Academic Stress among Nursing Students

Introduction

Nursing profession is a disciplined profession involved in the delivery of health to the society also it is helping profession, service oriented to maintain health and well- being of people, an art and science. But the nursing profession comes with stress both mentally and physically because of its fast- paced and emotional nature. Nursing colleges are now recognized as a stressful environment that often exerts a positive effect on the academic performances and psychological well-being of students. Academic source of stress are examination, long hours of study assignments, grade, lack of free time, lack of timely feed -back after their performance, special elements of the academic program like arrangement and conduction of workshop. Clinical sources of stress are like taking care of ill patients, inter personals conflicts with peer group, insecurity about personal clinical competence fear to complete clinical requirement, dealing with uncooperative patients, work load, prolonged standing learning psycho motor skills e.g.-bed making, bed bath and vital signs monitoring have also being associated with high level of stress. The reaction of parents and friends to the results weigh upon the student to create exam stress, lack of interest to study and inability to follow the professor cause disinterest in attending classes.

The American College Health Association National Health Assessment (2009, 2010) data revealed over one third of all post-secondary education student ranked stress as their highest health impediment followed with sleep issue, depression and anxiety [1]. Amr AM, et al. assessed the perceived stress among 373 baccalaureate Mansoura nursing students and analyzed the factors responsible for it. A self-administered questionnaire included socio- demographics, types of stressors, perceived stress, factors responsible for physical wellbeing, and symptoms of anxiety and depression were used. The findings revealed high levels of stress (40.2%), anxiety (46.6%), and depression (27.9%) among nursing students, in which academic pressure is the main cause of stress (mean score 4.6). This emphasized the significance of stress management programs in nursing institutions [2].

Bartlet L Michelle, et al. conducted a comparative study to assess the mental health characteristics and stress between baccalaureate nursing students and non-nursing students. The purpose of this study was to prepare the student nurses to cope with extremes of stress in the field of nursing profession, to make them understand about the signs of stress. The study explored the origin of stress among nursing students and compared these with non-nursing students using the paper-and-pencil version of the National College Health Assessment II. Nursing students were exposed to higher levels of stress when compared to general students [3].

Need For the Study

Nursing is a dignified line of work and the students are posted in clinical areas to render services, it is essential to have healthy mind set to deal with sick patients. It was noticed that during theory class most of the students showed disinterest and was proved by their academic results. Abhishek Singh, et al. used a descriptive cross-sectional study to analyze the perceived stress among 282 North Indian undergraduate nursing students in Haryana. The perceived stress scale was used to measure the stress level and was 28.67 (SD = 5.32), with a median of 26 (IQR = 22-34). The level of stress was more among female students (31.33) compared to male students (26.01). The second year students presented with greatest level of stress (29.66) while, third year students showed least stress score (26.28). This indicated the need for stress relieving measures in the nursing colleges [4].

Therefore, the researchers want to know the students perception of academic stress and how they cope with it on daily basis, as they are struggling to reduce the negative effects on their health, and their academic performance. In our opinion, it is very important for nursing students to learn how to manage academic stress, if it cannot be eliminated.

Farias Mota, conducted a transversal and quantitative study on stress among nursing students with the aim of the study was to estimate the level of stress and symptomatology reported in nursing students. Sample size involving 151 nursing students selected from a draw based on the list of students enrolled. Result of the study was 49.7% of students showed symptoms of the stress, and most students were attending the 8th and 9th periods. Psychological symptoms were more present (50.7%). The conclusion of the study was the implementation of lightweight care technology tools, at low cost and high resolutive power, such as providing information on stress, prevention and control, relaxation sessions, integrated community therapy, spaces for physical activity guided by trained professionals [5]. There is strong evidence of an inverse relationship between stress and lack of professional knowledge among nursing students Aku- Zaheya et al. [6].

Based on the above findings related to level of academic stress in nursing students, the researcher felt that academic stress in nursing students have a common problem everywhere and it is most vital to guide them in proper way. The academic stress in nursing students may be due to many factors. Nursing students experience multiple stressors as they are expected to apply theoretical learning and develop critical thinking skills while in the professional environment. Perceived overwhelming negative stressors can lead to absenteeism, job dissatisfaction and a high employment turnover rate. At this point, it is essential to find the level of academic stress in nursing students and rectify the problems. Hence the researchers are motivated to assess the level of academic stress among nursing students.

Research Methodology

A non-experimental research approach and descriptive design was used for the present study. The setting of the study was nursing colleges in Mandi district, HP. Nursing Students who were studying in selected Nursing colleges in different nursing courses like ANM, GNM, P.B.B.Sc Nursing and B.Sc. Nursing at Mandi district were selected as sample and the total sample size of the study was 200 nursing students. Convenience sampling technique was used to select the sample. Demographic profile and Self – Structured Academic Stress Scale was developed after detailed literature search and the scale was administered to participants after taking signature in the written consent form. The approximate time taken for administering scale was around 25 minutes.

Results

The data obtained in the study was analyzed using both descriptive and inferential statistics Table 1.

