Effects of Stress on Academic Performance of Nursing Students

Effects of Stress on Academic Performance of Nursing Students

CHAPTER ONE

Objectives of the Study

The purpose of this study was to investigate the relationship between the nursing students’ stress level on their academic performance while considering the confounding effects of age, gender, locus of control, course and level of study.

The objectives of the study were to:

Determine the extent to which nursing students’ stress levels relate to their academic performance
Establish the relationship between academic performance and psychosocial adjustment

CHAPTER TWO

LITERATURE REVIEW

Introduction

This chapter presents a review of the literature related to the study. The review discusses studies on the relationship between nursing students’ stress experience and their academic performance as well as psychosocial adjustment. Studies that investigated the confounding effect of age, gender personality (locus of control), level of study and course being studied in the relationship between stress, nursing students’ academic performance and psychosocial adjustment are also discussed. This is because the current study is also investigating how these variables play mediating roles in the relationship between stress, academic performance and psychosocial adjustment.

Coping processes play important role in the management of stress and consequently the influence of stress on academic performance and psychosocial adjustment. Therefore studies that addressed the coping strategies employed by the nursing students to manage their stress were also reviewed.

Stress has been studied from a variety of different theoretical perspectives. Three theories of stress were identified as the most relevant to this study and are therefore discussed in the theoretical framework. Finally, a conceptual framework showing the relationships between stress level as independent variable, academic performance and psychosocial adjustment as dependent variables is described. The conceptual framework also presents the intervening or confounding variables between the independent variable (stress) and dependent variables (academic performance and psychosocial adjustment).

The Relationship between Stress Level and Academic Performance

A considerable number of studies have investigated the relationship between stress and academic performance among nursing students (Kelly, Kelly & Clanton, 2001; Trockel, Barnes & Eggert, 2000; Watering & Rijt, 2006). The findings of these studies are, however, not consistent. Some of the studies associate high levels of stress with poor academic performance (Ogundipe, 2005; Agolla & Ongori, 2009; Turner, Bartlett, Andiappan & Cabot, 2015). For instance, a study by Solail (2013) using 120 nursing students from Allama Iqbal Medical College reported a negative relationship between stress and academic performance. The study instrument was a self- report stress questionnaire. The sample was selected using non-probability purposive sampling process and consisted of first year nursing students only. The study should have used more academic disciplines and more levels of study to justify adequate validity of the results and generalization to other nursing student populations.

Another study that reported negative relationship between stress and academic performance was conducted by Klomegan (2007). The study added another dimension by looking at a personality variable as the intervening factor between stress and academic performance. The researcher used 103 nursing students from a North Carolina Nursing school and found that stress undermined the nursing students’ academic performance. The study revealed that the nursing students’ self-efficacy was a significant predictor of academic performance. The researcher did not, however, test the relationship between stress and self-efficacy. The negative link between stress and academic performance cannot, therefore, be easily attributed to stress.

Although nursing students may report experiencing stress, it is not necessarily true that it always affects their academic performance negatively. In this context, there are studies which have failed to confirm the negative relationship between stress and academic performance (Deana, 2003; Feldman & Charion-Riignau, 2008; Awofodu & Emi, 2012).

CHAPTER THREE

METHODOLOGY

Introduction

This chapter outlines the research methodology which has been used in this study. The research design, population of the study, sampling procedures and sample size are described. Different research tools and data collection procedures are also explained. Procedures used in the development and piloting of the research instruments are discussed. Furthermore, data analysis procedures and how they were used to test the various research hypotheses are presented. The methodology outlined below consists of both quantitative and qualitative research instruments used to collect data from different categories of the respondents. The objective was to meet the requirement of triangulation necessary in attaining more detailed and rich data.

Research Design

This research used a cross-sectional survey method. This design, therefore, enabled the researcher to collect information from different years of the nursing student enrolment at a single point in time. The research design treated stress as independent variable with academic performance and psychosocial adjustment as dependent variables. Age, gender, locus of control, the courses in which the nursing students were registered and levels of study were treated as confounding variables in the relationship between stress, academic performance and psychosocial adjustment. The study was both quantitative and qualitative. The qualitative approach enabled the study to go beyond quantitative data by getting more detailed, in-depth information that could not have been captured through quantitative data.

Population and Location of the Study

The target population in this study constituted government- sponsored undergraduate nursing students registered in different academic programmes in the the six department of the Nursing school.

The nursing students were chosen because they were young and directly from nursing school undertaking new experiences. Moreover the majority of the nursing students were residents in the nursing students’ halls of residence, sharing nursing school facilities for the time they were in session. Due to large enrolment in these programmes, the demand on the shared resources such as rooms in the halls of residence, the libraries, lecture rooms, laboratories, and computer facilities may be overstretched to the point when conflicts may arise.

