RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,BANGALORE

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS

Mr. ROSHMON K.RIst YEAR M.Sc. NURSING STUDENT, N.D.R.K. COLLEGE OF NURSING B.M. ROAD HASSAN, KARNATAKA.

2 NAME OF THE INSTITUTION N.D.R.K. COLLEGE OF NURSING, B.M. ROAD HASSAN, KARNATAKA.

3 COURSE OF STUDY AND

SUBJECT

MASTER OF SCIENCE IN NURSING ( PSYCHIATRIC NURSING )

4 DATE OF ADMISSION TO THE

COURSE 25TH MAY 2008

5.1 TITLE OF THE TOPIC

“LEVEL OF STRESS AND COPING STRATEGIES

OF STUDENT NURSES DURING THEIR INITIAL

CLINICAL PRACTICE”

5.2 STATEMENT OF THE

PROBLEM

“A STUDY TO ASSESS THE LEVEL OF STRESS

AND COPING STRATEGIES OF STUDENT

NURSES DURING THEIR INITIAL CLINICAL

PRACTICE AT N.D.R.K COLLEGE OF NURSING,

HASSAN, KARNATAKA”

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

" I am a student nurse. I am dying. I write this to you who are, and will

become, nurses in the hope that by my sharing my feelings with you, you

may someday be better able to help those who share my experience."

- ANONYMOUS STUDENT NURSE

Today mental disorders stand among the leading cause of disease and

disability in the world. One in four (25%) people in the world will be affected by mental

or neurological disease at some point in their lives. Being 'stress' as a universal

phenomena reflecting in each aspect of lifecycle, was identified as a major cause of

attriction among all categories of people. Although stress affects the biophysical and

emotional wellbeing of the people, it varies with age, gender, mental capabilities and

environmental conditions.

In the transitional nature of student life in professional courses like nursing,

initial clinical practice is stressful and it adversely affects the emotional, physical, social

and academic functions. Even though the perception and response to stress and way of

coping differs individually, it may produce questionable behavioural patterns in student

nurses during initial clinical practice like feeling of loneliness, nervousness,

sleeplessness and worrying. Thus the student nurse faces a lot of challenges and

problems at the time of prime clinical exposure.

6.1 NEED FOR THE STUDY

Daily interactions with internal and external demand contribute to stress in

human beings who constantly are changing and adapting to their environmental stressful

events normally generate feeling of impotency and a loss of control that activate both

physiological and psychological responses. These responses are major components of

coping. An inability to cope with internal and external stressors increase feelings of

helplessness and vulnerability to illnesses.

Over the recent years, there has been growing concern about stress in nursing.

Stress can have an effect on the individual nurse, in terms of both physical and

physiological health. As petals of a responsible and honest profession, student nurses are

more prone to stress and competencies, especially in a situation like initial clinical

practice. Some important stressors are, lack of control in relation with patients, lack of

competence, contact with sufferings, feeling helpless, emotional involvement,

communication problems and lack of adequate knowledge and skill .

Harold Wolff, professor at Cornell University, studied human responses to chronic

stressors from 1930 - 1962. His research indicated that even when coping strategies are

appropriate, repeated use of a response sometimes causes pathologic changes and tissue

damage in a particular body system, organ or mucus membrane throughout the body.

A study was conducted in U.S.A to identify stressful events of first year nursing

students in the clinical setting and to determine how they cope with the stressful events.

The method used was a descriptive study and sample consisted of 104 nursing students.

The result of the study indicated that interpersonal relationship, initial experiences,

feeling helpless and most of the students utilized 'seeking social support' as category of

coping.1

During the Bachelor of Nursing programme, the Researcher himself experienced

a lot of stressful situations and fearful moments at the time of initial clinical practice.

Those eventful days were with questionable coping pattern and which adversely affects

the physical strength, emotional stability and academic activities. So far many students

and his collegues were experiencing the same situation, the researcher identified the

universality of the matter and he understood that stressors experienced by the student

nurse during initial clinical practice produces certain behavioural and emotional

responses.

Therefore based on the above life experience and ground full evidences , the

researcher took interest in exploring the stress experienced by first year BSc Nursing

students during the first clinical practice. Here the researcher tries to help student nurses

to better understand about the phenomenon of stress , coping and adaptation. The

researcher also tries to help nursing educators to understand the difficulties of nursing

students and, based on individual difference, assist them individually in order to promote

the quality of clinical practice

6.2 REVIEW OF LITERATURE

Good research generally builds upon existing knowledge. The more developed the

network linking a new study with other research is, the more of a contribution it is likely to

make. The accumulation of scientific knowledge is very much analogous to the fitting together

of a jig saw puzzle. Every piece of the puzzle, small though it may be, may help to link together

other parts of the puzzle.

