RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA,BANGALORE
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Mr. ROSHMON K.R

1 NAME OF THE CANDIDATE
Ist YEAR M.Sc. NURSING STUDENT,
AND ADDRESS N.D.R.K. COLLEGE OF NURSING
B.M. ROAD HASSAN, KARNATAKA.

N.D.R.K. COLLEGE OF NURSING, B.M. ROAD

2 NAME OF THE INSTITUTION
HASSAN, KARNATAKA.

MASTER OF SCIENCE IN NURSING

3 COURSE OF STUDY AND
( PSYCHIATRIC NURSING )
SUBJECT

4 DATE OF ADMISSION TO THE

25TH MAY 2008
COURSE

“LEVEL OF STRESS AND COPING STRATEGIES

5.1
TITLE OF THE TOPIC OF STUDENT NURSES DURING THEIR INITIAL
CLINICAL PRACTICE”

5.2 STATEMENT OF THE “A STUDY TO ASSESS THE LEVEL OF STRESS

PROBLEM AND COPING STRATEGIES OF STUDENT
NURSES DURING THEIR INITIAL CLINICAL
PRACTICE AT N.D.R.K COLLEGE OF NURSING,
HASSAN, KARNATAKA”

6. BRIEF RESUME OF INTENDED WORK

 INTRODUCTION

" I am a student nurse. I am dying. I write this to you who are, and will
become, nurses in the hope that by my sharing my feelings with you, you
may someday be better able to help those who share my experience."
- ANONYMOUS STUDENT NURSE

Today mental disorders stand among the leading cause of disease and
disability in the world. One in four (25%) people in the world will be affected by mental
or neurological disease at some point in their lives. Being 'stress' as a universal
phenomena reflecting in each aspect of lifecycle, was identified as a major cause of
attriction among all categories of people. Although stress affects the biophysical and
emotional wellbeing of the people, it varies with age, gender, mental capabilities and
environmental conditions.
In the transitional nature of student life in professional courses like nursing,
initial clinical practice is stressful and it adversely affects the emotional, physical, social
and academic functions. Even though the perception and response to stress and way of
coping differs individually, it may produce questionable behavioural patterns in student
nurses during initial clinical practice like feeling of loneliness, nervousness,
sleeplessness and worrying. Thus the student nurse faces a lot of challenges and
problems at the time of prime clinical exposure.

6.1 NEED FOR THE STUDY

Daily interactions with internal and external demand contribute to stress in

human beings who constantly are changing and adapting to their environmental stressful
events normally generate feeling of impotency and a loss of control that activate both
physiological and psychological responses. These responses are major components of
coping. An inability to cope with internal and external stressors increase feelings of
helplessness and vulnerability to illnesses.
 Over the recent years, there has been growing concern about stress in nursing.
Stress can have an effect on the individual nurse, in terms of both physical and
physiological health. As petals of a responsible and honest profession, student nurses are
more prone to stress and competencies, especially in a situation like initial clinical
practice. Some important stressors are, lack of control in relation with patients, lack of
competence, contact with sufferings, feeling helpless, emotional involvement,
communication problems and lack of adequate knowledge and skill .

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

stressors from 1930 - 1962. His research indicated that even when coping strategies are
appropriate, repeated use of a response sometimes causes pathologic changes and tissue
damage in a particular body system, organ or mucus membrane throughout the body.

A study was conducted in U.S.A to identify stressful events of first year nursing
students in the clinical setting and to determine how they cope with the stressful events.
The method used was a descriptive study and sample consisted of 104 nursing students.
The result of the study indicated that interpersonal relationship, initial experiences,
feeling helpless and most of the students utilized 'seeking social support' as category of
coping.1

During the Bachelor of Nursing programme, the Researcher himself experienced

a lot of stressful situations and fearful moments at the time of initial clinical practice.
Those eventful days were with questionable coping pattern and which adversely affects
the physical strength, emotional stability and academic activities. So far many students
and his collegues were experiencing the same situation, the researcher identified the
universality of the matter and he understood that stressors experienced by the student
nurse during initial clinical practice produces certain behavioural and emotional
responses.

Therefore based on the above life experience and ground full evidences , the
researcher took interest in exploring the stress experienced by first year BSc Nursing
students during the first clinical practice. Here the researcher tries to help student nurses
to better understand about the phenomenon of stress , coping and adaptation. The
researcher also tries to help nursing educators to understand the difficulties of nursing
students and, based on individual difference, assist them individually in order to promote
the quality of clinical practice

6.2 REVIEW OF LITERATURE

Good research generally builds upon existing knowledge. The more developed the
network linking a new study with other research is, the more of a contribution it is likely to
make. The accumulation of scientific knowledge is very much analogous to the fitting together
of a jig saw puzzle. Every piece of the puzzle, small though it may be, may help to link together
other parts of the puzzle.

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

exhaustive and systematic examination of publications relevant to the research project. Relevant
literature refers to those sources that are pertinent or highly important in providing in depth
knowledge needed to study a selected problem. The review of literature is defined as a critical
summary of research on a topic of interest often prepared to put a research problem in context or
as the basic for as implementation project.

