RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

THAHASUNNISA BEGUMI YEAR M. Sc. PSYCHIATRIC NURSINGVYDEHI INSTITUTE OF NURSING SCIENCES AND

REASEARCHE CENTRE

# 82, EPIP AREA, WHITEFIELD, BANGALORE, 560066.

2. NAME OF THE INSTITUTION

VYDEHI INSTITUTE OF NURSING SCIENCES AND

REASEARCHE CENTRE

3. COURSE OF THE STUDY AND SUBJECT

DEGREE OF MASTERS OF NURSING

PSYCHIATRIC NURSING

4. DATE OF ADMISSION TO COURSE

13-6-2008

5. TITLE OF THE TOPIC

EFFECTIVENESS OF STRESS MANAGEMENT PROGRAM FOR

STUDENT NURSES RELATED TO INITIAL CLINICAL

EXPERIENCE IN A SELECTED INSTITUTION, BANGALORE.

6. BRIEF RESUME OF INTENDED WORD

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INTRODUCTION

Stress is an integral part of life, especially for a college student. In fact, not all stress is

bad. At times little stress makes us to become more alert and aware of our surroundings,

or causes us to take more time with a course project. This can be beneficial. But when

one recognizes that the stress is detrimental to one’s life, we need to take action. There

are a number of techniques to help college students to minimize the stress they are

feeling. Managing stress will help them cope with the daily pressures of college and give

them more time and energy to enjoy their college experience. Stress is a life event that

causes imbalance in a person’s life. An unhealthy response to stress occurs when the

demands of the stressor exceed the person’s coping ability.1

It is well known that stress is highest among students and adolescents. During their

college years students experience constant challenge and demand for adjustment and

change. Along with academic pressures, students are seeking independence and

autonomy from their parents and responsibilities, acceptance from their peer in a world of

mixed values. Nursing is a profession where we are dealing with human beings. Student

Nurses join the profession during their teenage. Student nurses during their academic

lives have to fulfill their clinical practice as a requirement of curriculum due to which

they are exposed to various life situations, which are stressful. When students are

exposed to the clinical set up for the first time the main stressors which are identified are

personnel inadequacy, fear of making errors, uncertainty, interpersonal conflict with

other peer nurses. Student nurses are also scared or frightened of senior nurses,

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supervisors, clinical instructor and doctors and they also have a fear of failure .The ward

environment is very demanding in nature, the students as beginners are unable to manage

as they lack experience and skill. They face other situational stressors like care of dying

patients, handling equipment and performing procedures on patients so on. Hence student

nurses during initial experience in the clinical area find it difficult to balance their stress.

So as teachers in nursing it is necessary to have a better understanding of student stress

and help them to cope in a positive way.

6.1 NEED FOR THE STUDY

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New graduates entering the workplace are faced with many stresses associated with

beginning practice. The initial clinical experience stressors lead to the maladaptive

behavior and coping. They frequently become sick and absenteeism, in serious cases

discontinuation of course; anxiety, depression and other behavioral and mental symptoms

can be seen. Common stress reactions include tension, irritability, inability to concentrate

and a variety of physical symptoms that include headache and a fast heartbeat. If stress

gets out of control, it may harm health, relationships, and enjoyment of life. Many

addictions are linked to a stressful life style such as over eating, smoking, drinking and

drug abuse. These are used as an escape or to a temporary way of “switching off”- but

they do not address the under lying problem.

The goal of any nursing education program is to graduate competent nurses. There are

numerous stressors associated with nursing education as the student develops critical

thinking and complex psychomotor skills. One potentially stressful time for nursing

students is during clinical where they need the application of critical thinking skills, As

nursing faculty we must explore the best method to address the problems of the nursing

students and help them in terms of enhancing their ability to perform and work efficiently

in clinical area.

Sundaram.S. conducted a comparative study on stress among 30 first year and 30 fourth

year B.Sc nursing students in Chennai. The study revealed that the first year B.Sc.

Nursing students had comparatively more stress and less coping than the final year B.Sc.

