CHAPTER - I

INTRODUCTION

Give wings for your stress and let it fly away

- Terri guillemet

1.Background of the study

Stress, first coined in the 1930’s, has in more recent decades become a

commonplace of popular parlance. Stress could be defined simply as the rate of wear

and tear on the body systems caused by life.1 It occurs when a person has difficulty in

dealing with life situations, problems and goals.2Stress has physical, emotional, and

cognitive effects. Although everybody has the capacity to adapt himself to stress, not

everyone responds to similar stressors exactly the same.3

The word stress is derived from the Latin word "stringi", which means, "to

bedrawn tight". Stress can be defined as any factor that threatens the health of the

body or has an adverse effect on its functioning, such as injury, disease, or worry.

According to Randy and David, "Stress is the subjective feeling produced by events

that are uncontrollable or threatening." Constant stress brings about changes in the

balance of hormones in the body which may lead to the situation or thought that

makes us feel frustrated, angry, nervous, or anxious.59

“Newman4defined Stress, as the relationship between the person and the

environment that is appraised by the person as taxing or exceeding the person’s

resources. Stressors are disruptive forces operating exposed to, through a stimulus or

stressor. Stress is also the appraisal or perception of a stressor.

Stress is a natural phenomenon that everyone experiences in his or her life

time46and is caused by stress causing factors or stressors47Constant stress brings

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about changes in the balance of hormones in the body which may lead to the

situation or thought that makes us feel frustrated, angry, nervous, or anxious.47

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Seward acknowledges that there are three types of stress: eustress,neutress

and distress. Eustress is the first type that is experienced by people as motivating or

inspiring, such as the stress that accompanies getting married. Neustress is considered

neither good nor bad. Distress is the most common and identifiable type that is

considered bad. People experience stress as either being acute, which is generally

abbreviated, or chronic which continues over a prolonged period of time.

Stress is a part of everyone’s life. Stress for short periods may not affect you

but stress over time may cause or make some illness worse, such as heart diseases,

stroke, high blood pressures, diabetes, irritable bowel syndrome, asthma, arthritis.

Other common disorders linked to psychological state are eating disorders, tension

headaches, migraines, muscle spasms, chest pains, excessive menstrual cramps, acne,

rapid or irregular heart rate, intestinal ulcers, frequent urination and rheumatoid

arthritis flare ups. Mental health problems – depression and anxiety may be the result

of chronic stress.48

Nature of stress

1. Stress is inevitable

2. Stress can be positive as well as negative

3. Stress can be harmful to health

4. We can prevent, control and cope up with stress

Negativeeffectsofstress

1. Promotingnegativethinking

2. Damagingself- confidence

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 3. Narrowing attention

4. Pre-occupation

5. Consumesmentalenergy

6. Generatesunpleasantemotion

7. Bring about Interpersonalproblem

8.Manyofourbadhabitsandillnessareduetothe effect ofstress

Positiveeffects

1.Stressisasourceofenergy

2.Preparesthebodytomeetchallenges63

Stress brings advantages and disadvantages to us, it depends on how student

nurses going to look upon them and take over them. Stresses can cause them to

become stressful, feel distress and emotional affected while on the other hand,stresses

give motivation and evoke them to be more upholding and persistent in the study in

order to reach the optimum target and achieve fur ther success. As the eustress is good

for them ,distress is a disadvantage for them. Stress affects the mind, body, and

behaviour in many ways, and everyone experiences stress differently. Long time of

stress in nursing student or prolonged stress can cause memory problems and unable

to concentrate in the studies, sometimes they will feel chest pain, rapid hear tbeat,

depression or general unhappiness and sleeping too much or too little whenever there

is something goes wrong and may even lead to burnout64

According to Frassrand,62excessive stress can be harmful to a student's

academic performance and students who perceive their stress levels as very high may

often become depressed. This depression can lead to mental health problems, such as

excessive corrupted interpersonal relationships.

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 Most of the student nurses are usually in the stage of late adolescents. Hence

the problems faced by the adolescent population will be present among student nurses

too. If asked a college student as to what makes college life stressful? One will

receive a long list of situations including taking exams, preparing for term papers, lab

reports, applying for loans, new friends, more demands on time and mind.50

Stress affects the mind, body, and behaviour in many ways, and every one

experiences stress differently. Long time stress among student nurses or prolonged

stress can cause memory problems and inability to concentrate in the studies.

