1

CHAPTER 1
INTRODUCTION
Globally,

nurses

had

normal

experience

of

being

overwhelmed from time to time. It is virtually impossible to

eliminate

times

when

events

conspire

and

the

bodys

stress

response is triggered, but there are ways that we can quickly

reverse our bodys reaction to stress, like buffering the damage
to our health and keeping our thinking clear so we can deal more
effectively with whats going on in the moment (Carrasco, 2009).
In the Philippines, a student may face many challenges and
stressors. However, nursing students are likely to experience
even more stress than their friends and colleagues enrolled in
other programs. To support this statement, a study comparing the
stress levels of various professional students by Bautista found
that nursing students experience higher levels of stress than
medical, social work and pharmacy students (Salazar, 2002).
Stress

has

been

defined

as

barrier

to

concentration,

problem solving, decision making, and other necessary abilities

for students learning. Stress among nursing students becomes a
hindrance

in

managing

their

time

and

study

and

may

lead

to

distress. Complying with a longer academic program and having to

contend

with

clinical

duties,

makes

it

impossible

for

these

students to make it out of a stressful environment. Some of the

most

common

decisions,

stressors

continuous

are

time

changes

and

pressures,
economic

workload,
mistakes

making
at

work

(M.Pulido-Martos phD, Augusto-Landa phD and E.Lopez-Zafra phD).

Nursing students have limited time in doing other activities,
neglecting their social life and basically having a good time now
and then, because they have to deal with their academic standings
and sometimes become tired from clinical duties and long hours at
school. Although pressure can help in motivating student nurses
in doing their tasks, yet too much pressure will give them a
breakdown.
Despite of dealing with the academic standing, attaining
high

grades,

long

hours

of

studying,

another

stressor

among

student nurses is how to survive their clinical requirements.

According to Sharif and Masoumi, 2005, clinical practice has been
identified as one of the most anxiety producing components in
nursing programs. Lack of experience, fear of making mistakes,
difficult patients,

discomfort at being evaluated by faculty

members, worrying about giving patients the wrong information or

medication

and concern about possibly harming a patient are just

a few of the stressors for the beginning student nurse.

Managing

stress

is

important

for

nursing

students

since

their practice involves taking care of sick patients, functioning

properly

to

save

lives

and

studying

hard

to

become

future

registered nurses. Student nurses should be able to identify the

stressors

that

cause

them

to

become

stressed.

If

they

let

stressors take over them, their practice will be highly affected

and will cause disruption to their mind and body. These are a few
key things that nurses can do to help decrease stress in their
lives: Take time for themselves, think positive self-thoughts,
identify

stressors

they

encounter,

collaborate

with

administration to resolve workplace issues, make the effort to

balance

their

lives

people

outside

and

the

pursue

job,

supportive

supporting

relationships

fellow

nurses

with
and

acknowledging success also helps reduce workplace stress, eating

a well-balanced diet, exercising, meditating, doing yoga therapy
and other relaxation techniques (Kirkland, 2003).
At Saint Gabriel College, stress among students is prevalent
nowadays. Students are striving to get atleast grades above 75%80%, cramming and procrastinating on assignments, requirements,
altered sleep patterns due to clinical duties, limited time in
studying,

and

continuous

quizzes

everyday

are

some

of

the

stressors experienced by Saint Gabriel College Nursing students.

What these students do to relieve stress is finding time to relax
by

going

out

with

friends

and

taking

the

time

for

leisure

activities.
Based on the above premise, this study was conducted to
determine how levels of stress and stress management techniques

are

utilized

by

student

nurses

of

Saint

Gabriel

College

of

Nursing.
STATEMENT OF THE PROBLEM
This study was conducted to determine the levels of stress
and stress management techniques utilized by student nurses of
Saint Gabriel College of Nursing.
Specifically it will have the following objectives:
1. To

find

nurses

out

such

the
as

demographic

age,

gender,

profile
year

of

student

level,

marital

status, residence , allowance per week

and number

of subjects
2. To assess the level of stress among student nurses
of Saint Gabriel College of Nursing.
3. To
identify
the
stress
management

techniques

utilized by student nurses of Saint Gabriel College

of Nursing.
4. To determine the relationship between the profile,
the levels of stress to stress management techniques
utilized by student nurses of Saint Gabriel College
of Nursing.

THEORETICAL FRAMEWORK:

This study was based on Sister Callista Roys adaptation

model and concept of stress. Sister Callista Roys Adaptation
model

has

theories.

some
Roy

characteristics

borrowed

and

of

expanded

stress
on

and

theories

interaction
from

other,

including Seyle (1936), Helson (1964) and Maslow (1970). RAM

focuses on the individual (person) as a biopsychosocial adaptive
system and describes nursing as a humanistic discipline that
places emphasis on the persons own coping abilities to achieve
health (Roy 1984).
Roy defined stress as a constantly changing point, made up
of focal, contextual and residual stimuli which represent the
persons

own

respond

with

standard

of

ordinary

the

range

adaptive

of

stimuli

response.

to

Stress

which

can

for

Roy

represents the parity of the person in terms of survival, growth,

reproduction and mastery. A persons adaption level is determined
by combined effect of the three classes of stimuli (input).
Health results when adaptation reaches the optimal level of the
individuals potential to meet his or her psychosocial and self
actualization needs. The individuals use both innate and acquired
biological, psychological or social adaptive mechanisms of all
three.
In

this

study,

stress

refers

to

the

physiological

and

psychological response of the nursing students to the stressors

in the academic field and stress management techniques are ways

people maintain equilibrium despite the stressors present in the

environment. The Bachelor of Science of Nursing requirements has
been identified as one of the most stress producing component in
the nursing field such as lack of experience, fear of making
mistakes, being evaluated by the clinical instructor, major exams
and paper works like case studies, thesis reports, concept maps
and nursing care plan. It is essential that they learn to utilize
successfully the stress management techniques to cope with the
stressors to maintain their wellness and to model a healthy
behavior.
In relation, the regular Bachelor of Science in Nursing
Students experiences different levels of stress, the greater the
stressors, the greater the stress level, the greater the need for
stress management techniques to be utilized.

CONCEPTUAL PARDIGM:
The conceptual framework shows the relationship between the
independent

and

dependent

variables.

In

this

study,

the

independent variables are the levels of stress of the respondents

which is classified into high, moderate, and low.
dependent

variable

intervening

are

variable

the

are

stress

the

management

personal

while the

techniques.

characteristics

of

The
the

respondents which identifies the age, gender, year level, marital

status, residence, allowance per week, and number of subjects.

Independent Variable

Dependent Variable

LEVELS OF STRESS
High
Moderate
Low

STRESS MANAGEMENT
TECHNIQUES

Moderator Variable
PERSONAL
CHARACTERISTICS

E.g. Age
Gender
Year level
Marital status
Residence
Allowance per week
Number of subjects
Hours of Sleep

Figure

1:

Figure

1:

The

Schematic

Diagram

showing

the

relationship between the independent, dependent and intervening

variables.

NULL HYPOTHESIS:
There is no significant difference between stress and stress
management techniques utilized by student nurses of Saint Gabriel
College.

ASSUMPTION:
All nursing students experience stress.
SCOPE AND LIMITATIONS
The study was focused on describing the relationship
between the levels of stress and stress management techniques
utilized by regular Bachelor of Science in Nursing Students,
enrolled

in

the

Saint

Gabriel

College.

Data

which

will

be

utilized in this study was gathered from the nursing students

through a modified questionnaire which is originally taken from
the study of Dangan (2006) and Nacilla (2006) and modified by the
researchers. The study was conducted during the 2nd semester of
school year 2012-2013.
Limitations of the study includes gathering 20 respondents
who are willing to answer the given questionnaires, which was
comprised of student nurses from different year levels at Saint
Gabriel College, Old Buswang, Kalibo, Aklan.