A study was conducted in Ramban medical centre, Israel to identify nursing student`s
perceptions of stress in their initial clinical setting experience. The method adopted was
exploratory longitudinal study by using stress scale which include six subscales. The stress scale
was administered three times during the clinical experience to 46 students. The result revealed
that, there is significant difference in pre-clinical stress level and the actual level of stress in the
clinical setting.2

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

between the perception of stress, coping methods and personality traits in 280 nursing students
who had undertaken their first clinical practice. Clinical practice stress scale (CPSS) and clinical
practice physio-psycho-social scale (CPPS) were used to examine the stressors. The results of
the study showed that the most common stressors were lack of professional knowledge and skill
and taking care of patients. The study concluded that perception of stress, coping behavior and
psychosocial status are significantly related to personality characteristics including social
adaptiveness and emotional stability.3

A study was conducted in China to explore the factors affecting psychological status and
stress, coping style and social support of the nursing student`s during their initial clinical
experience. The method adopted was co-relational study in which 288 nursing students were
included and assessed by 'adopting college seniors stress scale', 'coping style questionnaire' and
'support questionnaire'. The result of the study was that, positive correlations were found
between stressful events and negative coping style, the negative correlations related to positive
coping style and social stressful factors. The study concluded that, to improve the psychological
condition of nursing students, it is very necessary to enhance the social support and encourage
them to adopt positive coping style.4

A study was conducted in Tehran to determine sources of stress and coping strategies in
nursing students studying at Iran faculty of nursing. The method adopted was descriptive cross
sectional study in which 366 students were included in the study. 'The Student Stress Survey'
and 'The adolescent coping orientation for problem experiences inventory' were used for data
collection. The result interpreted that the frequent stressors were increased class workload and
clinical exposure. The study concluded that, first year nursing students are more exposed to a
variety of stressors and establishment of a 'student support system' is necessary for them for
their effective coping.5

A study was to understand the living experience of nursing student`s coping with the
demands of their clinical practice. The method adopted was Husserlian phenomenological
approach and the data revealed several strategies that, 14 student nurses utilized to cope with the
demands of their undergraduate clinical programme. The result of the study revealed that, the
students having a strong determination to complete their course and talking things over with
family, friends and other students as a means of coping, helped them to get relief from stress and
also considered other nursing could really understand the feeling and experience of being as
'student nurse'.6

A cross sectional survey was conducted in India with 145 nursing students using General
Health Questionnaire 12 the Eysenck Personality Questionnaire and the Bell`s Adjustment
Inventory to investigate psychological distress, personality problems and coping strategies
among nursing students studying in College of Nursing, Christian Medical College Vellore. The
result of the study indicated that only 30 participants (20.7%) of the 145 students reported high
scores on the General Health Questionnaire and was significantly associated with having
neurotic personality and adjustment difficulties in different areas of functioning.7

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

perceived stressors and ways of coping during the initial component of nursing education and
the use of coping strategies by students with different ethnic background. The method adopted
was a comparative study and the data were collected from 107 nursing students enrolled in the
first clinical course. The results of the study reflects that, students utilized two problem-focused
coping strategies (problem solving and seeking social support) more frequently than two
emotion-focused coping strategies(tension reduction and avoidance coping).The study
concluded that, both Cancasian and African-American students use more problem-focused than
emotion-focused coping strategies.8

A study was conducted in Ireland to examine the stress experiences and coping abilities
of student nurses. A survey design was adopted, as method and done it in a large Dublin
teaching hospital. A questionnaire was used to assess the stressors pertaining the student nurses.
It included clinical stress, academic stress, coping and personal factors. The results indicated
that the level and intensity of academic workload, the theory practice gap and poor relationship
with clinical staff and patients leading to stressors. Student adopted short term emotion focused
coping strategies to deal with stress. The study recommended that the provision of adequate
support services from a clinical and academic section, a lecture-practitioner model of education
delivery which helps in developing student`s self awareness skills and reduction of stress.9

A study was conducted in Scotland to assess the level of affective distress, sources of
stress and coping strategies in first year student nurses. The method adopted was a comparative
study using General Health Questionnaire (30-item version), the Beck and Srivastava Stress
Inventory(BSSI) and a modified 'ways of Coping Questionnaire'. The result suggests that 50.5%
of students in Cohort 1(n=109,week 40) and 67.9% of students in Cohort 2 (n=111,week 24)
suffered significant affective distress, indicates problem with student distress around an initial
series of general/surgical and psycho-social ward placements.10

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

programme and also to determine personal and professional stressors experienced, and coping
strategies adopted by graduate nursing students. The stress management programme consisted
of practice of relaxation response, imagery, and diaphragmatic breathing and the subjects were
30 female graduate nursing students. The method adopted was experimental study in which the
students were randomly assigned to an experimental and a control group .The data collection
consisted of blood pressure measurements, weekly Palmar Sweat Prints(PSP) and a weekly
Self- Report(WSR). The result suggested that the control group reported significantly less
strategies for coping with stress than the experimental group.11

6.3 OBJECTIVES OF THE STUDY

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

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

demographic variables.