Sometimes they feel chest pain, rapid heartbeat, depression or general unhappiness

and sleeping too much or too little or whenever something goes wrong. It may even

lead to burnout. Clinical practicehas been identified as one of the most anxiety

producing components in nursing programs. Lack of experience, fear of making

mistakes, difficult patients, discomfort at being evaluated by faculty members,

worrying about giving patients the wrong information or medication and concern

about possibly harming a patientare just a few of the stressors for student nurse.61

Lazarus5states that appraisal is how people interpret the impact of the stressor

on themselves, of what is happening and what they can do about it. Stress arises from

any interaction between an individual and the environment when the individual

perceives the situation as threatening, challenging or possibly damaging. Essentially,

the individual perceives that a situation may tax or exceed the individual's resources

A stressor can be social, physiological or environmental origin.7"How a

person copes can influence the degree, duration, and frequency of a stressful event."

It's important to learn how to recognize when your stress levels are out of control.

One cannot completely eliminate stress from one's life,but can control how much it

affects. One may feel like the stress in life is out of control, but can always control the

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way one responds8. There are many ways to cope with stress. Research on stress

indicates that people tend to use a number of different coping approaches rather than

just one.9,10

In 1914, Harvard physiologist Walter Cannon first coined the term fight or

flightresponse to describe the dynamics involved in the body’s physiological arousal

tosurvive a threat” This response is known as our stress response” The fight aspect

can involve a physical argument, verbal assaults, and increasingly more common, the

use of technologies such as email and text messaging. Whereas, the flight response

includes physically escaping the stress, as well as through escapism such as playing

video games and the use of drugs or alcohol. Freezing is often seen in cases involving

young children. For example, children, when exposed to an acute stressor, will freeze

as a means of coping with the stressor. It is important to understand our bodies stress

response in order to help recognize the effects of stress on humans. In a healthy stress

response, once the stressor is no longer a threat, the body begins to recover and regain

homeostasis. An unhealthy stress response occurs when the individual is unable to

recover from the stressor or when the stressor is ongoing and prolonged. As a result,

the body and mind is uncomfortable with the thoughts and sensations it’s

experiencing and quickly works to internalize and/or inhibit the stress reaction.

Individuals can develop maladaptive coping behaviours in order to avoid their

uncomfortable thoughts and feelings. However over time, this often leads to

deregulation in the body, which can manifest itself in problems like depression and

anxiety disorders.74

Lazarus and Folkman60 proposed that the cognitive appraisal of a stressor

involves both Primary and Secondary appraisals that occur at virtually the same

time and interact to determine the significance and meaning of events with regard

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to well-being. During primary appraisal, an individual considers the personal

significance of a situation with regard to their own values, personal beliefs,

situational intentions, and goal commitments. Primary appraisal considers the

implications of a stressor for well-being through interpreting situations in one of

these ways: (a) irrelevant, where there are no implications for well-being; (b)

benign/ positive where the demands of the task are perceived as not threatening and

it is possible to preserve or enhance well-being; (c) stressful where the demands of

the task are perceived to threaten well-being. Secondary appraisal refers to a

cognitive-evaluative process that focuses on minimizing harm or maximizing

gains through coping responses. It involves purposeful evaluations of cognitive,

affective, and behavioural efforts to manage a stressor Coping options and

available resources may include social, physical, psychological and material

assets. Perceived control over events is also considered as part of secondary

appraisal as the individual decides what can or cannot be done to manage specific

external and/or internal demands that are appraised as surpassing a person's

resources. Coping is required only for following events that are perceived as

stressful.And as such benign or positive appraisals do not require copingand

responses It is widely recognized that coping has two primary functions. One function

is to regulate stressful emotions (emotion-focused coping) using strategies such as

venting oracceptance, the other function is to alter the circumstances causing

thedistress (problem-focused coping) using strategies such as increased effort or

planning.

According to Lazarus and Folkman5, a stressor is perceived as stressful when

the situation is appraised by the person as exceeding his or her resources and

endangering his or her well being. Doing something and refraining from doing

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something about the stressful situations are ways of coping. Coping is the constantly

changing cognitive and behavioural efforts for managing specific external or internal

demands that are appraised as exceeding the resources of the person. It is the process

by which a person manages the appraisal. The function of coping includes managing

or alleviating the problem causing the distress and regulation the emotional response

to the problem. Once the person has successfully coped with a situation, reappraisal

occurs. Reappraisal allows for feedback about the outcome and allows for adjusting to

the new situation. Successful coping results in adaptation Coping has been viewed

as a stabilizing factor that may assist individuals in maintaining psychosocial

adaptation during stressful events. The process of coping is a very complex response

that occurs when an individual attempts to remove stress or a perceived threat from

the environment. Thus, the actual reaction to an environmental event may be as

important as the event itself.When stress occurs, a person uses physiological

andpsychological energy to respond and adapt to a particular situation. This type of

coping strategy usually depends on the intensity, duration and number of stressors.