Review of Literature is an important step in research process. It refers to an extensive,

exhaustive and systematic examination of publications relevant to the research project. Relevant

literature refers to those sources that are pertinent or highly important in providing in depth

knowledge needed to study a selected problem. The review of literature is defined as a critical

summary of research on a topic of interest often prepared to put a research problem in context or

as the basic for as implementation project.

A study was conducted in Ramban medical centre, Israel to identify nursing student`s

perceptions of stress in their initial clinical setting experience. The method adopted was

exploratory longitudinal study by using stress scale which include six subscales. The stress scale

was administered three times during the clinical experience to 46 students. The result revealed

that, there is significant difference in pre-clinical stress level and the actual level of stress in the

clinical setting.2

A study was conducted in Fooyin institute of technology to examine the relationship

between the perception of stress, coping methods and personality traits in 280 nursing students

who had undertaken their first clinical practice. Clinical practice stress scale (CPSS) and clinical

practice physio-psycho-social scale (CPPS) were used to examine the stressors. The results of

the study showed that the most common stressors were lack of professional knowledge and skill

and taking care of patients. The study concluded that perception of stress, coping behavior and

psychosocial status are significantly related to personality characteristics including social

adaptiveness and emotional stability.3

A study was conducted in China to explore the factors affecting psychological status and

stress, coping style and social support of the nursing student`s during their initial clinical

experience. The method adopted was co-relational study in which 288 nursing students were

included and assessed by 'adopting college seniors stress scale', 'coping style questionnaire' and

'support questionnaire'. The result of the study was that, positive correlations were found

between stressful events and negative coping style, the negative correlations related to positive

coping style and social stressful factors. The study concluded that, to improve the psychological

condition of nursing students, it is very necessary to enhance the social support and encourage

them to adopt positive coping style.4

A study was conducted in Tehran to determine sources of stress and coping strategies in

nursing students studying at Iran faculty of nursing. The method adopted was descriptive cross

sectional study in which 366 students were included in the study. 'The Student Stress Survey'

and 'The adolescent coping orientation for problem experiences inventory' were used for data

collection. The result interpreted that the frequent stressors were increased class workload and

clinical exposure. The study concluded that, first year nursing students are more exposed to a

variety of stressors and establishment of a 'student support system' is necessary for them for

their effective coping.5

A study was to understand the living experience of nursing student`s coping with the

demands of their clinical practice. The method adopted was Husserlian phenomenological

approach and the data revealed several strategies that, 14 student nurses utilized to cope with the

demands of their undergraduate clinical programme. The result of the study revealed that, the

students having a strong determination to complete their course and talking things over with

family, friends and other students as a means of coping, helped them to get relief from stress

and also considered other nursing could really understand the feeling and experience of being as

'student nurse'.6

A cross sectional survey was conducted in India with 145 nursing students using

General Health Questionnaire 12 the Eysenck Personality Questionnaire and the Bell`s

Adjustment Inventory to investigate psychological distress, personality problems and coping

strategies among nursing students studying in College of Nursing, Christian Medical College

Vellore. The result of the study indicated that only 30 participants (20.7%) of the 145 students

reported high scores on the General Health Questionnaire and was significantly associated with

having neurotic personality and adjustment difficulties in different areas of functioning.7

A study was conducted in U.S.A to identify Junior baccalaureate nursing student`s

perceived stressors and ways of coping during the initial component of nursing education and

the use of coping strategies by students with different ethnic background. The method adopted

was a comparative study and the data were collected from 107 nursing students enrolled in the

first clinical course. The results of the study reflects that, students utilized two problem-focused

coping strategies (problem solving and seeking social support) more frequently than two

emotion-focused coping strategies(tension reduction and avoidance coping).The study

concluded that, both Cancasian and African-American students use more problem-focused than

emotion-focused coping strategies.8

A study was conducted in Ireland to examine the stress experiences and coping abilities

of student nurses. A survey design was adopted, as method and done it in a large Dublin

teaching hospital. A questionnaire was used to assess the stressors pertaining the student nurses.

