STRESS MANAGEMENT TECHNIQUES OF 3rd and 4th YEAR BSN STUDENTS IN OLFU-ANTIPOLO ON MAJOR EXAMINATIONS

A Thesis Presented to The Faculty of the College of Nursing Our Lady of Fatima University Antipolo Campus

In Partial Fulfillment of the Requirements for the Bachelor Of Science in Nursing

By: Altares, Charlyn Joy A. Batua, Julynie Calma, Norielou F. Corpuz, Aira Klaudine Y. De Paz, Bea Krissanti S. Del Rosario, Lea Katrina G. Gozum, Ella Joyce A. Mercado, Roseched M. Ruelos, Marissa P.

March 2012

CHAPTER I THE PROBLEM AND ITS BACKGROUND Introduction Managing stress is all about taking charge: taking charge of your thoughts, your emotions, your schedule, your environment, and the way you deal with problems. The ultimate goal is a balanced life, with time for work, relationships, relaxation, and fun plus the resilience to hold up under pressure and meet challenges head on (Smith & Segal,2011). Most people experience some degree of stress on a daily basis, and college students are even more likely to face situations and events that require them to make changes and adapt their behavior: Assigned readings, papers, studying for tests, juggling jobs, relationships and dealing with deadlines are all examples of things that can cause a student to experience stress and these are called as stressors which are the stress-causing events (Ciccarelli & White,2009). This study aims to determine and describe the different stress management techniques (SMT) that are utilized by the Nursing Students of OLFU-Antipolo. The researchers main concern is to learn how they manage their mental tension. We would like to do further assessment with the students management of their daily stressors especially those encountered for the upcoming major examinations. The group would like to focus on identifying the specific stress management techniques

practiced in the university though there are many different ways to manage stress (Neils, 2008). Basically, its best to adapt as many stressors as you can and find practical and emotional ways to better handle the stressors that are left (Scott, 2011). Furthermore, it gives us great interest to study about how they cope with these stressors which affect their performance. We aspire to pass the examinations once by utilizing the most effective stress management techniques because we all know how intense the hardships of nursing students are to become registered nurses (Lyle, 2009). There is multitude of stress management techniques that could be used by the examiners (Neils, 2008). Among all the styles of coping, the researchers would like to identify the most efficient way to deal such stressors. We assure that this study will provide a clear and detailed description of the different management skill. Moreover, almost all aspiring nurses prepare a lot. Some would enroll to review centers, conduct group studies and practicing various rituals to alleviate intense pressure (Malgaj, 2008). We choose this study because we would like to impart useful information to readers, OLFU-Antipolo nursing student batch 2013, and to other bachelor degree learners that will also be dealing with similar situations. With our determined approach, we emphasize that this may contribute new knowledge to the nursing service as what the nursing researchs end goal is (Clamp, 2004 & Mosby, 2007).

Statement of the Problem This study aims to determine and describe the Stress Management Techniques (SMT) of BSN graduating students in OLFU-Antipolo. Specifically, the study intends to answer the following questions: 1. What are the characteristics of nursing students/ respondents in terms of: 1.1 1.2 Age? Gender?

2. What triggers the stress management in terms of: 2.1 NCM 102&103? 2.2 NCM 106? 3. What are the effects of stress management techniques in the major examinations in terms of: 3.1 3.2 3.3 3.4 Study habits? Eating habits? Rest and sleep? Praying habits?

4. What are the commonalities and differences in the coping mechanisms of students? 5. Is there a significant relationship between the demographic profile and the stress management techniques?

6. Is there a significant difference between the major examinations and the stress management techniques?

Hypotheses of the Study The following hypotheses were drawn: 1. There is no significant relationship between the demographic profile and the stress management techniques. 2. There is no significant difference between the major examinations and the stress management techniques.