SIGNIFICANCE OF THE STUDY:

The study will benefit to the following:
Nursing Students

This study will benefit those nursing students who have been
experiencing stress under their academic/clinical program. The
result

of

this

study

will

help

them

identify

the

causes

of

stress, levels of stress and find means in managing the symptoms

of stress which settles as a threat for their normal functioning
and sense of well-being.

Clinical Instructors
This study will set as a guide for instructors in planning
activities and strategies that would help students in controlling
and avoiding stress when involved in the academic or clinical
field.
School Administrators
The study will serve as a basis to encourage them to
support and approve school activities which will benefit the
students well-being.

Guidance Counsel
This study will serve as a basis for guidance counselors to
develop activities or programs for those students to release
their tension on stress and help them relieve the symptoms of it.
Future Researchers
For future researchers, this study will benefit as a source
or reference for your future outputs and will provide information

10

about

the

levels

of

stress

and

stress

management

techniques

utilized by nursing students in the academic and clinical field.

DEFINITION OF TERMS:
The following terms are defined for clarity:
Level of stress refers to the severity of the manifested
physical or mental tension resulting from factors that alter an
existing equilibrium (Mosby, 2009).
In this study, this refers to the state or condition of
restrictions, demand, or constraints of nursing students. This
will be measured by a 30 items questionnaire by Dangan (2006)
which is modified by the researchers about manifestations of
stress and scores will be categorized as 0 for (never) did not
experience;

1 for (rarely) experience at least once a month; 2

for sometimes; 3 for often; and 4 for always experiencing.

Stress - is the bodys reaction to a change that requires a

physical, mental, or emotional adjustment or response (Morrow,
2009).
In

this

study

stress

refers

to

the

feeling

that

is

experienced by Bachelor of Science in nursing students. Acute

stress refers to stress that occurs suddenly, and lasting for a
short period of time (minutes). It has a stress level score of 1
to 40.Moderate stress refers to stress lasting for hours and more

11

often. It has a stress level score of 41to 80.Chronic stress

refers to an existing stress that lasts for days or longer. It
has a stress level score of 81 to 120.
Stressor a stimulus that causes stress (Meriam-Webster,
2013)
In this study, stressor refers to the causes of stress in
Bachelor of Science nursing students.
Stress

Management

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 to minimize their effects. (Gale, 2008)

In this study, stress management techniques refers to the
ways employed by nursing students to avoid stress and stressors
such as time management, music therapy, exercise, and allotting
adequate hours of sleep.
This will be measured by a 30 items questionnaire about
stress management techniques by Nacilla (2006) which is modified
by the researchers and the scores will be categorized as 0 for
not

practicing;

for

rarely

practicing

for

sometimes

practicing; 3 for often practicing; and 4 for always practicing.

12

CHAPTER II
REVIEW OF RELATED LITERATURE
This chapter presents the literatures reviewed, which may be
utilized in defining the methodology and/or interpretation of
data. Literature reviewed includes local and foreign books, local
and foreign researches, articles, and internet materials.

13

Local Literature:
Coping with Stress
For licesned Apruebo, Roxel, A. The Science of Psychology,
1st Edition. Philippines: Educational Publishing House Inc. 2009.
Process of Stress Stressful events may occur as sudden,
unexpected, potentially life-threatening experiences or traumas
qualify as catastrophic events, such as physical or sexual
assault, military combat, natural disasters, explosions, plane
crashes and accidents fall into this category. Life changes and
strains include marital separation, illness in the family,
difficulties at work, moving to a new place, and other
circumstances that create demand with which people must adjust.
Chronic stressors continue over a long period of time like living
due to adverse economic conditions, residing in a high-crime
neighborhood, being the victim of discrimination, and even
enduring years of job pressures. Daily hassles involve
irritations, heavy traffics, pressures, and annoyances that may
not be major stressors by themselves but such effects aggravate
to become significant. This frustration of daily commuting in
heavy traffic can become so intense for some drivers display a
pattern of aggression. People reactions to stressful events or
stressors, such as catastrophic events, life changes and strains,
chronic stressors, and daily hassles are contributing components

14

of stress. The use of coping skills reduces inappropriate stress

response and improves strategies in response to stress.
How Filipino Nursing Students Deal with Stress
(http://royfranciscordero.wordpress.com/sample-thesis/):

The

scenes of smiling and laughing Filipinos, singing and dancing

(and drinking) away can be deceptive. Quite often, Filipinos
especially the young ones and the students deal with stress by
trying to be happy. I put that in quotes because the Filipino
term

is masaya,

which

is

really

more

of

an

externalized

merriment. Masaya is social camaraderie, its making cheer and

quite often we do it precisely because there have been unhappy
events, stressful events. The best example is that of a death
our

wakes

are

notorious

for

its

merry-making,

but

that,

precisely, is part of our stress-coping mechanism.

We have folk psychology, maybe even folk psychiatry, at work
here, Filipinos aware of how dangerous it is to allow stress to
consume us. We warn people about excesses as a cause of illness,
and that includes the excessive emotions generated by stress.
But for all the talk about our communitarian orientation, of
helping

friends

Philippines

can

to

overcome

also

be

stress,

social

counterproductive

pressures

in

with

way

the

the
we

15

sometimes force people to repress the stress. Enjoy! we urge

them, not realizing there are limits to resilience.
There are power dimensions to all this, such as those found
in gender. Contrary to stereotypes about women student being more
expressive, Filipinas are actually more prone to dealing with
stressful

situations

through tiis (endurance)

and kimkim (repression). Check out the local scenes of merriment:

its usually men students having a good time, bringing out the
beer and toasting their problems away, while their women look for
ways to make ends meet.
Men, students too, are expected to keep their feelings in
check, but more out of masculine values of strength and stoicism.
Men are generally not allowed to cry, much less to go into
hysterics; and this probably helps to explain why more men suffer
from cardiovascular disease.
According to Dr. Lourdes Ignacio many students will express
their

stress

abdominal

by

complaining

pains,

accompanied

about
by

recurring

dizziness,

headaches,

nausea,

or

fatigue.

Doctors used to dismiss these as being all in the mind, but it

has become clear the physical pain and distress may be quite
real, that the pent-up stress is expressed through the body.

16

The macho imperatives around stress are inevitably tied to

alcohol and drugs. Younger male Filipinos especially nursing are
particularly vulnerable, given their struggles with identity,
masculinity and self-esteem, unable to express their frustrations
and resentment. Drugs are one way of dealing with the stress,
with all its attendant problems. Its significant though that the
most

abused

drugs

are

metaphetamines,

which

are

uppers

or

stimulants. Again, the Filipino response to stress is to look for

more stimulation. The nerve cells fire away until, frayed and
exhausted, the user develops paranoia (borrowed into Filipino
as praning) and then psychosis.
Ignacio

said

Filipinos

have

their

own

natural

coping

mechanism compared to other nationalities.

She said Filipinos strong faith in God, sense of humor and
concern for others, are among the mechanisms that help them cope
with depression. We are very much crisis-oriented and we have
natural ways of coping with it, she said. Ignacio said they
consider these as forms of coping with mental disorders even
without scientific basis.
Reyes
again

said

after

some

being

mental

treated.

patients
Of

could

course,

for

function
example,

normally
a

bank

manager suffered from schizophrenia, he or she cannot go back as

17

a bank manager, but as a clerk. There is some form of regression

but in terms of symptoms, they are free from symptoms, but their
functioning has already regressed in some form, he said.
On the other hand, Ignacio revealed that the Philippines is
facing an acute shortage of psychiatrists due to the unabated
migration of mental health doctors who seek greener pastures
abroad.
Stress plays a great part not only on students but on every
individuals daily living. Quoting from Arnold Burnout, defined as
exhaustion of physical and emotional strength is a term used to
describe the end result of prolonged stress.

