Evidence Based Practice

Stress in Returning Nursing Students

Maureen A. Hammond

Ferris State University

 Abstract

Having recently experienced in my own life the physical effects that stress can have on a

body when psychological stress is not properly addressed I took the opportunity of using

this paper to research ways to learn about better coping mechanisms as I return to school

to get my BSN. The following body of work highlights some of the contributing factors

of stress; it also looks at coping mechanisms one can learn to incorporate in their own

lives.
 While I was looking for articles for our APA reference list I came across an

article titled, “Women’s Multiple Role Stress: Testing Neuman’s Flexible Line of

Defense” by Eileen Gigliotti, RN; PhD. As you can imagine this article struck a chord

with me, for here I am twenty-three years out of nursing school and returning to school.

Why? I have a few answers to that question and I am sure that I will be reiterating that

conversation in my head as I continue down this road.

In this small paper I will be looking at four articles and three studies that were

conducted over the last decade to discern the causes of physical and psychological

stress in nursing students and the researchers’ identification of ways to combat stress.

I realize that the impetus for this paper may seem self centered however I have realized

from very recent experience that we as nurses can only best take care of our patients

when we ourselves have been properly cared for.

At the end of this last summer, I witnessed one of the most traumatic events in my

nursing career. I was present and watched a baby die in her mother’s arms. I cannot

begin to tell you how devastated and helpless I felt. The child had been born at thirty-one

weeks and was found to have a significant intracranial bleed. The surgeon had made the

parents aware of the fact that the child might not survive the operation. The parents opted

to go ahead with the procedure anyway. Looking back, I can say to myself that

everything was done to try to save this child but there was too much damage done by the

initial bleed.

After three hours of trying to find the source of bleeding, it was decided that we

would gather the family and leave the OR, allowing them to spend the last few moments

with their child. After this incident I sought out our Encompass program at the hospital
in addition, relayed this story to one of the counselors there. I remember having

nightmares previously in my nursing career but this was truly for me a living nightmare.

About a week and a half later, I woke up with severe pain in my shoulder and back that

took my breath away and caused my bladder to empty. I was later diagnosed with two

herniated discs which the neurosurgeon assured me were directly related to stress. Holy

Cow!

I had already made the decision to go back to school a year before and was

concerned about my level of stress in doing so. I think that when I saw this previously

mentioned article I latched in to it and I looked at this evidence-based paper as a way to

further look for ways to alleviate my level of stress.

The first article I will be reviewing is Dr. Gigliotti’s 1999 study published in

Nursing Science Quarterly. This article focused on stress experienced by female students

who were attempting to go to school for their nursing degrees as well as maintain their

role as mothers. It looked at the role of mothers as one of selflessness and the role of

students as being self-centered (Gigliotti, 1999). In this article, the author cited works

from many different sources in the formation of her article. Gigliotti felt that trying to

fulfill these multiple roles were testing their flexible line of defense relating this to

Neuman’s Systems Model (1995).

Gigliotti questioned 191 women who were returning to school of which she got a

66% response rate. This sample was quite homogeneous in nature. All were married, had

at least one child living at home and had little experience with higher education.
Gigliotti found that women above the age of 37 were often at a stage of self-definition

and more able to focus on their student role. Also important was their perceived amount

of social support. Suggestions were made that colleges not only focus on women’s

developmental as well as education needs.

I think that the narrow focus and the small amount of participants limited this

study’s applicability; however, I fit into this group and find myself questioning this stage

in my life. Am I looking to redefine who I am?

As I stated earlier I look at look at the research I did for this paper as a selfish

pursuit of knowledge. I am looking for tools to keep myself both physically and

emotionally healthy during these next two to three years. The mention of Neuman’s

Systems Theory also caught my eye. She is the theorist my group is presenting on later

in this semester.

I found another article by Dr. Gigliotti published in Nursing Science Quarterly in

April 2004. This article reviews her previous study in light of other information brought

forth by other more recent articles. An article by Meleis, Sawyer, Im, Messeas and

Schumacher was cited. Information was gleaned from an article in Nursing Research,

1998 written by Mercer, Nichols and Doyle. Gigliotti found after reviewing her previous

study and incorporating these previous mentioned authors’ articles the following

conclusions:

“Those with the lowest maternal-student role stress had diverse support
 networks capable of moderating the effects of high psychological

involvement in the student role. Faced with conflicting and ambiguous

role relations they broadened their support networks to include members

who did not know their families.” (p. 163)

I believe that the implications for practice are the same as mentioned

above in regards to Gigliotti’s first article. The nursing theory that I feel that fits in

with this work again would be Neuman. Gigliotti again refers to Neuman’s flexible line

of defense in this article. Neuman’s focus on taking preventative measures also comes in

to play here. I plan to look at ways I can integrate these ideas into my life.

