Stress and related factors among nursing students at Duy Tan university

Nội dung text: Stress and related factors among nursing students at Duy Tan university

1. RESEARCH ARTICLE STRESS AND RELATED FACTORS AMONG NURSING STUDENTS AT DUY TAN UNIVERSITY Nguyen Thi Hong Hanh1, Ho Thi Lan Vi1 1Duy Tan University ABSTRACT Objectives: This study aimed to describe ± 0.77). Students used more positive levels of stress, physio-psycho-social status, coping strategies than negative strategies, coping behaviors of nursing students at Duy and the most frequently used coping Tan University related factors on level of mechanism was optimistic behavior (2.51 stress. Method: The cross-sectional study ± 0.72). There were statistically significant design was conducted among 200 nursing differences between academic year, living students at Duy Tan University in 2020. expenses, interest in Nursing, and level of The data were collected by using three self- stress (F=17.36, p<0.01; F= 2.84, p=0.04; determination questionnaires: the Student F=6.69, p<0.01 respectively). Conclusion: Nurse Stress Index (SNSI), the Physio- Stress was a moderate level among nursing Psycho-Social Response Scale (PPSRS), students. Effective intervention strategies and the Coping Behavior Inventory (CBI). are needed to reduce or prevent stress in Results: The major finding were as follows: nursing students. So that this study has Stress of nursing students were at the important implications for nursing educators moderate level (60.2 ± 13.5), and stress for in helping their students to overcome stress these students came mainly from academic during stydying. load (21.5 ± 4.6). Nursing students were in Keywords: Nursing students, stress, good physio-psycho-social health (1.41 ± coping behavior, physio-psycho-social 0.60), and emotional symptoms were the status most common response to stress (1.85 1. INTRODUCTION Stress is a non-specific biological phenomenon that affects a lot of students response of the body to stressful situations, and can lead to other disorders besides low stress can stimulate positivity, mobilize academic performance such as physical, strength for people to overcome difficulties, psychological, and mental health [2]. but also has harmful effects. if it exceeds the body’s ability to respond, causing illnesses, Compared to students in other majors, diseases... [1]. Stress is a complex students in Healthcare system have a higher risk of experiencing problems that lead to stress [3]. The healthcare industry is changing at a rapid rate, and people have greater expectations of providing high Cor. author: NguyenThi Hong Hanh quality healthcare, which is also the cause Email: honghanhnguyen25@gmail.com of increased pressure. for medical staff Received: Nov 15, 2020 as well as nursing students [4]. Nursing Revised: Nov 22, 2020 students have been identified as at high Accepted: Mar 05, 2021 Journal of Nursing Science - Vol. 04 - No. 01 23
2. RESEARCH ARTICLE risk of stress during studying [5]. Bista’s 2.4. Sample size and sampling method research in Nepal 2017 showed that the - Sample size: 200 nursing students by stress among nursing students were 61.5% using a sample of quotas. Assigning all at moderate, 27.9% at high, and 10.6% at nursing students of Duy Tan University by low level [6]. Vu Dung’s study in 2015 at academic year Thang Long University showed that 32% of nursing students were under high stress, - Sampling method: 200 nursing students 68% were at medium and low levels [3]. were selected using the convenient In addition, some studies have shown that sampling method to select 50 nursing nursing students have been facing wwith students in each academic year (first year many different sources of pressure from to fouth year) who met the sample selection learning environment, clinical environment criteria. or other personal factors [4,7]. 2.5. Data collection The important point was nursing All data were collected by using self- instructors can recognize the stress of determination questionnaire. nursing students and then instructing them how to coping appropriately wwith stress. Students who meet the criteria were If students are not instructed to manage selected and explained about the study, stress appropriately, they can impair their ethical issues, data collection procedures ability to develop self-awareness as well and invited them to participate in the research. After that, nursing students as care, thus negatively affecting to patient answered the questions in the questionnaire care [4]. In order to analyze the current by themself. It took students about 15 stress situation of nursing students to minutes to finish. provide information as a basis for building measures to improve the health and After having all necessary information, learning outcomes of students, the study data collecting forms were checked for was conducted with the aim: To describe the completeness and prepared for analysis. level of stress, physio-psycho-social status, 2.6. Research instruments coping behaviors of nursing students at Duy Tan University and to examine relationships The research instruments were used in between related factors on level of stress. this study which consisted of 4 sections: 2. RESEARCH METHOD - The general personal factors. 