He further states

that sustained, intense stress decreases productivity and narrows

the individuals perceptions. Too much stress blocks learning and
decreases problem-solving ability, (1989:325).

Drs. Sally and

Rena Lawrence have done extensive study in the area of stress and
burnout in nursing. A recent article by these authors reads as
follows:

Common

stressors

for

nurses

are

environmental

conditions, emotional problems of patients and families, demands

of patients and supervisors, working conditions, interpersonal
and collegial relationships, and contemporary ethical and moral
dilemmas.

The list of stressors is endless because of the nature

of the nursing profession.

Unrealistic self-expectations are

perhaps the most critical sources of stress, Sally concurs with

18

the Lawrence statement; he writes, Expecting too much of oneself

can

lead

to

burnout

stressor,(1980:912).

faster
Smyth

than
in

any
her

other

single

book, Surviving

Nursing elaborates on the burnout phenomena: the three major

causes . . . are (1) a mismatch between efforts and results
leading to disappointment and frustration, (2) a mismatch between
nurse and environment leading to role ambiguity and conflict, and
(3) a mismatch, between people leading to interpersonal conflict.
Storlie

adds

final

dimension,

Disillusionment

and

burnout

follow confrontation with reality in which the human spirit is

pitted against circumstances intractable to change.
Stress Management
Cuevas, Frances Prescilla L. Public Helath Nursing in the
Phiippines, 10th Edition. Philippines: National League of
Philippine Government Nurses Inc. 2007. 9 stress management
techniques This related literature aids in identifying some of
the different stress management techniques that can be used to
mange stress. These are: 1. Meditation is a way of reaching
beyond the senses. It is very effective method of relaxation. The
idea of meditation is to focus ones thoughts on one relaxing
thing for a sustained period of time. It gives the body time to
relax and recuperate and clear away toxins that may have build up
through stress and mental or physical activity. Meditation may

19

have the following effects: a) lowers blood pressure; b) slow

breathing; c) gives the body time to eliminate lactic acid and
other waste products; d) eliminates stressful thoughts; e) helps
with clear thinking; f) helps with focus and concentration; g)
reduces stress headache; 2. Self awareness means knowing ones
self, getting in touch with ones feelings, or being pen to
experiences. It increases sensitivity to the inner self and
relationship with the world around. Self awareness is important
in evaluating ones abilities realistically, identifying the areas
which needs to be improved, recognizing and building strengths,
developing more effective interpersonal relationship,
understanding the kind of motivations that are influencing such
behavior, developing empathy and understanding to recognize both
personal needs and the needs of other people.

Scheduling:

time management time is a source. A source is something that

lies ready for use, or something that can be drawn upon for aid.
Time is a tool that can be drawn upon to help accomplish results,
an aid that can take care of a need, assistance in solving
problems. Managing time really refers to managing ones self in
such as a way as to optimize the time available in order to
achieve gratifying results. 4. Siesta mans taking a nap, short
rest, a break or recharging of battery in order to improve
productivity. It helps relax the mind and body muscles. It had
been proven thru a study that siesta invigorates ones body.

20

Performance of an individual scored high when siesta is observed

with a 15-30 minutes nap. It relieves stress tension and one
wakes up invigorated and set for the next activity. 5. Stretching
are simple movements performed rhythmical and slow pace
executed at the start of a demanding activity to loosen muscle,
lubricate joints, and increase bodys oxygen supply. It requires
no special equipment, no special clothes, and no special skills
and it can be done anywhere and anytime. Frequent exercise is
probably one of the best physical stress-reduction techniques
available. Exercise not only improves health, it also relaxes
tense muscles and induces sleep. 6. Sensation techniques the
sense of touch is highly a powerful and sensitive form of
communication. It is a natural reaction to reach out and touch
whether to feel the shape or texture of something or to response
to another person, perhaps by comforting them. Massage helps to
soothe away stress, unknotting tensed and aching muscles,
relieving headaches and helping sleep problems. But massage is
also invigorating; it improves the functioning of many of the
bodys system, promotes healing and tones muscles, leaving with a
feeling of renewed energy. 7. Sports engaging in sports and
physical activities like these have been known to relieve stress.
It also gives the body exercise it badly needs. 8. Socials a
man is a social being who exist in a relationship with his
physical environment and in relationship with people and society.

21

Socialization plays a very important role in the development of

interpersonal relationships. Through socialization life begins to
be meaningful, happy and worthy. On the contrary without
socialization life would be boring and unhappy. 9. Sounds and
songs music play is an important part in the everyday life of a
person. It provides medium of expression for thoughts and
emotions. It is also a way to relieve tension. Music adds to the
quality of life of a person.
Pegues, Deborah Smith. 30 days in Taming your Stress.
Philippines: OMF Literature Inc. 2007. Sleep is more important to
our survival than water or food. Getting sufficient sleep to
restore our bodies is a key factor in coping with day-to-day
stress. Further, failure to get enough sleep also increases
stress and can make us less able to handle stressful situations.
Most adults, regardless of age, need the recommended eight hour
us restful sleep a night. But sometimes stress can keep us awake,
making matters worse as we find ourselves in a vicious cycle of
stressful situation keeping us up and then a lack of sleep
causing more stress. Sleeplessness then can be one of many signs
that our body is under stress. What about your sleeping habits?
Do you have a sleep routine in which you go to bed and get up
about the same time, or do you allow events, people, deadlines or
other circumstances dictate your sleep schedule? For those of you
whose bedtime routine is rather extensive, do you start to wind

22

down in plenty of time to allow yourself to complete it, or does

the routine itself become stressor? Ever thought about completing
it hours before your bedtime? Most of us think of sleep as some
passive process in which we drift off into oblivion and wake up
several hours later well rested. The truth of the matter is that
sleep is an active state. Many metabolic and other restorative
processes occur during the various stages of sleep. If we do not
sleep long enough for our system to be rejuvenated, we will most
likely find ourselves irritated by the smallest things and
battling a whale of an appetite. The excess hunger is just our
bodys cry for the energy that was supposed to be supplied by a
good nights sleep. Nourish your body You will be able to manage
your stress much more effectively if you know how the foods you
consume affect your bodys ability to cope with daily pressures.
Despite the many books on the market today that adequately
explain how to properly fuel our bodies, nutritional ignorance
seems to be the norm as the rate of obesity continues to rise.
When the pressure is on, many find refuge and comfort in food.
Nourishing our bodies properly is a lifelong endeavor and we
would do well to become as nutrition-conscious as possible. If
you have the physical stress symptoms of poor concentration,
fatigue or a ferocious appetite, you may be tempted to get a
quick fix by eating junk food. The items of choice usually
contain caffeine, sugar or something salty with a crunch. Do your

23

find it interesting that when spelled backwards, s-t-r-e-s-s-e-d

is d-e-s-s-e-r-t-s? Have you noticed that you never tend to crave
foods like carrots, apples, or lean meats, even though they may
be better for you in the long run? But therein is the answer: the
long run. It takes a healthy food choice longer to raise our
blood sugar to the point where we feel satisfied, whereas the
junk food delivers an immediate result because its refined
ingredients are quickly assimilated. Further, they cause your
brain to release serotonin, a hormone that helps you to relax
for a brief time. The time is so brief that youll need another
hit of carbohydrates to recover from the precipitous drop in your
blood sugar. This time youll probably have to consume even more
carbohydrates because your blood sugar drops even lower than it
was originally after the first carbohydrate, so your body is
going to have to work harder to get your sugar level back to
normal. Is this beginning to sound like a drug addiction
scenario? Through all of this activity, there is a good chance
that you are not really hungry but rather feeding whatever the
emotion the stress generated. A 10 to 15 minute nap may be the
best solution. Of course, if you were diligent to make sure that
you eat the right foods frequently throughout the day, then your
blood sugar would stay at a level that would eliminate those
cravings. Nutritional and homeopathic supplements also play a
vital role in helping us to cope with stress, tension or anxiety.