It included clinical stress, academic stress, coping and personal factors. The results indicated

that the level and intensity of academic workload, the theory practice gap and poor relationship

with clinical staff and patients leading to stressors. Student adopted short term emotion focused

coping strategies to deal with stress. The study recommended that the provision of adequate

support services from a clinical and academic section, a lecture-practitioner model of education

delivery which helps in developing student`s self awareness skills and reduction of stress.9

A study was conducted in Scotland to assess the level of affective distress, sources of

stress and coping strategies in first year student nurses. The method adopted was a comparative

study using General Health Questionnaire (30-item version), the Beck and Srivastava Stress

Inventory(BSSI) and a modified 'ways of Coping Questionnaire'. The result suggests that 50.5%

of students in Cohort 1(n=109,week 40) and 67.9% of students in Cohort 2 (n=111,week 24)

suffered significant affective distress, indicates problem with student distress around an initial

series of general/surgical and psycho-social ward placements.10

A study was conducted to determine the effectiveness of a stress management

programme and also to determine personal and professional stressors experienced, and coping

strategies adopted by graduate nursing students. The stress management programme consisted

of practice of relaxation response, imagery, and diaphragmatic breathing and the subjects were

30 female graduate nursing students. The method adopted was experimental study in which the

students were randomly assigned to an experimental and a control group .The data collection

consisted of blood pressure measurements, weekly Palmar Sweat Prints(PSP) and a weekly

Self- Report(WSR). The result suggested that the control group reported significantly less

strategies for coping with stress than the experimental group.11

6.3 OBJECTIVES OF THE STUDY

1. To assess the level of perceived stress in student nurses during their initial clinical practice.

2. To associate the relationship between the level of stress and selected demographic variables.

3. To identify the coping behavior`s utilized by the student nurses at the time of initial clinical practice.

4. To identify the relationship between level of stress, coping strategies and initial clinical practice.

5. To develop a counseling guidelines for student nurses to cope with initial clinical practice.

6.4 RESEARCH HYPOTHESIS

H0 :- There will be no significant association between the level of stress and coping strategies among student nurses during their initial clinical practice.

H1 :- There will be significant association between the level of stress and coping strategies among student nurses during their initial clinical practice.

H2 :- There will be significant association between socio-demographic variables and level of stress and coping strategies.

6.5 OPERATIONAL DEFINITION

1. Assess : It is an activity to measure the outcome by using the perceived stress scale (PSS) and coping behavior`s inventory (CBI) for student nurses during initial clinical exposure. 2. Stress : It represents an internal pressure experienced by student nurses during their initial clinical practice due to unpleasant emotional and fearful situations.

3. Coping strategies : Coping strategies refers to the specific efforts both behavioral and psychological, that student nurses employ to master, tolerate, reduce or minimize stressful clinical events.

4.Student nurses : The students studying first year Bachelor of Nursing programme in N.D.R.K College of nursing Hassan.

5. Initial clinical practice : It is the first exposure of the BSc nursing students to the clinical area in the course of study as a part of clinical requirements.

6.6 ASSUMPTIONS

1. The level of stress is more in student nurses during their first clinical practice. 2. The level of coping is less in first year student nurses.

6.7 DELIMITATIONS OF THE STUDY

1. The data collection period will be limited to 4-6 weeks. 2. Sample size is limited to 60 student nurses. 3. The study is limited only to student nurses studying in 1st year BSc nursing at N.D.R.K College of Nursing, Hassan.

6.8 SIGNIFICANCE OF THE STUDY

1. The study will help to identify the level of stress and coping strategies of student nurses during their initial clinical practice.

2. The study will pave the way for first year BSc nursing students to express their stress and emotional status during initial clinical practice.

3. The study will help student nurses to better understand about the phenomenon of stress , coping and adaptation , thereby promoting the quality of clinical practice.

7. MATERIALS AND METHODS OF STUDY

7.1 SOURCES OF DATA

The data will be collected from first year BSc students studying at N.D.R.K College of nursing, B.M Road, Hassan, Karnataka.

7.2 RESEARCH DESIGN AND CONCEPTUAL FRAMEWORK

Descriptive research design is planned for the study.

The study is based on Lazarus model of stress.

7.3 METHOD OF DATA COLLECTION

PART A : Socio demographic profile.

PART B : Data will be collected by using clinical stress scale for student nurses (Self administered questionnaire will be prepared and content validity will be taken by the experts of the subject.)

