Chapter II

REVIEW OF RELATED LITERATURE AND STUDIES

The literature and studies were carefully selected and deliberated upon on the basis of relatively and
reliability of the information presented. The subjects or topics were structured for a better presentation of
the literature and studies needed in this study.

Foreign Literature

In our daily living, we are facing different kinds of stress. Stress is a natural phenomenon in which simply
means that it cannot be controlled (Selye). Usually, this stress was experienced by nursing student reaching high
levels of anxiety. (Goldberger). In the clinical setting, student need to consider assimilation of current knowledge
explosion, when stress reached high level, it makes the students reach with submissive maladaptive behaviors
which could damage and prevent problems on both students and educators. Stress is defined as the reaction of the
individual to demand from environment that possesses a threat. Stress is related specific fear of failure, fear of
teacher’s evaluations, fear of harming patient, fear of interaction with patient and families. The people who are
susceptible in psychological stressors are the one who have poor social network, neurotic disposition, lack of
hardness and who have experienced traumatic events in life (Domjan).

In psychobiological stress responses, it may affect the biological and constitutional prosperities like the
student’s background; age and sex, diet, smoking and alcohol intake, physical fitness and menstrual cycle may
also influence reactivity to stress (Duffy). Prolonged and extreme stress will eventually overwhelm the individual’s
physical and psychological resources, thus the student is unable to think rationally, unable to make wise decisions
that leads the student to failure and decreases his effort and accomplishment (Bosma). Being a student nurse, it
requires to have rational thinking, competence, assertiveness, patience and most especially, loving and caring to
render quality nursing care.

The stress reaction results from an out pouring of adrenaline, a stimulant hormone, into the blood stream.
This with other stress hormones, produces a number of changes in the body, which are intended to be protective.
The result is often called “the fight –or-flight response”. it provides the strength and energy to either fight or run
away from danger. The changes include an increase in heart rate and blood pressure (to get more blood to the
muscles, brain and heart) faster breathing (to take in more oxygen), tensing of muscles (preparation for action),
increase mental alertness and sensitivity of sense organs (to assess the situation and act quickly), increased blood
flow to the brain, heart and muscles, (the organs that are most important in dealing with danger) and less blood to
the skin, digestive tract, kidneys and liver (where it is least needed in times of crisis). In addition, there is an
increase in blood sugar, fats and cholesterol and a rise in platelets and blood clotting factors (Phipps).

Manifestations of stress are numerous and varied but they generally fall into four (4) categories (Reinham).

1. Physical: Fatigue, headache, insomnia, muscle aches/ stiffness (especially neck, shoulders, and low back),
heart palpitations, chest pains, abdominal cramps, nausea, trembling, cold extremities, flushing or sweating and
memory.

2. Mental: Decrease in concentration and memory Indecisiveness, mind racing or going blank, confusion loss of
sense of humor.

3. Emotional: Anxiety, nervousness, depression, angers, frustration, worry, fear, irritability, impatience, short
tempers.
4. Behavioral: pacing, fidgeting , nervous habits (nail-biting, foot tapping), increase eating, smoking, drinking,
crying, yelling, sweating, blaming and even things or hitting.

One of the most important thing nursing educators can do to students is to reach them about stress management.
The students maybe advised to change lifestyle such as decrease caffeine intake, eat and well balance diet,
decrease consumption of junk food, eat slowly, regular exercise, adequate sleep, and relaxation exercises such as
self-hypnosis and meditation. Other effective stress management includes time and money management, create
assertiveness , problem solving approach, refute negative thoughts and keep a sense of humor (Posen). It is
important to note that stress management can be self-generated and needs time to master.

Local Literature

Stress is an individual theory. What is stressful for one person is not necessarily be stressful for another
because each person perceived stress differently and depends on the coping and defense mechanism of the
individual (Madrigal).

The easiest way to reduce stress in our lives is to work on and must approachable problem first. Solve them
and then move on the difficult ones. There is no stress reducing methods that works every time for every person.
People are difficult in their reaction to various sources with stress that can vary to examine various techniques until
you find one that works for you. Moving immediately to reduce even smallest strain with the body is beneficial
because stress is cumulative (Chebato). It is more effective to work on the so-called minor stress related problem
rather than to develop into a crisis.
Stress is a part of life. The absence of stress means the absence of effort. Moderate tension promotes alertness,
effort and learning. Stress often brings the student at its peak, because he comes nearer to giving one hundred
percent of his energy and attention to what the student is doing. But stress may also cause deterioration in the
student’s performance. As the level of stress increases, effort, show altering performance in which may lower self-
esteem causing anxiety and confusion.

