RAJIV GANDHI UNIVERSITY OF HEALTHSCIENCES, KARNATAKA STATE

BANGALORE.

ANNEXURE II

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

COLUMBIA COLLEGE OF NURSING

HARITHA M. NAIR1st Year M.Sc. (Nursing)PSYCHIATRIC NURSINGCOLUMBIA COLLEGE OF NURSING

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESKARNATAKA STATE, BANGALORE.

1. NAME OF THE CANDIDATE AND ADDRESS

MISS.HARITHA M. NAIR 1st YEAR M.SC(NURSING)COLUMBIA COLLEGE OF NURSINGBANGALORE

2 NAME OF THE INSTITUTION

COLUMBIA COLLEGE OF NURSINGBANGALORE

3 COURSE OF STUDYAND SUBJECT

IST YEAR M.SC.(NURSING)PSYCHIATRIC NURSING SPECIALITY

4 DATE OF ADMISSIONTO THE COURSE

01/06/2011

5 TITLE OF THE STUDY: “A STUDY TO ASSESS THE LEVEL OF STRESS AND ACADEMIC PERFOMANCE IN RELATIONSHIP WITH THEORY AND PRACTICAL ASPECTS AMONG 1ST YEARS BSC NURSING STUDENT IN SELECTED NURSING COLLEGES AT BANGALORE”.

6. BRIEF RESUME OF THE INTENDED WORK: 

6.1. INTRODUCTION

    “If the only tool you have is a hammer, you tend to see every problem as a nail”.        - Abraham Maslow

Mental health is as important as physical health if the student nurse is to meet her

responsibilities .A student nurse is exposed to a variety of stresses in her day to day life

which imposes a demand up on her to activate mental apparatus before any other system

is involved .It is usually observed that student nursing professionals undergo tremendous

stress. 1

Nursing school is an exciting challenging adventure that will demand much of nursing

student in terms of time and energy .Because nursing is a discipline comprising

knowledge from many related field student nurse will be asked to learn to think critically

synthesize information and then apply it to situations involving live people. 2

A student may face many challenges and stressors .However nursing students are likely

to experience even more stress than their friends and colleagues’ enrolled in other

programs. To support this statement a study comparing the stress levels of various

professional students found that nursing students experience higher levels of stress than

medical, social work and pharmacy students. Even more poignant another study showed

that one third of nursing students experience stress severe enough to induce mental health

problems such as anxiety or depression. 3

One source of stress of nursing student is their learning experience. The related learning

experience is a series’ of planned activities in the community that would prepare student

technically and professionally should they decide to pursue higher education in the

health profession .specially in selected college of nursing.BSN students spend a

maximum of 24 hours a week for their duty wherein they engage in activities such as

nurse patient interaction ,nursing procedures ,construction of concept map ,nursing care

plan and drug study, individual conference with their instructors, and ward class. 4

A useful distinction can be made between stress deriving from an individual’s personality

or personal family situation and that arising from the study environment. For example, an

individual’s personality or personal characteristics may not “fit” in a given situation. The

individual may carry inter- personal or family conflicts over in to the study environment.

The need to balance multiple life roles also may create personal stress. 5

According to kapleman1993,the burnout behaviors of students are characterized by

reduction in their performance .Students were found to be maintaining a façade of high

achieving while succumbing to physical illness and emotional stress. The physical and

psychological symptoms of stress are present such as irritability, inability to concentrate,

insomnia, depression, muscular tension and aches, palpitations, lack of appetite. 6

As to the effect of stress to the nursing student’s performance, Neufeld [1989] cited the

yorkes-Dodeson law. He contended that as arousal increase in response to stress,

performance improves. However, as arousal increase with higher levels of stress,

performance starts to decline. This conforms to the general adaptation syndrome where

the individual may finally go in to exhaustion phase. 7

Contrasted with the individual sources are the stresses derived from the study itself or the

specific study environment. Scholars have long recognized the stress related to nursing’s

work; being at the bedside around the clock to assist patients through their experience of

illness and hospitalization. Multiple and often conflicting demands and the role of the

nurse have been identified as sources of stress. 8

According to an informal interview with the guidance councilor in a selected college of

nursing, there are certain students who consult for assistance regarding the everyday