Nursing students. The researcher suggests orientation classes for the newcomers and to

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conduct well organized guidance and counseling services to help the nursing students to

carry on their course of study with less stress and adequate coping.1

Yang Luo, Honghong Wang, conducted a correlation study on 288 college nursing

students, to explore the factors affecting nursing students’ psychological status, and the

interactions between mental symptoms and stressful factors, coping style and social

support in their early clinical experiences. The result of this study was that positive

correlations were found between stressful events, negative coping styles, while negative

correlations related to positive coping style, social support. They also found that stressful

factors, negative coping style and social support all have main effects on mental

symptoms. In order to improve the psychological condition of nursing students, the

authors suggest that, apart from reducing the stress incidents and avoiding negative

coping, it is very necessary to enhance the social support systems and to encourage them

to adopt the positive coping styles.2

A cohort study was carried out in order to evaluate the evolution of nursing students’

perception of stressors associated with clinical practice by Zupiria X et al. Sixty-nine

students answered the KEZKAK questionnaire at four stages of their studies. The most

powerful stressors identified by students both at the beginning and at the end of their

studies were: lack of competence, uncertainty, being harmed by the relationship with

patients, emotional involvement, lack of control in relationships with patients, contact

with suffering, relationships with tutors and companions, and overload. Nevertheless,

most of the stressors were found to lose stressor power during the course of nursing

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training. The researchers emphasized that interventions are necessary for helping student

nurses to overcome their stress related to clinical experience.3

Several studies show that nursing students have high level of stress. It is also seen that

initial clinical experience is very stressful for first year students. If the stressors are

identified and interventions are provided at the earliest, many physical and psychological

consequences of stress can be reduced and student nurses will be able to lead an effective

life. Very few studies have been done to help the students to cope with their clinical

related stress. Hence the student researcher felt the need to conduct an interventional

study to reduce stress related to initial clinical exposure among first year nursing

students. As she has been trained to be a trainer in Anapanasati Meditation, since then she

has been training people at meditation centre(The Buddha Pyramid Meditation Centre,

Regd.No.396)Kurnool, A.P.

6.2 REVIEW OF LITERATURE

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A quasi-experimental study was conducted by Ram Kumar Guptha (2007) to determine

the effectiveness of yoga nidhra on stress level among student nurses (30 in study group

and 30 in control group) in selected nursing institutes of Pune, India. Findings related to

effectiveness of yoga Nidra show that the mean post –test stress level of the experimental

group was lower than the mean pre-test stress level. Keeping in view of the study, the

following recommendations are made: A study can be done using other alternative

methods or techniques. It is also recommended to develop and implement policies to

promote mental well-being of students. This will not only assist in the prevention of

mental health problems but also contribute to a healthy working environment and reduced

levels of stress.4

Park MK, Lee ES, conducted a study on 77 junior nursing students to identify the effect

of aroma inhalation on stress responses of nursing students at Nambu University in

Korea. This study was a quasi-experimental research using a non-equivalent pre test and

post test design to measure body symptoms, the level of anxiety, and the level of

perceived stress. The results showed that following the aroma therapy there was a

decrease in physical symptoms, their anxiety scores were low, and their perceived stress

scores levels were low. This shows that aroma inhalation could be a very effective stress

management method.5

Jain.S et.al.conducted a randomized controlled trial to examine the effects of a 1-month

mindfulness meditation versus somatic relaxation training as compared to a control group

in 83 students. Results showed that hierarchical linear modeling reveals that both

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meditation and relaxation groups experienced significant decreases in distress as well as

and increases in positive mood states over a time, compared with the control group

(p<.05 in all cases). There are no significant differences between meditation and

relaxation on distress and relaxation on distress and positive mood states over time.6

Bittman BB. et al conducted a prospective cross over study, to examine the impact of a 6-

session Recreational Music-making (RMM) protocol on burnout and mood dimensions as

well as Total Mood Disturbance (TMD) in 75 first year associate degree nursing students

from Allegany college of Maryland. Burnout and mood dimensions were assessed with

the Maslac Burnout Inventory and the profile of Mood States respectively. This study

shows that a statistically significant reduction of multiple burnout and mood dimensions

as well as total mood disturbance scores in first year associate degree nursing students.