Active coping strategies which are viewed as positive coping, generally includes

strategies such as problem solving, seeking emotional support from others and

engagement in leisure pursuits.However the avoidance and maladaptive coping

primarily refers to strategies when individuals try to avoid dealing with problems by

cognitively and physically distancing themselves from the situation.58

Coping responses can be described as positive or negative and as reactive (i.e.

reacting to an individual's own thoughts and feelings) or active (dealing with actual

stressful situations or events). Active or reactive coping responses can be positive or

negative, depending on the situation and the content of the response 6. The coping

process is an important aspect of the person-environment interface. The kinds of

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coping strategies used in a given situation are a function of individual differences in

personality or experience as well as characteristics of the situation. Problem-focused

coping strategies are designed to help people live longer, feel better and avoid having

self-defeating thoughts. They assist people to understand themselves. This type of

interventions target the individual thoughts as a cognitive process. It is based on the

theory that changes in our emotions and behaviours are determined by our thoughts

about events that occur. People are often disturbed by their view on perception of

events rather than the events themselves. By being able to change the way that one

think about things, then one can be able to change the way that they also feel about

them.11,12 Cognitive-behavioral coping strategies are the most effective methods to

reduce the stress.13

Based on the research done by Folk man and Lazarus, the researchers Carver,

Sheier and Weintraub101 have devised a detailed coping inventory and added a few

additional dimensions of coping. This tool was used by Kirkland in a study on African

American student nurses’ perception of stressors in clinical and their use of coping

strategies. Problem-focused coping involves actions such as: taking action to remove

stressor; planning how to confront stressor; suppressing competing activities (putting

other projects aside in order to deal with the stressor); restraint coping (waiting until

an appropriate opportunity to act presents itself); seeking social support for

instrumental reasons (seeking advice, assistance or information) Emotion-focused

coping involves: seeking social support for emotional reasons (getting moral support,

understanding, or sympathy); positive reinterpretation and growth; acceptance;

turning to religion; focusing on and venting of emotions; denial; behavioural

disengagement (reducing effort to deal with stressor, or giving up on goal); mental

disengagement (i.e. daydreaming, escaping through sleep, immersion in computer,

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TV); alcohol and drug disengagement. Coping methods, whether emotion-focused or

problem-focused can be judged by an individual as effective or ineffective.

In general, everyone experiences the stress, but students are a group of people

who are at the higher risk of stressors due to the transitional nature of the student life;

because they need to adjust themselves with the life environment which requires

compliance with new social norms and new friendship. Accordingly, their perception

from an event is affected as a stressor and selecting coping strategies which they use them

in the particular situations. These groups should cope with the increasing global demands

i.e. decision making about issues such as occupation, life style, friends, family, religion

and politics. They should also meet the needs of family, teachers, friends and other

groups; therefore, they establish important emotional ties with the environment or non-

family members and also establish their own value systems which, in most of the cases,
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influenced by the family and the culture they have been belonged to. Significant

changes in living conditions, the novel demands of the college academic environment,

and the large change in social surroundings are just a few of the potential sources of

stress for a college student.33

College students experience high stress at predictable times each semester due

to academic commitments, financial pressures, and lack of time-management skills.

Moreover, regardless of year in school, college students often deal with pressures

related to finding a job or a potential life partner. These stressors do not cause anxiety

or tension by themselves. Instead, stress results from the interaction between stressors

and the individual's perception and reaction to those stressors. Other potential sources

of stress for college studentsinclude excessive homework, unclear assignments, and

uncomfortable classrooms. In addition to academic requirements, relations with

faculty members and time pressures may also be sources of stress.40

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 A study on Psychiatric morbidity in College and illiterate youths in India

revealed that about 10% to 30 % of University student have emotional problems and

nearly 30 % of them leave college or University without completing their studies. The

types of emotional disorders in the college and the University students include severe

mental disorders including psychosis (1 – 2 %), personality disorders (4 – 5 %),

sexual problems (8 – 10%) and depression (3 – 4%).52

Thus, academic stressors cover the whole area of learning and achieving, as

well as adjusting to a new environment, in which a great deal of content must be

assimilated in a seemingly inadequate period of time.53Moreover, excessive stress

may lead a student to drop out of college.54 If stress is not dealt with effectively,

feelings of loneliness and nervousness, as well as sleeplessness and excessive

worrying, may result. It is important that stress intervention programs should be