Significance of the Study Determining the Stress Management Techniques (SMT) of BSN examiners may serve as a guide and support for the awareness of all interested learners, with regards to their preparations to a great number of examinations. We would like all nursing students to get used to the most effective type of nursing techniques for the betterment of their stress management skill. This study would like to contribute by giving a scientific input that is about the human coping mechanisms/stress management. Therefore, it will be beneficial and helpful to the following:

School Administrators. The result of the study will be helpful in giving them an insight in formulating programs or activities for nursing students to alleviate the level of stress they encounter or manifest during their study thus, improving the academic and clinical performance of the students. Nursing Lecturers. This study will make them aware of the level of stress that the students manifest. Thus help them prepare better teaching strategies that will improve or enhance their academic performance accompanied with a better understanding and genuine concern for students. Furthermore, this will also serve as baseline information on the current condition of the level of stress that may affect clinical capability of the student. Nursing Students. This research will serve as eye opener to nursing students regarding the stress they might encounter during their study. Thus guiding them on how to cope with the different stress that could hinder their optimum performance in both academic and clinical setting and be able to adapt with situations in preparation for a stress bound career as professional nurses. Readers. The study will help them become aware of the effects of stress to students, which may contribute to their level of performance. Nurse Researchers. This may help provide additional information and serve as reference for further research about a persons level of efficiency

that may be directly linked to how they combat stressors through Stress Management Techniques in academic or clinical-related situations. The conclusion and findings of the study will be helpful in the continuum of nursing education enhancement.

Scope and Limitation of the Study The study is focused on the stress management techniques among BSN students in 3rd and 4th year level. Thus limited only to the output that the respondents from the selected university will provide such as data and information that will come from the interview questionnaire distributed as well as the information from literature that will be cited and reviewed .The study was further limited to five (5) BSN students per section. All the respondents will be those who are currently studying in the College of Nursing. Our Lady of Fatima University-Antipolo is chosen to be the place of the study that will be conducted in the College of Nursing (CON) because the researchers are studying on the said university, specifically former nursing students. Ethical Consideration The consideration of ethics in research, and in general business for that matter, is of growing importance. It is, therefore, critical that

understanding the basics of ethical research and how this might affect the research project. This is especially important if the research involves interaction with businesses or members of the general community who serve as participants (i.e., respondents) in the research. There are a range of interactions in the research that might occur, including in-depth interviews, focus groups, surveys, or even observing peoples behavior. Though all researchers (student, professional, or academic) are well intentioned, there is the possibility that interaction with participants may inadvertently harm them in some unintended way. This could include: a.) Psychological harmfor example, researching the use of nudity in advertising may show participants images that offend them. b.) Financial harmresearching unethical behavior within a given firm may provide management with information on individual employees that results in an individual getting fired, or undertaking industry based research may inadvertently share sensitive information with a firms competitors, resulting in financial harm to the organization. c.) Social harmresearching how lifestyle affects consumption may unintentionally disclose a persons sexual orientation when that person wanted to keep this confidential (Polonski, 2004).

CHAPTER II REVIEW OF RELATED LITERATURE This chapter deals with the presentation of related literature and studies with relevant implications which is generally essential because the researchers believe that effective research must be based upon past knowledge, as this tells what is already known. Stress management refers to a wide spectrum of techniques and psychotherapies aimed at controlling a person's levels of stress, especially chronic stress, usually for the purpose of improving everyday functioning. According to Sontrock (2000), some adolescents experience daily hassles like examinations, financial problem, personal, and social problems. The trouble starts when several stressors hit you all at once and it is not easy to lessen stress, when a person faces a whole range of problems rather than the one identifiable difficulty. Moreover, people under a lot of stress are less able to cope. This is turn falls to more stress and less ability to cope and viscous circle sets in. College students are prone to stress due to the transitional nature of college life. High levels of stress are believed to affect students health and academic functions. If the stress is not dealt with effectively, feelings of loneliness, nervousness, sleeplessness and worrying may result.

Effective coping strategies facilitate the return to a balanced state, reducing the negative effects of stress (Canfield, 2002). Stress and identification of potential stressors among nursing students have received much attention in the literature. Nursing students have the same academic stressors as other college students such as midterm and final examinations, research papers and other assignments. In addition, nursing students experience as clinical components, which is highly stressful. Students have a large amount of preparatory work before their clinical assignment. They often must travel long distances to clinical sites and use highly technical equipment. In addition, they must perform procedures that can cause serious harm to their patients, thus enhancing their fear of making mistakes. Studies indicate that nursing students may be more prone to stress than other students (www.biomedcentral.com). The Study of Stress According to Frey (2009) stress in humans results from

interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality, as well as differences in physical strength or general health. Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social variables. These

factors include lack or loss of control over one's physical environment, and lack or loss of social support networks. People who are dependent on others (e.g., children or the elderly) or who are socially disadvantaged (because of race, gender, educational level, or similar factors) are at greater risk of developing stress-related illnesses. Other risk factors include feelings of helplessness, hopelessness, extreme fear or anger, and cynicism or distrust of others. Selye (2007) explained that stress is non-specific response of the body to pay demand made upon it under ordinary circumstances, the bodys reaction to specific stimulus anticipate because of its repetitive pattern. Therefore, a person experiences pain. When the body is warm, it perspires and when it is used the body shivers. All human exhibits uniform response to stimulus because of homeostasis. When response is erotic and does not uniform to the usual reaction expected from the application of the stimulus, the body is said to be in stress. Cannon (2009) said that the human body reacts either positively or negatively to a stress factor producing two kinds of possible reaction. When the human body tries to flee from stress situation, negative reaction is exhibited. Positive reaction comes about when the body makes the principle of homeostasis apply the body to overcome stressful situation which is known as adaptation or coping. He advocated that while the concept of stress is an absolute fact, its presence and intensity

reception

are

all

relative

in

accordance

with

the

physical

and

psychological makeup of the individual. All people therefore, experience stress but the way stress is present and is handled by each individual is unique for each other. A little difficulty is hardly felt by another. By understanding, we can more easily identify stress factors and their effects on who need or seek healthcare. Each individual is experiencing stress, in her own particular manner. How the individual adopt or fails to adopt depend on several factors: personality and conditional make past experiences dealing with stress. It is important to remember that stress syndrome can be both positive and negative. Any change or alteration in the balance of life can create stress. We are all unique individual, we respond differently to various stressors. Thus, it neither does not matter whether it is positive or negative light or severe. What matter is how we developed adoptive mechanism to cope with these stressors and can be translated as the ability to withstand stress and create a life experiences that do not work against you. The implication of stress theory is by being able to withstand stress and by coping with it. Diluting it when occurs and eliminating it, you can actually affect your life. You are not programmed for premature aging. The fact is you control your own health.

The Study of Stress Management Techniques According to Smith, Segal R., and Segal J. (2011), in stress management, it is important to manage the symptoms like memory problems, inability to concentrate, moodiness, constant worrying, aches and pains, eating more or less, sleeping too much or too little, and also the causes which includes work, unrealistic expectations, financial problems, being too busy and so on. In managing stress, an individual must deal with its symptoms and causes since stress may affect a persons well being specifically in terms of his activities of daily living and in relation to the study, a student may develops changes in his studying habits, eating habits and sleeping habits. According to Tan (2006) stress management is a matter of helping people to recognize that the world, which seems stressful, can also be a source of pleasure, fulfillment and renewal. Some stress management techniques being dangled around are really meant as appetizers, ways of inducing the depressed person to garner enough strength and courage to re-engage not just the world, but life itself. Tan believes that stress is not just a negative thing but he sees the positive side behind this. He also wants to emphasize that one must include his environment in dealing with stress.

Smith, Segal R., and Segal J. (2011) denote stress management as they focus on their own way of promoting techniques, on common cause of stress, and stress affects an individual; on the other hand, Tan focuses on the environment as the cause but at the same time the key in order to manage stress. Scott (2012) stated that stress is an integral part of life, especially for a college student. In fact, not all stress is bad. Those times when a little stress nudges a student to become more alert and aware of their surroundings, or causes them to take more time with a course project, can be beneficial. When they recognize that the stress is causing harm to their life, they need to take action. There are a number of techniques to help college students minimize the stress they are feeling. Som techniques are setting goals and priorities, giving self time to be alone, proper exercising and eating, and most specially, take time to laugh. Stress is a part on an individual most especially of college students. It is not totally a bad thing but it depends on how a person percieves and manages it. Students must learn how to priorities their duties in terms of its difficulty and their understanding of the subject. Students need some time alone to reflect on his capabilities and some activities of his daily life.