The third article I found was from the Journal of Advanced Nursing, 2005. It was

written by two faculty members from the School of Nursing and Midwifery Studies,

Trinity College in Dublin, Ireland. A quantitative study was done with a group of 70

students exploring their perceived stressors while they undertook their RN to BSN road.

The researchers found those items that were the most challenging to returning students;

balancing home, work and school commitments, demands placed on them by the RN to

BSN program, and writing papers at a degreed level. These were a few of the stressors

mentioned. Recommendations were given to educators to ease returning students back

into school life.

The limitations of this study were cited within the article. The sample used was

small and confined. Stress was not defined in the questionnaire. It was felt that the

participants might have answered in a somewhat coerced manner.

I was not able to take much from this study other than the fact that,

returning to school is stressful and that needs to be acknowledged by both educators as

well as participants. Maybe I need to act as more as an advocate for myself. As I look at

Sr. Callista Roy’s Adaptation Model, I am drawn to her “Vision Basics to Concepts for

the Twenty-first Century” Tomey and Alligood (2005). Many of the assumptions listed

reflect our human need to find commonalities with one another. This is one of the reasons

that probably pulled me to these articles.

The last article I found relating to this subject was published in the

Journal of Psychiatric and Mental Health Nursing in April 2007. Their article draws on a

book titled, Emotional Intelligence by Daniel Goleman (1995). Emotional Intelligence

(EI) as defined by Goleman is: (1) the ability to identify our and other’s emotions; (2)

The ability to regulate and modify our mood in a adequate manner; and (3) one’s ability

to improve our own thoughts. Those people that could see their emotions with clarity and

not ruminate on them were found to have better coping strategies (Montes-Berges et al,

2007).

A sample of 119 nursing students was used for this study. It was found that those

students who were able to identify a specific emotion during stressful situations were

better able to implement more adaptive coping mechanisms (Montes-Berges et al, 2007).

The authors also emphasized the importance of social support. They stated that social

support was not only beneficial but also necessary. It was underlined that it is better to

prevent stress than to suffer from it (Montes-Berges at al, 2007).

The limitations of this study are as follows. Participants were all from the same

nursing school. The study can only be applied to nursing students and not professional
nurses in practice. The authors did state that if stress in nursing is not addressed there

were possible financial, physical and psychological risks. Stress is an issue that is often

not addressed by employers or nurses themselves. The nursing shortage is another reason

to address this issue. Prevention appears to be the underlining idea behind this study.

Prevention as intervention is one of the cornerstones of Neuman’s Systems Theory.

This evidence base paper has given me the opportunity to consider how research

can and does influence my practice; I feel that part of my professional practice must also

include taking care of me.

References:

Gigliotti, E. RN; PhD. (1999a). Women’s multiple role stress: Testing Neuman’s flexible

line of defense. Nursing Science Quaterly, 12(1). 36-44 Sage Publications, Inc

Gigliotti, E. RN; PhD. (2004b). Etiology of maternal-student role stress. Nursing Science

Quarterly, 17(2). Retrieved April 4, 2004 doi: 177/0894318404263304

Goleman, D. (1995) Emotional Intelligence. Bantam, New York, N.Y,

Meleis, A. I., Sawyer L. M., Im E. O., Messias, A. K., and Schumacher K. (2000)

Experiencing transitions: An emerging middle range theory. Advances in Nursing

Science, 23(1), 12-28

Mercer, R. T., Nichols E. G. & Doyle, G. C. (1988). Transitions over the life cycle: A

Comparisons of mothers and non-mothers. Nursing Research, 37,144-151

Montes-Berges, B. & Augusto, J. M. (2007). Exploring the relationship between

perceived emotional intelligence, coping, social support and mental health

in nursing students. Journal of Psychiatric and Mental Health Nursing,

14 (2), 163-171 doi: 10.1111/j.1365-2850.2007.01059.x

Nicholl, H. & Timmins, F. (2005). Program-related stressors among part-time

undergraduate nursing students. Journal of Advanced Nursing, 50(1), 93-100.

Blackwell Publishing Ltd. Dublin, Ireland.

Tomey, A. M. &Alligood, M. R. (2005). Nursing theorist and their work. Chpt 17,

p. 361, box 17-1, Mosby Elsevier, St. Louis, Missouri