Chapter I

Introduction Background of the study For every shift of a nursing students duty, there are several circumstances that hinder the care to their patients. Generally, these are the different kinds of stress they encounter before and during their duty. Because of those interruptions, the student nurses might be affected in their performance. Thus, this study pertains to managements that can relieve stress. The pressures, expectations and the competitive environment brought about by the modernization of life have stimulated and challenged the individual to perform at his optimum capacity to cope with its demands. However, such situation may also threaten the health of the individual and possibly cause a deterioration of his or her function as a result of being stressed out or being unable to rise from the state of stress. Stress is a term in psychology and biology, first coined in the 1930s; it can be defined in different contexts. Generally, it refers to the consequence of the failure of an organism human or animal to respond appropriately to emotional or physical threats, whether actual or imagined. (http://en.wikipedia.org/wiki/Stress_ (biology), 2010) In the human biological aspect, stress is a state produced by a change in the environment that is perceived as challenging, threatening, or damaging to a persons dynamic balance or equilibrium. When a person is in a state of stress, he/she is, or feels unable to meet the demands of the new situation. (Smeltzer, 2008) Kozier (2008) considers stress as a universal phenomenon because it affects all people whether they are from different races or from different walks of life. Stress simply is part of human existence (Birion, 2006).

The concept of stress is important because it provides a way of understanding the person as a being who responds in totality (mind, body, and spirit) to a variety of changes that take place in daily life.The state of stress occurs when there is a change or stimulus that evokes it called as a stressor. The nature of the stressor is variable; an event or change that is stressful for one person may not be stressful for another, and an event that produces stress at one time and place may not do so in another situation (Smeltzer, 2008). The state of stress has a multidimensional influence on the totality of the person; it can have physical, emotional, intellectual, social, and spiritual consequences. Usually the effects are mixed, because stress affects the whole person. Physically, stress can threaten a persons physiologic homeostasis. Emotionally, stress can produce negative or nonconstructive feelings about the self. Intellectually, stress can influence a persons perceptual and problem- solving abilities. Socially, stress can alter a persons relationships with others while spiritually; it can challenge ones beliefs and values. (Kozier, 2008) In a more specific perspective of stress and stressors, Hamaideh (2009) noted that university students are prone to stressors due to the transitional nature of university life. Based on a national study of more than 300,000 freshmen at more than 500 colleges and universities in the U.S.A, todays college students experience more stress and are more depressed than in the past because of the growing expectations from them such as the pressure to succeed, finding employment after graduation and achieving a sense of financial stability (Santrock, 2006). Universities offer numerous programs to study and one of the most stressful programs offered is the nursing course as stated by Comeau (2009). In the nursing curriculum according to Snell (1995), students invest longer hours and have greater emotional demands than most other students. Other than the usual stress, such as paper works, tests, exams,final grades, class environment, professors and competition, nursing students experience

clinical-related stress such as constantlyhaving to deal with patients pain, anxiety and death, as well as giving emotional support to patients families and even the disruption of the circadian rhythms in effect of shift work (Gross, 2007). High levels of stress are believed to affect students health as well as their academic performance that is why issues on stress should be managed. Generally, people handle stress through coping Lazarus and Folkman (1984) as constantly changing cognitive and behavioral efforts to manage external and/or internal demands that are appraised as taxing or exceeding the resources of the person. Comeau (2009) suggested that to achieve an effective nursing program, stress management workshops should be provided during the academic year, adding that implementing techniques to cope with stress in a nursing program has an effect on retention and performance.

Statement of the problem

This study was conducted to identify the stress management techniques utilized by the third year nursing students of Aklan State University with regards to their clinical duties. Specifically this study aims to answer the following questions: 1. What are the socio-demographic characteristics of the respondents? 2. What are the the different stressors encountered by the third year nursing students of ASU in their clinical duties? 3. What are the stress management techniques utilized by the BSN III students of ASU?

Conceptual framework The independent variables in the conceptual framework include the socio-demographic characteristics such as age, sex, economic status, and religion. It shows that characteristics can influence the stress management of student nurse in their clinical duty. Including age, sex, and economic status can change the ability to manage the stress because if a person experiences financial problem, he/she cannot even buy foods to relieve it if the stressor is being hungry. Intellectually, stress can influence a persons perceptual and problem- solving abilities. Socially, stress can alter a persons relationships with others while spiritually, it can challenge ones beliefs and values. (Kozier, 2008)

Conceptual framework

Independent Socio Demographic Profile

Types of stressor *Doing bedside care to the patient. * Finishing charting on time.

Dependent Stress management techniques

*Meditation *Praying * Too many patients to handle. *Brisk walking *Preparation of requirements. and submission *Eating *Self-talk *Humour

*Age *Gender *Daily allowance *Religion

*Patient with serious cases. *Lack of hospital facilities and equipments. *Relationship with the patient. *Relationship with the co-students. *Relationship with the clinical instructors. * Relationship with the nursing staffs. * Relationship with the physician. * Relationship with the patients relatives and visitors. family,

*Recognition of some evident changes with regards to patients symptoms. *Mixed cases of patients due to lack of rooms. *Unfamiliar healthcare setting in the hospitals. *Wrong proced ure performed to the patient.

