“Evidence-Based Strategies to Improve Mental Health Outcomes Among Third

Year Nursing Students.”

By

MARAVILLA, RUFFA MAY J.

ONCEPIDO, LYNDY KAYE

TORRE, CHERIE VIC A.

WABE, KARLEE ALLISON

An Undergraduate Thesis Proposal Presented to the Faculty

College of Nursing and Health Sciences

Palawan State University

Puerto Princesa City

In Partial Fulfillment of the Requirements

For the Degree in

Bachelor of Science in Nursing

December 2024
 TABLE OF CONTENTS

Content

Tittle Page
Table of Contents

CHAPTER

I. Introduction

Background of the study

State of the Problem
Objective of the study
Significance of the study
Scope and Delimitations
Definitions of Terms

II. Review of Related Literature and Studies

Related Literature
Related Studies
Conceptual Framework
Research Paradigm

III. Methodology

Research Method
Research Locale
Research Procedure
Data Collection
Data Analysis
Interpretation of Data
 CHAPTER I

INTRODUCTION

Background of the Study

Mental health is a state of well-being where individuals realize their

potential, cope with the normal stresses of life, work productively, and contribute to their

community. It encompasses emotional, psychological, and social well-being. Mental health

disorders such as anxiety, depression and stress can significantly impact an individual’s

quality of life, relationship, and overall functioning.

According to the World Health Organization (WHO) has highlighted the high rates

of anxiety, depression and stress among university students, and nursing students are

particularly vulnerable due to the nature of their training. Studies have shown that more

than 50% of nursing students report experiencing moderate to severe levels of stress during

their academic journey.

In the Philippines, mental health has long been stigmatized, leading to

underdiagnosis and undertreatment of mental health disorders. Cultural factors, such as the

emphasis on resilience and stoicism, can hinder individuals from seeking help.

It is evident that in the nursing program at Palawan State University, students across

all disciplines experience a diverse range of intrapersonal and interpersonal difficulties.

Nursing students are particularly vulnerable to mental health challenges due to the

demanding nature of the program. Heavy academic workload, long clinical hours, and

exposure to stressful situations can contribute to increased levels of stress, anxiety and
depression. Given that nursing students are the future workforce of the healthcare system,

ensuring their mental well-being is critical not only for their personal health but also for

the quality of patient care they provide. Some students are exposed to circumstances and

expectations that may place them at risk for mental health or substance use disorders or

exacerbate pre-existing problems.

Ultimately, the study endeavors to enhance our understanding in addressing the

mental health challenges facing by the nursing students and contribute to their academic

success and overall quality of life while also enhancing their preparedness to meet the

demands of the nursing profession.

Statement of the problem

1. What is the prevalence of mental health such as, stress, depression and anxiety

of BSN 3 nursing students?

2. How severity of perceived stress of BSN 3 nursing students?

3. What are the factors influencing stress of the BSN 3 nursing students about

Academic workload, clinical demands, family related factors, social factor,

and personal coping strategies?

4. What are the coping strategies of BSN 3 nursing students?

5. What are the practical interventions to mitigate stress and improve coping

mechanisms?
Objective of the Study

This study aims to analyze BSN 3 Students Under Pressure: Factors Influencing Stress

and Coping Assessed with DASS-21, PSS, and CSI.

The following were the specific objectives of the study:

1. To assess the commonality of mental health challenges such as, stress, depression

and anxiety of BSN 3 nursing students using:

a. Depression, Anxiety, Stress Scale (DASS-21).

2. To identify the severity of perceived stress of BSN 3 nursing students using:

a. Perceived Stress Scale (PSS).

3. To determine the factors influencing stress of the BSN 3 nursing students about

Academic workload, clinical demands, family related factors, social factor, and

personal coping strategies using open-ended questions.

a. Via Google Form Questionnaire

4. To assess the coping strategies of BSN 3 nursing students using:

a. Coping Strategies Inventory (CSI).