24

However, before you begin a herbal program, you should at least

make a call to your medical doctor to make sure that certain
herbs do not interfere with your current medications. It is a
known fact that during time of stress, more vitamin C is depleted
from the body. Therefore, an extra dose to replenish it may be
needed. Prolonged stress can cause our internal systems to
breakdown. We need to keep our insides strong by selecting foods
that nourish us rather than work against us. Get Physical
activity is an excellent stress-buster and is critical to
normalizing your body after a stressful event. When your brain
senses a threat or danger, it quickly releases hormones carrying
an urgent message via the bloodstream to the adrenal glands
(which sit atop the kidneys). The message says, Lets prepare to
resist or run now! The adrenal glands produce excess stress
chemicals, cortisol and adrenaline and rush them into the
bloodstream, where they get delivered to various parts of the
body via nerve fibers. The body responds with increased strength,
raised blood pressure and other assistance needed to resist or
run. There have been countless stories of people who exhibited
unusual strength in a crisis. I heard of a petite young mother
who actually lifted the back of a car under which her child had
been trapped. Of course a crisis is not limited to threats of
physical danger. The threat of losing a job or a loved one, or
even the excitement of a happy occasion can cause the brain to

25

put the body on high alert. The adrenal glands do not attempt to
distinguish between negative or positive excitement. Once the
crisis is over, the excess hormones need to be dissipated out of
the bloodstream. This is where exercise plays a critical role.
Regular physical activity helps to burn these extra chemicals so
your body can return to normal. Imagine their buildup if you tend
to live in a period of stress day in and day out. In addition to
its positive impact on stress, physical activity provides us with
numerous other benefits, including better resistance to illness,
stronger bones, more energy and stronger muscles. What activity
is best? The best form of exercise is the one you enjoy and find
the most convenient. These are the two biggest reasons why most
of us fail to be consistent in following an exercise program.
First, we either lose interest in the activity because we dont
really get a lot of satisfaction out of doing it. I have had
beginning lessons in almost every sport two or three times for
some.

Secondly, we tend to not be consistent in an activity if

it requires too much time or effort to access. Whether a brisk

walk or a high-energy fitness class almost any physical activity
will help you let off steam, distract you from your source of
stress and improve your mood. It also relaxes and reenergized
your body. The duration of the exercise should be a minimum of 30
minutes of physical activity a day at least five days a week.
Doing more is even better. Some fitness gurus suggest that if you

26

cannot carve out 30 minutes at a time, grab 10 minute segments

throughout the day. There are also other benefits to making
exercise the center of your stress-busting program. People who
are routinely active tend to eat better. In addition, physical
activity can help you lose weight, keep it off and feel better
about yourself. Feeling physically inadequate can be a stressor
in itself. Stress can wear your body down mentally and
physically; however, a healthy body can cope with stress better
than an unhealthy one. Schedule your day wisely Each new day
presents us with 1440 minutes to use at our discretion. If we
dont consciously decide how we will spend them, we will look up
and realize they passed us by without our ever starting the tasks
we desired to complete. The best approach to manage stress is to
prepare and follow a wisely prioritized to-do list. I should warn
you up front that the list itself can become a source of stress
if you include too many tasks. I use an electronic calendar and I
categorize every activity by its importance. Every activity is
not equally important. You really can put off until tomorrow
those insignificant things that would stress you if you were to
do them today. If you are not in the habit of developing a to-do
list, you may wander aimlessly throughout the day without a sense
of focus. A simple handwritten list will provide the same sense
of accomplishment as you strike off the completed items. As you
plan your schedule, do not plan on doing too many things at the

27

same time. Studies have linked chronic, high-stress multitasking

under intense pressure to short term- memory loss. Further,
experts have concluded that multitasking actually makes a person
more inefficient because it reduces the brain power needed to
perform each task. If you feel you must be productive during all
of your waking minutes, its time to redefine productive.
Solitude is productive. Taking a mental time out while waiting in
line is productive. Praying for each member of your family while
sitting in traffic is productive. Solidify your support system No
man is an island. No man stands alone. Just as God created our
physical bodies in such a way that our various internal systems
support each other, so it is in our relationships. Everybody
needs a support system. Resolve Conflicts There are few things I
find more stress generating than unresolved conflict. It keeps my
adrenaline on high alert and consumes my thoughts until I have
resolved it. Consequently, I try to confront offenses and
misunderstandings right away. If we are going to manage the
stress in our lives, we must develop the skills needed to address
the conflicts which are sure to arise for conflicts are
inevitable. Further, the problem with failing to confront an
issue is that it is likely to occur again. Strife is stressful
and it is to our advantage to keep it at bay. We cannot eliminate
conflicts from our lives because we are all unique individuals
with different backgrounds, communications styles and

28

preferences. However, we can confront the issues, resolve them

and grow as a result. Admit your mistakes and shortcomings Im
sorry I was wrong. My mistake! I dont know. These are words
that some people find hard to say. Staying blameless is a hard
and stressful position to maintain. Everybody makes a mistake,
misjudges an issue or otherwise messes up something at some
point. Its called being human. Oddly enough, mistakes are one of
the major ways we learn. However, because of our fear of being
judged negatively or losing face, we often try to cover up our
mistake which opens the door wide for stress. On the other
hand, admitting a mistake is a surefire stress-buster. It is a
relief to yourself and an inspiration to others when you show the
courage and the confidence to acknowledge you mistake without
defining yourself by them. The only real tragedy about mistakes
is if you dont learn anything from them. Refusing to admit a
mistake closes the door for growth. In addition to creating
stress, there is another downside to an attempt to be blameless.
When you deny your shortcomings and mistakes, people are likely
to label you as arrogant and proud. The irony is that others
connect with you better and will declare you humble when you
admit your weaknesses. Humility is one of the traits that people
admire most in others; pride is detested even by other proud
folks. Humans make mistakes. They have blind spots. Peace comes
when we start confessing our faults to one another. Taking a

29

time-out short breaks are essential in managing stress. Longer

breaks are equally critical. You have to begin to deem your
leisure time as important as any other commitment. Time-outs
wont happen without a firm resolve and careful planning. Release
your tension In addition to walking, running or other physical
activities; we must practice ways to release the tension that
builds up in us when we experience temporary stress. I have set
forth a few strategies: Take a deep breath. Taking a deep breath
can do wonders in diffusing the tension you may be feeling. Deep
breathing relaxes you because it lowers your heart rate and
circulates extra oxygen to various parts of the body. Squeeze an
antistress ball or gadget. Simply squeezing it as tightly as
youd like relieves tension. Sing. Like in the Bible, when Paul
and Silas were jailed for preaching the gospel, they chose to
sing. I have found that a nice worship song ushers me into the
presence of God and floods my soul with peace. Self-massage.
Learn to massage you tense areas yourself. Laugh Humor has been a
key stress reliever for me for as long as I can remember/ In
fact, many people have told me they assumed I had no problems
because I always seem so happy/ What they do not realize is that
if I thought about it or more than a minute, I could find
something to cry about each day. Rather than focusing on what
isnt Ive made a conscious decision to maintain a merry heart.
The impact of laughter on stress is well documented Studies show