stress that they encounter. There were even instances of suicidal attempts, drop- out the

subjects, absenteeism, misconduct behaviors, and failure to finish the course due to stress

situations that exceeds their capacity to overcome. 9

Stress is seen as varying with other organizational variables such as satisfaction, turn

over, productivity, and group cohesion as well as with other structural, procedural and

contextual factors. Examples might include administrative support of student nurses and

nursing, quality of nursing leadership; inter professional turf battles, constantly changing

technology, or organizational restructuring. 10

The sources of stress identified by mc Grath [1976] include the physical and technical

environment, the social medium or patterns of interpersonal relations, and the focal

person under consideration. Leatt and Schneck [1981] conceptualized the sources of

stress as falling in to two major categories: role based situations and task-based

situations. 11

Yet, despite these stressors and stress reactions manifested by nursing students, majority

of the class manage to graduate within the expected time. Some even graduate with flying

colors .What then they were the stress management technique utilized by these students?

How have they been able to cope and adjust with the everyday stressors they encounter

each day?. 12

From the review of the literature on nursing student turnover, stress and satisfaction,

Hingham and Atwood[1983] Identified the following categories of stressors: the physical

work environment; professional-bureaucratic role conflict; role strain and tensions from

multiple expectations; management, communication patterns, and leadership style, and

work load problems; negative patient outcomes; communications with teachers ;lack of

participation in policy and practice decisions; and inadequate knowledge and skills for

role functions. 13

Lyon, B.L, &Werner say “within nursing research, stress has been seen as stimulus, a

response, or a transaction”. The consequences of very high stress in nursing have been

identified as burnout. According to Hardy and Hardy, [1988] role stress is external to a

role occupant and is a social structural condition in which role obligations are vague,

irritating, difficult, conflicting, or impossible to meet. 14

Student nurses’ continual and intermittent exposure to crisis situations and emotionally

charged the situations have made them key targets for stress reactions. Human service

professionals have traditionally sought more from their carriers than mere monetary

rewards. They expect their jobs to increase dealings of self-worth, fulfill achievement

needs and provide a sense of purposes. 15

The gap between student nurse’s expectations and reality of the work place is not

surprising. Nurses are particularly susceptible to pressures because of the nature and

context of their work. 16

Each person perceives and reacts to situations and changes differently depending on her

or his personal characteristics, abilities, experience, external support system and

characteristics of stressor itself. The stress response produced may be elicited by real,

potential or imagined threats, leading to varied and multiple patterns of hormonal

discharge. 17

According to Dr. M.L. santhanum [1997], stress is a response to a number of triggers.

But it’s wrong to think of stress as always negative. The stress response has value if there

is an emergency that means we need to run faster or jump higher. Whenever the word

stress is used it is always referred with negative connotation viz., distress, which causes

problems. 18

The stressful factors are a part of our lives, It is essential to develop adaptive response to

stress their by minimizing illness and generating health. Studying stress, stressors student

nurses will enable to find out suitable ways to reduce stress in nurses . 19

Student nurses need to become more sensitive and aware of the needs of their colleagues.

It must be made acceptable for individuals to express their feelings or seek help. There

are certain stresses inherent in nursing work, but there are also many unnecessary sources

of stress, which can be prevented or changed. If the problem of stress in nursing is

addressed in a coordinated way, the benefits to both student nurses and patients whom

she takes care in the future. 20

The above said information makes clear that a student nurse’s life is full of stressful

conditions and if she or he feels uncomfortable, they should try to alter reaction or

situation and develop a positive attitude to life.

6.2. NEED FOR STUDY:

Hans Selye (1992), a respected researcher in the area of stress has identified the causes of

stress and called them stressors. The same man coined the term “distress” to describe the

effects of too much normal stress. 21

According to Jindal et al (1978), a student nurse on study is exposed to variety of

stresses, which result in psychological and physical disorders. Such as professional has

low energy, low enthusiasm, high anxiety, irritability, and strained inter personal

relations. This affects work efficiency and patient care. 22

Nurses can experiences stress on the clinical unit while trying to meet the multiple needs

of assigned clients. One way to manage stress is through the use of time management.