Students also try to cope with changing environment. Coping is a process by which an individual deals with
stressors on his own unique manner (Lara). People used both form of coping in virtually every type stressful
encounter or any stressful situations. Through coping, individual decided on actions that are relevant to their
welfare.

Problem – focused forms of coping include aggressive interpersonal efforts to alter the situation, as well as
cool, rational, deliberate efforts to solve problems and emotion focused on distancing, self – controlling, seeking
social support, escape avoidance, accepting and positive appraisal.

Foreign Studies

The present study compared the academic stress levels of 450 colleges sophomore student at a public
university and a public two year college Benson). This investigation also explored the levels of academic stress by
institutional type, age, gender, and ethnicity. Data were obtained from having the subjects complete the Academic
Stress Scale, a questionnaire in which lists 35 stress items found in the college classroom. Analysis of variance
and t-tests were used to analyze the data.
 There were 225 subjects each in the community college group and the university group. The university
group had a statistically significant higher mean stress score than to the community college group.

Two hundred ninety-four traditional age (23 and younger) and 156 non-traditional age (24 and over) subjects
stress levels were compared. It was found that the traditional age of college student group experienced a
statistically significant higher academic stress level in both academic settings.

Group means were compared between the stress score of 245 female and 205 male subjects. At both the
community college and university levels, the female group had a statistically significant higher level of academic
stress.

The academic stress level was also compared according to ethnicity. The minority group consisted of 104
subject and 346 subjects comprised the non-minority group. At the community college, the minority group had a
statistically significant higher level of academic stress. However, at the university level, there was no statistically
significant difference by ethnicity.

Examination, final grades, term papers, homework, and studying for examinations were ranked as being
stressful by the largest percentage of all the subjects. It was found in this study that level of academic stress differ
significantly by institutional type, age, gender, and ethnicity. Implications for college students, instructors, and
administrators, based on this study’s conclusions are offered.

This study had several purposes. The first purpose was to assess perceived levels of stress experienced by
college students. A second purpose was to detect the primary sources of perceived stress among college student.
A third purpose was to find out the activities students routinely participate in these types of activities. The fourth
purpose was to find out how effectively these preferred relaxing, stress managing, coping activities reduce
perceived stress. A final purpose was to find out if any difference exists among selected variables (gender, year in
school, race and age) for perceived stress levels, sources of stress, and methods for managing stress (Olpin).

Results were obtained from a survey of 559 students enrolled of Healthful Living 201at Southern Illinois
University at Carbondale. The subjects for this study were predominantly white and black males and females
between ages of 18-23. The representation of freshmen, sophomores. Juniors, and seniors was fairly even with the
largest proportion of subjects being sophomores. Survey packets were distributed to section during November of
1995.

Subjects responded to a questionnaire that gathered information regarding perceived levels of stress,
sources of stress and type and frequency of preferred methods of dealing with individual stress. The instruments
used to gather this data included the Perceived Stress Scale (PSS), The Inventory of College Students’ Recent
Life Experiences (ICSRLE) and the Relaxation Frequency Inventory (RFI).

The chief stressors that these students’ experienced had to do mainly with their academic life. These
stressors include many responsibilities, struggling to meet academic standards, time and money management
worries and concerns over grades. As the number and intensity of these hassles go up, so do the individual’s level
of stress.

Students of this survey use social activities, watching television, and leisure activities more than other
methods for managing stress. They tend to use methods that are specifically designed to reduce stress much less
than other activities that had, as a byproduct, relaxation or management of stress. The subsequent analysis of the
effectiveness of stress managing activities suggested that the methods that the students commonly use to manage
stress are not particularly effective at doing so.
 This study examined teacher’s perceptions of their relationships with specific students, their experience of
stress in relation to those students, and whether those perceptions and experience translated into differences in
observed teacher behavior toward those students in the classroom (Boesen). Thirty teachers from two middle
schools in Virginia were asked to complete three questionnaires in relation to a behaviorally challenging student
and a control student in their classroom: the Index of Teaching Stress (ITS), the Student – Teacher Relationship
Scale (STRS) and the Achenbach Teacher Report Form (TFR). A simple observation checklist was used to note
positive, negative and neutral teacher behaviors towards their students. The observational data were then
compared to the teacher (ITS) and relationship (STRS) measures to assess the predictive validity of the
instrument.