Significance of the study

The researchers believe in the merits of the study especially to the following: The researchers. Conducting this kind of study brought a learning experience for them. It handed them the pulse of the major third year nursing students when it comes to stress management they performed with regards to their clinical duties, which was hardly known withoutsurvey. The nursing students. Who may acquire greater insights of the stressors, problems and challenges they may encounter all throughout their clinical performances which is part of their chosen career. This knowledge will give them better and wider perspective about their profession and aid them in enhancing their coping abilities and self-confidence.

The Clinical Instructors. The findings may provide them understanding why nursing students behave like they do. This study will also provide them hints of what remedial measures they need to institute to lessen the learning difficulties of their students while undergoing clinical exposure. Further, it will eventually help them to build a better relationship with the students, promote educational growth, and improve human and public relations with the identified clinical area of operation.

The school administrators and faculty. Who may help to work out solutions and course of action that will improve the students performance and to lessen their burden in their clinical duties while on the learning process. It also gives them the chance to improve the quality of nursing education for the benefit of the students The parents. This study will give insights to the parents about the stressors encountered by their siblings and to prepare them nor strengthen them by means of giving emotional and moral supports in ways that may help them how to face and manage their stress during their clinical duties. The patients. Who are the recipients of the healthcare service given by the nursing students. The future researchers. This study can serve as reference material to those students who will conduct exactly the same correlated studies. and the institution as well.

Scope and Delimitation

This study focused on Stress Management Performed by the third year nursing students of Aklan State University with regards to their Clinical Duties. The problems were on the following: The different stressors encountered by the third year nursing students of Aklan State University with regards to their clinical duties, and the different stress management performed by the respondents with regards to their clinical duties. The study would be in a qualitative form wherein the data gathered were in descriptive form. The study is all about the different stress management techniques of BSN 3 students of ASU Banga.

Definition of terms

AgeThe length of time that life.(http://www.thefreedictionary.com/age)

one

has

existed;

duration

of

Sex-in this study it refers to the sex of the respondent (male or female) Daily allowance- Something, such as money, given at regular intervals or for a specific purpose.( http://www.thefreedictionary.com/allowance) Religion- an organized collection of beliefs, cultural systems, and world views that relate humanity to the supernatural, and to spirituality.( http://en.wikipedia.org/wiki/Religion) Meditation- a practice in which an individual trains the mind or induces a mode of consciousness, either to realize some benefit.( http://en.wikipedia.org/wiki/Meditation) Praying-to offer devout petition, praise, thanks, etc., to (God or anobject of worship. Brisk walking-an act of exercise that can improve confidence, stamina, energy, weight control, life expectancy and reduce stress Eating- food with reference to its quality or tastiness when eaten Self-talk-one form of relaxation that relieves stress Humour- a state of mind; temper; mood Stressorany agent that causes organism(http://wordnetweb.princeton.edu/perl/webwn?s=stressor) stress to an

Chapter II
REVIEW OF RELATED LITERATURE The review of related literature section is composed of different studies that pertains to stress management techniques including the kinds of stress that encountered by several individuals. The studies stated about the coping strategies if stress is present in life. Socio Demographic Profile Age The current study examined whether stress reactivity becomes stronger or weaker with age. Daily stress and daily negative affect were modeled using 1,012 subjects from the National Study of Daily Events (NSDE), an 8-day daily diaryssss study. Age ranged from 25 to 74. Data were modeled using within-person HLM techniques. Daily stress and neuroticism interacted in their effect on daily negative affect. There was a stronger association between daily stress and negative affect for persons high in neuroticism as compared to those low on the trait. In addition, daily stress and age interacted in their effect on daily negative effect. There was a stronger association between daily stress and negative affect for older as compared to younger adults. Results suggest heightened reactivity to stressors in older adulthood, perhaps due to kindling effects. Changes in the aging brain may explain this effect. Our investigations illuminate the complexities that characterize the set of associations among negative effect, stress, personality, and age, and point to potential aging or cohort

effects.(http://www.midus.wisc.edu/findings/pdfs/221.pdf)

Gender
The researchers found that all signs point largely to oxytocin, a hormone that promotes both maternal and social behavior and enhances relaxation, as the key factor behind the gender difference. When faced with stress, the body releases a number of different hormones, says Redford Williams, MD, director of the Behavioral Medicine Research Center at Duke University in Durham, N.C. Some of these hormones, notably cortisol and adrenaline, raise blood pressure and cholesterol levels and suppress the immune system, putting oft-stressed people at greater risk for everything from colds to cancer to heart disease. Some research also suggests that constant, long-term exposure to stress can lead to weight gain thanks to elevated cortisol levels. Initially, women have the same response to stress as men, leaving them somewhat vulnerable to cortisol and adrenaline. But then women also begin secreting oxytocin from the pituitary gland, which helps scale back the production of cortisol and adrenaline, minimizing their harmful

effects.(http://www.webmd.com/balance/stress-management/features/stress-gender)