5. To recommend practical interventions to mitigate stress and improve coping

mechanisms.

a. BSN 3 Nursing Students

Significance of the Study

The study conducted will present the importance of identifying and analyzing the

mental health challenges among the third-year nursing students. This research is deemed

significant to the following:

Commission on Higher Education (CHED). Development of policies and

regulations that support mental health initiatives in nursing education, CHED can

guarantee that all institutions provide standardized support systems.

Nursing Industry. Improved mental health outcomes enhance resilience and job

satisfaction, which lowers the possibility that new nurses would quit their jobs too soon

from stress or burnout.

Palawan State University. Improve its credibility as a stimulating and encouraging

environment dedicated to the success and well-being of its students.

College of Nursing. Understanding of mental health in developing student-specific

and evidenced-based mental health support services and practices, fostering a more

positive learning environment and the findings will also contribute in possible making of

manual handbook to encourages students to be aware of their mental health chellenge..

 BSN 3 Students. The students will develop effective coping mechanisms for

managing stress, enhancing their overall mental well-being, and improving their academic

performance.

Future Researchers. The study serves as a resource for future studies about mental

health interventions in nursing and other healthcare education programs that can build upon

the findings.

Researchers. The study enhances the researcher’s knowledge and skill in handling

personal mental health challenges.

Future Nursing Students. This study can raise awareness about the importance of

mental health and encourages help seeking behaviors.

Readers. The findings of this study could educate readers about the significance of

mental health in nursing education and promote more public support for mental health

programs.

Scope and Delimitations

This research study focuses only on the BSN 3 Students Under Pressure: Factors

Influencing Stress and Coping Assessed with DASS, PSS, and CSI”. The study respondents

are composed of 117 third year BSN students enrolled in the College of Nursing and Health

Sciences in Palawan State University, Main, in a Public Institution in Puerto Princesa City

for the Academic Year 2024-2025 including the 4 researchers.

 The data gathering collection will be utilizing the Online Questionnaire Method via

Google Forms as an official platform, DASS-21, PSS and CSI questionnaire. The research

does not include first-year, second-year, or fourth-year students, nor does it explore long-

term psychological outcomes. The data gathering period will be done in the month of

January 2025 until May 2025.

Definitions of Terms

Academic Performance – refers to students’ achievement in their studies, typically

measured by grades, test scores and other assessments.

Anxiety – a feeling of worry, nervousness, or unease, often accompanied by physical

symptoms like increased heart rate, sweating, or difficult breathing.

Clinical Demands – the pressures and requirements of clinical practices including patient

care, documentation and administrative tasks.

CHED - Commission on Higher Education

Coping Mechanism – a behavior or strategy that people use to deal with stressful or

traumatic situations or to manage difficult emotions

CSI – Coping Strategies Inventory

Depression – a mood disorder that causes persistent feelings of sadness and loss interest
Evidence-Based Strategies – Interventions or approach that have been shown to be effective

through scientific research.

Google Forms Questionnaire – an online survey tools used to collect data from

respondents.

Mental Health Challenges – difficulties in emotional, psychological, or social well-being

that can interfere with daily life.

Mental Health Outcomes – the results of effects of interventions.

Nursing Industry – the field of nursing including all aspects of nursing practice,

education, and research.

Personal Life – an individual’s private life, including relationship, family and hobbies.

Prevalence – the proportion of a populations affected by a particular condition at a

specific time.

Research-Supported Interventions – Interventions that have been supported by scientific

research and are considered effective.

Stress – a state of mental or emotional tension resulting from adverse or demanding

circumstances
 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter deals with the related literature readings, studies and conceptual

framework that helps with the formulations of the outline of the study.

Historical Overview of the Theory and Research Literature

The literature from existing books, journals, conference proceedings, and other

reading materials are here with presented to strengthen the present study.

