Nurse Media Journal of Nursing e-ISSN: 2406-8799, p-ISSN: 2087-7811 https://medianers.
:1-15.
April 2024 https://doi.
org/10.
14710/nmjn.
ORIGINAL RESEARCH
Stressors and Coping Strategies as Perceived among Nursing Students during Related Learning Experience (RLE) Geraldine S.
Ridad1.
Haniya S.
Angintaopan1.
Princess Haniefa Mae K.
Ayunan1.
Saipoden M.
Manalocon1 1College of Health Sciences.
Mindanao State University (MSU) - Iligan Institute of Technology.
Iligan City.
Philippines Article Info Abstract Article History:
Received: 29 April 2023 Revised: 13 March 2024 Accepted: 19 March 2024 Online: 30 April 2024 Keywords: Curriculum.
nursing students.
Corresponding Author:
Geraldine S.
Ridad College of Health Sciences.
Mindanao State University (MSU) - Iligan Institute of Technology.
Iligan City.
Philippines Email:
ridad@g.
Background: Stress in relation to academic studies is identified to be one of the reasons behind suicide cases in higher education institutions around the world.
Locally, there is none to less studies that explored this area among nursing students.
As stress is inevitable in nursing studentsAo Related Learning Experience (RLE), recognizing the stressors that affect their quality of RLE is necessary.
Purpose: This study aimed to investigate the stressors and coping strategies that nursing students commonly use in managing stress during their RLE and their relationship to each other.
Methods: A descriptive correlational research design with total enumeration sampling was employed.
A pilot-tested questionnaire was used to gather data from 191 junior and senior nursing students from two nursing schools in Iligan City.
Weighted mean, standard deviation, percentages, and Spearman rho were used to analyze the data.
Results: The findings show that the "Clinical Instructor" (Mean=3.
is perceived to cause higher stress among all the intrapersonal and interpersonal stressors Students highly utilize both intrapersonal (Self-Concept Mean=3.
and interpersonal strategies (Role Function Mean=4.
Interdependence Mean=3.
to cope with stress.
When studentsAo clinical Auskill confusionAy increases, they tend to work less with others .
=-0.
259, p=0.
When Austaff nursesAy cause them less stress, their use of positive Auself-conceptAy decreases as well .
=0.
152, p=0.
Furthermore, when students are stressed with their AuDuty-mates,Ay they rely more on AuphysiologicalAy coping mechanisms .
=0.
160, p=0.
When their Auclinical instructorAy causes them stress, they cope less with AuphysiologicalAy .
=-0.
p=0.
and AuinterdependenceAy strategies .
=-0.
317, p=0.
Conclusion: Among all the stressors, clinical instructor causes more stress to the The studentsAo perceived stressors affect their effective use of intra and interpersonal coping strategies.
Nurse educators, nursing schools and regulating bodies can consider these results in designing a holistic curriculum and helping students manage stress healthily.
How to cite: Ridad.
Angintaopan.
Ayunan.
, & Manalocon.
Stressors and coping strategies as perceived among nursing students during related learning experience (RLE).
Nurse Media Journal of Nursing, 14.
, 1-15.
https://doi.
org/10.
14710/nmjn.
Copyright A 2024 by the Authors.
Published by Department of Nursing.
Faculty of Medicine.
Universitas Diponegoro.
This is an open access article under the CC BY-SA License .
ttp://creativecommons.
org/licenses/by-sa/4.
0/).
Introduction The rate and level of stress and depression among students in different academic fields is alarming (El Ansari et al.
, 2014.
Monteiro et al.
, 2.
For the past two years, there were approximately three completed suicide cases in a higher education institution in Southern Philippines, with one of the primary causes identified to be stress in relation to their academic studies (Mindanao State University-Iligan Institute of Technology Clinic, 2.
At present.
World Health Organization (WHO) claims that more than 700,000 adolescents die to suicide For many years, it has become a serious public health concern (World Health Organization, 2.
In India, academic stress is identified to be one of the reasons behind suicide cases among students in higher education institutions (Hindustan Times, 2.
In fact, many studies associate stress to increased adolescentsAo risk for suicidal behavior.
In the presence of stress, factors that are biologic and cognitive in nature, including personality factors, such as Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 2 being perfectionist, increase suicidal ideation and behavior (OAoConnor et al.
, 2020.
Stewart et al.
Stress is defined as a particular relationship between the person and the environment appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being (Hutmacher, 2.
However, it may be defined differently by people depending on the situation they are in (Fink, 2.
In the life of nursing students, juggling academic classes, clinical and community duties, and other responsibilities or workload, stress is inevitable.
In fact, globally, nursing is considered the most challenging and stress-provoking among all other professions (Ching et al.
, 2020.
Rayan, 2.