30

that laughter lowers blood pressure and reduces hypertension. It

reduces stress hormones and cleanses the lungs and body tissues
of accumulated stale air because laughter empties more air out
than it takes in. It boosts immune functions in the body. In
addition to all of the preceding benefits, laughter triggers the
release of endorphins those feel good chemicals in the brain
that make you feel good and elated. Swap jokes with friends. Let
people know you enjoy a good laugh. Dont be shy about sharing
your most embarrassing moments. Laugh at your mistakes
especially on the job. Be a good sport. Laughter can also take
your mind off whats stressing you. Maintain a positive outlook
Maintaining appositive outlook requires not only faith but also
mental discipline. While you may believe that God is in control
of your life, oftentimes the reality of a situation can overwhelm
your mind and threaten to negate your faith. As you arrest those
negative thoughts, fix your thoughts on what is true and
honorable and right. Think about things that are pure and lovely
and admirable. Think about things that are excellent and worthy
of praise. The amount of stress you experience in a situation
will be determined by your attitude toward what is happening. If
you start confessing that you are overwhelmed, then you will
experience what you have heard, for faith comes hearing. A
positive attitude will not only minimize how much stress affects
you but also has a direct correlation to how our bodies respond

31

to diseases. Numerous studies have shown that optimistic people

who are diagnosed with terminal illness tend to live way beyond
the normal predicted life span A relaxed attitude lengthens
life.
Exploring Brain and Behavior Correlates of Stress Management
When individuals are stressed, the sympathetic nervous system
stimulates the body to release adrenalin and cortisol in
preparation for a "fight or flight" response to actual or
perceived alterations in the surrounding environment. By
virtually effecting the entire body and mind with neurohormonal
and neurochemical level shifts, this often overlooked primitive
brain function has significant power over perceptions of crisis
situations and subsequent decision making. For those experiencing
chronic stress, the body is continually activating the
sympathetic nervous system which can exhaust the body, result in
repetitive response patterns to emergent and effectively charged
situations, and ultimately result in health problems such as
those previously described. The brain is responsible for
interpreting events and psychosocial situations as stressful or
not; therefore, when the brain perceives stress, the nervous
system reacts with a stress response. Conversely, when
individuals effectively gain control over affective and
behavioral responses to events through stress-management
techniques, the brain subsequently has become able to examine the

32

event, interpret it within a proactive frame of possible

solutions, including previously established self-soothing
techniques, and alternate effective responses follow (APA, 2004;
Benson, 1975).
Stress and Coping
Kozier, Barbara et

al.

Fundamentals

of

Nursing,

7th

Edition.

Stress and Coping. Philippines Pearson Education South Asia PTE

LTD. 2004.
Stress is a universal phenomenon. All people experience it.
Parents refer to the stress of raising children, working people
talk of the stress of their job, and students at all levels talk
of the stress of school. Stress can result from both positive and
negative experiences. The concept of stress is important because
it provides a way of understanding the person as a being who
responds in totality (mind, body, and spirit) to a variety of
changes that take place in daily life.
Stress is a condition in which

the

person

responds

to

changes in the normal balanced state. A stressor is any event or

stimulus that causes an individual to experience stress. When a
person

faces

stressors,

responses

are

referred

to

strategies, coping response, or coping mechanisms.

There are many sources of stress. They can

as
be

coping
broadly

classified as internal or external stressors, or developmental or

situational

stressors.

Internal

stressors

originate

within

person, for example, cancer or feelings of depression. External

33

stressors originate outside the individual, for example, a death

in the family, or pressure from peers. Developmental stressors
occur

at

predictable

times

throughout

an

individuals

life.

Within each developmental stage, certain tasks must be achieved

to

prevent

or

reduce

stress.

Situational

stressors

are

unpredictable and may occur at any time during life.

Stress can have physical, emotional, intellectual, social,
and

spiritual

consequences.

Usually

the

effects

are

mixed,

because stress affects the whole person. Physically, stress can

threaten a persons physiologic homeostasis. Emotionally, it can
produce negative or non-constructive feelings about the self.
Intellectually, stress can influence a persons perceptual and
problem-solving abilities. Socially, stress can alter a persons
relationship with others. Spiritually, it can challenge ones
belief sand values.
In Stimulus-Based Model, stress is defined as a stimulus, a
life event, or a set of circumstances that arouses physiologic
and/or psychological reactions that may increase the individuals
vulnerability to illness. While according to the Response Based
Model,

Selye

(1956-1976)

defined

stress

as

the

non-specific

response of the body to any kind of demand made upon it. Schafer
(2000)

defined

stress

as

the

arousal

of

mind

and

body

in

response to demands made upon it.

Cosmopolitan, January 2009 Edition. Philippines: Cosmo Summit
Media; Get a LifeBy: Zo Aguila

34

Stress is an epidemic today, and to make it worse, we are in

a situation where we are clueless about what is bugging the life
out of us. According to the Foundation for Integrated Research in
Mental Health in 2007, more than three out of five doctor visits
all over the world are for stress related problems. And, while
Filipinos are among the happiest people in the world, according
to a study by World Value Survey, we are still subject to a lot
of stress and suffer illnesses caused and made worse by it: high
blood pressure, stroke, diabetes, ulcer, and heart disease.
Todays stressors are so real and so self-created that you
wonder why they are there in your life at all (Ashima Puri,
R.N.). And, the problem expectedly is, we all end up lamenting
the symptoms instead of the main issue by bad moods and temper
tantrums, lost appetites, nail biting and nasty headaches, and a
million by-products in between.
Stress is not all bad news. A certain level of pressure is
good for us. The buzz of new challenges or the excitement of a
new relationship keeps life interesting. What we call stress is
more

often

than

not,

not

really

stress.

According

to

the

Encyclopedia of stress, stress is one of the most frequently

used but ill defined words in the English language.
Stress can affect our physical capabilities by giving us
headaches,

bad

tummy

or

feeling

sick,

back

pain,

trembling,

sweating, sleeping difficulties, colds, or infections. It can

also

change

our

mental

status

such

as

feelings

of

panic

or

35

anxiety, irritability, depression, poor concentration, feeling

helpless,

lacking

confidence,

and

not

wanting

to

socialize.

Thats why this article sited 5 Save Your Soul Strategies: a.)
Cognitive

Behavioral

Therapy

(CBT),

b.)

Stress

management

programs, c.) Aromatherapy, d.) Biofeedback, and e.) Swedish and

Shiatsu Massage.
Foreign Literature
(http://libportal.medilam.ac.ir/documents/10129/36342/A+longitudi
nal+study+of+stress+and+self-esteem+in+student+nurses.pdf)
Stress and Self Esteem Among Nursing Students
More recently, studies among Project 2000 students (Brown
andEdelmann, 2000; Evans and Kelly, 2004; Hamill, 1995; Jones
andJohnston,
2004)

have

1997,

1999;

identied

Timmins

specic

and

academic

Kaliszer,
and

2002a;

clinical

Tully,

stressors

throughout the program of study. A number of academic stressors

for rst year students which included lack of free time, long
hours of study, college response to student need and fear of
failing (Jones and Johnston, 1997).
Several studies have reported

academic

stressors

for

students in their nal year and these include not being treated
as an adult learner, confusing assignment guidelines and the
amount

of

self

directed

learning

(Hamill,

1995),

nancial

concerns and relationships with teaching related staff (Timmins

and Kaliszer, 2002a). Where studies have investigated academic

36

stress throughout the entire program of study the issues that

caused them stress included examinations (Evans and Kelly, 2004;
Lindop, 1999), the intense amount of work (Evans and Kelly, 2004;
Tully, 2004), nding the academic work difcult, being faced with
study (Evans and Kelly, 2004) and nancial concerns (Brown and
Edelmann, 2000). The clinical stressors identied by research
studies for students in their rst year of study were lack of
practical

skills,

negative

attitudes

of

ward

staff

and

misunderstanding of supernumerary status (Hamill, 1995), whereas

for nal year students the stressors were identied as death of a
patient and relationships with clinical related staff (Timmins
and Kaliszer, 2002a). Where studies have investigated clinical
stress throughout the entire program of study the issues that
cause them concern have been identied as the theory to practice
gap, atmosphere among clinical staff, being reprimanded in front
of staff and patients (Evans and Kelly, 2004) and the death of a
patient (Rhead, 1995). The most recent study conducted found that
stress in nursing students arises from a combination of personal
and

extracurricular

factors

rather

than

from

the

educational

programme itself (Pryjmachuk and Richards, 2007). While there are

signicant number of studies showing levels and contributors to
stress among students, there is little evidence of how these
levels change over time. The one longitudinal study to examine
this issue (Deary et al., 2003) found increasing levels of stress