All this study finding shows importance and effectiveness of stress management program

on nursing students.7

Amy E. Beddoe, Susan O.conducted a pilot study on baccalaureate nursing students

explored the effects of an 8-week mindfulness-based stress reduction (MBSR) course on

stress and empathy. The course was intended to provide students with tools to cope with

personal and professional stress and to foster empathy through intrapersonal knowing. A

convenience sample of 16 students participated in the course, used guided meditation

audiotapes at home, and completed journal assignments. Stress and empathy were

measured using paired sample t tests. Participation in the intervention significantly

reduced students’ anxiety (p > .05). Favorable trends were observed in a number of stress

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dimensions including attitude, time pressure, and total stress. Two dimensions of

empathy—personal distress and fantasy—also demonstrated favorable downward trends.

Regular home meditation was correlated with additional benefit. Participants reported

using meditation in daily life and experiencing greater well-being and improved coping

skills as a result of the program. Findings suggest that being mindful may also decrease

tendencies to take on others’ negative emotions. Coping with stress and fostering the

affective domain are important facets of nursing education that may be facilitated by

mindfulness training.8

STATEMENT OF THE PROBLEM:

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EFFECTIVENESS OF STRESS MANAGEMENT PROGRAM FOR STUDENT

NURSES RELATED TO INITIAL CLINICAL EXPERIENCE IN A SELECTED

INSTITUTION, BANGALORE.

6.3 OBJECTIVES OF THE STUDY

6.3.1. To assess the level of stress among the student nurses during the initial clinical

experience.

6.3.2. To assess the effectiveness of stress management program.

6.3.3. To find the association between study findings and selected demographic

variables.

6.4. OPERATIONAL DEFINATIONS:

EFECTIVENESS: In this study refers it to the effect of stress management

program on the level of stress among student nurses.

STRESS: Stress as an internal state which can be caused by physical demands on the

body (disease conditions, exercise, extremes of temperature, and the like) or by

environmental and social situations which are evaluated as potentially harmful,

uncontrollable, or exceeding our resources for coping.(Lazarus and Folkman,1984).9

STRESS MANAGEMENT PROGRAM: Stress management program consists of

planned instructions on stress and positive coping strategies, time management,

yoga and meditation.

Student Nurses: Student nurses enrolled for graduate program of first year in a

selected nursing institution Bangalore.

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Initial clinical experience: It refers the period when student nurses are posted for

the first time to the hospital for clinical experience in various wards.

6.5. Hypothesis:

H1 There will be statistically significant decrease in the level of the stress among

student nurses following stress management program.

H2 There will be statistically significant increase in adoptive coping among

student nurses following stress management program.

7. 0.0.MATERIALS AND METHODS:

7.1.0. Source of data:

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The source of data in the study will be first year graduate student nurses of a

selected nursing institutions Bangalore.

7.2 .0.METHODS OF DATA COLLECTION

The following steps will be used to collect the data:

1. The formal permission will be obtained from the authorities of selected

Nursing institution.

2. Consent from the first year graduate student nurses.

3. Conduct pre-test to student nurses.

4. Conducting of stress management program to student nurses, which includes

planned instructions on stress and positive coping strategies, time management,

yoga and meditation.

5. Conduct post test 2 weeks following intervention.

7.2.1. Data collection Tool

The following tools will be used to collect the data:

Interview schedule will be prepared to collect socio-demographic data,

questionnaire will be prepared to assess stress and coping among student nurses.

7.2.2. Research design and approach:

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The research design is one group pre test, post test quasi experimental research

design.

7.2.3. Research Setting:

The setting considered for the present study will be in a selected nursing

institution in Bangalore.

7.2.4. Population:

First year Graduate Student Nurses of a selected nursing institution in Bangalore.

7.2.5. Sample:

The sample of study comprises of first year graduate student nurses in a

selected nursing institution Bangalore.

7.2.6. Sample technique:

Simple random sampling technique.

Criteria for selection of sample

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Inclusion criteria:

1. First year graduate nurses who are willing to participate in the study.

Exclusion criteria:

1. Student nurses who are not willing to participate in the study.

2. Student nurses who are absent during the period of data collection.

7.2.7. METHOD OF DATA ANALYSIS

1. Descriptive statistics: Percentage, mean and standard deviation will be used to describe

demographic variables.