Many studies claimed that nursing students endure more stress from various sources than other non-nursing students (Ching et al.
, 2020.
Tharani et , 2.
Several studies identified various sources of stress for students under the nursing program (Alghamdi et al.
, 2019.
Lavoie-Tremblay et al.
, 2022.
Milton-Wildey et al.
, 2.
They are summarized into academic, clinical, social, and personal stressors.
Some of them claimed that academic stressors cause higher stress than all other sources which involves large bulk of workload, demanding schedules for different course subjects, exhausting course requirements that entail long hours of studying (Alghamdi et al.
, 2019.
Lavoie-Tremblay et al.
, 2022.
MiltonWildey et al.
, 2.
Other studies include the lack of time for rest and leisure, tests, or exams in varying mode, low or failing grades, meeting deadlines and expectations (Chaabane et al.
, 2021.
McCarthy et al.
, 2.
On the contrary, several studies also claimed that studentsAo clinical training is the highest source of stress among students (Admi et al.
, 2018.
Ching et al.
, 2020.
Aljohani et al.
, 2021.
Chaabane et al.
, 2.
The studentsAo clinical training or Related Learning Experience (RLE) is the core component of nursing education, as it is basically skills or practice-based, which makes nursing unique among all other professions.
In the Philippines, according to the Commission on Higher Education Memorandum Order No.
14, 2009, a nursing student is required to complete 2,346 hours of RLE.
This is composed of teaching-learning opportunities designed to develop the competencies of students utilizing processes in various health situations (Commission on Higher Education, 2.
However, this requirement can be stressful to the students.
Their clinical training might even impact how they perceive stress on their future nursing career (Aljohani et , 2021.
Chaabane et al.
, 2021.
Lavoie-Tremblay et al.
, 2.
Clinical stressors include lack of confidence in oneAos skills, unfamiliarity with the clinical setting, technology or equipment, fear of committing errors, patient care itself and harming the patients (Admi et al.
, 2018.
Aljohani et al.
Chaabane et al.
, 2021.
Ching et al.
, 2.
Other studies include witnessing death and suffering of patients, negative relationships with clinical instructor and hospital staff, disconnection of theory from actual clinical practice, as well as the noise, smell, and crowdedness of hospitals (AlAaGamal et al.
, 2018.
Bam et al.
, 2.
Regrettably, stress can have numerous negative effects on student nurses.
Stress can affect health and memory, decrease concentration or ability to focus and motivation leading to poor academic performance.
Successively, decreased academic performance can lead to higher stress levels, catching the student in an unhealthy cycle of distress.
It adversely affects the studentsAo wellbeing and quality of life (Ching et al.
, 2020.
Durgun Ozan et al.
, 2020.
Lavoie-Tremblay et al.
Ribeiro et al.
, 2.
As increased stress in the clinical area affects memory and attention, it also increases the risk of committing errors especially in drug administration, as well as decreases oneAos capacity to promptly recognize and address critical needs of the patients (Alvarez et al.
, 2.
In general, students cannot eradicate stress, but they can reduce it, and so coping strategies is an element that helps to preserve their psychosocial well-being.
It is the deliberate use of cognitive and behavioral strategies to manage internal or external demands or any stressful It aimed to preserve mental health by overcoming stress instead of avoiding it.
These coping strategies could either be helpful or less helpful.
It could bring out good results when used successfully, and psychological distress when used unsuccessfully (Lavoie-Tremblay et al.
, 2022.
Mahomed et al.
, 2.
Indeed, stress is recognized to affect the physical and psychological well-being and quality of life of nursing students.
Current studies that explore stressors among nursing students were of international origin which involve diverse social, cultural, and environmental factors (Aljohani et , 2021.
Alvarez et al.
, 2019.
Cheng et al.
, 2.
Internationally, a lot of studies (Admi et al.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 3 Aedh et al.
, 2015.
Alghamdi et al.
, 2019.
Bam et al.
, 2014.
Ching et al.
, 2020.
Hirsch et al.
Ismaile, 2017.
Lavoie-Tremblay et al.
, 2022.
Msiska et al.
, 2019.
Shdaifat et al.
, 2018.
Toqan et al.
, 2.
and systematic reviews (Chaabane et al.
, 2021.
Labrague et al.
, 2017.
McCarthy et al.
Ribeiro et al.
, 2.
explore the various sources and levels of stress and coping mechanisms among nursing students in the many facets of their nursing education, especially in their academic and clinical trainings.
Locally, only one study (Labrague et al.
, 2.
was found that explored stressors and coping strategies among 153 nursing students in the Northern Philippines but none in the Southern Philippines.
Two other studies (Labrague, 2021.
Labrague, 2.
from the same author explore stress and nursing studentsAo coping skills during the Covid-19 pandemic in the Central Philippines.