Related Literature

Commonality of Mental Health Challenges

The Depression, Anxiety, and Stress Scale (DASS-21) is a widely used self-report

instrument that assesses an individual's current mental health status, focusing specifically

on depression, anxiety, and stress symptoms. In terms of its use for understanding the

commonality of mental health issues, the DASS-21 can provide valuable insights into how

prevalent these mental health challenges are across different populations, including

students, healthcare professionals, and other groups. Research has shown that the DASS-

21 can effectively capture the severity of mental health symptoms and help identify

individuals who might need further psychological evaluation or intervention. For example,

a study in Portugal during the COVID-19 pandemic revealed that students exhibited

varying degrees of depression, anxiety, and stress, with stress being more common than
anxiety or depression. (Psychometric Properties of the 21-Item Depression Anxiety Stress

Scale (DASS-21), 2023)

Perceived Stress

Perceived stress refers to the subjective feeling of stress experienced by individuals

in response to various demands or threats. It has been widely studied in relation to

psychological well-being, coping mechanisms, and overall mental health. Research has

shown that higher levels of perceived stress often correlate with poorer psychological

outcomes, including anxiety, depression, and reduced quality of life. (Perceived Stress And

Psychological Well-Being: The Role Of The Emotional Stability, 2018)

Factors Influencing Stress

The factors influencing stress are varied and can significantly affect mental health,

particularly in academic and professional settings. Academic stress, in particular, is a

common challenge for students. It has been linked to mental health issues like anxiety and

depression, and research shows that academic stress is often triggered by factors like

workload, deadlines, and performance expectations. Gender differences are also notable,

with some studies showing that female and non-binary students tend to report higher levels

of academic stress compared to male students. (Academic Stress and Mental Well-Being,

2022)
Coping Strategies

Coping strategies are essential in managing stress, particularly in high-stress

environments like healthcare and academic settings. Research has highlighted various

strategies used by students and professionals to cope with stress, such as problem-focused

and emotion-focused approaches, which may include seeking social support, engaging in

relaxation techniques, or utilizing time management skills. (Stress Management and

Coping Strategies, 2021)

Practical Interventions

Practical interventions for stress management and building resilience can take many

forms, and they focus on various aspects of well-being, from social support to struct. Social

Support: Leaning on support systems such as friends, family, and colleagues is crucial in

enhancing resilience. Having a strong network provides emotional support, guidance, and

practical assistance during challenging times, helping individuals manage stress and

improve mental well-being (Strategies for Enhancing Mental Health and Building

Resilience coping techniques, 2021)

Related Studies

A descriptive study of adverse childhood experiences and depression, anxiety

and stress among undergraduate nursing students

The 10-point Adverse Childhood Experiences (ACEs) score measures childhood

exposure to traumatic events. An ACEs score of 4 or higher has been associated with long-

term physical and mental health problems, and increased mortality. The purpose of this

study was to assess the rate of ACEs in nursing students and to examine the relationship

between ACEs and perceived depression, anxiety, and stress among undergraduate nursing

students. This is a descriptive correlational study to determine Adverse Childhood

Experiences (ACEs) scores and Modified Depression Anxiety and Stress Scale (DASS-21)

scores for undergraduate pre-licensure students at a private mid-western college. Students'

ACEs scores were correlated with DASS-21 scores and demographic data. 409 students

volunteered to participate in the study. Seventeen percent of students had high ACEs scores

(≥4). Those students with high ACEs scores also scored statically significantly higher on

the DASS-21 items relating to depression, anxiety, and stress. Results from this study

demonstrated that many nursing students have experienced ACEs and nursing students

with ACEs scores of 4 or higher had higher rates of depression, anxiety, and stress. These

findings should drive faculty in nursing programs to acknowledge the prevalence of ACEs

among their nursing students and recognize that impact on the mental health of students.

(Hedrick, J., et al., 2021)

 PM is thekey: perceived stress and mental health as the key indicator of well-

being of selected college online students in the Philippines during covid-19 pandemic.

The COVID-19 pandemic had a significant impact on students' mental health.