2.1. Setting and research period - The Student Nurse Stress Index (SNSI) questionnaire of Jones & Johnston - Setting: Duy Tan University. in 1999 has 22 items incuding 4 subscales: - Research period: from December 2019 Academic load, clinical concerns, personal to June 2020. problems, interface worries. The answers 2.2. Research subjects were indicated by applying Likert’s 5 point- rating sacle which are from 1 being stress - Inclusion criteria: Nursing students from free to 5 being extremely stressful. The first year to fouth year, Duy Tan University mean score will be represented the level of - Exclusion criteria: Students do not stress: the higher score means the higher agree to participate in the study. stress level. 2.3. Research design - The Physio Psycho Social Response Cross-sectional descriptive study Scale (PPSRS) questionnaire of Sheu et al 24 Journal of Nursing Science - Vol. 04 - No. 01
3. RESEARCH ARTICLE in 2002 has 21 items including 3 subscaes: indicated by applying Likert’s 5 point-rating Physical symptoms, emotional symptoms, sacle from 0 (never) to 4 (always). The social behavior symptoms. The answers higher score for any behavior indicates that were indicated by applying Likert’s 5 point- the behavior is used more frequently and rating sacle which are: 0 = never; 1 = rarely; effectively among the behaviors dealing 2 = sometimes; 3 = quite often; 4 = very with stress. often. The mean score will be represented 2.7. Data analysis the level of Physio Psycho Social status. The higher the score means the more The data were synthesized by using frequent and more severe symptoms are SPSS 20.0 software. Descriptive statistical present, the worse the socio-physiological including mean, percentage, standard state of physical health. deviation were used to describe the general personal factors, level of stress, physio- - The Coping Behavior Inventory psycho-social status, coping behaviors. (CBI): Sheu et al’s Coping Behavior ANOVA statistical analysis was used to Inventory (CBI) were modified by Devkota determine the relationships between some et al in 2018 has 20 items including 4 factors and the stress level of nursing subscaes: Avoidance coping, problems- students. solving behavior, optimistic behavior and transference behavior. The answers were 3. RESULTS 3.1. General personal factors of research subjects The total number of nursing students participating in the research were 200. There are 50 nursing students in each academic year. The majority of the subjects were female (89%). Table 1. Characteristics of research subjects (n=200) Characteristics Number Percentage In dormitory 10 5.0 Alone in the motel room 25 12.5 Living Sharing room with friends 116 58.0 Staying with parents/relatives 49 24.5 Living expenses <2 millions/month 51 25.5 2 – under 3 millions/month 90 45.0 3 - 4 millions/month 44 22.0 >4 millions/month 15 7.5 Interested in nursing None 7 3.5 Low 14 7.0 Medium 113 56.5 High 66 33.0 Journal of Nursing Science - Vol. 04 - No. 01 25
4. RESEARCH ARTICLE The majority of students shared room with friends (58%) and stayed with their parents/ relatives (24.5%). Most of students had living expenses <3 million / month. More than a half of the subjects had medium interested in nursing (56.5%). 3.2. Stress levels, physio -psycho - social response, and coping behaviors of nursing students. Table 2. Stress levels of nursing students (n=200) Score Contents Rank SD Reliaty Standard X General Stress (SNSI) 24-93 22-110 60.2 13.5 Stress because of academic load 1 8-33 7-35 21.5 4.6 Stress because of clinical concerns 3 7-33 7-35 17.2 5.7 Stress because of personal problems 4-19 4-20 9.7 3.4 Stress because of interface worries 2 8-30 7-35 19.6 4.6 The stress nursing students were at moderate level (60.2 ± 13.5). Stress for these students came mainly from academic load (21.5 ± 4.6), followed by interface worries (19.6 ± 4.6), stress due to clinical concerns (17.2 ± 5.7). Table 3. Describes in detail the stress levels of nursing students (n=200) Stress factors Contents X SD Examinations and/or scores 3.71 0.92 Academic load The difficulty of the material/curriculum to be 3.32 0.76 learned Relationship with people in the healthcare 2.48 1.05 Clinical concerns system Too much responsibility 2.92 1.13 Personal problems Health status of other family members 2.66 1.15 Other’s attitudes / expectations for the 3.28 1.09 Interface worries nursing profession Little free time 3.22 1.05 The factors of academic load that most stress nursing students are examinations and/or scores (3.71 ± 0.92) and the difficulty of materials/curriculum to be learned (3.32 ± 0.76). ), for clinical concerns are too much responsibility (2.92 ± 1.13) and relationships with people in the healthcare system (2.48 ± 1.05), for personal problrms are the health status of other family members (2.66 ± 1.15), for interface worries are other’s attitudes / expectations for the nursing profession (3.28 ± 1.09) and little free time (3.22 ± 1.05). 26 Journal of Nursing Science - Vol. 04 - No. 01