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

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

initial clinical practice.

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

clinical practice.

6.4 RESEARCH HYPOTHESIS

H0 :- There will be no significant association between the level of stress and

coping strategies among student nurses during their initial clinical
practice.

H1 :- There will be significant association between the level of stress and

coping strategies among student nurses during their initial clinical
practice.

H2 :- There will be significant association between socio-demographic variables

and level of stress and coping strategies.
6.5 OPERATIONAL DEFINITION

1. Assess : It is an activity to measure the outcome by using the perceived

stress scale (PSS) and coping behavior`s inventory (CBI) for student nurses
during initial clinical exposure.

2. Stress : It represents an internal pressure experienced by student nurses

during their initial clinical practice due to unpleasant emotional and fearful
situations.

3. Coping strategies : Coping strategies refers to the specific efforts both

behavioral and psychological, that student nurses employ to master, tolerate,
reduce or minimize stressful clinical events.

4.Student nurses : The students studying first year Bachelor of Nursing

programme in N.D.R.K College of nursing Hassan.

5. Initial clinical practice : It is the first exposure of the BSc nursing

students to the clinical area in the course of study as a part of clinical
requirements.

6.6 ASSUMPTIONS

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

2. The level of coping is less in first year student nurses.

6.7 DELIMITATIONS OF THE STUDY

1. The data collection period will be limited to 4-6 weeks.

2. Sample size is limited to 60 student nurses.
3. The study is limited only to student nurses studying in 1st year BSc nursing at
N.D.R.K College of Nursing, Hassan.

6.8 SIGNIFICANCE OF THE STUDY

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

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

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

7. MATERIALS AND METHODS OF STUDY

7.1 SOURCES OF DATA

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

7.2 RESEARCH DESIGN AND CONCEPTUAL

FRAMEWORK

Descriptive research design is planned for the study.

The study is based on Lazarus model of stress.

7.3 METHOD OF DATA COLLECTION

PART A : Socio demographic profile.

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

Stress Response scale (Standardized tool used by Thippe Swamy)

Coping Behavior Inventory (Standardized tool)

SAMPLING PROCEDURES

POPULATION :

Target population: First year BSc nursing students.

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

SAMPLE :

CRITERIA FOR SAMPLE SELECTION

Inclusion Criteria:

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

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

Exclusion Criteria:

1. Those who are not willing to participate.

2. Those who are not available at the time of study.

SAMPLE SIZE :

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

SAMPLING TECHNIQUE :

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

STUDY SETTING

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

10 % of population is planned for the pilot study.

VARIABLES

Independent variable : Level of stress and coping strategies.

Dependent variable : Student nurses in first year BSc nursing.

Socio demographic variable.

PLAN FOR DATA ANALYSIS

Descriptive statistics:- Mean and Standard deviation.

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

7.4. ETHICAL CLEARANCE

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

Yes.

2. Has the consent been taken from the sample?

Yes.

8. LIST OF REFERENCES

1. Mahat G et al, "Stress and coping of first year Nepalese students in clinical
settings", Journal of Nursing Education.1996 April; 35(4) : 163 - 9.

2. Admi H, "Nursing student`s stress during the initial clinical experience", Journal of nursing
education, 1997 September; 36(7) : 323 - 7.
3. Hwang S L, Sheu S, "Relationships among stress, physio-psycho-social status,
Coping behaviours and personality traits of Nursing students during first time clinical
Practice.", Journal in Chinese. 2001 January; 9(3) : 233 - 46.

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

students against stress, coping way and social support", Nurses education today,
2008 August; 38(7) : 89 -19.

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

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

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

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

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

adjustment amoung nursing students." Journal of Nursing Education Today."
2007 August; 27(6) : 597 - 601.

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

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

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

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

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

11. Macini J, Clegg R, "Graduate nursing students stress", Journal of nursing education,
1983 October, 22(8) : 329 - 34.

12. www.pubmed.com
OTHER REFERENCES

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

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

2. Chiriboga D A, Jenkins G, Bailey J, "Stress and coping among student nurse",Test of

analytic model, Nursing Research, 1999 January; 294 - 299.

3. Sheu S, Lin H S, "Perceived stress and physio-psycho-social status of nursing students

during their initial period of clinical practice", Journal of nursing students, 2002 February;
39(2) : 165 - 75
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4. Fortinash H W, "Psychiatric Mental Health Nursing." 4th Edition, Mosby
Publishers, Pp : 610 - 612

5. Basavanthappa B T, "Nursing Research," 1st Edition, Jaypee brothers Medical Publishers

Pvt limited, New Delhi, 2005; Pp :49 - 50.

6. Polit and Hungler, "Nursing Research : principles and methods", 6th Edition,
Lippincott Publishers, 1999; Pp : 144.

7. www.google.com