Monitoring and managing the students' wellbeing during a crisis such as this pandemic is

a priority. In this study, the researchers' main objective is to determine the relationship

between perceived stress and the mental health of selected college online students in the

context of the COVID-19 pandemic. A total of 307 college online students served as the

respondents to this research, where two instruments were used: (a) Perceived Stress Scale

(PSS-10), which measured Perceived Stress; and (b) Mental Health Inventory-18 (MHI),

which assessed the respondents' Mental Health. The researchers utilized statistical methods

such as frequency, percentage, mean, standard deviation, one-way analysis of variance, and

Pearson r correlation to analyze the data. It was also found out that perceived stress and

mental health have a significant negative relationship, implying that the higher the

students’ perceived stress, the lower their mental health and vice-versa. Moreover, the

respondents have low anxiety levels and moderate degrees for depression, behavioral

control, and positive affect, respectively. Furthermore, the study revealed that a higher

percentage of stress has a lesser influence on one’s positive affect than anxiety, depression,

and behavioral control. Therefore, it suggests that high behavioral control is an important

factor in students' healthy mental state in this time of the pandemic. Finally, the gathered

information may also serve as a basis for developing students’ wellness programs. (Canillo,

G., et al., 2022)

 Psychosocial stress factors among mental health nursing students in KSA

This study has examined the psychosocial stress factors that influence mental-

health nursing students in a Saudi University. This study has adopted a qualitative

interpretive approach, using semi-structured interviews with 10 female fourth-year mental-

health nursing students. After the interviews were digitally recorded and transcribed, they

underwent content analysis using the NVIVO 10.1 application, generating the themes that

emerge in this study. The results of the present study make it possible to conceptualize the

dynamics that impede the progress of students nearing the end of their final academic year.

The analysis focuses on four main themes: (a) the clinical learning context; (b)

discrimination against nurses; (c) interpersonal relationships; and (d) social challenges.

The statements made by students were analyzed for emerging themes; their experiences

were subsequently grouped into eight sub-themes. The study findings highlight the

importance of encouraging students to strengthen peer relationships, improve their own

psychological wellbeing, and embrace strategies for managing both personal and academic

stress levels. They also reveal that understanding the expectations of students can provide

a platform for recognizing stressors. Effective interventions can be adopted to improve

understanding of stress factors and subsequent stress responses among mental-health

nursing students. These results may help to improve students' clinical, social, and academic

outcomes. (Alyousef, S., et al., 2019)

 Role of coping strategies and self-compassion in psychological distress among

college students

Life at college can be challenging and stressful, which can be a significant threat to

college students' mental health. Students have increasing responsibilities, and competing

demands such as academic pressure, family, social and personal interests, culture shock,

homesickness, and working while studying cause substantial distress. The current study

was designed to find the predictive relationship between coping strategies, self-

compassion, and psychological distress in college students. Independent research design

and purposive sampling were used to collect data from participants (male = 100, female =

100) aged 14 to 19 years (M = 17.49, SD = 1.28) from three private and four government

colleges in Lahore with a sample size of N = 200. The Self-Compassion Scale SCS (Kristin

Neff, 2003), Psychological Distress Scale DASS (Lovibond, 1995), and Coping Strategies

Inventory CSI (David L. Tobin, 1989) were used to measure self-compassion, coping

strategies, and psychological distress in college students. Simple Linear Regression and

Descriptive Statistics were used to analyses data to find out prediction and descriptive.

Disengagement coping strategies had a significant positive predictive relationship with

psychological distress. Engagement, coping strategies, and self-compassion had a negative

predictive relationship with psychological distress. Overall, the findings suggest that

coping strategies and self-compassion may be useful additions to interventions to mitigate

student distress and improve student well-being. (Khaild, N., et al., 2023)
 Stress and coping strategies among nursing students: an international study

Mounting literature on stress and coping in nursing students are available; however,

most of the findings are confined to a single cultural group. This study was conducted to

determine the level of stress, its sources and coping strategies among nursing students from

three countries: Greece, the Philippines and Nigeria. Using a descriptive, comparative

research design, 547 nursing students (161 Greek nursing students, 153 Filipino nursing

students, 233 Nigerian nursing students) participated in the study from August 2015 to

April 2016. Two standardized instruments were used, the Perceived Stress Scale (PSS) and

the Coping Behavior Inventory (CBI). Findings revealed that the degree of stress and the

type of stressors and coping styles utilized by nursing students differ according to the

country of origin. The year of study predicted overall stress (β = –0.149, p < 0.001) while

advanced age predicted overall coping (β = 0.008, p = 0.037) in the nursing students.