5. RESEARCH ARTICLE Table 4. Physio -psycho - social response of Nursing students (n=200) Contents Rank X SD Physio-psycho-social response scale 1.41 0.60 (PPSRS) 1. Emotional symptoms 1 1.85 0.77 You tend to be anxious or stressed 2.33 0.91 Lately you have a tendency to be nervous or 2.30 0.96 anxious You often feel depressed 2.08 0.98 2. Social behavior symptoms 2 1.39 0.76 You are not optimistic about your future 1.77 1.08 3. Physical symptoms 3 1.05 0.65 You often experience dizziness or dizziness 1.39 1.00 The physio-psycho-social response of nursing students was at a good level (1.41 ± 0.60). Nursing students had the most emotional symptoms (1.85 ± 0.77), followed by social behavior symptoms (1.39 ± 0.76), physical symptoms (1, 05 ± 0.65). The three most common symptoms in nursing students were emotional symptoms including tendency or stress to anxiety (2.33 ± 0.91), recent tendency to stress or anxiety. (2.30 ± 0.96), feeling depressed and depressed (2.08 ± 0.98). The most common symptom of social behavior among students was not being optimistic about the future (1.77 ± 1.08). The most frequent physical symptoms in students were dizziness and dizziness (1.39 ± 1.00). Table 5. Nursing students’ coping behaviors (n=200) Contents Rank X SD 1. Avoidance coping 4 0.78 0.57 Avoiding hard work in the academic/clinical setting 1.01 0.77 2. Problems-solving behavior 2 2.18 0.67 Using a variety of ways to solve the problem 2.29 0.82 3. Optimistic behavior 1 2.51 0.72 Keep a optimistic and positive attitude when dealing 2.65 0.86 with things in life 4. Transference behavior 3 1.98 0.61 Relax by watching TV, movies, bathing, exercising, meditating, visiting relatives, talking to friends and 2.66 0.81 relatives. Most nursing students have positive coping behaviors with stress. The most used stress-coping behaviors group was optimistic (2.51 ± 0.72) and the least used behavior group was avoidance (0.78 ± 0.57). Journal of Nursing Science - Vol. 04 - No. 01 27
6. RESEARCH ARTICLE The most commonly used behavior by nursing students to cope with stress is transference by relaxing by watching TV, movies, bathing, exercising, meditating, visiting relatives, talking to friends and relatives. (2.66 ± 0.81). Following is to keep a a optimistic and positive attitude when dealing with things in life (2.65 ± 0.86). For problem-solving behaviors, using a variety of ways to solve the problem was most chosen (2.29 ± 0.82). For avoidance coping, avoiding hard work in the academic/clinical setting was the most chosen (1.01 0.77). 3.3. Factors related to stress level of nursing students Table 6. Reationship between personal factors and stress level of nursing students (n=200) Contents X SD F P Academic year First year 50.94 11.90 Second year 58.34 14.56 17.36 p<0.01 Third year 64.88 11.22 Fouth year 66.68 10.40 Living In dormitory 59.60 18.58 Alone in the motel room 65.88 12.21 Sharing room with friends 60.53 13.06 2.66 0.05 Staying with parents/ 56.69 13.48 relatives Living expenses <2 millions/month 55.68 13.02 2 - under 3 millions/month 62.37 14.13 2.84 0.04 3 - 4 millions/month 60.39 13.29 > 4 millions/month 62.13 8.86 Interested in nursing None 74.00 7.00 Low 63.21 14.59 6.69 p<0.01 medium 61.88 12.25 High 55.26 14.26 There was a relationship between the academic year and stress level (F = 17.36, p <0.01). Closer to the final years of study, the stress level of nursing students increases. Living factor was not associated with stress levels, however there was an association that students living alone had higher stress levels than students living with a parent/relative (p = 0.006). Living expenses was associated with stress levels (F = 2.84, p = 0.04), students had living expenses 2 - under 3 million/month had higher stress levels than students. 28 Journal of Nursing Science - Vol. 04 - No. 01
7. RESEARCH ARTICLE have living expenses <2 million/month. factors such as too much lecture sessions Interested in nursing was associated with [12]. Less free time is also one of the factors stress levels (F = 6.69, p <0.01), the more that make students most anxious. Hirsch’s students interested in nursing, the lower the research (2014) on 146 nursing students stress level. in Brazil showed that students stress due to lack of free time or rest [13]. This result 4. DISCUSSION is similar to the study of Sharma (2011) in 4.1. Stress levels, physio-psycho- India [14]. The results also showed that one social response, coping behavior of of the clinical factors that most stresses nursing students students the most is the relationship with Resuts showed that nursing student is those in the healthcare system. The meta- under moderate stress level, this finding analysis study of 13 articles by Alzayyat was similar to the results of some studies (2014) also showed that most stressful for in other countries including the study of nursing students is the relationship with Vu Dung (2015) at Thang Long University medical staff and instructors [15]. and the study of Devkot Shrestha (2018) in Overall, the physio-psycho-social Nepal [1,3]. Kucukakca’s study in 2019 in response of the Nursing students was Turkey on 315 nursing students found that at a good level. In particular, nursing students had high stress levels [8]. This students had more emotional symptoms difference may be due to the fact that the than physical symptoms. These results are nursing training programs are not the same similar to the study of Jimenez (2009) on 357 between the two countries. In addition, Nursing students from School of Nursing in nursing students dealed with academic Spain [16]. Jimenez (2009) also showed stress more than clinical stress, this result similar results that the three most common is similar to Nuriye Yildirim’s stydy (2016) symptoms among nursing students in on 821 nursing students at 