designed to address stress in college students. To design effective intervention

programs, it is necessary to identify the stressors specific to college students. Student

perception of high stress levels can lead to poor academic performance, depression,

attrition and serious health problems. Methods to reduce student stress ofteninclude

effective time management, social support, positive reappraisal, and engagement in

leisure pursuits.55

Juminez PM, Navia – osoreio, Diaz CV found that student nurses experience

clinical training stressors more intensively than academic or external stressors and

display more psychological symptoms than physiological symptoms.113

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Lazarus distinguishes 15 basic emotions. Nine of these are negative (anger,

fright,anxiety, guilt, shame, sadness, envy, jealousy, and disgust), whereas four are

positive(happiness, pride, relief, and love). (Two more emotions, hope and

compassion, have a mixed valence.) At a molecular level of analysis, the anxiety

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reaction, for example, is based on the following pattern of primary and secondary

appraisals: there must be some goal relevance to the encounter. Furthermore, goal

incongruence is high, i.e., personal goals are thwarted. Finally, ego- involvement

concentrates on the protection of personal meaning or ego- identity against existential

threats. At a more molar level, specific appraisal patterns related to stress or distinct

emotional reactions are described as core relational themes. The theme of anxiety, for

example, is the confrontation with uncertainty and existential threat. The core

relational theme of relief, however, is `a distressing goal-incongruent condition that

has changed for the better or gone away' Coping is intimately related to the concept of

cognitive appraisal and, hence, to the stress relevant person-environment transactions.

Most approaches in coping research followFolkman and Lazarus who define coping

as `the cognitive and behavioural efforts made to master, tolerate, or reduce external

and internal demands and conflicts among them.' This definition contains the

following implications. (a) Coping actions are not classified according to their effects

(e.g., as reality-distorting), but according to certain characteristics of the coping

process. (b) This process encompasses behavioural as well as cognitive reactions in

the individual. (c) In most cases, coping consists of different single acts andis

organized sequentially, forming a coping episode. In this sense, coping is often

characterized by the simultaneous occurrence of different action sequences and,

hence, an inter-connection of coping episodes. (d) Coping actions can be

distinguished by their focus on different elements of a stressful encounter Lazarus

and Folkman. They can attempt to change the person–environment realities behind

negative emotions or stress (problem-focused coping). They can also relate to internal

elements and try to reduce a negative emotional state, or change the appraisal of the

demanding situation ( emotion-focused coping).

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 Coping strategies are defined as the person’s constantly changing cognitive

and behavioral efforts to manage specific external or internal demands that are

appraised as taxing or exceeding the persons resources.69Previous research showed

that students with an active coping style have lower levels of psychological distress.70

In view of the potential long term benefits of managing stress in a more

effective way, it may be important for students to develop such skills early in their

medical career. Stress not only happens at workplace but students are subjected to

different kinds of stressors, such as the presence of the academics with an obligation

to succeed, an uncertain future and difficulties of integrating into the system. The

students faced social, emotional, physical and family problems which might affect

their learning ability and academic performance. As a result, it is important that

individuals develop different strategies in order to manage stressful situations.71,72In

terms of stress management, Lazarus and Folk man defined eight separate coping

strategies that they believed individuals employed in stressful situations.These are

confrontation, seeking social support, planned problem-solving, self-control,

accepting responsibility, distancing, positive reappraisal, and escape/avoidance.73

Therefore, studying student stress and the methods which students use to deal

with it can have important implications for higher education

administrators.56According to the World Health Organisation (WHO) report,

worldwide – 66 million suffer from depression, 24 million affected from alcohol

related problems, 1 million people commit suicide each year (rates for attempted

suicide are 10 – 20 times higher), 1 in 4 people is affected by mental or neurological

disorders at some point of his or her life. This means such disorders are the fourth

leading cause of ill health and disability worldwide. Mental disorders are expected to

rank 2nd by 2020, behind ischemic heart disease.57

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 Stress-inducing academic demands include grade competition; lack of time

and issues relating to time or task management the need to adapt to new learning

environments in terms of the increased complexity of the material to be learned and

the greater time and effort required to do so; and the need to constantly self-regulate

and to develop better thinking skills, including learning to use specific learning

techniques. Another category that evokes stress is social adjustment, particularly

adjusting to university life and separating from family and friends. Finally, there are
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financial pressures and other technical difficulties Archer and Lamnin found that

tests, grades, competition, time demands, professors and the class environment, and

concern about future careers were major sources of academic stress 42. Stress and the

identification of potential stressors among student nurses have received much

attention in the literature.43

Student nurses have the same academic stressors as other college students,

such as midterm and final examinations, research papers and other assignments In

addition, student nurses experience a clinical component, which is highly stressful.