Strengthening nursing students’ positive coping skills may be helpful for them to

effectively deal with various stressors during their educational experiences while

maximizing learning. Implementing empirically tested approaches maybe useful to prevent

the recurrence of stress and lessen its impact such as stress management counseling,

counseling programs, establishing peer and family support systems, and formulating

hospital policies that will support nursing students. (Labrague, L., et al., 2018)
Conceptual Framework

Input

Identifying and assessing the commonality of mental health challenges, perceived

stress, coping strategies and stress factors they experienced.

Process

The process of collection of data will be utilizing the DASS-21 for the collection

of commonalities of the respondent’s mental health challenges such as depression, anxiety

and stress, PSS for evaluation of level of stress, CSI for examining the coping strategies,

and google form questionnaire for collecting the open-ended answer to identify the factors

influencing the respondents

Output

The study's output consists of evaluation of impacts that contribute to mental health

and analyzing the mental health outcomes in terms of academic performances, clinical

demands and personal life.

Feedback/ Recommendation

Practical research-support interventions to mental health of third year nursing

students of Palawan State University.

 INPUT PROCESS OUTPUT

➢ Depression, Anxiety, ➢ DASS-21

➢ Commonality of Mental Health
Stress ➢ PSS Challenges
➢ Perceived Stress ➢ CSI ➢ Perceived Stress Level
➢ Coping Strategies ➢ Google Form ➢ Coping Strategies Mechanism
➢ Factors Influencing Stress
➢ Stress Factors Questionnaire

FEEDBACK/ RECOMMENDATION

Practical interventions to mitigate stress and help

improve coping mechanism of BSN 3 nursing

students.

Model 2.1: Conceptual Framework

Research Paradigm
It allows researchers to assess the extent of mental health challenges within the
population.

RECRUITMENT OF PARTICIPANTS

Population and Ethical

Sampling Consideration

117 Informed
Nursing Students Consent

DATA COLLECTION

Quantitative-
Descriptive Design

DASS-21 PSS Stress Factors CSI

DATA ANALYSIS

Descriptive Statistics Group Comparison

Mean, Median, Age, Gender

Standard Deviation

INTERPRETATION OF DATA

RECOMMENDATION

Model 2.2: Research Paradigm

 CHAPTER III

METHODOLOGY

This chapter provides an overview of the diverse methodologies to be employed for

collecting and analyzing data pertinent to the research objective.

Research Method

This study employs a quantitative-descriptive research design to analyze and

recommend practical interventions to mitigate stress and to help improve the coping

strategies mechanism. The quantitative-descriptive research design enables a systematic

analysis of stress and coping strategies among nursing students. This design facilitates the

identification of patterns, relationships, and key factors that influence the mental health of

BSN 3 students.

This design enables the researcher to assess mental health challenges that are

experiencing and overcoming by the nursing students to help formulate and recommend

practical interventions and improve coping strategies mechanism.

Research Locale

Provides a general picture of the mapping of the location.

a. Photograph of the mapping of College of Nursing and Health Sciences.

College of Nursing
and Health Sciences

Figure 3.1: College of Nursing and Health Sciences at Palawan State University,

(Google Maps, 2024) 9.778042 N, 118.734537 E.

Research Procedure

Recruitment of Participants

Population and Sampling: The target population for this study consists of 117

third year BSN students enrolled in the College of Nursing and Health Sciences in Palawan

State University, Main, in a Public Institution in Puerto Princesa City for the Academic

Year 2024-2025 including the 4 researchers.

Ethical Considerations

Informed Consent: All participants will be provided with detailed information

about the study's objectives, procedures, and ethical considerations. They will sign

informed consent forms, which will explain their right to withdraw at any point without

penalty. Participants will be assured of confidentiality, and data will be anonymized.