Moreover, most of the studies (Monteiro et al.
, 2014.
Rayan, 2.
explored the influence of various factors such as demographics .
ge, gender, and emotio.
, mindfulness and self-efficacy on studentsAo coping and stress, but none explores how stressors influence their utilization of coping strategies.
Lastly, there is an increased need and urgency to conduct the study, as stress was being identified as one of the causes of completed suicides in a university in Southern Philippines.
Hence, this study aimed to investigate the stressors and coping strategies that nursing students commonly used during their RLE and their relationship to each other.
Methods Research design This study used a descriptive correlational research design to describe the common clinical stressors of the selected nursing students during their RLE and their coping strategies.
It is deemed to be the most appropriate design (Polit & Beck, 2.
to determine any significant relationship between the independent variable, stressors and the dependent, studentsAo coping Setting and samples This study employed total enumeration sampling with a total of one hundred ninety-one .
junior and senior nursing students.
Two out of the four nursing schools in Iligan City.
Southern Philippines, consented to participate in the study.
One school is a government institution, while the other is a private one.
The names of the participating schools would not be divulged to uphold confidentiality as per their request.
The return rate was 100% from the two selected schools.
The transition of the new educational system which is the K-12 curriculum resulted to the lack of second year college students.
Thus, the selection of the respondents was delimited to the thirdand fourth-year nursing students who were known to already have clinical exposures.
They were officially enrolled during the second semester of school year 2019.
These nursing students were exposed to related learning experience for an estimated 153 hours for the whole semester having four rotations each for three weeks and eight hours per day of duty.
They were also at least 18 years old.
First year students were excluded from the study.
Students who did not complete at least four clinical rotations during the second semester of school year 2019 were also excluded.
Data collection The researchers categorized the stressors into interpersonal and intrapersonal based on Betty NeumanAos System Model (McEwen & Wills, 2.
Coping strategies were also categorized into self-concept, physiological, role function, and interdependence according to RoyAos Adaptation Model (Roy, 2.
However, existing research instruments do not gather the data necessary to address the objectives of the study, which are the stressors and coping strategies of nursing students during RLE based on the two models.
Hence, a researcher-made questionnaire, a Likert scale type questionnaire was used.
Questions were constructed from related literatures, various books, journals, and personal experience of the authors themselves.
The crafted instrument was checked by seven experts in the field for content validity.
Selected subject matter experts (SME.
in the field of study were three guidance counsellors and four nurses.
The three guidance counselors have worked in the university for at least 15 years.
They have conducted several studies related to stress and coping strategies of university students in general.
Two nurses were Clinical Instructors and two were staff nurses who have also worked for at least 15 years in their respective All of them have conducted studies related to stress and coping.
The seven SMEs evaluated each item of the constructed questionnaire with content validity ratio that ranges from 0.
84 to 1.
Five items that did not reach at least 0.
99 or above the critical value were removed.
The final Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 4 questionnaire has 55 items with two parts: the first part is the identified clinical stressors, which is divided into two subsections: interpersonal and intrapersonal.
and the second part is the identified coping strategies, which is also divided in another two subsections: interpersonal and The studentsAo perceived interpersonal and intrapersonal stressors and effective coping strategies were determined using a 5-point Likert Scale.
1-Never, 2-Almost Never, 3Sometimes, 4-Most of the time, 5-Always.
The respondentsAo answers relating to their perceptions regarding the stressors were scored as: Highly Stressor .
Quite a bit of Stressor .
Moderately Stressor .
Some Stressor .
, and Low Stressor .
Whereas responses regarding the coping strategies utilized by the respondents were interpreted as: Very High Coping Strategy .
High Coping Strategy .
Moderate Coping Strategy .
Low Coping Strategy .
Poor Coping Strategy .
The instrument was also pilot tested to determine the questionnaireAos reliability.
The CronbachAos Alpha of .
854 with 35 items for the clinical stressors and .
840 with 20 items for coping strategies indicated that the instrument had high reliability.
Demographic data on age and sex were also obtained using the instrument.
Data were gathered for three months from February 18 to May 18.
Data analysis The researchers tallied, organized, and analyzed the actual data from the respondents using the SPSS software version 19.
Weighted mean, standard deviation, and percentages were used to describe the clinical stressors and coping strategies of the selected nursing students.
Spearman correlation coefficient was used to determine the degree of correlation between the two variables, the stressors, and coping strategies.
P-value was used to determine the significance of relationships between the independent variable and the dependent variable.
Ethical considerations Permission was sought from the College of Nursing Research Ethics Committee to conduct the study.
This is to ensure that the study was conducted as thoroughly and ethically as possible.
This study was granted ethical clearance and approved by the College of Nursing Research Ethics Committee.