These skills involve learning how, where, and when to use your time. Because the nurse

have a limited amount of time with client, it is essential to remain goal oriented and use

to time wisely. The nurse learns early the importance of using clients goals as a way to

identify priorities. However, the nurse must also learn how to establish personal goals

and time frames. 23

Experience a clinical duty followed by a tight whole day class schedule with quizzes and

recitations, the researchers had observed that most of their classmates were sleeping

during class hours, lacked interest in lessons, had decreased concentrations and difficulty

in the retention of the lecture following a sleepless nights. 24

Nursing students stress experiences in different clinical areas of the selected colleges of

nursing by Fajardo, Goldiene Angeli in 2004. College experiences is one in which a

transition from a period of dependence to independence take place. As you move from

the unknown, the list of stressors a college student experiences is rather starting. Some of

the most common stressors that college students encounter includes room- mate

dynamics, professional pursuits, academic dead line, financial aids and loan. 25

Some strategies for self management and coping with stress: use high priority goals as a

guide in making decision, make your personal health priority, know your personal

response to stress, self evaluate your response frequently, use strategies that healp you

maintain balance and self- control, refocus on your priorities whenever you feel

overwhelmed, network with colleagues and members of interdisciplinary team, maintain

an attitude of openness to new ideas, avoid over commitment, manage time effectively,

recognize your own limitations, and affirm self esteem and accomplishments. 26

Stressful situations experience by the nursing student in clinical area by Sales, Georgina

in1995. Experience related to clinical instructors, patients, personal knowledge and skill,

environmental, resources, and self care perceived by the student to be stressful, therefore

student’s experiences stressful situation in the clinical areas. 27

According to Ted Hamilton, (1994) stress has been defined as an activity or condition

that requires coping. Stress is ‘something that everybody experiences, but nobody can

quit defines’. Stress was originally an engineering term referring to physical forces that

affect structures. Medicine and other fields of science have also begun using the term.

But for most of us, the word has psychological meaning. Stressful events are not new.

Conflicts and injuries have occurred since the beginning of history. 28

Lazarus and Folkman in 1984 defined stress as “a relationship between an individual and

his or her environment that is appraised by the person as taxing or exceeding his or her

resources, and endangering well- being”. According to Dr. M.L. santhanum (1997), stress

is a very common event that no one can escape. In fact, no day passes without some

exposure to stress- inducing happenings. It is an unpleasant state and exerts harmful

effects on those who experience it. 29

Stress can cause a rise in blood pressure and blood sugar level and increase in stomach

acid and constriction of the arteries (Smolensky, 1977). Although a number of

prescriptions are being advocated for how nursing administrators can help nurses handle

stress provoking situations it would seem that more research is yet needed to find out the

exact nature and sources of stress for nurse working in a variety of specialties so that

nursing administrators can tailor helping mechanism appropriately according to the

quantities and qualities of stresses being experienced. 30

Mc Garth (1976) has suggested that there is a potential for stress in situations that make

demands, which threaten to exceed a person’s capability of coping with them. In these

situations the rewards for meeting the demands are weighed as a greater than the costs of

not meeting the demands. Stress shows up as absenteeism, sickies, poor quality work,

maintenance of the “status quo” and poor human relations. If not adequately managed,

the pressure of work can lead to premature burn out, retirement and for some permanent

or long- term sick leave. 31

The occupation of nursing has traditionally been one of nurturing the sick, providing for

their physical, as well as emotional needs. In addition to this, nurses today are expected to

fulfill a more contemporary role, which includes everything from preventative

interventions to high-tech intensive care of the critically ill patient. Recently researchers

have begun to ask at what personal cost to nurses, these services are provided, and what

in turn, are nurses’ needs . 32

Smith (1986) conducted one such study, but looked at nurses’ support needs from a static

perspective. The stress-support model on the other hand, emphasizes the specific and

dynamic nature of support. The support needs of individual staff nurses are in fact both

unique and constantly changing as a result of existing intra-personal, organizational or

environmental, and job component of stressors. Needs must therefore be assessed on an

ongoing basis. Little existing research has explored the nurses’ perception of their own

support needs. 33

6.4. REVIEW OF LITERATURE:

This chapter deals with the literature focused on the stress of student nurses who are

studying in colleges. Generally the student nurses come across stressful situations.

Review of literature consists of following parts:-

A} Literature related to the information about stress.