4 Universities in clinical practice are anxiety, stress, and lack Turkey and Jones’s study (2018) on 1707 of optimism about the future [16]. nursing students found that Brunei and Most nursing students have positive Malta students felt more academic stress coping behaviors and the most commonly [9,10]. used stress-coping behavior is to optimistic The further analysis found the factors behavior. This result is similar to research by that most stress nursing students are Ahtisham Younas (2016) on stress of nursing examination and/or scores, this result is students in Asian countries including India, also found by Shdaifat (2018) from 184 Pakistan, Iran, Philippines, Hong Kong and nursing students in Saudi Arabia. The Jordan [17]. Avoidance behavior with stress students feel stressed because of anxiety was the least chosen by nursing students is low scores; Bista’s 2017 study in Nepal also the result found in studies by Devkot on 283 nursing students found that tests, Shrestha (2018) at 3 Universities in Nepal exams, and assessments were factors and Shdaifat’s 2018 study at Saudi Arabia that lead to stress [6, 11]. In addition, the [1,11]. Further analysis shows that the factor of difficulty of materials / curriculum behaviors most used by nursing students to is also one of the issues that most stresses cope with stress are transference behavior nursing students. Ly Van Xuan’s study in by relaxing by watching TV, movies, bathing, 2013 on 441 nursing students of Military exercising, meditating, visiting relatives, Medical College 2 also showed stress talking to friends, family members or close Journal of Nursing Science - Vol. 04 - No. 01 29
8. RESEARCH ARTICLE ones. This result is similar to a study by Vu students showed that students with higher Dung (2015) at Thang Long University on living expenses have higher stress levels 153 regular nursing students in the 2nd and [6]. In contrast, Shdaifat’s 2018 study found 3rd years in the 2014 - 2015 school year a negative correlation between income shows that having close friends, there is and stress levels in nursing students [11]. a division According to friends, exercise This difference may be due to the income habits are factors that protect students from from the two research subjects originating high stress [3]. Jones (2018) also shows from different sources, Duy Tan University that participating in recreational activities or students have to work part-time or do many reducing stress can help nursing students other jobs to increase their income. manage their own stress [10]. Interested in nursing was associated 4.2. Several factors related to stress with stress levels. The more interested in level of nursing students nursing, the lower the stress level. In Hakime There is a relationship between the Aslan’s (2018) study also found similar academic year and stress level. Closer to results that students who are interested and the final years of study, the stress level of determined to pursue a career in nursing nursing students increases. This result is have lower stress levels [5]. In contrast, similar to the study of Phung Nhu Hanh the study of Kucukakca (2019) found that (2018) in Tien Giang, third year students there was no difference in the stress level have higher levels of academic stress, between students who were reluctant to clinical stress than first year and second choose nursing or did not enjoy nursing year students [18]. Research by Kucukakca care compared to the rest of the students (2019) at Haci Bektas Veli University, Turkey [8]. This difference may be due to different on 315 nursing students also showed that career orientations or training programs, the more students studying in the final year, students in Turkey in Kucukakca’s study the higher the stress level [8]. In contrast, have high stress levels while students at research by Ahtisham Younas (2016) found Duy Tan University are only average. . that first year students had higher stress levels than those in the above course due 5. CONCLUSION to feeling new and unfamiliar with the new The findings of this study showed nursing learning environment [17]. This difference students had moderate stress level (60.2 ± may be due to the different approaches 13.5). The physio-psycho-social response to first year Nursing students, students of nursing students was at a good level at Duy Tan University are introduced to (1.41 ± 0.60). Most nursing students had the university study method and career positive coping behaviors with stress. There guidance from the beginning. So that to deal was a relationship between the academic with the new environment will be easier. year, living expenses/month, interested The living expenses was associated with in nursing and stress levels of nursing the stress level, in which students with living students (F = 17.36, p <0.01; F = 2.84, p = expenses 2 - under 3 million/month had 0.04; F = 6.69, p <0.01). Monitoring stress higher stress levels than students with living status, physio-psycho-social responses, expenses < 2 million/month. This finding is and orienting positive coping behaviors for similar to research by Hakime Aslan (2018) students are essential to help prevent and at Inonu University, Turkey on 479 nursing reduce stress levels in nursing students. 30 Journal of Nursing Science - Vol. 04 - No. 01
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