According to Dellova (2011) in stress management, it is important to manage the symptoms, trigger, aggravating factors, and the root carrier. Here are some of the symptoms of stress: feeling irritable, frustrated at having to wait for something, restless, unable to concentrate, becoming easily confused, and having memory problems. The cause of stress is known as stressors. It depends on the person on how they manage their own stress. Wills (2011) states that students everywhere experience

considerable school stress in all levels of education. Here are some student stress relief tips and tools that students can use to learn study skills, prepare for exams and minimize their school stress levels to make learning easier: manage time wisely, get organized, create a good study environment, know your learning style, develop optimism, get enough sleep, and use stress management techniques. According to Zephyr (2007) managing the level of stress in your life is important because it not only can make you happier and more productive, but healthier as well. Studies show that high stress levels can take a big toll on the body that can catch up with you later in life. Healia (2009) said that modern life is full of hassles, deadlines, frustrations, and demands. For many people, stress is so commonplace that it has become a way of life. Stress isnt always bad. In small doses, it can help you perform under pressure and motivate you to do your best.

But when youre constantly running in emergency mode, your mind and body pay the price. Smith (2011) affirms that if you frequently find yourself feeling frazzled and overwhelmed, its time to take action to bring your nervous system back into balance. You can protect yourself by learning how to recognize the signs and symptoms of stress and taking steps to reduce its harmful effects. Agarwal (2009) believes that if you've been keeping up with the latest industry news and trends across the globe, you will know that time management is not for business persons and harried housewives alone who juggle different tasks and need to always come out tops! It is equally important for the student community at large, especially college level students who have just come out of the sheltered and structured environment of high school and need to understand the essence of basic time management in order to prioritize goals, have an organized life, advance towards their dream careers and also reduce stress by working out a balance in their lifestyle. According to Malgaj (2007) stress affects all students, from graduate level to those in the kindergarten. The term stress refers to the response you have when facing circumstances that force you to act, change or adjust in some way to keep things balanced. It is your body's way of responding to any kind of demand. It can be caused by both good

and bad experiences. In the right dose, stress can be healthy or even enjoyable. However, stress can be very damaging for students when it becomes excessive. It can harm students' health, happiness,

performance, relationships and personal development. Platt (2004) postulated that our study skills guides for colleges students were designed with college students in mind. Time

management, note taking, reading comprehension, essay writing, test taking, active listening, stress management, researching, and

memorization are only a few of the topics addressed in our study skills guides for college students. Gupta (2011) states that smiling can relieve stress. Whenever we feel stressed during the exam, we could also try it. By smiling we are able to let our body know that everything is actually good and all right. Smiling decreases the amount of adrenaline that is released and helps us in decreasing stress. Instead of telling our body that it is time to fight or fly, smiling tells our body that it is time to relax. Smith & Segal (2011) emphasize that thinking can have a profound effect on individuals emotional and physical well-being. Each time when we are thinking a negative thought about self, the body reacts as if it were in the throes of a tension-filled situation. Thus, if seeing good things, we will more likely to feel good.

Conceptual Framework

IV

Demographic Profile Age Gender DV

IV

Stress Management Techniques

Major Examinations -

NCM NCM NCM NCM

102 103 104 105

Figure 1. Research Paradigm Showing the Relationship of the Variables

Theoretical Framework According to the Cognitive Appraisal Theory of Richard Lazarus, it is believed that, The concept of individuals interpretation of events as harmful, threatening or challenging and their determination of whether they have the resources to efficiently cope with the event. The coping strategies of Lazarus show how coping takes place in every individuals at the onset of stressful event, a person primarily assess the meaning and the effect of a stressful event to his life if it possess harm, threat or challenge. The primary appraisal is then processed in to a secondary appraisal where at in this point, resources and options are the best course of action. A coping response is then identified and applied with its corresponding tasks. After coping with the stressful events, a person may regain psychological functioning, resume their usual activities and may not suffer from distress. Lazarus also believes that the two general types of coping strategies are distinguished, this are problem-focused coping which refers to attempt to modify or eliminate the source of stressors by taking instrumental action and cognitive strategy of squarely facing their problems and trying to solve them. On the other hand, emotion-focused coping refers to attempt control stress-relate emotions and maintain effective equilibrium, which also responding in emotional manner, especially using defensive appraisal. (Acuyong et al., 2003)

Li, (1999), developed the emotional stability concept based on self organizational theory. Under the paradigm of self-organization theory, emotional stability is defined as a property to label whether or not a complex emotion system can automatically maintain its equilibrium efficiently. And it was proposed to hold two dimensions, threshold of emotional respond and emotional recovery from the methodology of selforganization. (Schachter & Singer, 2001).