Furthermore, the nursing students managed their financial and social life as they responded to the demands of their academic programmes and social relationships in the absence of the supervisory and supporting roles of their immediate families and guardians or teachers as it was the case during their nursing school years. Most of these nursing students’ financial support came from the government, in addition to loans provided by the Higher Education Loans Board (HELB). However, the nursing students’ parents and guardians also supplemented their financial needs for both tuition and accommodation.

CHAPTER FOUR

RESULTS

Introduction

The results of the data analysis on stress and its relationship to academic performance and psychosocial adjustment are presented in this chapter.. Data on how the relationship between stress and both academic performance and psychosocial adjustment is influenced by age, gender, level of study, course being studied, and locus of control has been analyzed and the results of the analyses are presented in this chapter. The research findings are presented using both descriptive and inferential statistics.

Furthermore, qualitative analysis of data gathered during focus group discussions with nursing students and interviews with key informants are also presented. The qualitative data is accompanied by brief narratives from some selected nursing students who participated in the focus group discussions. Similarly, narratives from the key informants are included.The statistical procedures used to test the hypotheses of the study included Chi-square for 2×2 cross tabulations and three-way chi- square for three categorical groups.

The results aimed at addressing the following research questions.

To what extent do nursing students’ stress levels relate to their academic performance?
In what way is stress level associated with the psychosocial adjustment among nursing students?
What is the relationship between the nursing students’ academic performance and their psychosocial adjustment among nursing students experiencing different levels of stress?

In order to provide answers to the above research questions, the following hypotheses were tested using three-way chi-square.

Hypothesis One

H₁ : The nursing students’ stress levels are related to their academic performance. .In this hypothesis, stress level of the nursing student is the independent variable while the nursing student’s academic performance is the dependent variable. Since the data is categorical, a two-way chi-square for independent samples was used to test the significance of the relationship between the two variables. Age, gender and locus of ontrol of the nursing students, level of study and course of study are confounding or intervening variables. .A three-way chi-square for categorical variables was used to test the significance of the confounding effects on the relationship between stress and academic performance.

CHAPTER FIVE

SUMMARY DISCUSSIONS CONCLUSIONS IMPLICATIONS AND RECOMMENDATIONS

Introduction

The purpose of this study was to investigate the relationship between the stress level, academic performance and psychosocial adjustment among Nursing students. The mediating roles of age, gender, locus of control, level of study and type of course in this relationship was also studied. Furthermore, the relationship between psychosocial adjustment and academic performance was explored. Finally, the study identified the coping strategies that the nursing students used to manage their stress. This study was carried out within the six Department of the Nursing school. Both quantitative and qualitative methodologies were applied. Questionnaires, an interview schedule and focus group discussion were used to collect data from key informants and nursing students. This chapter therefore presents the conclusions reached as well as the discussions and implications of the findings. Recommendations and areas that need further research are proposed.

Internal and External Validity of the Study

Efforts to ascertain adequate validity of the study were done done by minimizing the limitations in the study. Triangulation of methodologies was applied to achieve this objective. However, internal validity of the study may have been undermined by the inability of the researcher to control all the prevailing confounding variables operating within the Nursing school at the time of the study. The Nursing school has different categories of nursing students who live in different campuses and the effect of this may not have been captured in the sampling process. The external validity or generalization of the findings of this study may be affected by the differences pertaining in different universities in and out of Nigeria where this study could be generalized.

Summary of the Findings

Based on both quantitative and qualitative analyses, the following is summary of major findings:

The Nursing school government-sponsored undergraduate nursing students experience different levels of stress. Most of the nursing students (64.4%), reported that they experienced between moderate to high levels of The level of stress had statistically significant positive relationship with age, gender, course of study, level of study and locus of control of the nursing students. This is in line with both Selye’s (1976) and Lazarus & Folkman’s (1984 theories which propose that people may experience stress when exposed to stressors.
The nursing students experienced the following stressors: academic workload, difficult course, poor academic facilities, fear of failing, financial difficulties, high cost of living, problems with roommates, relationship issues, poor job prospects, ethnic conflicts, lecturers asking for sex, tuition fees, dirty hostels, uncooperative lecturers. The most common stressors for all the nursing students are dirty halls of residence (76.4%), Issues with room mates (76.2%), high cost of living (75.8%). For male nursing students the most common stressors are high cost of living (87.8%), issues with room mates (76.8%) and cost of tuition (75.5%). For female nursing students the most common stressors were dirty halls of residence (79.3%), the cost was too demanding (77.7%), issues with room mate (75.5%) and lack of job prospects (75.5%). Although the stress =as ethnic conflict, dirty hostels, uncooperative lecturers, strikes/riots, demand for sex by lecturers, high cost of living which are reported in this study are rare or nonexistent in the stress literature. This finding supports Lazarus (1984) theory proposes that individuals may experience stress according to their cognitions of stressors

In fact some coping strategies such as taking alcohol and drugs or looking for sexual partners may create more problems than they are intended to solve.