B} Literature related to effect of stress.

C} Literature related to the information about causes of stress.

D} Literature related to the process of stress.

E} Literature related to the levels of stress.

Literature related to information about stress.

The word stress comes from the Latin word “stringers” which means to draw tight [Skeat

1958]. Hans’s selye [1950] used the word stress to refer to the general break down of the

body in response to the word and power of modern life. In this book entitled “stress”, he

suggested that there are environmental agents called stressors and that the response or

internal condition of the organism when faced with stressors is stress. It has been

recognized that stress is a complex and imprecise concept with no universally accepted

meaning among social and behavioral scientists .34

Potter, Patricia says that stress can occur when an individual is faced to a numerous or

new challenges. Stress can either be bad or good. Stressors such as activities and events

can be good in the sense that it promotes personal growth and coping abilities. Stress on

the other half, may cause an individual to experience an abnormal feeling that disturbs an

individual’s mind and body. Stress management can be complicated or confusing because

there are different types of stress-acute, moderate, chronic stress-with each its own

characteristics. 35

A study conducted by Lazarus in 1999 reveals that people use the term stress in many

ways. First, stress is an experience a person to, through a stimulus or a stressor. Stressors

are disruptive forces to operating within or any system [Neuman 1995]. Stress is also the

appraisal, or perceptions of a stressor. Appraisal is how people interpret the impact of the

stressor or on themselves, of what is happening and what they can do about it. 36

According to Selye there are two types of stress; distress, or damaging stress, and

eustress, stress that protects health. Eustress is motivating energy, such as happiness,

hope fullness, and purposeful movement. However the idea of healthy stress has become

controversial because it is difficult to tell whether a person has benefited from stress or is

coping by denying the stress in some way. Other types of stress are work stress, family

stress, chronic stress, acute stress, trauma and crisis. 37

According to Kozier & Barbara stress is a universal phenomenon. All people experience

it. Parents refer to the stress of raising children, working people talk of the stress of their

gob, and students at all levels talk of the stress of school. Stress can result from both

positive and negative experiences. The concept of stress is important because it provides

a way of understanding the person as a being who responds in totality to a variety of

changes that take place in daily life. Stress is a condition in which the person responds to

changes in the normal balanced state. A stress or is any event or stimulus that causes an

individual to experience stress. 38

There are many sources of stress. They can be broadly classified as internal or external

stressors, or developmental or situational stressors. Internal stressors originate within a

person, for example, cancer or feelings of depression. External stressors originate outside

the indivisual, for example, a death in the family, or pressure from peers. Developmental

stressors occur at predictable times throughout an individual’s life. Within each

developmental stage, certain tasks must be achieved to prevent or reduce stress.

Situational stressors are unpredictable and may occur at any time during life. 39

Stress can have physical, emotional, intellectual, social, and spiritual consequences.

Usuailly the effects are mixed, because stress affects the whole person. Physically, stress

can threaten a person’s physiologic homeostasis. Emotional, it can produce negative or

non-constructive feelings about the self. Intellectually, stress can influence a person’s

perceptual and problem- solving abilities. Socially, stress can alter a person’s relationship

with others. Spiritually, it can challenge one’s belief and values. In stimulus – based

model, stress is defined as a stimulus, a life event, or a set of circumstances that arouses

physiologic and or psychological reactions that may increases the individual’s

vulnerability to the illness. While according to the responds based model Selye (1956-

1976) defined stress as “the non-specific responses of the body. 40

According to Borbowski & Nancy Stress is an environment event stress can also be

defined as a thing or event that triggers the adaptive physiological; and psychological

responses in an individual. The event creates change in the life patterns of the individual,

requires significant adjustment in life style and taxes available personal resources. The

change can either be positive such as outstanding personal achievement or negative such

as being fired from a job the emphasis here is on change from the existing steady state of

the individual’s life pattern. In miller and Rahe’s study, it found that women react to life

stress events at higher levels of response than men and that illness or actually precipitates

it, but there does appear to be a causal link. Individuals differ in there reactions to life

events, and these variations are related to the degree to which the change is perceived as

stressful. 41

Lazarus and Folkman define stress as a relationship between the person and the

environment that is appraised by the person as taxing or exceeding his or her resources

and endangering his or her well being. A precipitating event is a stimulus arising from the

internal or external environment and is perceived by the individual in a specific manner.