Definitions of Terms Terms Conceptual Definition Stress Management Techniques used by the respondents to overcome the stress brought by major examinations. Operational Definition A set of techniques and programs intended to help people deal more effectively with stress in their lives by analyzing the specific stressors and taking positive actions. Medlineplus.com(2012)

Major Examination

The specific stressors faced by the respondents.

An exercise designed to examine progress or test qualification or knowledge. Medlineplus.com(2012)

BSN students

These are the respondents of the study who are enrolled in OLFU-Fatima.

One who studies nursing course. Medlineplus.com(2012)

Stressor

Major examination is the stressor of this study.

Something that makes you worried or anxious; a source of stress. Medlineplus.com(2012)

References Camel.(2005).TheoryClustersCommunication/transactional_model _of_stress_and_coping. www.utwente.com. Flanagan, Mark. (2003). Ongoing-Stress-Management-Resources. http://www.stress.about.com Gupta, Sabyasachi. (2011). Stress-Management-Strategy-duringpmp-exam. http://www.simplilearn.com/simplilearn/pmp-2

Highstein,Mav.(2009).Stress_Management_Links.www.tranquilityyo urs.com Polit & Beck. Nursing Research, 8th Edition. 2008 Polonski (2004). Polonski _chapter_5. http://www.sagepub.com/upapter_5.pdfm-data/49 99_Polonski_Ch Schwarzer, Ralf. (2007). Health/Stress. http://web.fu-berlin.com Smith, Melinda & Segal, Robert. (2011).

Stress_Management_Relief_Coping. http://www.helpguide.com Tan (2006). Stress and the Filipino. Philippine Center for Investigatice Journalism., from http://pcij.org/stories/stress-and-thefilipino/ Smith, Segal R., and Segal J. (2011). Understanding Stress., from http://helpguide.org/mental/stress_signs.htm Scott (2012). School Stress Relievers for Students. Health's Disease and Condition., from http://stress.about.com/od/studentstress/tp/school_stress.htm

CHAPTER III RESEARCH METHODOLOGY This chapter includes the research methods and techniques that were used, the description of respondents, sources of data, data gathering instrument, procedures and statistical treatment of the data. Research Design This study will utilize a descriptive quantitative type of research. According to Sevilla et. al (2005), the principal aim in employing the

descriptive method is to describe the nature of a situation as it exists at the time of the study and to explore the causes of particular phenomena. This approach is appropriate wherever the object of any class varies among themselves and one is interested in knowing the extent to which different conditions obtain among these objects. It uses a questionnaire as the technique in data collection. Therefore this method or design is appropriate in determining the different stress management techniques for 3rd and 4th year BSN students of OLFU-Antipolo regarding to a stressor brought by the major examination. Locale of the study The study will be conducted at OLFU-Antipolo of 3rd and 4th year BSN students in the 1st semester of the year 2012-2013. The researchers would like to implement their study in this place because 3rd

and 4th year students had their major examinations and according to the professors in this university that there are low percentage of students who are passing the exams. Participants or Subject of the Study The OLFU-Antipolo has a total of 702 population of 3rd and 4th year BSN students. The researchers will take their samples by using a Probability Technique specifically the Stratified Random Sampling (Ymas Jr, et. al. 2006). There will be approximately fifty (50) students in each section, but researcher would only get five (5) respondents. The researchers are aware that every section may vary in quantity that is why they used five (5) as a constant variable in order not to be biased. Using the Slovins formula, the size of the sample will determine to serve as representation of the whole population of BSN to determine their stress management techniques. The Slovins Formula:

Where: n = no. of samples N = no. of population E = marginal error of 0.05 (due to unexpected instances)

Research Instruments The researchers used the questionnaire as the primary tool in gathering data. This was made from created materials and statements that could generate the desired result when the correspondents followed correctly the direction given by the researchers for answering. The construction of the questionnaire was preceded by intensive reading and review of related literature, which provided the researchers insights in forming the questionnaire. The researchers formulated questions based on their readings from various books, manuals, journal and experiences as nursing students. The questionnaire was first drafted for the approval of their adviser and other members of the faculty who are knowledgeable on the topic. This is composed of 7 problems. Problem no. 1 involves the profile of the level II nursing student of Nueva Ecija University of Science and Technology. Problem no. 2 involves the different stressors encountered by the level III nursing students of Nueva EcijaUniversity of Science and Technology with regards to their clinical duties. Problem no. 3 is the different stress management performed by the respondents. While, Problem no. 4 is the implication of the study to nursing practice in rendering effective quality nursing care. Then the final draft was reproduced for distribution to the respondents.