N=200. Table 1: Frequency and Percentage Distribution of Socio Demographic Variables of the Nursing Students

The above table shows that out of 200 nursing students, 104 (52%) were in age group of 18 – 20 years. Majority of nursing students were belongs to Hindu religion 191(96%) , 82 (41%)were from the B.Sc. Nursing course of study, 134 (67%) were from rural area, 139 (70%) were from nuclear family, most of the students father’s and mother had educational status were higher in Matric education 71 (36%) and 87(44%) respectively. Majority of nursing students 69(35%) monthly family income up to 10,000/ , 133(67%) students medium of education status was in English, and most of the students 98(49%) used meditation as a stress relieving technique Table 2.

Variables Demographic data options severe moderate mild Chi Test P Value

Age

Religion

Course of Study

Residential Area Rural 28 85 21 5.677 0.059NS Urban 24 35 7

Type of Family

Education Status of Father

Education Status of Mother

N=200. Table 2: Frequency and Distribution of Nursing Students in Terms of Level of Academic Stress. The data in above table reveals that most of nursing students 60% had moderate stress, 26% had severe stress and few of them 14% had mild stress Table 3.

18 – 20 years 27 65 12

22.156 0.001* 21 – 23 years 12 40 15

24 – 26 years 5 13 1

> 27 years 8 2 0

Hindu 51 114 26

3.963 0.411NS Muslim 0 3 0

Sikh 0 0 0

Christian 1 3 2

ANM 22 12 3

28.723 0.000* GNM 6 33 9

B.Sc. Nursing 18 54 10

Post Basic B.Sc. Nursing 6 21 6

Nuclear Family 35 80 24

4.581 0.333NS Joint Family 17 39 4

Extended Family 0 1 0

No formal education 4 2 0

Middle 2 15 3

Matric 23 37 11

19.258 0.037* Senior secondary 13 29 6

Graduate 7 33 4

Post graduate 3 4 4

No formal education 6 10 3

Middle 4 16 2

Matric 26 47 14

6.109 0.806NS Senior secondary 10 27 4

Graduate 5 16 5

Post graduate 1 4 0

N = 200 *Significant at P<0.05 NS (Not significant) Table 3: Association of academic stress with selected socio-demographic variables of nursing students.

The above table depicts that there was a significant association between the academic stress of nursing students with age, course of study, education status of father, monthly family income, medium of education status of school at P<0.05 level. Other socio-demographic variables religions, residential area, types of the family, education status of mother, stress relieving techniques were not statistically significant at 0.05 level of significance.

Discussion

In this discussion the researcher ties together all the loose ends of the study. The current narrative review highlights the students commonly reports moderate level of academic related stress which impact their mental and physical health and leads to a range of academic related problems. Good stress management skills have the potential to benefit students in an ongoing manner throughout their lives. The findings of the present study were discussed in accordance with the objectives of the study.

Objective 1: To assess the level of academic stress among nursing students.

The findings show that more than half 120 (60%) nursing students had moderate level of academic stress, less than half 52 (26%) nursing students had severe level of academic stress and 28 (14%) nursing students have mild level of academic level of academic stress.

Most of the nursing students 77% revealed that the syllabus is too vast and worried about examination. Around

74% stated that the stress is due to the discrepancy between theory and practical classes. About 72.2% expressed that teacher makes too many extra demands on them.

Hence it concluded that the maximum nursing students have moderate level of academic stress.

The study was similar with findings of Kavaline Karunagari conducted a study on stress and coping among the under graduate nursing students. The aim of this research study was to assess the stress and coping level among the B.Sc. nursing students. The results showed the overall stress level among nursing students were under mild stress 27%, moderate 65%, high stress 8% and also the coping level among nursing students had poor coping 4%, mild coping 43%, moderate coping 45% and good coping 8% [7].

Objective 2: To determine the association of level of academic stress among nursing students with selected socio- demographic variables.

The results reveals that there was no association between religion, residential area, type of family, education status of mother, stress relieving technique because the calculated chi square value was less than table value but in age the calculated chi square value was 22.156, in course of study calculated chi square value was 28.723, in education status of father calculated chi square value was 19.258, in the monthly income calculated chi square value was 8.090, in the medium of education status calculated chi square value was 13.086 which was more than table value. Association found significant at p<0.05 level.

The study was similar with findings of Acta Paul Enferm conducted a study on stress in nursing students, socio- demographic and academic vulnerabilities. The aim of this study was to analyze the association between the presence of stress in nursing study and socio-demographic and academic vulnerabilities. The result of this research study among all students 64% presenting stress with the stress following associated factor sex p<0.010, age group p<0.029, mental status p<0.001, cost of children p<0.001, occupational status p<0.001, cost of education p<0.009 and current study period p<0.001. The study concludes that women, students with partners, and those in the final year of study were more likely to have stress [8].

Conclusion

Academic stress becomes a pervasive problem among nursing students across the country. The present study brought into light that academic stress still continues to be a destructive problem affecting the students’ academic performance, mental health and wellbeing. Hence the study recommends it is very important to arrange some workshops at the beginning of every semester. Thus the students will be able to learn how to overcome the stress and perform well in the studies. Institutions should arrange classes for yoga, meditation and other stress relieving therapy to practice in class rooms. Counselors and psychologist should be arranged for effective counseling so that the students can overcome the stress. Increasing students stress management skills and abilities is an important target for change.