Discussion of the Results

This section presents a discussion of the findings as presented within each of the three objectives. The link between the findings and the theoretical perspectives are also discussed.

The Relationship between Stress Level and Academic Performance

The study addressed the first objective through a hypothesis that the relationship between stress and academic performance is significant. The discussions of the findings are presented in this section.

The stress literature presents inconsistent findings regarding the relationship between stress and academic performance. Some studies have found that stress affects academic performance negatively (Raffidah, Azizah, Norzaidi, Chang, Salwani & Noraini, 2009; Klomegan, 2007). Others studies have found no effect of stress on academic performance (Womble, 2003; Awofodu & Emi, 2011).The findings of this study showed that stress has a moderate but significant association with academic performance (X²=9.49, N=584, df=4, p=0.048). Higher levels of stress resulted in poor academic performance. This finding concurs with similar findings in other studies (Raffidah, Azizah, Norzaid, Salwani, & Noraini, 2009; Klomegan, 2007).This finding fits in with Selye’ (1976) proposal that long term exposure to stress may undermine the individual’s biological and cognitive abilities to operate. The nursing students’ exposure to stressors may create intrinsic experiences such as negative physical and mental health outcomes that could interfere with their academic performance

The confounding effects of several intrinsic and extrinsic variables were investigated. Stress and academic performance are significantly related within age groups 19-22 years (X²=8.34, N=101, df=4, p=0.049). and 23-26 years (X²=9.72, N=79, df=4, p=0.041). The association between stress and academic performance is strong and statistically significant in the two age categories. The results indicate that age mediates the relationship between stress and academic performance. Older nursing students appear to be better at dealing with their problems and consequently minimize the effects of stress on their academic work. According to researchers, people are able to manage stress better as they get older (Monteiro et al, 2014, Hara et al, 2014). The nursing students in this study are not only getting older but also becoming more adept at dealing with issues they face in campus.

Gender variable was of interest in this research because it has been found to influence stress experience (Scott, 2009; Taylor, 2003). Across the gender categories, the relationship between stress and academic performance was found to be statistically significant among both male (X²=12.18, N=319, df=4, p=0.025) and female X²=9.74, N=265, df=4, p=0.049) respondents. The results therefore suggest that the relationship between stress and academic performance is significant for both male and female nursing students. This implies that stress will affect academic performance in both male and female nursing students. The findings concur with some studies (Talib & Zia-ur-Rehman, 2012 but not others (Kania, 2014).

Several studies indicate that stress may be caused by the type of course that nursing students are doing due to the demands of the course on them (Fairbrother & Warn, 2003; Lawrence, Williams & Eiland; Britz & Pappas, 2012). The researcher wanted to find out whether the relationship =in. Six categories of courses were used in this study. A three way chi-square analysis was done to test the significance of the influence of type of course on the relationship between stress and academic performance. The results do not support studies that suggest that stress is an issue in science and medical courses only (Saravanan & Wilks, 2014; Harris, Millichamp & Thomson, 2015). For instance the relationship between stress and academic performance was significant among nursing students in Agriculture and Veterinary Sciences(X²=12.46, N=58,df=4, p=0.014) Humanities and Social Sciences(X²=10.968, N=187, df=4, p=0.046) only but not others

The Relationship between Stress Level and Psychosocial Adjustment.

The relationship between Psychosocial Adjustment and Academic Performance

The third objective of the study was to establish the relationship between the nursing students’ psychosocial adjustment and academic performance within stress levels. This is in view of the fact that both academic performance and psychosocial adjustment may be affected by stress. Academic performance may, however, act as independent variables in influencing each other. They may therefore act as intrinsic stressors consequently undermining the the nursing students academic and psychosocial adaptation. Both Selye’s (1976) and Lazarus’ (1984) theories propose that intrinsic factors may influence stress outcomes. This position has a bearing in the results which show that most nursing students who displayed poor psychosocial adjustment had poor academic peformance compared to the nursing students who indicated that they had good adjustment. When considered within stress levels it was found that nursing students with poor psychosocial adjustment had poor grades in their academic work (X²=9.43, df=2, p<0.01 This finding concurs with other studies (McKenzie & Schweiter, 2001; Krisher & Shechtman, 2016). Petersen, Louw & Dumont (2009) however, found a negative relationship between psychosocial adjustment and academic performance.

The relationship between psychosocial adjustment and academic performance appear to be influenced by the nursing students coping processes.Most nursing students report using coping strategies which are emotion-focused (57%) than problem focused (43%). The coping strategies identified during focus group discussions appear to have a significant role of social support. The results of the study confirm the third objective about the relationship between academic performance and psychosocial adjustment.