Students have a large amount of preparatory work before their clinical assignments.

They often must travel long distances to clinical sites and use highly technical

equipment.44

However the dynamic relationship between the person and environment in

stress perception and reaction is especially magnified in college students. The

problems and situations encountered by college students may differ from those faced

by their non-student peer.65

The environment in which college students live is quite different, while jobs

outside of the university setting involve their own sources of stress, such as evaluation

by superiors and striving for goals. The continuous evaluation that college students

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are subjected to, such as weekly tests and papers, more which is not often seen by

non-students. The pressure to earn good grades and to earn a degree is very high. In

addition to academic requirements, relations with faculty members and time pressures

may also be sources of stress.66

In addition, relationships with family, friends, eating, sleeping habits, and

loneliness may affect students adversely.67

Top five major sources of stress were detected among nursing college students:

change in sleeping habits, vacations, breaks, and change in eating habits, increased work

load, and new responsibilities. Furthermore, stress may result from being separated from

home for the first time, the transition from a personal to an impersonal academic

environment, and the structure of the academic experience at the college level.68

Sax14 found that 9.7% of college freshmen report frequent depression.

Additionally, only 48% of female students and 59.3% of male students were confident

of their mental health. Douglas, Collins and Warren15 reported that on the National

College Risk Survey as many as 10.3% of the students that participated had serious

thoughts of suicide.Among college and university students, some stress is motivating

whereas too high a level interferes with teaching Excessive stress can be harmful to a

student's academic performance and students who perceive their stress levels as very

high may often become depressed. This depression can lead to other mental health

problems, such as excessive drinking or indiscriminate use of other substances.

One aim of Cognitive Behaviour Treatment is used to help individuals

restructure their thoughts, which in turn should improve the way, the person feels

about particular stressful situation.109Another aim of preventive and remedial

psychological interventions is to increase the participants’ personal awareness. When

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a presenting issue is stress-related, it is important that students gain increased

awareness of their personal response to the stressful situation.110

Timmins and Kaliszer16 did factor analysis of various stressors that cause stress

amongst student nurses. They had reported that the five factors which emerged, as

sources of stress amongst student nurses were academic, relationship with teacher and

staff in the ward, financial constraints, and the death of a patient. In another study,17

the four main stressors in descending order were nursing studies, finances, family, and

health.

The goal of any Nursing education programme is to graduate competent

registered professional Nurses. During the process of acquiring and demonstrating

skill competencies and passing written examinations, the Students undergo a

considerable amount of stress. Apart from academic stressors, there are financial

hardships and other personal stressors that the Student Nurses encounter. A great deal

of stress is encountered by the Student Nurses in the course of adjusting to a rigorous

course of clinical practice as they lack sufficient knowledge and skill to perform in

duties.18

According to Melinda Smith MA and RobertSega,75Managing stress is all

about taking charge: of your thoughts, emotions, schedule, and the way you deal with

problems. Stress management starts with identifying the sources of stress in your life.

This isn’t as easy as it sounds. Your true sources of stress aren’t always obvious, and

it’s all too easy to overlook your own stress-inducing thoughts, feelings, and

behaviours. Sure, you may know that you’re constantly worried about work deadlines.

But maybe it’s your procrastination, rather than the actual job demands, that leads to

deadline stress.

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 To identify your true sources of stress, look closely at your habits, attitude, and

excuses:

 Do you explain away stress as temporary (“I just have a million things going

on right now”) even though you can’t remember the last time you took a

breather?

 Do you define stress as an integral part of your work or home life (“Things

are always crazy around here”) or as a part of your personality (“I have a lot

of nervous energy, that’s all”).

 Do you blame your stress on other people or outside events, or view it as

entirely normal and unexceptional?

Until you accept responsibility for the role you play in creating or maintaining

it, your stress level will remain outside your control.

Look at how you currently cope with stress

Think about the ways you currently manage and cope with stress in your life.

Your stress journal can help you identify them. Are your coping strategies healthy or

unhealthy, helpful or unproductive? Unfortunately, many people cope with stress in

ways that compound the problem.

Unhealthy ways of coping with stress

These coping strategies may temporarily reduce stress, but they cause more

damage in the long run:

• Smoking

• Drinking too much

• Overeating or under eating

• Zoning out for hours in front of the TV or computer

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 • Withdrawing from friends, family, and activities

• Using pills or drugs to relax

• Sleeping too much

• Procrastinating

• Filling up every minute of the day to avoid facing problems

• Taking out your stress on

• others (lashing out, angry outbursts, physical violence)

Learning healthier ways to manage stress

If your methods of coping with stress aren’t contributing to your greater

emotional and physical health, it’s time to find healthier ones. There are many healthy

ways to manage and cope with stress, but they all require change. You can either

change the situation or change your reaction. When deciding which option to choose,

it’s helpful to think of the four ‘A’s’: avoid, alter, adapt, or accept.