Determination that a particular person/environment relationship is stressful depends on

the individual’s cognitive appraisal of the situation. Cognitive appraisal is an individual’s

evaluation of the personal significance of the event or occurrence. The event

“precipitates” a response on the part of the individual and the response is influenced by

the individual’s perception of the event. The cognitive response consists of primary

appraisal and secondary appraisal. 42

A variety of elements influence how an individual perceives and response to a stressful

event. These predisposing factors strongly influence whether the response is adaptive or

maladaptive. Types of predisposing factors include genetic influences, past experiences

and existing conditions. Genetic influences are those circumstances of an individual’s life

that are acquired through heredity. Examples include family history of physical and

psychological conditions and temperament. Past experiences are occurrences that result

in learned patterns that can influence an individual’s adaptation response. They include

previous exposure to the stressor or other stressors, learned coping responses and degree

of adaptation to previous stressors. 43

LITERATURE RELATED TO EFFECTS OF STRESS;

In a study by Stoke Mandeville trust (1995) where 82 qualified nurses participated

revealed interesting and important result, which run s contrary to some research, was that

the more time staff spent with patients the less likely they were to experience emotional

exhaustion. The satisfaction derived from patient contact seemed to be the most positive

aspect of their work. 44

A study conducted by Avinash Supe (2000) to determine incidence of stress and factors

controlling stress in student nurses at different situations in public hospital, 90 student

nurses (30 each from wards, operation theaters and intensive care units) showed that

majority of student nurses (59/90-65.5%) perceived stress. Stress was found to be

significantly more in wards and ICU rather than Operation Theater. 45

In a study conducted by Healy and McKay MF (2000) on, “The effects of stress in a

sample of Australian student nurses, which examined and their impact upon nurses’

levels of job satisfaction and mood disturbance. Results revealed a significant positive

relationship between nursing stress and mood disturbance, and a significant negative

relationship between nursing stress and job satisfaction. 46

A study by Kandolin (1993) on “Burnout and psychological stress of student nurses in

two and three shift work revealed that, Female nurses in three-shift work reported more

stress symptoms and had ceased to enjoy their work more often than women in two- shift

work. Besides shift work demands and passive stress contribute to the experience of

burnout and stress. Family demands did no0t correlate with burnout of the nurses. 47

LITERATURE RELATED TO CAUSES OF STRESS;

People can experiences either external or internal stressors. External stressors include

adverse physical conditions (such as pain or hot or cold temperatures) or stressful

psychological environment (such as poor working conditions or abusive relationships).

Internal stressors can also be physical (infections, inflammation) or psychological. An

example of internal psychological stressors is intense worry about a harmful event that

may or may not occur. As far as anyone can tell, internal psychological stressors are rare

are absent in most animals accepts humans. 48

According to Cuevas& Frances Prescilla acute stress is the reaction to an immediate

threat, commonly known as the flight or flight response. The threat can be any situation

that is experienced, even subconsciously or falsely, as a danger. Common acute stressors

include; Noise, crowding, Isolation, Hunger, Danger, Infection, and imagining a threat or

remembering a dangerous event. It becomes chronic stress when modern life poses

ongoing stressful situations that are not short lived, and the urge to act (to fight or to flee)

must be suppressed. Common chronic stressors include: ongoing highly pressured work,

long –term relationships problems, loneliness, and persistent financial worries. 49

Stress is an everyday fact of life and everyone experiences stress from time to time.

Stress is any change that one must adapt to, ranging from the negative extremes of actual

physical danger at exhilaration of falling in love or achieving some long desired success.

And in between, day to day living confronts even the well most managed life with

continuous streams of potential stressful experiences. Thus, stress is not only inevitable

and essential but also normal part of life. However normal does not necessarily means

health. Stress triggers hormones that change the way the body way that is unhealthy, like

drinking, smoking or over eating. 50

Fortunately, stress management is largely a learnable skill. Everybody can learn to

effectively handle stress even when pressure persist it is not possible live without stress.