The results of the analyses suggest that teachers have different perceptions of and experiences different
stress levels with regard to specific students in their classroom. These perceptions and stress levels are linked to
their classroom behaviors and may bias their behavior toward those students. Moreover, the ITS sores were found
to be useful in determining child membership in either group. These findings provide initial validation of the use of
ITS and STRS in understanding teacher stress, the quality of teacher – student relationship and teacher behavior,
and also have implication for a number of other issues in the teaching profession.

Many special education students that were once relatively isolated in Resource rooms are now being sent to
the regular education classroom, accompanied by modifications (Bonesek). The teachers bear the responsibility
not only for enforcing every aspect of the law with regard to how those mainstreamed students are taught, but also
for the outcome of what is learned. The increased number f students with special needs in regular classroom has
impact on the teacher’s behavior and need attitudes towards those students’ which became a concern for building
administrators.
 This study has multiple purpose: (1) to describe the nature of the relationships between the number of
students needing modifications in a classroom and the teacher’s attitudes towards mainstreaming/ inclusion as well
as the stress level; (2) to describe the nature of the relationship between the teacher’s attitude toward
mainstreaming/ inclusion and the teacher’s stress level; (3) to describe the nature of the relationship between the
teacher’s attitudes toward mainstreaming/ inclusion, as well as the teacher’s stress, and numerous variables.

The survey instrument consisted of three sections: demographics, teacher attitudes and mainstreaming and
special – needs student, and teacher stress.

This study shows that there is a slight relationship between the numbers of special – need students. There is
evidence to show that there is relationship between the teacher’s attitude and their stress level, showing that as a
teacher’s attitude toward these students with disabilities becomes more negative, the teacher’s stress level is
higher. The research also indicates that as teacher attitudes become increasing negative, teachers tend to view
less success with special – need students, less availability of support service and lack of administrative support.

Local Studies

Educational program in nursing nearly always subject the students to a certain number of stressful as well
as certain number of satisfying experiences. Stress is an inescapable part of life, and one cannot evade on it
(Lantican). The rules of cognition in viewing stress and reacting to it have been well recognized. Mind and body are
integrated parts of whole being, the connection between thinking stress and emotion are seen as reflecting a battle
of mind versus body, logic versus feeling, and rational versus irrational emotion. A cardinal principle of human
functioning is that it is not events in themselves but how we view them that causes emotional distress, our
behavior, what we do as much as we think can either add or reduce the stress in our daily lives.
 The sources of tension for the nurse in the general area of conflict identified were nursing administration,
scheduling and staffing families, research procedures, other nurses, patients and physician (Miranda).

The clinical area is a crisis filled environment and makes great demands on the nursing staff. The nurse,
new to the area who had difficulty in adapting may also manipulate some of the behavioral response seen from
patient like apathy, inappropriate euphoria, crying, irritability, negativism, complaining, forgetfulness poor judgment
etc. the nurse may feel incompetent and attempt to avoid stress by giving orders, staying at the desk or being
preoccupied with housekeeping or clerical chores.

The role of the professional nurse is undergoing dramatic expansion in relation to the delivery of health
services. There are many stressful demand placed upon the expanding nursing role in the clinical area. Within the
unit forces such as technological environment, the patient and his care, the patient’s family, staff personnel
relationship and administrative hierarchy of the hospital contribute to the development of stress in the nurse. It is
evident the nurse must be able to manage stress in order to meet high standards of nursing care. it can be
assumed that poor management of stress result in poor nursing care, job dissatisfaction and diminished potential
for further professional development. The nurse is as vital to quality care as is widely accepted, and then it is
important to help her identify the sources of stress, which makes her difficult work even more trying.

Environment changes are indeed anxiety – provoking, yet change can be positive in that its stimulates
reappraisal of behavior, alertness, learning and self actualization. Various defense mechanisms maybe used
unconsciously. Frequent feeling of anxiety in security or incompetence is handled by displacement or projection.
Displacement occurs when the student nurse “takes our “ feelings on someone or something in the environment;
acting in aggressive manner. Human being adapt to various life stresses both internal and external. When certain
stressors make demands on a person, stress will occur only if the person anticipates that he will not be able to
cope with them adequately or he believes that he will be able to cope them without endangering other goals. To
adequately assess adaptation to stress, the student nurse cannot rely on only an objective analysis if the demands
and supports of an individual, but must assess the person’s perception of these demands and supports.

Nursing course is indeed stressful, adaptation or survival in this course must be established. The above
literatures suggest that in order for the student nurse to cope with stress, he or she must learn how to identify the
negative and positive effects of stressors and most especially the manner of adaptation.