Since everyone has a unique response to stress, there is no “one size fits all”

solution to managing it. No single method works for everyone or in every situation, so

experiment with different techniques and strategies. Focus on what makes you feel

calm and in control.

Dealing with Stressful Situations: The Four ‘A’s’

Change the situation:

Avoid the stressor.

Alter the stressor.

Change your reaction:

Adapt to the stressor.

Accept the stressor.

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Stress management strategy 1: Avoid unnecessary stress

Not all stress can be avoided, and it’s not healthy to avoid a situation that

needs to be addressed. You may be surprised, however, by the number of stressors in

your life that you can eliminate.

Learn how to say “no” – Know your limits and stick to them. Whether in your

personal or professional life, refuse to accept added responsibilities when you’re close

to reaching them. Taking on more than you can handle is a sure-fire recipe for stress.

Avoid people who stress you out – If someone consistently causes stress in your life

and you can’t turn the relationship around, limit the amount of time you spend with

that person or end the relationship entirely.

Take control of your environment – If the evening news makes you anxious, turn

the TV off. If traffic has got you tense, take a longer but less-travelled route. If going

to the market is an unpleasant chore, do your grocery shopping online.

Avoid hot-button topics – If you get upset over religion or politics, cross them off

your conversation list. If you repeatedly argue about the same subject with the same

people, stop bringing it up or excuse yourself when it’s the topic of discussion.

Pare down your to-do list – Analyze your schedule, responsibilities, and daily tasks.

If you’ve got too much on your plate, distinguish between the “shoulds” and the

“musts.” Drop tasks that aren’t truly necessary to the bottom of the list or eliminate

them entirely.

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Stress management strategy 2: Alter the situation

If you can’t avoid a stressful situation, try to alter it. Figure out what you can

do to change things so the problem doesn’t present itself in the future. Often, this

involves changing the way you communicate and operate in your daily life.

Express your feelings instead of bottling them up. If something or someone is

bothering you, communicate your concerns in an open and respectful way. If you

don’t voice your feelings, resentment will build and the situation will likely remain

the same.

Be willing to compromise. When you ask someone to change their behavior,

be willing to do the same. If you both are willing to bend at least a little, you’ll have a

good chance of finding a happy middle ground.

Be more assertive. Don’t take a backseat in your own life. Deal with problems

head on, doing your best to anticipate and prevent them. If you’ve got an exam to

study for and your chatty roommate just got home, say up front that you only have

five minutes to talk.

Manage your time better. Poor time management can cause a lot of stress.

When you’re stretched too thin and running behind, it’s hard to stay calm and

focused. But if you plan ahead and make sure you don’t overextend yourself, you can

alter the amount of stress you’re under.

Stress management strategy 3: Adapt to the stressor

If you can’t change the stressor, change yourself. You can adapt to stressful

situations and regain your sense of control by changing your expectations andattitude.

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 Reframe problems. Try to view stressful situations from a more positive

perspective. Rather than fuming about a traffic jam, look at it as an opportunity to

pause and regroup, listen to your favorite radio station, or enjoy some alone time.

Look at the big picture. Take perspective of the stressful situation. Ask

yourself how important it will be in the long run. Will it matter in a month? A year? Is

it really worth getting upset over? If the answer is no, focus your time and energy

elsewhere.

Adjust your standards. Perfectionism is a major source of avoidable stress.

Stop setting yourself up for failure by demanding perfection. Set reasonable standards

for yourself and others, and learn to be okay with “good enough.”

Focus on the positive. When stress is getting you down, take a moment to

reflect on all the things you appreciate in your life, including your own positive

qualities and gifts. This simple strategy can help you keep things in perspective.

Stress management strategy 4: Accept the things you can’t change

Some sources of stress are unavoidable. You can’t prevent or change stressors

such as the death of a loved one, a serious illness, or a national recession. In such

cases, the best way to cope with stress is to accept things as they are. Acceptance may

be difficult, but in the long run, it’s easier than railing against a situation you can’t

change.

Don’t try to control the uncontrollable. Many things in life are beyond our

control— particularly the behaviour of other people. Rather than stressing out over

them, focus on the things you can control such as the way you choose to react to

problems.