But one can learn ways to handle stress of daily life efficiently, and to learn to identify

the situations that evoke them. When these symptoms persist, the risk for serious health

problems is greater because stress can exhaust the immune system. Recent research

demonstrates that 90 per. of illness is due to stress related. 51

LITERATURE RELATED TO PROCESS OF STRESS;

A research study about process of stress by Apruebo & Roxel stressful events may occur

as sudden, unexpected, potentially life threatening experiences or traumas qualify as

catastrophic events, such as physical or sexual assault, military combat, natural disasters,

explosions, plane crashes and accident fall in to this category. Life changes and strains

include marital separation, illness in the family, difficulties at work, moving to a new

place, and other circumstances that create demand with which people must adjust. 52

Chronic stressors continue over a long period of time like living due to adverse economic

conditions, residing in high-crime neighborhood, being the victim of the discrimination,

and even enduring years of job pressure. Daily hassles involve, irritation, heavy traffics,

pressures and annoyances that may not be major stressors by themselves but such effect

aggravate to become significant. The frustration of daily commuting in heavy traffic can

become so intense for some drivers display a pattern of aggression. 53

According to Zo Aguila stress is an epidemic today, and to make it worse, we are in a

situation where we are clueless about what is bugging the life out of us. According to the

foundation for integrated research in mental health in 2007, more than three out of five

doctor visits all over the word are for stress related problems. And while Filipinos are

among the happiest people in the world, according to study by world value survey, we are

still subject to a lot of stress and suffer illness caused and made worse by it: high blood

pressure, stroke, ulcer, diabetes, and heart disease. 54

Stress is not all bad news. A certain level of pressure good for us. The buzz of new

challenges or the excitement or new relationship keeps life interesting. What we call

stress is more often than not, not really stress. According to the encyclopedia of stress,

stress is one of the most frequently used but ill defined words in the English language. 55

Stress can affect our physical capabilities by giving us headache, bad tummy or feeling

sick, back pain, trembling, sweating, sleeping difficulties, colds, or infections. It can also

change our mental status such as feelings of panic or anxiety, irritability, depression, poor

concentration, feeling helpless, lacking confidence, and not wanting to socialize. 56

LITERATURE RELATED TO LEVELS OF STRESS

Stress are mainly classified in to

ACCUTE STRESS;

According to the APA, the most common form of stress is acute stress. Stressors defined

as acute are things that ruin your plans or your day: a flat tire, a missed dead line, an

unplanned meeting with child’s principal at school. The inevitable by- product of living,

acute stress happens everyone and tends to be manageable. These stressors don’t do the

damage of chronic stress, but they certainly affect our body and mind. This is the king of

stress that can easily be helped with the stress management and relaxation techniques. 57

MODERATE STRESS

According to Miller & Smith, everyone meets at least one stressor every day, but some

people have a pattern of reacting as if everything is a big problem. People who are

chronically and catasthrophize have deep-seated pattern to address. These awfulizers also

tend to be over arouse and tense, but are more anxious and depressed and angry and

hostile. “Often, lifestyle and personality issues are so ingrained and habitual with these

individuals” that they see nothing wrong with the way they conduct their lives. They

blame their woes on other people and external events. Frequently, they see their life style,

their patterns of interacting with others, and their ways of perceiving the world as part

and parcel of whom and what they are, when the pain and discomfort of moderate stress

get in the way of life as usual, that’s the time to seek out stress management, often in the

form of intervention. 58

CHRONIC STRESS

Miller and Smith define chronic stresses away day after day, year after year. Chronic

stress wears as the grinding stress and destroys bodies, minds and lives. It wreaks havoc

through long term attrition. The worst aspect of chronic stress, say Miller and Smith, “is

that people get use to it” they forgot it theirs. People are immediately aware of acute

stress because it is new; then ignores chronic stress because it is old and familiar and

sometimes almost comfortable. 59

COLLEGE STRESS

A study conducted among college students by Hensslin & James College is advancement

in education that deals with greater workload and academic pressures. Courses in

colleges have different stressors, specifically in nursing, it consist of academics and RLE

in the form of duty. Nursing students face up to different stressors such as paper works

together with physical, social, emotional and logical challenges in their RLE. 60

A student faces many challenges and stressors. However, as a “nursing” student likely to

experience even “more stress “than others enrolled in other programs. A study comparing

the stress levels of various professional students found that nursing students experience

higher levels of stress than medical, social work and pharmacy students. Even more

poignant another study showed that “one third” of nursing students experience stress

severe enough to induce mental health problems such as anxiety and depression. In

addition to contending with exams, grades, long hours of studying, work, family and

other personal commitments they are also faced with challenges of clinical practice.

