The sample consisted of 89 nursing students and 33 social work students. Data was obtained through self-reported survey procedures. The researcher visited appropriate classrooms identified by faculty. Participants were given a packet with three instruments. The first instrument was a demographic tool developed by the researcher. Perceived stress levels were measured by Cohen’s Perceived Stress Scale. Coping styles were identified by the Moos Coping Responses Inventory. Responses indicated that social work students have significantly higher perceived stress levels than nursing students.
Nursing students identified more reliance on approach coping responses, while social work students identified more reliance on avoidance coping responses. No significant differences were identified between the two groups based on age, gender, marital status, employment status or class. iii ACKNOWLEDGEMENTS Although a dissertation is credited to only one person, it actually should be credited to many. Therefore, I would like to recognize those individuals that were so helpful in assisting me to reach my goal. First, I would like to acknowledge the members of my dissertation committee.
I would especially like to express my sincere gratitude to my Chair, Dr. Dennis Prisk, for his constant support and guidance. From helping to reassemble my committee to putting the finishing touches on my dissertation, he has been absolutely priceless. I must also express my thanks to Dr. Paul Leary for helping me choose an interesting topic (much better than my first) and for his expert advice and “trenchant observations”. I need to recognize Dr. Lynne Welch for her support, guidance and thoughtful suggestions. Special thanks must go to Dr.
Steven Banks for all his help with my statistics and for handling all my silly questions with good-natured patience and understanding. Second, I must thank Dr. Germie Berhey for allowing me to survey his social work students. He was accommodating and helpful. For this he has my heartfelt thanks. Third, I would like to acknowledge my friends David Ridpath and Karen Kirtley for providing me with support and encouragement, as well as valuable advice from their own recent dissertation process. I only wish I could have met you both earlier.
I would also like to thank Sheila Kyle for loaning me her articles and for providing advice whenever I needed it. Third, I would be remiss not to acknowledge my family. To my mother and father, Lindy and Twyla Browning, I must express my sincerest appreciation not only for their encouragement and support, but also for all the countless meals they had ready iv when I would return from class in Charleston. My husband, Roger and my daughter, Bethany need to be recognized for their support and understanding, as well as for enduring a house cluttered with books and papers.
Without the love and support of my family, I could never have accomplished this endeavor. Lastly, I need to recognize my mentor, role model and dear friend, Giovanna Morton. It was Ginny’s gentle prodding that started me on the journey to the completion of this degree. All along the way she provided me with encouragement and motivation. Even when she was gravely ill, Ginny never failed to ask how things were going and to provide her own wisdom and advice. I truly hope that I may serve as an inspiration to my students as Ginny did to me. Ginny is truly what I want to be “when I grow up”.
Therefore, the study of this phenomenon and how students deal with it can have important implications for higher education administrators. The perception of nursing faculty and students is that nursing students have higher perceived stress levels than the general student population (Beck & Srivastava, 1991; Carter, 1982). Nursing students have the same academic stressors as other college students such as midterm and final examinations, research papers and other assignments. In addition, however, nursing students also experience a clinical component, 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 (Shriver, 2000). In their clinical rotations, students must exhibit a high level of responsibility and accountability in dealing with patients (Carter, 1982). Students often perform procedures that can cause serious harm to their patients and fear making a mistake. They use highly technical equipment. Time management can be a pressure as they have many tasks that must be accomplished in a short period of time. They deal with patients that are seriously ill or often dying.
Students may face hostility or rejection from patients and their families. Many times the atmosphere on the nursing unit may be unfriendly or aloof, 1 which adds to the student’s sense of self-doubt and insecurity. Additionally, students are in continuous contact with faculty and often believe that every task or interaction is being evaluated (Jones & Johnson, 1997; Kleehammer, Hart, & Keck, 1990; Mahat, 1998). The literature indicates that students in other disciplines may perceive stressors that are unique to their discipline. According to Zastrow (1985), social work students experience a variety of challenges on their path to a career.
Many students in social work may have concerns about their capacity to handle field placements. They worry about their ability to assist clients without becoming emotionally involved. Often, they see situations that are emotionally draining such as child abuse, mental illness and homelessness. These students often express anxiety about their own emotional strength and are concerned whether social work is the correct choice for them as a career (Zastrow, 1985). Therefore, researchers have documented that perceived stress levels are high in nursing students (Burke, 1999; Mahat, 1996; Shriver, 2000).
However, is this perception of stress in nursing students different than those of students in other helping professions? This study will attempt to identify whether or not there is a difference in the perceived stress levels and coping styles of nursing students and students enrolled in social work programs. Background of the Problem The effects of stress on college and university students have been well documented. Whitman (1995) states that excessive stress can be harmful to a student’s academic performance. Additionally, students who perceive their stress levels as very high often will become depressed.
This depression can lead to other mental health 2 problems such as excessive drinking or indiscriminate use of other substances. In severe cases, this depression can lead to suicide (Hirsch & Ellis, 1996; Morgan, 1997). As well, severe stress levels can lead to attrition. With the current nursing shortage, it is imperative that the nursing profession retain as many qualified students as possible (Alspach, 2000). Individuals in colleges and universities experience a wide array of stressful events. Many students move away from home for the first time.