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 Look for the upside. As the saying goes, “What doesn’t kill us makes us

stronger.” When facing major challenges, try to look at them as opportunities for

personal growth. If your own poor choices contributed to a stressful situation, reflect

on them and learn from your mistakes.

Share your feelings. Talk to a trusted friend or make an appointment with a

therapist. Expressing what you’re going through can be very cathartic, even if there’s

nothing you can do to alter the stressful situation.

Learn to forgive. Accept the fact that we live in an imperfect world and that

people make mistakes. Let go of anger and resentments. Free yourself from negative

energy by forgiving and moving on.

Stress management strategy 5: Make time for fun and relaxation

Beyond a take-charge approach and a positive attitude, you can reduce stress

in your life by nurturing yourself. If you regularly make time for fun and relaxation,

you’ll be in a better place to handle life’s stressors when they inevitably come.

Healthy ways to relax and recharge

Go for a walk.

Spend time in nature.

Call a good friend.

Sweat out tension with a good workout.

Write in your journal.

Take a long bath.

Light scented candles.

Savour a warm cup of coffee or tea.

Play with a pet.

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 Work in your garden.

Get a massage.

Curl up with a good book.

Listen to music.

Watch a comedy.

Don’t get so caught up in the hustle and bustle of life that you forget to take

care of your own needs. Nurturing yourself is a necessity, not a luxury.

Set aside relaxation time. Include rest and relaxation in your daily schedule.

Don’t allow other obligations to encroach. This is your time to take a break from all

responsibilities and recharge your batteries.

Connect with others. Spend time with positive people who enhance your life.

A strong support system will buffer you from the negative effects of stress.

Do something you enjoy every day. Make time for leisure activities that bring

you joy, whether it be stargazing, playing the piano, or working on your bike.

Keep your sense of humor. This includes the ability to laugh at yourself. The

act of laughing helps your body fight stress in a number of ways.

Stress management strategy 6: Adopt a healthy lifestyle

You can increase your resistance to stress by strengthening your physical

health.

Exercise regularly. Physical activity plays a key role in reducing and

preventing the effects of stress. Make time for at least 30 minutes of exercise, three

times per week. Nothing beats aerobic exercise for releasing pent-up stress and

tension.

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 Eat a healthy diet. Well-nourished bodies are better prepared to cope with

stress, so be mindful of what you eat. Start your day right with breakfast, and keep

your energy up and your mind clear with balanced, nutritious meals throughout the

day.

Reduce caffeine and sugar. The temporary "highs" caffeine and sugar provide

often end in with a crash in mood and energy. By reducing the amount of coffee, soft

drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll

sleep better.Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or

drugs may provide an easy escape from stress, but the relief is only temporary. Don’t

avoid or mask the issue at hand; deal with problems head on and with a clear mind.

Get enough sleep. Adequate sleep fuels your mind, as well as your body.

Feeling tired will increase your stress because it may cause you to think

irrationally74practise stress management techniques can help prevent professional

burnout. Research has also shown that participants who practise stress management

reap many personal benefits. Shapiro76 performed a meta-analysis study of stress

management programs in medical schools and reported medical trainees participating

in stress-management programs demonstrated: (1) improved immunologic

functioning; (2) decreases in depression and anxiety; (3) increased spirituality and

empathy; (4) enhanced knowledge of alternative therapies for future referrals;

(5)improved knowledge of the effects of stress; (6) greater use of positive coping

skills; and (7) the ability to resolve role conflicts.

When dealing with stressful situation, most people use problem-focused and

emotion-focused coping. The Student Nurses should be assisted by fostering

awareness of coping strategies and by helping to minimize perceived stressors.

Mainly, they should be encouraged to have an optimistic attitude, to be more

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understanding and less critical during clinical practice, venting of emotions with

peers, friends or family members, time management skills in order to navigate the

large amount of material in a short time, relaxation and problem solving skills.

1.2.Significance and need forthe study

A study was conducted by Sayed FN, Hagani19 in Tehran to determine sources

of stress and coping strategies in student nurses 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 student nurses are more

exposed to a variety of stressors and establishment of a 'student support system' is

necessary for them for their effective coping.

Researches indicated that stress management was associated with reduction of

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the depression and anxiety symptoms. Kang also in his study titled as “the

effectiveness of a stress coping program based on mindfulness meditation on the

stress, anxiety, and depression experienced by student nurses in Korea” showed that

the above approach could be effective in reduction of the stress and anxiety of the

student nurses.