MSU-IIT .
/16/2.
Proper communication and coordination were done with and through the Deans of the selected Nursing Schools in Iligan City, the Clinical Coordinators, and College Evaluators.
After the study was approved, the respondents were informed about the study in complete detail before obtaining their consent.
They were assured that they would have full confidentiality throughout the study and data obtained would not be disclosed elsewhere, except for the intended study and certainly would not be used against them.
The respondents were provided an opportunity and enough time to ask questions, which have been answered to the best of the researchersAo ability.
Therefore, the individuals have not been forced to give consent.
It was freely given by the students who volunteered to participate in the study.
Results Demographic characteristics of the respondents A total of 191 nursing students completed the questionnaire with 100% return rate.
portrayed on Table 1, the majority of them are females, which accounts 76%, while males comprise only 24%.
The respondents were at least 19 years of age.
more than half .
%) of them were 2122 years old while the rest .
%) were 19-20 years old.
Table 1.
Frequency distribution of the respondents according to age and gender Characteristics Gender Female Male Age .
Frequency .
Percentage (%) Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 5 Perceived intrapersonal stressors of nursing students during RLE Table 2 portrays the intrapersonal stressors that commonly caused or increased nursing studentsAo stress level during their RLE subcategorized into knowledge insufficiency, fear of clinical area, and skills confusion.
As depicted in the table, intrapersonal stressors are considered by the respondents as some stressor or rarely caused them stress.
Most students revealed that being not certain with the protocols in the clinical area and the etiology and disease condition of the patient causes them some stress under Knowledge Insufficiency category.
Under Fear of the Clinical Area, the handwritings in the patientAos chart that are difficult to read and understand give them moderate stress.
Being unable to systematically perform a certain procedure as presented in the book or following the procedures manual also give them moderate stress, under Skills Confusion.
Table 2.
Perceived intrapersonal stressors of nursing students during RLE Stressors Intrapersonal Knowledge Insufficiency Not certain with the protocols in the clinical area.
Not certain with the procedures IAoll be performing to my patient.
Not certain with the etiology and disease condition of my patient.
Not certain with the drugs of my patient Not certain with my general and specific objectives before going to duty Fear of Clinical Area Worried with certain protocols of the hospital Worried with the location of equipment and drugs in the clinical Worried with the location of the respective wards or departments of the hospital Worried that the institution is not conducive for learning.
Worried that the handwritings in the patientAos chart are difficult to read and understand Skills Confusion Not able to systematically perform a certain procedure as presented in the book or manual.
Not able to follow the prioritization of the problems identified in my nursing care plans.
Not able to apply and perform all the interventions listed on my nursing care plans.
Not able to check and evaluate my patientAos condition adequately after doing nursing interventions and medications are given.
Not able to anticipate the need of my patient in accordance with his/her situation Mean
(SD)
Interpretation Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Moderately Stressor Some Stressor Moderately Stressor Some Stressor Some Stressor Some Stressor Some Stressor Perceived interpersonal stressors of nursing students during RLE Table 3 shows the interpersonal stressors that caused or increased studentsAo stress level during their clinical exposure subdivided into staff nurses, duty-mates, clinical instructor, patients, and significant other/s.
Similar with intrapersonal, these interpersonal stressors caused students some stress.
It can also be noted that the Clinical Instructor factor is considered a moderately stressor, which causes students higher stress among all the other identified stressors with the highest mean of 3.
One of the circumstances that very often gives them stress is when their clinical instructor converse or scolds them in a loud tone of voice.
Under Staff Nurses factor, students identified that situations like when the staff nurses offer them an opportunity to perform a procedure without their clinical instructor knowing it give them moderate stress.
Likewise, unable to answer or satisfy patient and/ or their SOs on any of their queries caused moderate Perceived intrapersonal and interpersonal coping strategies during RLE Table 4 depicts the coping strategies that the respondents commonly used to manage stress during their clinical exposures, categorized into intra- and interpersonal.
Students recognized Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 6 coping strategies involving Self-Concept.
Physiological care.
Role Function, and Interdependence to be effective and helpful in managing and dealing stress during their RLE.
They very often employ all the identified strategies or consider them High Coping strategy, except for Physiological which they only consider a Moderate Coping strategy.
Table 3.
Perceived interpersonal stressors of nursing students during RLE Stressors Interpersonal Staff Nurses To establish rapport to the staff nurses To approach the staff nurses When my concerns and queries are not entertained by the staff When I do not know who the staff nurses on-duty during my shift are When the nurses offer me an opportunity to perform a procedure without my clinical instructor knowing it Duty-Mates To establish rapport with my duty mates To coordinate and/or collaborate with my duty mates.