Clinical practice has been identified as one of the most anxiety producing components in

nursing programs. 61

Incorporating practices that can reduce some of the stress associated with all of these

challenges is important, useful and essential to your well being. Stress management and

self-care practices will help navigate through nursing school and will and also provide a

wonderful foundation for creating a balanced and wholesome life. 62

SCHOOL STRESS;

A study conducted by Massachusetts in school students. Large body of research has

demonstrated that emotional high levels of stress debilitate psychological well-beeing,

physical health, and task performance. A number of studies have focused on the source of

students stress while in school, which are many students may report that someone hit

them, kicked or punched them, or threatened them with a knife or gun, and that they have

felt unsafe in school. Being made fun of in front of the class or by friends is also a source

of stress, or being shouted at or screamed by the teachers. Anything that affects the

harmony and interferes with the class room activities may be a source of stress and

certainly affects academic functioning in the school situations. 63

A study conducted by Marge Hegge and Sr. Vicky Larson found that younger students do

not perceive more stress than alder, more mature students. Neither age nor work

experience was a factor influencing perceive stress in student nurses. Both associate

degree and baccalaureate nursing students perceive the clinical instructor as the primary

source of stress during clinical experiences. Interactions with clinical instructors were

highly stressful events for 45%of the 107 junior student nurses. 64

The most common stressful events for them included interpersonal relationships with

instructors, ability to perform heavy workload and helpless feelings. The accelerated

students in this study found religion and social support to be the most helpful in coping

with stress, whereas denial and disengagement were least helpful to them. They

experiences moderate to severe stress during their academic experiences. This research

suggests the need to determine the impact of stress and coping strategies on learning

outcomes and academic success. 65

Nursing school is an exciting, challenging adventure that will demand much of nursing

students in terms of time energy. Because nursing is a discipline comprising knowledge

from many related fields, student nurses will asked to learn to think critically, synthesized

information, and then apply it to situations involving people. Becoming a nursing student

automatically increases stress level because of the complexity of the information to be

learned and applied, and because of new constraints on time. There are several ways

students can consciously decreases the stress associated with school. 66

6.5. STATEMENT OF PROBLEM:

“A STUDY TO ASSESS THE LEVEL OF STRESS AND ACADEMIC PERFOMANCE IN RELATIONSHIP WITH THEORY AND PRACTICAL ASPECTS AMONG 1ST YEAR BSC NURSING STUDENT IN SELECTED NURSING COLLEGES AT BANGALORE”.

6.6. AIM OF THE STUDY:

6.7. OBJECTIVES OF THE STUDY

1. To determine the level of stress between theory and practical aspects among 1st

year B.sc nursing students.

2. To determine the Academic performance between theory and practical aspects

among 1st year B.sc nursing students

3. To determine the relationship between level of stress and academic performance

in theory aspect among 1st year B.sc nursing students

4. To determine the relationship between level of stress and academic performance

in practical aspect among 1st year B.sc nursing students.

6.8. OPERATIONAL DEFINITION:

1. Asses: It refers to determine the level of stress between theory and practical aspects

of nursing student.

2. Stress: Stress can occur when an individual is faced to a numerous or new

challenges. Stress cans either bad or good.

3. Academic performance refers to how students deal with their studies and how they

cope with or accomplish different tasks given to them by their teachers. 

4. Theory:The branch of a science or art that deals with its principlesor methods, as di

stinguis.

5. Practical: of or pertaining to practice  or action. Engaged or experienced in actual 

practice  or work.

6. Bachelor of science in nursing :Refers to the 1st year regular students entrolled in

RGUHS.

6.9. HYPOTHESIS:

H1: There will be a significant difference in the level of stress between theory and

practical aspects among 1st year B,sc nursing students.

H2: There will be a significant difference in academic performance between theory

and practical aspects among 1st year B,sc nursing students.

H3: There will be a significant correlation between the level of stress and academic

performance among 1st year B,sc nursing students.