37

and use of emotion-oriented, avoidance and distraction coping

strategies, as the programme progressed. Stress was measured at
baseline and at the end of the rst year whereas all other
variables were measured again during the second and third year.
Burnard et al. (2008) reported data from a series of crosssectional surveys in student nurses in each year of training, and
found no evidence of changes in the intensity of stress during
the

course

of

training.

Accordingly,

there

is

need

of

longitudinal study of student stress over time. Self-esteem has

long been identied as an important predictor of adjustment to
stress

(Lazarus

and

Folkman,

1984).

Now

considered

multidimensional construct that can change over time in response

to a variety of external and internal inuences (Greenier et al.,
1995), high levels of self-esteem are considered important in
terms of both managing the demands placed on nurses during their
training and for developing a strong and therapeutic relationship
with a patient (Ohlen and Segesten, 1998). Although a number of
studies have shown how self-esteem varies over the course of the
training

period,

there

is

little

consensus

within

the

data

(Begley and Glacken, 2004; Lees and Ellis, 1990; Randle, 2003;
Sasat et al.,
2002). Different aspects of self-esteem (social, personal and
general) in nursing students were investigated across three years
of nurse training programmes in two countries and no relationship

38

as found between self-esteem and year of study (Sasat et al.,

2002).The three longitudinal studies conducted in the UK provided
conicting

evidence.

Randle

(2003)found

that

although

the

majority of students commenced their nurse training with average

levels of self-esteem as classied by the Tennessee Self Concept
Scale, by the time they nished their education their self-esteem
had

fallen

to

the

point

that

95%

of

the

students

perceived

themselves as anxious, depressed and unhappy. By contrast, Begley

and Glacken (2004) found that students self-esteem rose as they
neared

the

end

of

their

education

programme,

although

their

overall self-esteem levels at their highest were only average.

Lees and Ellis (1990) revealed that self condence and selfesteem was higher at the beginning of the nursing program and
decreased with each subsequent year.
In view of these contradictory or preliminary ndings, there
is a clear need for more data concerning the longitudinal course
of both stress and self-esteem in student nurses. This study
provides such data. The aim of the study was to investigate
nursing students experiences of stress and levels of self-esteem
during three years of their undergraduate nursing programme and
whether changes occur over this time. The is the rst study of
its kind which has explored stress and self-esteem. The study was
longitudinal and prospective, and followed an entire year-of-

39

entry cohort at one University (including nurses from adult,

child and mental health training pathways).

(http://www.foxbusiness.com/personal-finance/2011/03/31/stresscollege-causes-combat/#ixzz2MvQeL4NX)
College Stress
Its no secret that many college students spend most of
their time on campus stressed out. Balancing classes, tests,
projects, extra-curricular activities and work is enough to make
anyone feel overwhelmed, especially with final exams right around
the corner.
College life has become a lot more competitive--its much
harder to get into schools, its gotten a lot more expensive,
says Elizabeth Scott, stress management expert. There are a lot
of things that are factors that have made society more stressful,
and that really translates to college life as well.
Having stress in your life is unavoidable, but there are steps
students can take to mitigate its effects on their lives and
health.

40

Healthy worry is felt in the feeling of uneasiness and

concern, says Barbara Rubel, stress management counselor and
speaker. Unhealthy anxiety is when uneasiness and concern fills
them with apprehension and they are constantly worried and cannot
control their anxiety level.
We talked with some stress and health experts about the
presence of stress in college and why its important to identify
certain types of stress and learn how to cope.

Why College is Stressful

Going off to college involves significant adjustments to
your daily routine; your sleeping and eating habits, timemanagement skills, and stress levels will be altered in one way
or another. And even though its been barely three months since
you left high school, you are now expected to be more independent
and self sufficient.
Adapting to this new life stage and the inevitable stress
that comes with it (both good and bad) affects students
differently.
A lot of people are going away to school, so theyre moving
away from their social support network and thats a pretty huge

41

change right there, Scott says. At the same time, they have a
lot of new things they have to navigate--not just getting around
campus and living on their own, but choosing their classes,
choosing what direction they want to go in their lives and
choosing who to hang out with.
Striking a balance between school and personal life takes
discipline and strong time-management stills, something that not
every student comes equipped with as a freshman.
We have more ways to help ourselves and more ways to distract
ourselves, says Dr. Gregory Jantz , psychologist and author of
How to De-Stress Your Life. We actually create more stress
because we end up not being good time stewards.
Relationships can also be a source of stress for students. Wishywashy friends who are supportive one minute and negative and
insulting the next adds unnecessary stress, and according to
Scott, can be worse for your health than having a completely
conflicted relationship with an enemy.
Knowing who is toxic to you and safe guarding a little bit
[can] keep the stress from happening, she says. Theres going
to be conflict in every relationship at some point. Working on
conflict resolution skills and communication skills in yourself
can really help you manage the conflicts that come along.

42

Effects of Stress
A constant state of stress can affect all aspects of
students bodies: physical, mental, emotional, cognitive, and
behavioral functions can go haywire under duress.
Scott points out that stress has a profound effect on your immune
system and your state of equilibrium. Prolonged stress and
sleepless nights can compromise your health, adding another thing
for a student to stress about.
When people are stressed, they tend to not take care of
themselves as well, says Scott. They dont do healthy behaviors
like eating right, exercising and even going to the doctor as
much as they need to. Youre attacking your health on several
different fronts.
Stress can also impact relationships in your life, whether
its with friends, family, classmates or teachers. Jantz explains
that stress distorts emotions, and you may be more irritable and
defensive as a result.
If you are stressed out, you are not going to be able to
form these bonds or you're going to have problems maintaining
relationships, says Rubel.
Chronic Stress

43

While it is perfectly normal, and even healthy to feel

stressed out from time to time, there is a point where stress
crosses the line into what experts call chronic stress.
Jantz explains that constant levels of tension can cause adrenal
glands to release too much cortisol, keeping the body in a
physiological state of stress.
Chronic stress diminishes the amount of time you spend in the
sleep cycles that we need to stay in [and] affects our digestion
and our bodies, he says.
Scott says that chronic stress is aggravated by not allowing
your body to recover and return to a normal, relaxed state. It
can either be because your body is being triggered over and over
again in a period of time, or it can be a constant stream of
stress and you never recover from it, she says.
In addition to strain on your body, Jantz points out that under
chronic stress, you may subside to unhealthy behaviors. If
they're under chronic stress, maybe they're going to drink more
or use [drugs], he says. We tend to look for more destructive
outlets alternately.
How to Relieve Stress

44

The experts agree that it is important for students to have

stress-relief techniques that help them return to a calm and
relaxed state of mind, even if the stress is still present.
De-stressing techniques vary, and what works for one student
might not work for others.
Jantz says to restore your sanity, some people may only need
something as simple as taking themselves out of their normal
setting. Going outside and sitting under a tree can help regroup
thoughts and let out some stress.
Maybe theres too much stimuli and you have to remove yourself
from distraction, he says. Use a different environment to help
calm you down.
Taking care of your body is also a simple, yet efficient way
to curb anxiety and stress overload. Students should schedule in
exercise so it becomes a part of your daily routine. If you can,
avoid processed foods, too much sugar, and energy drinks, which
the experts unanimously agree can agitate stress levels.
The body can get dehydrated, so [hydration] is another way
of helping your mind, says Jantz. Water improves
concentration.