Conclusion

The purpose of this study was to investigate the relationship between stress and academic performance and well as psychosocial adjustment. The study also examined the influence of the nursing students’ age, gender, locus of control, level and course of study on the nursing students’ stress experience. It was also intended to identify the coping strategies that the nursing students used to manage stress. It was found that the majority of nursing students experienced stress at moderate to high levels. Several causes of stress were identified. These causes can be categorized as academic (eg difficult course, fear of failing and heavy workload), psychosocial (eg relationship issues, problems with roommate and lecturers asking for sex), economic (eg high cost of living, tuition fees and no job prospects after graduation), and environmental (eg dirty hostels, crowded library and lecture rooms and insecurity in the campus especially at night).

From the findings of this study it was concluded that stress has negative impact on the nursing students’ academic performance and psychosocial adjustment. Age, gender, year of study, course of study and locus of control were significantly related to the level of stress. However, these factors influenced the relationship between stress and academic performance in different ways. For instance, the relationship between stress and academic performance was not significant in certain age levels, years and types of course.

The psychosocial wellbeing of the nursing students was determined by the level of their stress experience. Age, gender, type of course and level of study were significant determinants in this relationship. The nursing students used both problem-focused and emotion- focused coping strategies but mostly emotion-focussed strategies. Gender factor was not a major influence in the type of coping strategy used. The nursing school should institute programs that can help identify and reduce causes and effects of stress. The counseling programs of the nursing school should be strengthened. Finally further research should be undertaken to investigate the coping strategies employed by the nursing students.

Recommendations

It is evident from the findings of this study that most nursing students experienced moderate to high levels of stress. The stress was due to a variety of factors. The stress experience also had significant effects on the nursing students’ academic performance and psychosocial adjustment. Further, it was revealed that age, gender, type of course, level of study and locus of control were significant mediating factors in the relationship between stress and both academic performance and psychosocial adjustment. Based on the findings of this study the following recommendations are made:

Programmes that can help not only identify but reduce the causes of stress among the nursing student population should be instituted by the relevant authorities
The nursing school should ensure that the counselling services offered to the nursing students have the professional capacity to help nursing students engage in more problem-focused than emotion-focussed coping strategies.
Non counselling programmes that can enable nursing students to source for financial support should
There is need for people responsible for the running of academic programmes to ensure that teaching of these programmes are undertaken with minimum frustrations on the part of the nursing students.
The nursing school should initiate in-house training in counselling for lecturers administrative staff so that they can be able to understand nursing students’ problems and provide the necessary help whenever possible.
There is need to improve the living arrangements in the halls of residence to reduce sharing of rooms which may a serious source of conflict for many nursing students.
The loan scheme should be improved to enable the nursing students have enough financial resources to meet their food and non food requirements.
More teaching resources should be availed to reduce congestion in the lecture theatres
The library and computer facilities should be improved to enable the nursing students’ access relevant up to date learning

REFERENCES

Abdulghani, H. M., Alkanhai, A.A., Mohmoud, E.S. et al (2011) Stress and its Effects on Medical Sudents: A cross-sectional Study at College of Medicine in Saudi Arabia Journal of Health Population Nutrition, 29(5) ,516-522
Abdullah, M. C., Elias, H., Mahyuddin, R., & Uli, J.(2009).Adjustment among First Year Nursing students in a Malaysian Nursing school. European Journal of Social Sciences, 8 (3), 496 – 505.
Abdullah, M.C., Elias, H. & Mahyuddin, R., Ulli, J.(2010) Relationship between Coping , Nursing school Adjustment and Academic Achievement among First Year Undergraduate Nursing students in a Malaysian Public Nursing school. International Journal of Arts and Sciences, 3(11), 379-392
Abid, M.A, Kanwal, S. Nasir, M. A. T., Iqbal, S & Huda, N.U.(2016)The Effect of Locus of Control on Academic Performance of Nursing students at Tertiary Level International Review of Management and Business Research ,5(3), 860-869
Adams, D. R., Meyers, S.A. & Beidas, R.S. (2016) The Relationship between Financial Strain, Perceived Stress Psychological Symptoms and Academic and Social Integration in Undergraduate Nursing students. Journal of American College Health, 64 (5), 362-370. https://doi.org/10.1080/07448481.2016.1154559
Agolla, J.E. & Ongori, H. (2009). An Assessment of Academic Stress among Undergraduate Nursing students: The Case of Nursing school of Botswana. Educational Research and Review, 4(2), 63-70.
Al – Kandari, F. & Vidal,V. (2007). Correlations of the Health – Promoting Life Style Enrollment Level and Academic Performance of College of Nursing Nursing students in Kuwait Nursing and Health Sciences, 9, 112 – 119.

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