2. Inferential statistics:

a. Parametric test

“t” test will be used to compare Pre test and Post test scores

b. Non Parametric test

Chi-square test will be used to find association between test scores

with selected demographic variables.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS

OR ANIMALS?

YES.

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7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.3?

1. Permission will be obtained from the head of the institution.

2. Informed Consent will be taken from individual students before conducting the study.

3. Confidentiality of the sample will be maintained.

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8. REFERENCES:

1. Sundaram.S., Stress and Coping between first year students and final year BSc(N)

students, Nurses of India 2006 Dec;7(12):11-12.

2. Luo Yang, Wong Honghong, Correlation research on psychological health impact on

nursing students against stress, coping way and social support, Nurse Educ Today. In

press.

3.Xabier   Zupiria Gorostidi a , Xabier   Huitzi Egilegor b , Mari   Jose Alberdi Erice c ,

Mari   Jose Uranga Iturriotz b , Inma   Eizmendi Garate d , Maite   Barandiaran Lasa c ,et.al.,

Stress sources in nursing practice, evolution during nursing training, Nurse EducToday

2007 Oct;27(7):777-787.

4. Guptha Ramkumar, Effectiveness of yoga nidra on stress level among student nurses,

Nurses of India 2007 Jul; 8(7): 9-10.

5. Park MK., Lee ES., The effect of aroma inhalation method on stress responses of

nursing students, Taehan Kanho Hakho Chi.2004 Apr; 34(2):344-51

6. Jain.S., Shapiro SL., Swanick S., Roesch SC,Mills PJ.,Bell I. et.al, A randomized

controlled trial of mindfulness meditation versus relaxation training: effects on distress,

positive states of mind, rumination and distraction, Ann Behav Med.2007 Feb; 33(1):11-

21.

7. Bittman BB.,Synder C., Bruhn KT., Liebfried F.,Stevens SK.,Westengard J. et.al,

Recreational music- making: an integrative group intervention for reducing burnout and

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improving mood state in first year associate degree nursing students: insights and

economic impact, Int .J. Nurs Educ Scholarsh, 2004 Jul;1(12).

8. Army E.Beddoe, Susan O.Murphy, Does Mind fullness decrease stress and foster

empathy among nursing students? , J Nurs Educ. 2004 Jul; 43(7).

9.MorganT.Clifford, King A. Richard, Weisz R. John, Schopler John, Introduction to

Psychology, Seventh Edition,NewDelhi:Tata McGraw-Hill,2003.

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9. SIGNATURE OF CANDIDATE

10. REMARKS OF THE GUIDE: Nursing is a profession where we deal with human beings. As nursing

students are exposed to the clinical area for the first time they face

multiple stressors, for which they need to adopt quickly. The student

researchers is trained in Anapanasati Meditation and is keen on including

this as a part of stress management programme. The study will help the

student nurses to adopt effectively into the initial clinical experience. This

programme could be used regularly for the new comers if it is effective.

11. NAME&DESIGNATION OF THE GUIDE

Mrs. Regina Shoba Dass, H.O.D. & Professor, Psychiatric Nursing Department Vydehi Institute of Nursing Sciences & Research Centre, # 82, EPIP Area, Whitefield, Bangalore 560 066.

11.2. SIGNATURE

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11.3. CO- GUIDE Mrs. Valliammal S., Asst. Professor, Paediatric Nursing Department Vydehi Institute of Nursing Sciences & Research Centre. # 82, EPIP Area, Whitefield, Bangalore 560 066

11.4. SIGNATURE

11.5. HEAD OF DEPARTMENT Mrs. Regina Shoba Dass, H.O.D. & Professor, Psychiatric Nursing Department Vydehi Institute of Nursing Sciences & Research Centre, # 82, EPIP Area, Whitefield, Bangalore 560 066.

11.6. SIGNATURE

12. 12.1 REMARKS OF THE PRINCIPAL Prof.L.E.Madhumathi, Principal, Vydehi Institute of Nursing Sciences & Research Centre, #82,EPIP Area, Whitefield, Bangalore 560 066

This interventional study will help the graduate first year student

nurses to prepare themselves for the initial exposure to the clinical

area and also this study will encourage the student nurses to develop

a positive attitude to provide comprehensive nursing care to the

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patients.

12.2SIGNATURE

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