6.10. ASSUMPTION:

1. Nursing students will experience stress in theory aspect

2. Nursing students will experience stress in practical aspect

3.There will be a correlation between stress and academic performance of the nursing

students.

7. METHODOLOGY:

7.1. RESEARCH APPROACH:

The approach of this study will be descriptive in nature.

7.2. RESEARCH DESIGN:

The research design that will be used to achieve the objectives of the study is non

experimental research design.

7.3. SETTING OF THE STUDY:

This study will be conducted in selected nursing colleges at Bangalore.

7.4. POPULATION:

The population of the   study comprises of nursing students in selected nursing

colleges at Bangalore.  

7.5. SAMPLE:

Sample includes the 1st year B.sc nursing students in selected nursing institutions

in Bangalore.

7.6. SAMPLE SIZE:

The total sample of the study consists of 50 nursing students.

7.7. SAMPLING TECHNIQUE:

Simple Random sampling

7.8. SAMPLING CRITERIA:

Inclusion Criteria

1. Students who are willing to participate.

2. Students who are available during the period of data collection.

3. Students who are studying in 1st year B.sc Nursing.

Exclusion Criteria

     1.  Students who are not willing to participate

     2.  Students who are not available during the data collection.

     3.  Students who are studying other than the nursing course

7.9. TOOL FOR DATA COLLECTION:

Structured self administered Questionnaire.

Part – I:

Deals with demographic variable.

Part- II:

Rating scale to assess the level of stress in theoretical and practical aspect.

Part- II:

Rating scale to assess the academic performance in theoretical and practical aspect.

7.10. VARIABLES:

Study Variable:

Level of stress between theory and practical aspects ,academic performance.

Extraneous Variable:

Demographic variables. 

 

7.11. METHOD OF DATA COLLECTION:

The data will be collected with in the prescribed time period in selected students by using

self administered questionnaire.

 7.12. DATA ANALYSIS METHOD:

The data analysis will be carried out through descriptive and inferential statistics with the

help of computer software package (SPSS).

1. Descriptive Statistics:

The basic statistical techniques such as mean, standard deviation range and mean score

percentage of described demographic variables will be computed and interpreted suitably.

2. Inferential Statistics:

Chi square test will be used to find out the association between the knowledge and

selected demographic variables of students.

7.13. DURATION OF DATA COLLECTION:

The data will be collected for a period of 6 weeks.

7.14. PROJECTED OUTCOME:

This study will help the investigator to know the existing level of stress and academic

performance between theory and practical aspects among 1st year nursing students in

selected nursing institutions at Bangalore.

7.14. DELIMITATION:

This study is delimited to 1ST year Bsc nursing students.

This study is delimited to nursing students.

This study is delimited to 50 students

7.15. Does the study require any investigation or intervention to be conducted on patients

or other human or animals? If so describe briefly.

                         No.

7.16. Has ethical clearance been obtained from your institution?

                        Yes, will be obtained. 

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SIGNATURE OF CANDIDATE: Haritha. m Nair

REMARKS OF THE GUIDE: The topic selected for the study is relevant

NAME AND DESIGNATION OFGUIDE:

SIGNATUREOF THEGUIDE:

HEAD OF THE DEPARTMENT:

SIGNATURE OF THE HOD

REMARKS OF THE PRINCIPAL: : The topic selected for the study is relevant

NAME AND DESIGNATION OF PRINCIPAL :MRS. Reeta subashini. PRINCIPAL COLUMBIA COLLEGE OF NURSING

SIGNATURE:

ETHICAL COMMITTEE CLEARANCE

1:TITLE OF THE DISSERTATION : “A STUDY TO ASSESS THE LEVEL OF STRESS AND ACADEMIC PERFORMANCE IN RELATIONSHIP WITH THEORY AND PRACTICAL ASPECTS AMONG 1ST YEAES BSC NURSING STUDENT IN SELECTED NURSING COLLEGES AT BANGALORE”.

1.

2.

3. NAME OF THE CANDIDATE : HARITHA .M NAIR 1st

4 SUBJECT : PSYCHIATRY

5 NAME OF THE GUIDE :

6 APPROVED/NOT APPROVED : (If not approved, suggestion)