When I do not know who my duty mates are When I cannot accomplish any task.
with my duty mates When I cannot gain knowledge and skills from my duty mates Clinical Instructor When my clinical instructor is present during a procedure I am When my clinical instructor converse with me in a loud tone of When my clinical instructor has high expectation of me When I cannot gain knowledge and skills from my clinical To approach my clinical instructor Patients and significant other/s To build rapport with my patients and their significant others To approach my patient.
and/or their significant other.
If whether my patient and their significant others accept me as their primary care provider When I am not able to provide comfort to my patient.
and/or their significant other.
just when they needed most When I am not able to satisfy the queries related to their situation by the patient.
and/or significant other.
Mean
(SD)
Interpretation Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Moderately Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Moderately Stressor Moderately Stressor Moderately Stressor Moderately Stressor Moderately Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Some Stressor Moderately Stressor Most of the students prefer to take a break on their vacant time during RLE to manage stress.
They expressed that praying before starting their day and sleeping, as well as crying when they feel tired or burned-out from stress highly helped them intra-personally.
They are less likely to take vitamins and other supplements, as well as do not have enough time for exercise as other means to manage stress.
In terms of interpersonal coping, most of them conveyed .
listening attentively during hospital orientation, .
reviewing the concepts and practice the procedures learned before reporting to duty, and .
expressing or sharing their concerns to their families, friends, and duty-mates to be of great help to them.
Relationship between stressors and coping strategies .
oth intrapersonal and As illustrated on Table 5, among all the Intrapersonal stressors only Skill Confusion has significant relationship with interdependence under Interpersonal Coping strategy, since its pvalue of 0.
000 is less than 0.
01 level of significance.
Furthermore, the SpearmanAos correlation coefficient r of -0.
259 indicates a low degree of correlation.
This means a significant negative relationship between Skill Confusion and Interdependence of Interpersonal coping strategy.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 7 During student nursesAo RLE, increased Skill confusion .
nterpersonal stresso.
lead to decreased Interdependence .
nterpersonal copin.
Table 4.
Perceived intrapersonal and interpersonal coping strategies of nursing students during RLE Coping Strategies Intrapersonal Self-Concept Pray before starting my day and before going to sleep.
Engage in recreational activities.
Cry whenever I feel burned out/tired due to stress.
Self-talking, reinforcing positive feedback.
Self-awareness exercises and over-come my weaknesses by means of meditation.
Physiological Sleep adequately and take nap.
daily Take a break during my vacant time Eat my meals three times a day and eat snacks Take vitamin supplements every day Do exercise at least 30 minutes a day Interpersonal Role Function Collaborate with my duty mates and refer endorsements Listen attentively during hospital orientation.
Review the concepts and practice the procedures learned Before reporting duty.
Formulate a plan of care for my patient and anticipate any possible events during my care.
Evaluate patientAos condition after the nursing interventions and medication administration Interdependence Express/ share my concerns to my duty mates Express/ share my concerns to my Clinical Instructor Express/ share my concerns to the staff nurses Express/ share my concerns to my friends Express/share my concerns to my family Mean Interpretation High Coping Strategy High Coping Strategy High Coping Strategy High Coping Strategy High Coping Strategy High Coping Strategy Moderate Coping Strategy High Coping Strategy High Coping Strategy High Coping Strategy Moderate Coping Strategy Moderate Coping Strategy High Coping Strategy High Coping Strategy Very High Coping Strategy High Coping Strategy High Coping Strategy High Coping Strategy High Coping Strategy High Coping Strategy Moderate Coping Strategy Moderate Coping Strategy High Coping Strategy High Coping Strategy Table 5 also summarizes the SpearmanAos Correlation test results between Interpersonal StressorsAo variables on Staff Nurses.
Duty-Mates.
Clinical Instructor and Patients and Significant others, and the respondentsAo identified Coping Strategies.
The results portray that in all the factors under interpersonal stressor.
Staff Nurses has a significant relationship with Self-Concept .
ntrapersonal copin.
with r=0.
152 and p=.
035 tested at 0.
05 confidence level.
This implies a weak positive correlation between staff nurses and self-concept.
Also.
Duty-mates with r=0.
160 and p=0.
027 tested at 0.
05 confidence level and Clinical Instructor with r=-0.
237 and p=0.
001 tested at 0.
01 confidence level, were both significantly correlated with Physiological coping strategy .
This indicates that Duty-mates, an interpersonal stressor, is positively correlated to Physiological coping strategy, an intrapersonal coping, while, the interpersonal stressor.
Clinical Instructor, has a negative relationship with Physiological coping strategy of nursing students.
Clinical Instructor also has a significant moderate negative correlation with Interdependence, an interpersonal coping, with r=-0.
317 and p=.
000 tested at 0.