Data Collection

Quantitative-Descriptive Research Design

This study uses a quantitative-descriptive research design, as it aims to measure and

analyze stress levels, anxiety, depression, and coping strategies through validated

instruments as follows:

DASS-21 (Depression, Anxiety, Stress Scale): This scale will measure the levels

of depression, anxiety, and stress among the students (Lovibond & Lovibond, 1995).

PSS (Perceived Stress Scale): This scale will assess the level of stress experienced

by the participants in their academic and personal lives (Cohen et al., 1983).

Stress Factors

These questions and their theoretical foundations can serve as strong starting points

for research or inquiry in these respective areas.

1. Academic Workload

Question:

How do you feel your academic workload affects your psychological well-being?

Theory:

Demand-Control Model (Karasek, 1979) – This model suggests that high job demands (or

in this case, academic workload) combined with low control can lead to stress and reduced

well-being.

Reference:

Karasek, R. A. (1979). "Job demands, job decision latitude, and mental strain: Implications

for job redesign." Administrative Science Quarterly, 24(2), 285–308.

2. Clinical Demands

Question:

What coping strategies do you use to manage stress caused by the demands of your

clinical duties?

Theory:

Transactional Model of Stress and Coping (Lazarus & Folkman, 1984) – This model

explains how individuals appraise stressful situations and utilize coping mechanisms to

deal with them.

Reference:

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.
3. Family-Related Factors

Question:

How does support from your family help you cope with and stay resilient to stress?

Theory:

Family Systems Theory (Bowen, 1978) – This theory posits that family interactions and

support play a critical role in shaping individuals' responses to stress.

Reference:

Bowen, M. (1978). Family therapy in clinical practice. Jason Aronson.

4. Social Factors

Question:

How does staying connected with others help you reduce the effects of feeling

isolated on your mental health?

Theory:

Social Support Theory (Cohen & Wills, 1985) – This theory suggests that social

connections and support systems buffer individuals against stress and promote mental well-

being.

Reference:

Cohen, S., & Wills, T. A. (1985). "Stress, social support, and the buffering hypothesis."

Psychological Bulletin, 98(2), 310–357.

5. Personal Adaptation Strategies

Question:

How effective do you find mindfulness practices in helping you build resilience to

stress?

Theory:

Mindfulness-Based Stress Reduction (MBSR) Theory (Kabat-Zinn, 1990) – This theory

underlines the role of mindfulness in managing stress by promoting awareness and

reducing reactivity to stressors.

Reference:

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind

to face stress, pain, and illness. Delacorte.

Data Analysis

Descriptive Statistics: After collecting the data, descriptive statistics (mean,

median, standard deviation) will be calculated to summarize the mental health status of the

participants across the measures of depression, anxiety, stress, and overall mental health.

This will provide a general view of the baseline mental health status of the nursing students.

𝑠𝑢𝑚 𝑜𝑓 𝑎𝑙𝑙 𝑝𝑜𝑖𝑛𝑡𝑠

1. Mean - 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑟𝑒𝑠𝑝𝑜𝑛𝑑𝑒𝑛𝑡𝑠

2. Median – Middle Value if odd number of respondents, average of two middle

value if even number of respondents.

𝑠𝑢𝑚 𝑜𝑓 (𝑑𝑎𝑡𝑎 𝑝𝑜𝑖𝑛𝑡 − 𝑚𝑒𝑎𝑛)2

3. Standard deviation - √ 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑟𝑒𝑠𝑝𝑜𝑛𝑑𝑒𝑛𝑡𝑠 −1
 Group Comparisons: The data will be used to compare subgroups to explore

variations in mental health across different student demographics in terms of:

1. Age

2. Gender

Interpretation of Data

Each instrument provides unique data that will be interpreted in a complementary

manner, considering the academic, clinical, social, familial, and personal factors affecting

BSN 3 students. Below is the descriptive explanation of the data interpretation for each

tool and stress factors:

1. Data Interpretation Using DASS-21 (Depression, Anxiety, Stress Scale)

The DASS-21 measures the intensity of depression, anxiety, and stress experienced

by students.