Statistical Treatment of Data After the distribution, collection and completion of distributed questionnaires, the researchers tallied the gathered data and used frequency, percentage, average mean, weighted mean, and interpretation and ranking. The following statistical computations were accomplished using the following formula: For the Percentage Computation of the percentage was made using the expression: Percentage (%) = F x 100 N Where: % - Percentage F - Frequency or number of response to every item or question N - Total number of respondents

For the Average Mean Computation of the average mean was made using the expression: AM= F x E Where: AM - Average mean F - Frequency used E - Numerical equivalent/ degree of response

For the Weighted Mean Computation expression: WM = AM N Where: WM - Weighted mean AM - Summation of the degree of response multiply frequency (F x E(DoR)) N - Total number of respondents of the weighted mean was made using the

The researcher used ranking to determine the position of each variable.

NUMBER 4.20-5.00 3.40-4.19 2.60-3.39 1.80-2.59 1.0-1.79

VALUE E 5 4 3 2 1

INTERPRETATION Always Often Sometimes Seldom Never

Westside Test Anxiety Scale Rate how true each of the following is of you, from extremely or always true, to not at all or never true. Use the following 5 point scale. Circle your answers: 5 4 3 2 1 extremely highly moderately slightly not at all always usually sometimes seldom never true true true true true __ 1) The closer I am to a major exam, the harder it is for me to concentrate on the material. 5 4 3 2 1 __ 2) When I study for my exams, I worry that I will not remember the material on the exam. 5 4 3 2 1 __ 3) During important exams, I think that I am doing awful or that I may fail. 5 4 3 2

__ 4) I lose focus on important exams, and I cannot remember material that I knew before the exam. 5 4 3 2 1 __ 5) I finally remember the answer to exam questions after the exam is already over. 5 4 3 2 1 __ 6) I worry so much before a major exam that I am too worn out to do my best on the exam. 5 4 3 2 1 __ 7) I feel out of sorts or not really myself when I take important exams. 5 4 3 2

__ 8) I find that my mind sometimes wanders when I am taking important exams. 5 4 3 2 1 __ 9) After an exam, I worry about whether I did well enough. 5 4 3

__ 10) I struggle with written assignments, or avoid doing them, because I feel that whatever I do will not be good enough. I want it to be perfect. 5 4 3 2 1 _____ Sum of the 10 questions < _____ > Divide the sum by 10. This is your Test Anxiety score. Name ____________________ School ____________ phone _____________ email ____________________

 2004 by Richard Driscoll, Ph.D. You have permission to copy this material. (Please include author & copyright). ******** What does your score mean? < _____ > Test Anxiety score (from 10 item scale). Interpreting your test anxiety scores: 1.01.9 Comfortably low test anxiety 2.02.5 Normal or average test anxiety 2.52.9 High normal test anxiety 3.03.4 Moderately high (some items rated 4=high) 3.53.9 High test anxiety (half or more of the items rated 4=high) 4.05.0 Extremely high anxiety (items rated 4=high and 5=extreme) Rationale. The scale is constructed to measure anxiety impairments, with most items asking directly about performance impairment or about worrying, which interferes with concentration. Simple indications of physiological stress are found to be relatively weak indicators of performance impairments. Incapacity (memory loss and poor cognitive processing) 6 Items #1, 4, 5, 6, 8 & 10 Worry (catastrophizing) 4 Items #2, 3, 7, 9 Physiological symptoms no items. Recommendations. We have found that students who score at least 3.0 or more on our scale (moderately high anxiety) tend to benefit from anxiety reduction training, experiencing lower anxiety on tests and achieving higher grades.