01 confidence level, as perceived by the respondents during their RLE duty in the hospitals.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 8 Table 5.
Relationship between stressors and coping strategies .
oth intrapersonal and Stressors Intrapersonal Knowledge Insufficiency Correlation Coefficient Sig.
-taile.
Fear of Clinical Area Correlation Coefficient Sig.
-taile.
Skill Confusion Correlation Coefficient Sig.
-taile.
Interpersonal Staff Nurses Correlation Coefficient Sig.
-taile.
Duty-Mates Correlation Coefficient Sig.
-taile.
Clinical Instructor Correlation Coefficient Sig.
-taile.
Patients and Correlation Significant Others Coefficient Sig.
-taile.
Self-Concept Coping Strategies Role Physiological Function Interdependence *Correlation is significant at the 0.
01 level .
-taile.
**Correlation is significant at the 0.
05 level .
-taile.
Discussion This study aimed to investigate the stressors and coping strategies that nursing students commonly used in managing stress and their relationship to each other.
It has been portrayed that all the identified intrapersonal and interpersonal stressors were perceived to be Ausome stressorAy by the respondents, except for the interpersonal stressor Clinical Instructor, which is perceived to be Aumoderately stressorAy.
This implies that this interpersonal stressor caused more stress than all the other stressors identified by nursing students.
Similar findings of Shdaifat et al.
point out that nursing students experience a moderate level of stress because of their teacher and nursing staff, peers, daily life, and taking care of patients.
Moreover, a study in the Arab American University yielded the same results that identify teachers and nursing staff as the main stressors of nursing students in their first clinical training (Toqan et al.
, 2.
phenomenological study among Malawian nursing students revealed that a lecturer who interacts in a Aupolicing mannerAy induces more stress (Msiska et al.
, 2.
These students shared that the intimidating and unfriendly way of supervising them arouses stress, which causes them to commit mistakes more.
They feel threatened whenever their teacher approach them and starts asking questions or shouts at them when doing procedures or committing errors.
Because of the way their lecturers approach them, they feel nervous and avoids them.
This poor lecturer-student relationship affects the clinical experience and learning of the students (Msiska et al.
, 2.
Students who experienced stress in the practice settings because of their teachers felt embarrassed, belittled, and stupid (Al-Qerem et al.
, 2.
The instructorAos role in assisting student nurses to reach professional excellence is very In the same study conducted at Shiraz University of Medical Sciences (Shiraz.
Ira.
most of the students had the perception that their instructors have a more evaluative role than a teaching role.
The clinical instructor or mentors can play an important role in student nurses' selfconfidence, promote role socialization, and encourage independence which leads to clinical A supportive and socializing role was identified by the students as the recommended function of a mentor.
Nursing faculties can also help meet student needs by acknowledging their Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 9 complaints of heavy workloads and extra assignments, offering supportive services.
The results of this study highlight the necessity of building a more connected, healthy, and positive teacherlearner relationship especially in the clinical setting.
This entails the need for continuing professional education among educators that enhances their relational competence as well as effective supervision of students in the clinical practice setting (Msiska et al.
, 2.
As to the utilization of coping strategies, results revealed a AuHigh Coping StrategyAy utilization of both the intrapersonal and interpersonal strategies, except for Physiological, an intrapersonal coping strategy.
According to Roy .
Physiological coping strategy pertains to the way a person responds as a physical being to the stimuli from the environment.
The goal of this coping strategy is primarily geared towards physiological integrity.
It basically means that one must attend to his physical bodily needs to establish individual coping against stressors.
Students may be able to benefit from this coping strategy through activities that facilitate proper physiological functioning such as eating healthy foods and instituting adequate rest and sleep patterns.
Similar results were observed in the study of Toqan et al.
, that revealed a combination of problemsolving and avoidance, both of which are interpersonal, as well as optimism which is an intrapersonal coping strategy were occasionally utilized by students to manage stressors.
While transference behaviors like feasting a deep sleep, relaxing by watching TV, taking a shower, exercise, etc.
have low impact on their stressors.
However, a study among nursing students in Najran University in Saudi Arabia yielded a contradicting result such that transference or shifting stress to leisure activities like sleeping, listening to music, watching movies, or sports was the most frequently employed coping strategy (Aedh et al.
, 2.
Furthermore, among all the coping strategies identified in this study, role function was found to be utilized the most.
It is defined by Roy .
as the primary, secondary, or tertiary roles that a person performs in the society.
Being aware of oneAos role enables an individual to accomplish tasks effectively.
Students establish role function coping by being thoroughly competent in their role as a care provider.
Attentively listening to nursing endorsements, participating in hospital orientations, reviewing concepts and procedures before going to duties, and the like increase studentAos sense of preparedness and confidence to attend clinical duties and do their role as care Bodys-Cupak et al.
affirms that students feel less stressed when they are more confident and better prepared to perform procedures to their patients.