This can necessitate leaving all previously learned support systems such as parents, siblings and high school friends. Students may need to develop entirely new social contacts. They might be responsible for their own needs for the first time. They may have difficulty adjusting to more rigorous academic expectations and the need to learn to deal with individuals of differing cultures and beliefs (Hefferin, 1982; Hudd et al.. , 2000; Misra et al.. , 2000). Older students, living at home, often have multiple role demands such as family or occupational responsibilities that can lead to increased erceptions of stress. (Lengacher, 1996). Tinto (1995) states that many times older students may feel disenfranchised from the institution and have a feeling of isolation. They often believe they have nothing in common with other students and are unable to establish the peer supports that are established by younger more traditional students. Studies indicate that nursing students may be more prone to stress than other students. Personality characteristics of nursing students might put them at risk. Gallagher (1989) found that most individuals entering the nursing profession are action oriented.
They set high standards for themselves and others and are attentive to detail. In most cases, they will not accept work that is not perfect. They are giving, and often will 3 place others needs above their own. Characteristics such as these place an individual at higher risk for stress and burnout than the general population (Flanagan, 1997). Currently, society is experiencing a severe nursing shortage (Alspach, 2000; Bozell, 2001; Egger, 2000; Johnson, 2000; Jones, 2001). This shortage is projected to worsen in the next decade and could seriously effect the nation’s healthcare.
It is imperative that the nursing profession is able to recruit and retain qualified nurses. This must begin with the educational process. Colleges and schools of nursing must recruit and graduate students of the highest quality that are ready to meet the challenges and demands of the profession. High perceived stress levels and lack of effective coping skills could present a barrier to this goal. Therefore, those involved in nursing education must assess this problem in order to identify effective strategies to deal with it. Historical Perspective The educational path to a career in nursing has always been a difficult journey.
Initially, most training programs were based in hospitals and often provided the institution with free labor. This training consisted of minimal theory and was based mainly on hands-on tasks and skills. Students were required to work 50 – 60 hours a week (Ashley, 1976). Admission requirements varied from hospital to hospital. In most cases, the applicant had to be female. The minimum age was usually 21. African-American applicants were generally not considered. Married women were usually excluded and divorced women were totally unacceptable (Kelley, 1996). Today, however, nursing education is quite different.
Nursing schools are now associated with universities and community colleges. Although technical skills remain 4 important, there is an increased emphasis on theory and critical thinking (Reed & Procter, 1993). Additionally, the student nurse population is much more diverse (Deloughery, 1998; McCloskey & Grace, 1997; Reed & Proctor, 1993). Nursing students are now older and are more culturally diverse. They are more likely to be married and have children. Many are employed. Some have previous degrees in either nursing or other fields, such as business, education or psychology.
These changes have major implications for nursing education programs, as well as colleges and universities in general. Perceived Stress and Coping Styles in University Programs Stress in College Students Stress in college students is increasing (Peden, Rayens, Hall & Beebe, 2001). Sax (1997) found that 9. 7% of college freshmen report frequent depression. Additionally, only 48% of female students and 59. 3% of male students were confident in their mental health. Douglas, Collins and Warren (1997) reported that on the National College Risk survey, as many as 10. 3% of the students that participated had serious thoughts of suicide.
Sarafino and Ewing (1999) emphasize being able to assess and reduce student’s stress is of paramount importance to college counseling and health centers. They emphasize the role that stress can play in causing psychological and physical illnesses such as hypertension, headaches and even the common cold. Their research focused on life event stress and the stress of daily “hassles”. Life events referred to major changes in ones life such as employment, personal relationships or health. The term “hassles” 5 referred to common annoyances or irritants such as misplacing items, time pressures or interpersonal conflicts.
Results were related to frequency, perceived unpleasantness and the process of rumination, or as they term it “dwelling”. Their research validated that many times the severity of the perceived stress is often dependent on the individuals’ coping skills. Also, students that dwell on stressors and problems will often continue to experience chronic anxiety and strain after the actual stressor is no longer present. Hudd et al.. (2000) found that students reporting high stress levels will exhibit more unhealthy behaviors. This includes poor diet, lack of exercise and sleep patterns.
They found that highly stressed students perceive themselves as less healthy, are prone to less healthy habits and report a lower level of self-esteem. Misra et al.. (2000) conducted research to determine if there is a difference in student and faculty perceptions of student stress. They found that faculty tended to perceive student’s stress levels as higher than the students actually reported. They did, however, find that students at the freshman and sophomore levels experience more perceived stress than juniors or seniors. This could indicate that students develop more effective coping skills as they proceed through their academic careers.