The effectiveness of stress management training on the academic achievement

of Tiran and Karvan's students was investigated; the results showed that stress

management training could result in progression in academic achievement.21

Though we heard a lot about stress and coping behaviours among Student

Nurses from the West, it is not as such studied in our Indian Culture. So the

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researcher felt the need of assessing the stressors, level of stress and coping

behaviours employed by the Students in response to stressful situations.

Secondly the freshers were not aware of coping strategies in the first year

itself. If they become aware of adaptive coping strategies, they can be able to lead a

life smoothly in the after coming years. Due to their ignorance, some maladaptive

strategies can be used by them. In order to make the Student to appraise the event or

occurrences cognitively positive and to facilitate the Student’s success, the researcher

has planned to teach about adoptive coping strategies like Time management, Positive

reappraisal, Relaxation, problem solving and ventilation of emotions.

1.3.Statement of the problem

A study to assess the level of stress and coping behaviours and to evaluate the

effectiveness of selected coping strategies among Student Nurses in selected

institutions of Tamil Nadu.

Aim and objectives

1.4.Aim

 The aim of the study is to assess the level of stress and coping behaviours and

to help the Students to be aware of adaptive coping and to practise those

behaviours in their day today lifeamong first year Student Nurses.

1.5.Objectives

 To assess the pre-test level of stress and coping behaviours among Student

Nurses in interventional and control group.

 To assess the post-test level of stress and coping behaviours among Student

Nurses in interventional and control group.

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  To evaluate the effectiveness of coping strategies on the level of stress and

coping behaviours among Student Nurses

 To find out the correlation between the stress and coping behaviours in

interventional and control group.

 To find out the association between the stress with selected demographic

variables of experimental and control group.

 To find out the association between the coping behaviours with selected

demographic variables of experimental and control group.

1.6.Hypothesis

H1: There is a significant difference between pre-test and post-test level of stress

and coping behaviours among Student Nurses in the interventional group.

H2: There is a significant reduction in the level of stress and increase in the level

of coping behaviours among student nurses in the interventional group

compared to the students in control group.

H3: There is a significant correlation between the level of stress and coping

behaviours among Student Nurses

H4: There is a significant association between the level of stress among Student

Nurses with selected demographic variables

H5: There is a significant association between the level of coping among Student

Nurses with selected demographic variables

1.7.Operational definitions

Stress

In this study, stress refers to the relationship between the Student Nurses and

their environment that is appraised by them as taxing or exceeding his or her

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resources and endangering his or her wellbeing in areas like academics, time balance,

interpersonal, intrapersonal, family and environmental factors as measured by a 5

point Likert scale.

Coping behaviours

In this study, coping behaviours are the adaptive response elicited from the

students’ behaviour that maintains a healthy response in the areas of academics, time

balance, intrapersonal, interpersonal, family and environmental factors, as measured

by a 5 point Likert scale.

Effectiveness

It refers to the outcome of selected coping strategies in terms of improvement

in coping behaviours which is due to the result of adaptive coping of the student

nurses , as elicited through stress scale and coping inventory of 5 point likert scale.

Selected coping strategies

In this study, these are the interventions which are designed to increase self

management to allow persons to change the things that can be changed and accept the

things that cannot be changed which includes time management, positive reappraisal,

relaxation, problem-solving and decision- making and ventilation.

Student nurses

In this study, it refers to studentswho are studying I year in the institutions

which are offering B.Sc Nursing programmes affiliated to TN DR MGR medical

university in selected places of Tamil Nadu.

Selected places of tamilnadu

In this study is refers to the students studying B.Sc., Nursing Programme from

selected places of Madurai, Viruthunagar&Pudukottai Districts.

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1.8. Assumptions

Stressors in day today life not only affect Student Nurse’s physical health but

also their emotional ,social relationships and academics.

Coping strategies like time management, positive thinking, problem-solving

and decision making, relaxation and ventilation in their day-today activities can

promote the mental health and improve academic achievement and provide clinical

services in the hospital by the students.

1.9. Delimitations

The following delimitation was applied:

 Since only B.Sc. student nurses are included in this study, the results may not

be generalized to Diploma and Post-basic students

 B.Sc. Only I year B.Sc. nursing degree students studying at selected

institutions, Madurai, Tamil Nadu have been selected.

 The participants constitute a purposive sampling that may limit transferability

of results to other populations.

 Only five coping strategies were taught

 The responses of the participants were elicited through 5 point likert scale

1.10.projected outcome

 The findings of the study reveal the effectiveness of selected coping strategies

in reducing the level of stress among first year B.ScStudent nurses.

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 The findings of the study will help the authorities of Nursing education to plan

stress management programmes for first year student Nurses to cope up in

their lives.

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