Several studies (Ab Latif & Nor, 2019.
Baluwa et al.
, 2021.
Nebhinani et al.
, 2.
yield somewhat similar results that active coping skills and planning are the commonly used coping strategies among nursing A qualitative study also claims that actively confronting stressful situations by developing oneAos professional competence, reflection, observation, and learning from the experience of others, and previous mistakes helped them control stress (Rafati et al.
, 2.
It was also disclosed in this study that among all the Intrapersonal stressors.
Skill confusion has significant inverse relationship with interdependence under Interpersonal Coping strategy.
Skill confusion can be rooted down from the lack of knowledge and professional abilities coupled with the responsibilities of patient care.
A study in Saudi Arabia expressed that the lack of knowledge and skill proficiency is perceived to be the topmost stressor by students.
This happens when they are not familiar with the medical terms, patient history, diagnosis, and treatment regimen (Aedh et al.
, 2.
The students experience more stress when they lack confidence and do not feel ready or prepared to perform a procedure towards their patients (Bodys-Cupak et al.
Interdependence as defined by Callista Roy .
, pertains to the coping strategy from forming close relationship to foster collaboration and coordination.
The results of this study imply that in the clinical setting, when the student nurse has increased stress from Skill confusion .
nterpersonal stresso.
it can lead to decreased utilization of Interdependence .
nterpersonal copin.
This means that when students are stressed due to poor performance during RLE, wrong intervention, or was not able to prioritize and implement nursing care plans accordingly, they work and talk less with others.
On another note, when the Interdependence coping strategy is increased, it promotes collaboration and therefore decreases the Skill confusion as a stressor.
This means that they collaborate and talk more with their others, their duty-mates, and assigned clinical instructor when students perform well and are less A longitudinal study among nursing students in Hong Kong shared similar findings.
The lack of knowledge and lost confidence causes them frustrations, self-doubt, and heightened The overwhelming stress from the clinical placement keeps them from working effectively with their peers.
This often caused them to struggle in keeping up with their fellow Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 10 duty-mates (Cheng et al.
, 2.
However, these are contrary to the results of a cross-sectional study in Kelantan.
Malaysia which found significant positive correlation of Austress from lack of professional knowledge and skills and ward staffAy with emotional and instrumental supports as coping (Ab Latif & Nor, 2.
The contrasting results could be attributed to the differing demographics of the sample of this study and that of the study in Malaysia.
Moreover, the instruments and methodologies used in the two studies were also different.
This could be explored more on further studies.
Also, in all the factors under interpersonal stressor.
Staff Nurses has a positive significant relationship with studentsAo Self-Concept under intrapersonal coping.
When the nursing student has a higher self-concept, it can be said that he or she will be likely to perform better.
as he or she perceives himself or herself as a person who is able to provide quality care to the patients in the hospital and able to perform certain procedures and tasks (Duraku & Hoxha, 2.
Additionally, when the staff nurses have higher confidence on students performing procedures on patient care, this causes decreased stress on students.
Decreased stress implies a lesser need for the selfconcept coping strategy, since the students will be able to carry out responsibilities given to them by the staff nurses without fear or anxiety.
The results somehow correspond with the study of Grobecker .
, that claims that good relationships with the healthcare team, especially the staff nurses, and studentsAo sense of belongingness in the clinical environment positively impacts studentsAo self-concept, motivation, confidence, leading to a maximized learning.
On the other hand, an unwelcoming or intimidating practice setting caused by an unapproachable, ignoring nursing staff can decrease studentsAo sense of belongingness.
This is strongly associated with increased distress among nursing students (Admi et al.
, 2018.
Labrague et al.
, 2017.
McCloughen et al.
, 2.
Staff nurses are an integral piece of the nursing studentsAo education process.
Due to the nursing shortage, fewer staff is available to assist in the educational process.
Faculty depends on staff nurses to assist them in clinical education of nursing students and often staff nurses are not given any direction on how to provide this assistance to both faculty and nursing students (Gorton, & Foss, 2.
Establishing proper communication to staff nurses aids the student nurses to perform properly in rendering care to the patient.
The result of this study is somewhat in congruence with the study of Ismaile .
, as well as the study of AlAaZayyat & AlAaGamal .
, that staff nurses cause high level of stress among undergraduate student nurses during their clinical exposures.
The lack of support and uncooperative nursing staff are the commonly identified great source of stress among the student nurses.
They highlighted the need to employ appropriate strategies to improve this student-staff nurse relationship such as improving clear communication between the nursing school and affiliated hospital on studentsAo preceptorship programs especially before the start of the studentsAo exposure, as well as an integral part of the clinical instructors in the process.