Scoring: Responses are scored, summed, and multiplied by 2 for each subscale to

provide scores for depression, anxiety, and stress.

Categorization: Scores are classified into normal, mild, moderate, severe, and

extremely severe levels using established thresholds.

2. Data Interpretation Using PSS (Perceived Stress Scale)

 The PSS evaluates students' perception of stress based on how uncontrollable or

overwhelming their current experiences feel.

Scoring: Total scores are calculated from responses to questions about

unpredictability, overload, and perceived lack of control.

3. Data Interpretation Using CSI (Coping Strategies Inventory)

The CSI identifies the coping mechanisms employed by students to manage

stress.

Categories: Coping strategies are categorized into task-oriented, emotion-

oriented, and avoidance-oriented.

4. Interpretation of Stress Factors Questions

These questions explore academic workload, clinical demands, family-related

factors, social factors, and personal adaptation strategies as potential contributors to

stress.

Academic Workload:

Analyze responses to identify if high workloads correlate with elevated stress scores.

Compare with coping strategies to see how students manage workload stress.

Clinical Demands:

Evaluate how clinical rotations, patient interactions, and practical tasks contribute to

anxiety and stress.

Assess if clinical stress aligns with specific DASS-21 subscale scores.

Family-Related Factors:
Examine if family support impacts perceived stress or mental health.

Analyze correlations with coping strategies, such as emotion-oriented coping.

Social Factors:

Determine the role of social connectedness and peer support in mitigating stress.

High PSS or DASS-21 scores with low social support might indicate isolation as a stress

amplifier.

Personal Adaptation Strategies:

Explore how personal resilience and adaptation skills affect stress and coping

effectiveness.

Integrated Analysis Across Tools

Descriptive Statistics

Standard
Measures Mean Median Range Interpretation
Deviation
Stress
(DASS-21)
Anxiety
(DASS-21)
Depression
(DASS-21)
Perceived
Stress
(PSS)

Descriptive statistics provide a summary of the data measures like mean, median,

standard deviation, and range help describe the central tendency, variability, and

distribution of stress levels and coping mechanisms among students.

1. Mean

The mean provides the average stress level, perceived stress, or frequency of coping

strategies among BSN 3 students. If the mean is high for stress scores but low for task-

oriented coping strategies, it may suggest that students are not effectively managing their

stress.

2. Median

The median helps confirm whether the majority of students experience stress or coping

levels closer to the lower or higher end of the scale.

3. Standard Deviation (SD)

A low SD indicates that most students have similar stress or coping scores, suggesting a

more homogeneous experience.

A high SD suggests wide variability, meaning that some students experience significantly

higher or lower stress levels than others.

4. Range

The range highlights the extent of variability in stress levels or coping strategies among

students.

If the range of DASS-21 stress scores is very large, it indicates that while some students

experience minimal stress, others face extremely high levels. A large range in coping

strategies might reflect diverse approaches to stress management within the cohort. A
large range in PSS scores may suggest that students perceive stress very differently based

on personal or situational factors.

5. Interpretation

Mean and Standard Deviation

The combination of the mean and standard deviation gives a snapshot of the average

stress levels and how consistently they are distributed. A high mean and low SD in

DASS-21 stress scores might indicate that most students are experiencing high but

consistent stress levels.

Median

The median helps detect the influence of outliers. If the median differs significantly from

the mean, it suggests that a few extreme values are affecting the dataset.

Range

The range reveals the diversity of student experiences. A wide range in coping strategies

(CSI) scores might indicate that some students rely heavily on adaptive strategies, while

others may struggle with maladaptive methods.

DASS-21:

If the mean DASS-21 stress score is high and the range is wide, it may suggest that while

stress is generally high, the severity varies significantly among students.

Coping Strategies:
If the SD for task-oriented coping strategies (CSI) is low, it indicates that most students

employ similar adaptive methods.

Perceived Stress (PSS):

A low mean PSS score with a high SD might suggest that while many students perceive

low stress, some outliers feel overwhelmed.