45

If projects, papers and tests are the main source of your

stress, Rubel recommends not procrastinating and keeping a tight
schedule and organized notes and work area.
Although it may seem impossible to reinforce the good things in
your life when you feel like tearing your hair out, constructive
thinking can help you see the proverbial glass as half-full.
Students can change the way they think about things, says
Rubel. Maintain an optimistic, positive attitude with high selfesteem. Keep boundaries in place, laugh when you can, and share
that laughter with others.

(http://onsopcontent.ons.org/Publications/StudentVoice/Nov04/arti
cle5.html)
Stress Management is the key during Nursing School
One important thing that I always tell my students is to
take care of them. If they cannot take care of themselves, how
will they be able to take care of the clients they encounter
throughout their nursing career? Nursing is the one profession
with the most "dropouts." Nurses change careers because of high
stress levels or "burnout," which is synonymous with total
exhaustion.

46

Nursing school is very stressful. Students experience

increased tension prior to their clinical rotations or their
written examinations, especially their finals. The major sources
of stress experienced are interpersonal relationships and
performance demands. Nursing school is very demanding with its
paperwork and skill performance. Multiple stressors combine and
result in cumulative stress. Research shows that catastrophic
life events correlate more highly with subsequent illness than
joyful life events.
Nursing students need to assess their stress levels and
determine what will decrease their tension. Important ways to
reduce stress include avoiding change, blocking time, becoming
skilled in time management, and setting goals. To avoid change,
we need to try to keep the same routines. I always tell students
to eat before a clinical rotation or an examination. Even if they
have no time, just taking one minute to place a tablespoon of
peanut butter in their mouths will give them some protein and
energy to perform better.
The second important point is taking time. Take time to
address important goals. For a student, setting aside a block of
time to study before an examination or setting aside time to
complete a client database for a clinical rotation are important.
Cramming for the examination or staying up all night to complete

47

a client database will increase anxiety, frustration, and chances

for failure. Scheduling fun time is also important. You need to
leave the hospital or the nursing school environment behind at
times and enjoy something that will bring happiness into your
life. This will make it easier to come back to the school or the
hospital. Go out, explore creation, and enjoy the sunset, or go
home and enjoy your family or a special relationship.
Spiritual resources also help the student nurse to adapt to
stress. I enjoy singing with my church choir. We always have a
special concert before the Christmas Eve service, when all of the
choir members dress up in their finery and sing beautiful
Christmas music. The choir members support me spiritually and
emotionally in many projects that I have completed. My friends
were my walking and running mates during the 2002 Relay for Life
in Austin, for which I was the chair. In 2003, they helped me
plan the Luminaria ceremony [explain what this is?] and
participated again during the Relay for Life.
The third way to reduce stress levels is time management.
Establishing goals and having the time available to accomplish
those goals are important. Tasks can be reduced into smaller
parts. Tasks not related to school can be delegated to other
family members or delayed in favor of more important tasks. Avoid
waiting too long to begin a task. This will only increase anxiety

48

and tension. Schedule activities-this will increase positive

tensions and promote growth. Forget those all-nighters! Get
control over the situation. Make time in your schedule for
studying and sleeping at night, and eat during the day. I carry
many small snacks such as nuts, cheese, and vegetables (little
carrots and tomatoes), which I can eat throughout the day when I
know I will not be able to sit down for a meal. You can place
snacks in plastic bags the night before a clinical rotation or a
long school day.
Exercise is a wonderful stress reducer. I have made that the
priority in my own life. Schedule 30 minutes of vigorous exercise
three times per week, and you will increase your strength and
stamina, which are needed in nursing school. I cannot stress
enough the importance of taking care of yourself. My family has
been a great support to me physically and emotionally. Although
my family members live far away, we are close. We call one
another often, plan family reunions, and take vacations together.
These are very special and joyful times of my life.
Create a strong social support network. Friends and family
can provide encouragement and emotional support. Create a
relationship with someone who can be your mentor, someone who
will not only encourage and support you but also give advice
about your nursing career and guidance to achieve your goals in

49

nursing school, advice that you will fall back on throughout your
nursing career. I have had many incredible mentors throughout my
nursing career. I would not be where I am today, a clinical
instructor of holistic adult health, without these mentors. Visit
your teachers, and ask for feedback about how you are performing.
Teachers can help with developing your clinical assessment
skills. Use your health resources at school. Visit the skills
laboratory to gain competence in your nursing skills. Visit your
coordinator of learning enhancement to discuss test taking
strategies or help establish goals to reduce stress. Establish
supportive relationships with your fellow students. You can help
each other to deal with stress, encourage each other, and provide
emotional support during those stressful times in nursing school.
Do plan ahead for the holiday overload of stress. Make room
in your calendar for those important people in your life. Turn
down requests and people who make demands on your life. Get
plenty of rest and sleep during the holidays, and take care of
yourself (Davis, 2004).
(http://www.medicalnewstoday.com/releases/160265.php)
Significant Sleep Deprivation and Stress Among College Students
Stress about school and life keeps 68 percent of students
awake at night - 20 percent of them at least once a week. Stress

50

affects the quality of their sleep far more than alcohol,

caffeine or late-night electronics use, a new study shows. Not
only that, more than 60 percent of college students have
disturbed sleep-wake patterns and many take drugs and alcohol
regularly to help them do one or the other.

The study of 1,125 students appears online in the Journal of

Adolescent Health. It found that only 30 percent of students
sleep at least eight hours a night - the average requirement for
young adults.
On weeknights, 20 percent of students stay up all night at
least once a month and 35 percent stay up until 3 a.m. at least
once a week. Twelve percent of poor sleepers miss class three or
more times a month or fall asleep in class.

"Students underestimate the importance of sleep in their

daily lives. They forgot sleep during periods of stress, not
realizing that they are sabotaging their physical and mental
health," said study co-author Roxanne Prichard, an assistant
professor of psychology at the University of St. Thomas, in St.
Paul, Minn, where the study took place.

Impairments in the immune and cardiovascular systems are

health risks associated with insufficient sleep, as is weight

51

gain, Prichard said.

Daniel Taylor, an assistant professor of psychology at the

University of North Texas, said, "We know little about the health
of this age range even though the consequences - substance use,
psychopathology, poor grades, dropout and subsequent unemployment
- of sleep disturbance could be greatest."

Of concern to researchers was the students' tendency to use

alcohol and drugs to regulate their cycles. Poor sleepers are
more likely than good sleepers are to use medication to stay
awake or fall asleep, and twice as likely to use alcohol to
induce sleep. Alternating between stimulants and sedatives has
been associated to a higher risk of addiction.

Prichard said that physicians, counselors and student health

professionals should be more aware of and proactive in helping
students realize the importance of sleep.