Profession There is a growing body of evidence to support the view that stress in nursing for both qualified and student nurses is induced by a wide range of physical, social psychological stressors that can eventually cause burnout and emotional exhaustion. These include the climate of continuous change, large workload, nursing dying patients, lack of support and poor work conditions.( http://www.inmo.ie/tempDocs/cover_story_student%20nurses_oct%2005.pdf)

Religion Spiritual practices, including meditation, prayer and contemplation, are intended to develop an individual's inner life and can reduce stress. Secular spiritualityemphasizes humanistic qualities such as love, compassion, patience, tolerance, forgiveness, contentment, responsibility, harmony, and a concern for others. Secular spirituality also emphasizes aspects of life and human experience that go beyond a purely materialist view of the world, without necessarily accepting belief in a supernatural reality or divine being. Spiritual practices such as mindfulnessand meditation can be experienced as beneficial or even necessary for human fulfillment without any supernatural interpretation or explanation. Spirituality in this context may be a matter of nurturing thoughts, emotions, words, and actions that are in harmony with a belief that everything in the universe is mutually dependent; this stance has much in common with some versions of Buddhist spirituality.( https://www.boundless.com/psychology/stress-andinfluences-on-health/healthy-coping-with-stress/how-does-religion-and-spirtuality-affect-stress/) Stressors Coping usually involves adjusting to or tolerating negative events or realities while attempting to maintain your positive self-image and emotional equilibrium. Coping occurs in the context of life changes that are perceived to be stressful. Psychological stress is usually associated with negative life changes, such as losing a job or loved one. However, because all changes require some sort of adaptation, even positive changes, such as getting married or having a child, can be stressful. Changes are stressful because changes require us to adjust and to adapt. Experiencing too many changes within a brief time period often creates a perception that we are not in control of

important events. This perception contributes to low self-esteem and may even contribute to the development of anxiety or depression. In some cases, physical illnesses may develop or be exacerbated when a person's capacity to adapt to change is overwhelmed by too much change. Coping involves adjusting to unusual demands, or stressors, and thus requires the mobilization of greater effort and the use of greater energy than is required by the daily routines of life. Prolonged mobilization of effort can contribute to elevated levels of stress-related hormones and to eventual physical breakdown and illness. Stressors that require coping may be acute, such as a change in residence or onset of marital problems. Stressors also occur that are of longer duration, such as chronic pain, chronic illness, or enduring financial problems. The effect of many acute stressors that occur within a relatively brief period of time may be cumulative and profound. Thus, the individual who experiences a marital separation, the death of an aging parent, and a change in his or her job within a brief period of time may find himself or herself struggling to adjust to maintain his or her physical and emotional health.(http://my.clevelandclinic.org/healthy_living/stress_management/hic_coping_with_lifes_s tressors.aspx) Stress management Stress may be referred to as an unpleasant state of emotional and physiological arousal that people experience in situations that they perceive as dangerous or threatening to their wellbeing. The word stress means different things to different people. Some people define stress as events or situations that cause them to feel tension, pressure, or negative emotions such as anxiety and anger. Others view stress as the response to these situations. This response

includes physiological changessuch as increased heart rate and muscle tensionas well as emotional and behavioral changes. However, most psychologists regard stress as a process involving a persons interpretation and response to a threatening

event.(http://www.docstoc.com/Docs/DownloadFile.ashx?docId=25279867&key=&pass=)

Chapter III METHODOLOGY

and This chapter presents the method of research used, the instruments, the sources of data the procedures used in gathering of data. of Research

Methods

The researcher will use the descriptive method to accomplish this study, to describe the stress management performed by the third year nursing students of Aklan State University with regards to their clinical duties Research design The researcher will use a questionnaire as the primary tool in gathering data. This is composed of 3 problems. Problem no. 1 involves the profile of the third year nursing students of Aklan State University. Problem no. 2 involves the different stressors encountered by the third

year nursing students with regards to their clinical duties. Problem no. 3 is the different stress management performed by the respondents. . Sources of Data The researcher will use the third year nursing students of Aklan State University as his respondents who will be randomly selected.They were chosen using single random sampling, each number of the population has an equal chance to be included in the sample gathered.(Ymas Jr, et. al. 2006)

STRESS MANAGEMENT TECHNIQUES UTILIZED DURING CLINICAL DUTIES BY THE LEVEL THREE BACHELOR OF SCIENCE IN NURSING OF AKLAN STATE UNIVERSITY.

A Thesis proposal Presented to The Faculty of Bachelor of Science in Nursing Program School of Arts and Sciences Aklan State University

In partial Fulfillment of the

Requirements for the Subject Nursing Research 1

CHESTER GLEE N. ZOLINA 2013