in
1978, the concept of personal interpretation was introduced, suggesting that a change or life
event could be interpreted as a positive or negative experience based on cognitive and
emotional factors. Lazarus (2015), in attempting to explain stress as a dynamic process,
developed the Transactional Theory of Stress and Coping (TTSC), which presents stress as a
product of a transaction between a person including multiple systems such as cognitive,
physiological, affective, psychological, and neurological) and his or her complex
environment.

In this study, this theory was utilized to determine the degree of anxiety and coping
mechanisms among Nursing students at Northern Christian College during the COVID-19
pandemic. The Selye’s Theory of stress: General Adaptation Syndrome proposes that
students who perceive that they are susceptible to anxiety and coping mechanisms are more
likely to find ways to reduce their predisposition to the distress, thus they can identify the
nature of the stress. As to perceived severity, people who perceive anxiety as a serious
disorder can engage to different approaches to become aware and will seek ways to be
educated. Consequently, people who does not perceive it as a serious disorder tends to
disregard things about it regardless of the availability of resources. As to perceived benefits,
people who perceives that it is beneficial on their part to be equipped with knowledge about it
will more likely to engage in different ways to learn it’s nature, development and progression.
However, perceived barriers are also of vital importance to consider because this can affect
and threaten the level of awareness of people.

Conceptual Framework
The degree of anxiety and coping mechanisms during pandemic among nursing
student in northern Christian college were describe by their demographic profile. The first
year to fourth year nursing student determined their level of anxiety and coping mechanisms
includes: a) what are the demographic profiles of the respondents? In terms of age, gender,
civil status and religion; b) The level of anxiety adopted by respondents; c) and the coping
mechanisms adopted by respondent
 Figure 1. The Research Paradigm

Independent variables Dependent variables

1 Demographic variables
1.1 age
1.2 gender
1.3 civil status
1.4 religion

2. Level of anxiety
2.1 Minimal
2.2 Mild
2.3 Moderate
2.4 Severe Level of anxiety and coping mechanisms among
3. Coping mechanisms nursing student during COVID19 pandemic
3.1 Resilience/ Self-esteem
3.2 Seeking information and
Consultation
3.3 Mental disengagement
3.4 Spiritual and not Scientific sources
of support
3.5 Humor