52

Jones, M.C. & Johnston, D.W. Distress, Stress and Coping in

First-Year Student Nurses. Journal of Advanced Nursing. 1997 and
Cottrell, S. Occupational Stress and Job Satisfaction in Mental
Health Nursing: Focussed Interventions Via Evidence-Based
Assessment. The Journal of Psychiatric and Mental Health Nursing.
2000.
Stress During Nursing Training
Stress from many sources has been reported for some time by
student nurses. Academic sources of stress include examinations,
long hours of study, assignments and grades, lack of free time,
faculty response to student need and lack of timely feedback
(Beck & Srivastava 1991). Specific elements of the academic
programme, e.g. palliative care experiential workshops (Lawrence
et al. 1985), produce stress reactions in students.
Clinical sources of stress include working with dying
patients, interpersonal conflict with other nurses, insecurity
about personal clinical competence, fear of failure,
interpersonal problems with patients, work overload and concerns
about nursing care given to patients (Parkes 1985). Learning
psychomotor skills, e.g. administering injections (Speck 1990)
and performing female catheterization (Bell 1991), have been
associated with high levels of anxiety, and a perceived lack of

53

practical skills is a common worry for many students (Hamill

1995).
The atmosphere created by clinical faculty, patient care
responsibilities, working with HIV/AIDs (Mueller et al. 1992) and
supernumery status itself (Wilson-Barnett et al. 1995) are all
clinical sources of stress.
The setting in which student nurses are placed may also have
an impact on affective well-being. Initial ward placements
produce greater anxiety for students than for any other period in
the early part of training, regardless of whether the experience
is in a male/female, or a medical/surgical placement (Parkes
1982). Changes in ward allocation have also been shown to be a
source of stress for student nurses (Jack 1992).
Examples of this three-level approach can be summarised as
follows:
Individual perspective:

Stress reduction - personal stress profile feedback, time

management training, career and training consultations,
assertiveness training, communication skills development and
psycho-education.

54

Stress management - health lifestyle promotion, reflection,

clinical supervision, mentorship, buddy systems, relaxation
and home/work interface.

Stress treatment - counselling, psychotherapy, occupational

health interventions and physical wellness: diet, exercise,
addictions, lifestyle work.

Team perspective:

Stress reduction - team building, team role analysis and

boundary clarification.

Stress management - group development diagnosis and

intervention, clinical team supervision, dependency/skill mix
and workload analysis and review.

Stress treatment - therapeutic remedial team work and work

group role negotiation.

SYNTHESIS:
Stress
Stress as defined by Arnold Burnout as exhaustion of
physical and emotional strength. It plays a great part not only
on students but in every individuals daily living. He further
states that sustained, intense stress decreases productivity and

55

narrows the individuals perceptions. Too much stress blocks

learning and decreases problem solving ability (Burnout, 1989).
Stress is a universal phenomenon. All people experience it.
Parents refer to the stress of raising children, working people
talk of the stress of their job, and students at all levels talk
of the stress of school (Kozier, 2004)
Stress can result from both positive and negative
experiences. The concept of stress is important because it
provides a way of understanding the person as a being who
responds in totality (mind, body and spirit) to a variety of
changes in life. Stress is a condition in which the person
responds to changes in the normal balanced state (Kozier, 2004).
Stress is the arousal of mind and body in response to
demands made upon it (Schafer, 2000).
Stress is the non-specific response of the body to any kind
of demand upon it (Selye 1956-1976).
Stressors
A recent article reads as follows: common stressors for the
nurses are environmental conditions, emotional problems and
management of stress. A stressor is any event or stimulus that
causes an individual to experience stress. When a person faces

56

stressors, responses are referred to as coping strategies, coping

responses or coping mechanisms (Kozier, 2004).
Academic sources of stress among nursing students include
examinations, long hours of study, assignments and grades, lack
of free time, faculty response to student need and lack of timely
feedback (Beck & Srivasta, 1991). Clinical sources of stress
among nursing students include working with dying patients,
interpersonal conflict with other nurses, insecurity about
personal clinical competence, fear of failure, interpersonal
problems with patients, work overload and concerns about nursing
care given to patients (Parkes, 1985).
Levels of Stress
Nursing students need to assess their stress levels and
determine what will decrease their tension. Important ways to
reduce stress include avoiding change, blocking time, becoming
skilled in time management and setting goals.
Stress Management
Managing you stress includes restoring your sanity, some
people may only need something as simple as taking themselves out
their normal setting. Taking care of your body is also a simple,
yet efficient way to curb anxiety and stress overload. Students

57

should schedule in exercise so it becomes a part of your daily

routine. If you can avoid processed foods, too much sugar and
energy drinks which the experts unanimously agree that it can
agitate stress levels. the body can get dehydrated, so hydration
is another way of helping your mind, says Janta. Water improves
concentration.
If projects, papers and tests are the main sources of your
stress, Rebel recommends not procrastinating and keeping a tight
schedule and organize notes and work area (Rubel, 2005).
Students can change the way they think about things. Maintain
an optimistic, positive attitude with high self-esteem. Keep
boundaries in place, laugh when you can and share that laughter
with others (Rubel, 2005).
To avoid change, we need to try to keep the same routines.
Second, take time to address important goals. Third is time
management. Spiritual resources also help the student nurse to
adapt to stress. Exercise is also a wonderful stress reducer.
Create a strong social support network. Friends and family can
provide encouragement and emotional support. Do plan ahead for
holiday overload stress. Make room in your calendar for those
important people in your life. Turn down request and people who
make demands on your life. Get plenty of rest and sleep during
the holidays and take care of yourself (Davis, 2004).

58

Chapter III
Methodology
This chapter will present the research design, sampling
procedure, description of subjects and description of research
locale.
RESEARCH DESIGN
In this study, the design that was applied is the
correlational descriptive research which examines the extent of
the relationship between the levels of stress and stress
management techniques utilized by Bachelor of Science in nursing
students of Saint Gabriel College. The study will determine if
the relationship of variables will have a direct or indirect
relationship.
SAMPLING SIZE AND POPULATION
The population of regular and irregular Bachelor of Science
in nursing students from 1st year to 4th year enrolled in the
school year of 2012-2013 is 225, excluding the researcher. The
sample size will be 69.
Sample size will be computed using the Sloven Formula with
90% level of confidence where in 10% error will be used.

59

Using the formula:

n=

N
1+ N (e)2

n=

225
Whereas:
2 = 69
1+225 ( 0.10 ) N= Population

e= Percentage of
Error
n= Sample Size

SAMPLING METHOD:
The sampling method that was utilized in this study was the
non-random sampling method. The sampling design of which will be
snowball or networking sampling design. The researcher will
gather 69 respondents from different year levels which will be 17
students from each class, approaching those students who meet the
inclusion criteria then refer to other students who meet the
criteria as well. The students of which will be respondents
should be on their free time and become available to the
researcher. There will be no manipulation or experimentation that
will be involved.

DESCRIPTION OF SUBJECTS

The subjects should be regular students enrolled in Saint

Gabriel College, Old Buswang, Kalibo, Aklan taking up the course
of Bachelor of Science in nursing. These subjects were chosen
because the researcher feels that stress in epidemic in the
college today. The inclusion criteria for the subjects includes:
being a male and female, with grades not lower than 80%, have a
moderate or high academic performance in school and has

60

experienced stress in some point of time. The respondents should

be on their free time, with willingness to answer the given
questionnaires.

DESCRIPTION OF RESEARCH LOCALE

The location of the study will be in the Saint Gabriel
College Campus, Old Buswang, Kalibo, Aklan. The private college
was established in 1970 and it is known as the pioneer nursing
school in Kalibo, Aklan. This location was chosen to determine
the levels of stress and stress management techniques utilized by
students under the Bachelor of Science in nursing curriculum of
this college. There are 4 classrooms occupied by the Bachelor of
Science in nursing students in this 4 story building. The
researcher will have the availability and time in this location
to conduct the study and the participants are known to the
researcher.