As to the duty-mates stressor and physiological coping strategy having a positive significant relationship, when the stressor, duty mates, is increased, there will be a higher need for the physiologic coping strategies.
For the student nurse to combat the stress brought about by their duty mates, the student nurses usually attend to his or her physical bodily needs.
This facilitates proper physiological functioning.
by this the student nurses can perform their duties well, with the ample hours of rest, balanced diet, and exercise.
A healthy student nurse can provide their competent skills during their duties.
The results of this study imply that an increased stressor on duty-mates necessitates an increased physiologic coping strategy.
Several studies also report that problems in communication and interactions among student nurses and their groupmates during their supervised clinical or practical trainings to be a significant root of academic stress (Hirsch et al.
, 2.
Lastly, the clinical instructor as a stressor has a negative significant relationship with both the physiological and interdependence coping strategies.
During the clinical exposure of the student nurses, the clinical instructor has their own expectations and requirements to be complied with, therefore causes increased stress to the students on duty.
In this study, the more the Clinical Instructor becomes a stressor, the lesser is the utilization of physiologic coping strategy by the student nurses.
This is because the time that should be spent for eating, sleeping, taking a break and the like will be more likely spent on completing requirements and improving patient care to meet the instructorAos expectations (Guro & Buenavidez, 2.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 11 When the interpersonal stressor, clinical instructors, causes students more stress, they utilize Interdependence coping strategy less.
This means that they share concerns less with each other when they are stressed by their instructor.
When the instructorAos approach or expectation/s cause them stress or pressure, it can lead them to focus their full attention on their individual patients to meet deadlines and these expectations.
When the stress brought upon by the Clinical Instructor increases, the team dynamics is also affected as well as the ability of the group to perform their nursing responsibilities efficiently and effectively as a team (Delawala, 2.
Various studies affirm these results such that over dedication to academic studies and inefficient management of stress adversely affect their quality of life, social and family relationships (Quah, 2.
It also harmfully impacts the student nursesAo sleep, mood, affinity, and ability to perform some physical exercise, their over-all physiological and mental health (Hirsch et al.
, 2.
Ismaile .
also attributes the stress brought about by their teachers to unclear or undefined expectations from both sides.
Setting of clear learning objectives and outcomes for each clinical duties will help resolve and prevent instructors from having unrealistic and unconstructive expectations from their students.
Implications and limitations The findings of this study imply the need for the nursing educators to reflect on what role and attitude they have when supervising students during their RLE, whether more of the strict, nonapproachable, non-accommodating or the other way around.
A balance of imposing appropriate discipline in the right tone and timing in the clinical area and the provision of the much-needed support, and a clinical environment conducive for learning will better help students manage stress during the RLE.
As stress is known to have various impact on the academic performance and quality of life of the students, this result highlights the importance for the nursing administrators to consider and regularly monitor student feedback when it comes to what causes them stress.
This study also has implications also for nursing administrators as well as nursing regulating bodies to review the current curriculum and consider the inclusion of programs and strategies that help students manage stress more efficiently especially in their RLE.
Effective curriculum should offer students quality nursing education but should not cause them stress that could compromise their academic performance as well as over-all quality of life.
This study has limitations.
It is purely descriptive and correlational.
hence no direct causal relationships can be drawn from the findings.
Great insights on nursing studentsAo stressors and coping during their RLE can be derived from the study, nonetheless.
Also, the instrument used was a researcher-crafted one which has only undergone content validity.
Appropriate psychometric tests of construct validity should be done for it to be widely used for future studies.
Lastly, although the study employed total enumeration sampling, data were gathered from only two out of three schools in Iligan City who gave consent.
Upscaling the sample size could enhance Conclusion This study concludes that stressors are inevitable and integral in nursing studentsAo related learning experience.
All intrapersonal and interpersonal stressors experienced by the nursing students rarely cause them stress except for the Clinical Instructor.
The impact of Clinical instructor causes more stress to the students among all other stressors.
Responding to and confronting these stressors resulted to high intrapersonal and interpersonal adaptive coping utilization among these students.
The current study only describes the common stressors and coping strategies of nursing students as well as its significant relationship.
Further studies on other factors such as demographic data, effectiveness of various coping techniques and existing stress management programs are recommended.
Acknowledgment The researchers personally funded this research study.
However, the authors would like to extend gratitude to all the nursing schools, administration, and students who in one way or another made contributions in the completion of the study.
Copyright A 2024, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 14.
, 2024, 12 Author contribution All the authors contributed in the conceptualization, review of related literature, data collection and analysis, writing of the manuscript and approved the final output.
GSR repackaged the manuscript for publication approved by the rest of the authors.
Conflict of interest There is no conflict of interest for all the authors of this study.
References