This may have implications for administrators and faculty. If appropriate coping styles are identified, perhaps stress management programs could be implemented with younger students before they experience the damaging effects of perceived stress. Stress in Social Work Students Research indicates that social work students, like those in nursing, experience the most stress in clinical placements. May and Kilpatrick (1988) found that social work programs do very little to prepare students for the stress of self-awareness needed in 6 clinical practice.
Strategies identified that might address this problem were video feedback of interviews with clients, meeting with students already in clinical placements and relevant classroom material to be discussed during placements. Half of the schools surveyed were neutral about students seeking therapy during clinical placements. Field instructors identified themselves as the most important person in assisting students to overcome stress during these placements. Rauch (1984) suggests that an effective orientation could assist social work students with the transition to clinical rotations.
This researcher believes that hospital placement is one of the most stressful for social work students beginning field placements. It was found that a thorough orientation, with emphasis on the social worker role and focus of services, assisted the student to have a better learning experience. Simmonds (1984) found that the greatest source of stress in social work students results from the transition from student to practitioner. He determined that many social work students must work through an actual mourning process. If this does not occur, he states that burnout and poor worker-management relations may occur.
He recommends that faculty discuss the transition process with undergraduate social work students to assist them in dealing with the stress and anxiety involved in assuming a role in independent practice. Stress in Nursing Students Stress in nursing students has been well documented (Beck & Srivastava, 1991; Kleehammer, Hart & Fogel, 1990; Lindop, 1991). Beck & Srivastava (1991) found that nursing students suffer from long hours of study, multiple assignments, lack of free time, lack of timely feedback and lack of faculty response to student needs. Hamill (1995) 7 ound that nursing students often have difficulty adjusting to the academic environment of higher education, as well as difficulty adjusting to the environment of a nursing unit. Studies indicate that the clinical component of nursing school is the most stressful (Mahat, 1996; Kleehamer, Hart & Fogel, 1990; Admi, 1997). Pagana (1988) surveyed 262 baccalaureate nursing students and found that personal inadequacy and a fear of making mistakes were constant stressors. Lindop (1991) identified conflict between the ideal and real clinical practice was also a source of stress.
He also found that time management problems, when trying to complete nursing tasks, added to a student’s perception of stress. Bell (1991) found that anxiety and stress could interfere with learning a complex, psychomotor skill. Other studies identify social factors as a major source of stress in nursing students (Lengacher, 1996; Green, 1987; Beck, 1995). The demographics of nursing students has changed dramatically in the last two decades (Bednash, 1997). Many students are now married with families.
Some students are already practicing nurses returning for their baccalaureate degree. These facts can lead to stressors related to role strain and role conflict. Cox (1995) found that the greatest stresses for Registered Nursing Students (RN) in returning to school were fulfilling multiple roles, loss of time with family and friends, lack of time for leisure activities and an overwhelming amount of schoolwork. Lengacher (1993) found that personality, stage of career development and marital status were predictive factors in role strain in nursing students.
Stetson (1997) found that in a large survey by Manderino, Ganong and Darnell, in 1988, only 2% of 276 baccalaureate degree programs that are accredited by the National League for Nursing required a stress management program within their curriculum. This 8 leads one to question if faculty recognize the problem and are assisting students to develop effective coping skills. In addition to the foregoing, the literature indicates that several factors may have an influence on a student’s perceived stress level.
These factors are age, gender, marital status, whether the student is employed and whether the student is a generic student or a RN student. According to Johnson and Christenson (2000), these factors should be identified as extraneous variables and should be examined to determine if they vary significantly within the independent variable, which is the type of program the student is attending. For example, if a majority of the students in the nursing program are older than the students in the social work program, this may influence the student’s perception of stress.
Johnson and Christenson (2000) state that if an extraneous variable is found to systematically vary within the independent variable, it may produce a confounding effect and limit the validity of the study (Johnson & Christenson, 2000). Therefore, the following extraneous variables will be examined to determine if a significant relationship exists between them and the dependent variable, student’s perception of stress or coping style in the designated programs of nursing and social work. Age
Research indicates that an individual’s age may have an influence on his or her perceived stress level. Whitman (1985) suggests that younger students experience many stressful changes in their lives. These students often leave home for the first time when going away to school. Often, they experience ambivalent feelings resulting from the need for parental/familial support and the drive for independence. Additionally, the academic expectations in college can be an abrupt change from those in high school. The 9 pressure to achieve good grades can result in a battle for self-esteem.
Hefferin (1982) adds that younger students often develop intimate psychosocial relationships at this time in their lives. Older students, however, also have stressors unique to their age group. Nunnery (1997) states that older students sometimes believe that they do not fit in. In some cases, these students are more prone to test and computer anxiety. Green (1987) states that older students will have to deal with more decisions about career commitment, alterations in family relationships and planning for financial security.
They often have more roles that compete for their time and energy. Many nursing programs expect older students to have more life experiences, and therefore, deal more effectively with stress. Pagana (1988) found that they have significantly less fear of making a mistake and indicate they are less stressed by interactions with faculty. Beck (1995), however, states that these students may have more outside responsibilities. Therefore, it is important to include an individual’s age as a possible extraneous variable.