Group Comparison

1. Group Comparison by Age

Depression, Anxiety Stress Scales (DASS-21):

Compare depression, anxiety, and stress scores among younger and older students.

Hypothesis: Older students might report lower stress due to better-developed coping

mechanisms or life experience. Younger students might struggle more due to less

experience managing academic or clinical demands.

Perceived Stress (PSS):

Analyze whether younger students report higher perceived stress compared to older

students, potentially linked to adjustment challenges or workload.

Coping Strategies (CSI):

Examine the preferred coping styles across age groups.

 Hypothesis: Older students may lean more toward task-oriented coping, while

younger students may rely more on emotion-oriented or avoidance strategies.

2. Group Comparison by Gender

Depression, Anxiety Stress Scales (DASS-21):

Compare depression, anxiety, and stress scores between male and female students.

Hypothesis: Female students might report higher levels of stress and anxiety due to

societal expectations, caregiving responsibilities, or differing perceptions of clinical

demands. Male students might report lower scores but could underreport

psychological distress due to stigma.

Perceived Stress Scale (PSS):

Analyze whether female students perceive higher stress levels compared to male

students.

Explore if male students exhibit different triggers for stress, such as clinical

performance or peer expectations.

Coping Strategies (CSI):

Examine the coping styles preferred by each gender:

Females might use emotion-oriented coping more frequently, such as seeking social

support.
Males might lean toward task-oriented coping but could also exhibit avoidance strategies,

depending on cultural or personal factors.

Data Interpretation of Recommendations Practical Interventions

Which focuses on recommending practical, interventions to help mitigate stress

and help improve coping strategies mechanism.

1. Link Findings to Practical Interventions:

If the study found that high academic workload contributes to increased stress, it

can recommend interventions such as time management training or academic counseling.

Research has shown that time management interventions reduce stress by improving

student organization and preventing last-minute pressure (Macan et al., 1990).

2. Cite Evidence-Based Practices:

Mindfulness Training: Mindfulness and relaxation techniques have been shown

to reduce anxiety and improve emotional regulation. A study by Bamber & Morpeth (2013)

demonstrated that mindfulness-based interventions could reduce stress and anxiety in

university students.

Cognitive Behavioral Therapy (CBT): CBT is an effective strategy for managing

depression and anxiety. Research by Hofmann et al. (2012) indicates that CBT helps

individuals reframe negative thought patterns, which is particularly beneficial for students

dealing with stress and anxiety.

3. Address Academic and Clinical Stress:

Academic Stress: Implement peer mentorship programs where experienced

students can guide newcomers, reducing the sense of isolation and academic pressure.

Research by Skovholt & Rønnestad (2003) suggests that mentorship can build resilience

in nursing students and improve coping strategies.

Clinical Stress: Offering clinical debriefing sessions or stress management

workshops for students after clinical rotations can help manage the emotional burden of

patient care. Studies such as Doyle & Staden (2018) show that structured debriefing helps

students process stressful clinical experiences.

4. Promote Social Support Systems:

Encourage the development of peer support groups. A study by Shapiro et al.

(2007) found that group support for medical students improved mental health and helped

with coping mechanisms.

Facilitate access to mental health resources on campus, including counseling

and stress-relief programs. Research by Eisenberg et al. (2007) emphasizes the importance

of accessible mental health resources for improving well-being among students.

5. Focus on Coping Strategies:

Promote coping skills training such as cognitive restructuring and stress

management techniques. Research by Carver et al. (1989) showed that teaching students

adaptive coping strategies can reduce anxiety and improve overall mental health outcomes.
6. Family and Personal Life Support:

Provide family counseling services for students experiencing family-related

stress. Research by Gonzalez et al. (2017) found that family support interventions helped

reduce stress and anxiety among students facing personal challenges.

In this interpretation, recommendations are directly linked to the findings from the

data. This approach ensures that the interventions proposed are not only practical but also

grounded in existing research, making them more likely to be effective. By using

evidence-based strategies that address the specific factors contributing to mental health

challenges, it can help improve the mental health outcomes of nursing students.