Stress Response scale (Standardized tool used by Thippe Swamy)

Coping Behavior Inventory (Standardized tool)

SAMPLING PROCEDURES

POPULATION :

Target population: First year BSc nursing students.

Accessible population: All the first year BSc nursing students studying in N.D.R.K College of nursing.

SAMPLE :

CRITERIA FOR SAMPLE SELECTION

Inclusion Criteria:

1. 60 students of first year BSc nursing, studying in N.D.R.K College of nursing, Hassan.

2. Both male and female students are included.3. Students of first year BSc nursing, studying in N.D.R.K College of nursing, who are

willing to participate.

Exclusion Criteria: 1. Those who are not willing to participate. 2. Those who are not available at the time of study.

SAMPLE SIZE :

60 first year BSc nursing students studying at N.D.R.K College of nursing, Hassan.

SAMPLING TECHNIQUE :

Non probability convenient sampling is used for the selection of subject.

STUDY SETTING

First year classroom of BSc nursing students in N.D.R.K College of nursing, Hassan, Karnataka.

PILOT STUDY

10 % of population is planned for the pilot study.

VARIABLES

Independent variable : Level of stress and coping strategies. Dependent variable : Student nurses in first year BSc nursing. Socio demographic variable.

PLAN FOR DATA ANALYSIS

Descriptive statistics:- Mean and Standard deviation.

Inferential statistics :- Student 't' test and Anova test.

7.4. ETHICAL CLEARANCE

1. Has the ethical clearance been obtained from the institution?

Yes.

2. Has the consent been taken from the sample? Yes.

8. LIST OF REFERENCES

1. Mahat G et al, "Stress and coping of first year Nepalese students in clinical

settings", Journal of Nursing Education.1996 April; 35(4) : 163 - 9.

2. Admi H, "Nursing student`s stress during the initial clinical experience", Journal of nursing education, 1997 September; 36(7) : 323 - 7.

3. Hwang S L, Sheu S, "Relationships among stress, physio-psycho-social status,

Coping behaviours and personality traits of Nursing students during first time clinical

Practice.", Journal in Chinese. 2001 January; 9(3) : 233 - 46.

4. Luo Y, Wang H, "Correlation research on psychological health impact on nursing

students against stress, coping way and social support", Nurses education today,

2008 August; 38(7) : 89 -19.

5. Sayed F N, Hagani H, "Experienced stressors and coping strategies amoung Iranian

nursing students", Journal for nurses, 2007 November; 13(1) : 11 - 6.

6. Champan R, Orb A, "Coping strategies in clinical practice", Journal of nursing

Students, 2001 September; 11(1) : 102 - 95.

7. Sathiyaseelam M, Vijayakumar C, "Psychological distress, personality and

adjustment amoung nursing students." Journal of Nursing Education Today."

2007 August; 27(6) : 597 - 601.

8. Mahat G, "Stress and coping of nursing students in clinical settings", Nurses forum, 1998 January; 33(1) : 11 - 9.

9. Envas W, Kelly B, "Pre-registration diploma student nurse stress and coping

Measures". Nurses education today, 2004 August; 24(6) : 473 - 82.

10. Jones M C, Johnston D W, "Distress, stress and coping in first-year student

Nurses." Journal of Advanced Nursing, 1997 September;26(3) : 475 - 82.

11. Macini J, Clegg R, "Graduate nursing students stress", Journal of nursing education,

1983 October, 22(8) : 329 - 34.

12. www.pubmed.com

OTHER REFERENCES

1. Novreen C F, Lawrence E F, "Textbook of Psychiatric Mental Health Nursing"

1st Edition, Delmar Publishers, U.S.A, Pp : 151 - 152.

2. Chiriboga D A, Jenkins G, Bailey J, "Stress and coping among student nurse",Test of analytic model, Nursing Research, 1999 January; 294 - 299.

3. Sheu S, Lin H S, "Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice", Journal of nursing students, 2002 February; 39(2) : 165 - 75.

4. Fortinash H W, "Psychiatric Mental Health Nursing." 4th Edition, Mosby

Publishers, Pp : 610 - 612

5. Basavanthappa B T, "Nursing Research," 1st Edition, Jaypee brothers Medical Publishers Pvt limited, New Delhi, 2005; Pp :49 - 50.

6. Polit and Hungler, "Nursing Research : principles and methods", 6th Edition,

Lippincott Publishers, 1999; Pp : 144.

7. www.google.com