Effects of Early Life Early Life Stress on Cognitive Development of 400l Nursing Students in Madonna University Elele, Nigeria
Chapter One
Objective of the Study
- Investigate sources of stress in the nursing school program.
- Examine recent nursing graduates’ perspectives on effective stress-relieving interventions.
- Provide coping techniques for future nursing students.
- Address stressors related to the economy for nursing graduates.
CHAPTER TWO
RELATED LITERATURE
Stress Themes
Work schedules
The growing scarcity of jobs, there is some literature focused on the prevalence of 400l nursing students that have chosen to keep working while completing their program and the impact this has on their academic performance and on their psyche. The general consensus concluded that employment, whether part-time or full-time, has a negative impact on the 400l nursing student’s academic performance (Cheung & Tang, 2009; Collins, Coffey & Morris, 2010; Munson, 1987). One study found that 72 percent of younger bachelor of 400l nursing students (BSW) and 62 percent of older BSW students had challenges balancing their student and work responsibilities and that students working part-time with a full course load were typical for the sample that was surveyed (Hawkins, Smith, Hawkins II & Grant, 2005). In response to the existing research regarding the significant impact of employment on a student’s academic performance, this study plans to explore solutions to address this pertinent issue.
Field Placements
In addition to stressors originating from employment, students may also experience anxiety that is distinct in comparison to other programs, especially when considering that 400l nursing students typically balance their academic work with their fieldwork (Ngal & Cheung, 2009; Wilks, 2008; Moran & Hughes, 2006; Collins, 2006; Collins, et al., 2010; Tobin & Carson, 1994). Although an education that combines schoolwork with fieldwork provides a holistic experience for the 400l nursing student, it is important to prepare the student for the realities of fieldwork and the influence it can have on them emotionally. The research has found that professional education programs that combine academic and professional instruction, such as nursing, tend to evoke more stress than traditional educational programs (Collins, 2006; Collins, et al., 2010). Another study found that 400l nursing students might experience higher levels of stress in their educational career than in their career as a nurse, is attributed in part to learning to cope with stressors associated with professional placement (Wilks, 2008).
Maidment (2003) discusses the stress levels of students in field placements, noting that students stress levels are high when they do not have a set of clear expectations and role clarification, when there is a problem in the relationship between supervisor and student, and when field does not integrate practice and theory. Therefore, it is suggested, that students are prepared in their programs to set realistic expectations in the field to be exposed to both the positive and negative aspects of field placement. Overall, stress levels are reduced and students respond well when they have regular feedback and when they have good role models in their field placements.
Class Load
Several studies found that a large number of 400l nursing students experience anxiety in regards to completion of courses related to research (Ying, 2009; Ying, 2008; Davis, 2003). One study in particular that surveyed 41 nursing students asserts that because 400l nursing students have a “propensity toward humanistic values and social interaction”, they have a tendency to experience stress and anxiety in taking a course related to mathematical computations (Davis, 2003).
Green et al’s (2001) study discusses the stress of nursing students when it comes to research and computer anxiety. nursing students generally have this belief compared to psychology and business students that research is less important to their profession, therefore, while in those classes they report higher levels of stress and anxiety.
Personality Types
In a study regarding idealism among 400l nursing students, it was found that students tending towards idealism reported higher levels of emotional exhaustion (Ngai & Cheung, 2009). It was found that the causes of emotional exhaustion were derived from a gap between the 400l nursing student’s expectation of fieldwork and the reality of their actual experience (Ngai & Cheung, 2009).
Multiple studies found that students that had experience in volunteer work were found to report lower levels of stress in regards to their field placement and noted increased competence (Cheung & Tang, 2009; Collins, et al., 2010; Rompf, Royse & Dhooper, 1993). Similarly, an early study suggests that in regards to reducing risk factors of burnout, experience outweighed age (Rompf, et al., 1993). The study contends that those students that had prior experience in volunteer work or even part-time summer jobs were better prepared and more confident in beginning their internship (Rompf, et al., 1993).
Carvalho et al (2009) discusses student’s levels of stress in correlation to their locus of control. They found that students with very high levels of severe stress associate their stress levels to chance, where as students with mild or moderate stress levels do not associate too much of their stress to chance.
One recent study of 37 entering and 28 graduating masters of 400l nursing students found that students in their last semester reported lower self esteem and sense of coherence and poorer mental health than incoming first year students (Ying, 2008). The study asserts that as students progressed in the program they became less mindful, which had a direct negative impact on the student’s sense of competence and caused stress. This points to why many universities recently began educating students on the practice and value of mindfulness and spirituality as a resource when faced with stressors (Csiernik & Adams, 2003).
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
The basic purpose of this study is to explore the sources of stress experienced during the graduate nursing program from the perspective of recent nursing graduates and their opinion of effective stress relieving solutions. This study design is a qualitative method content analysis. . At the most basic level quantitative research usually contains numbers and statistics and is used when something needs to be measured. Whereas Qualitative research usually has no measurements or statistics, instead it uses words, descriptions and quotes to explore meaning (Shields & Twycross, 2003). It is concerned with the behavior, experiences and opinions of individuals; and aims to explore subjective patterns of an individual, group or organizational experience in order to gauge the meanings for people involved. More specifically qualitative nursing research, by its very nature can be seen as process orientated, whereby the researcher enters the natural setting and touches, feels, lives and observes the subject of study in an attempt to gain a better understanding of social realities and to draw attention to processes, meanings and structural features (Davies, 2007; Matthew & Ross, 2010). A qualitative design was chosen by the researcher in order to explore and analyze individual experiences of the participants rather than gathering statistical data from a greater pool of participants. In doing so the researcher was able to decipher commonalities in the participants’ responses. Through this approach, the researcher was also able to gather perspectives related to the high cost of living of the Nigerian economy and its impact on the nursing graduates. Both primary and secondary sources were used in order to gather pertinent data for the study.
This chapter focuses on the study design, sampling procedures, data collection procedures, instruments; data analysis approaches, organizing principles. The structure of this study was administered using both a qualitative and exploratory design field observation were carried out to collect primary data. Besides, secondary sources such as books, journals, and other relevant documents were reviewed in the study.
Sampling procedure
The sampling technique which I adopted was purposive sampling. This type of sampling is concerned with the exploration and interpretation of experiences and perceptions and is therefore ideally suited for small in-depth qualitative studies. Purposive sampling does not attempt to create a sample which is statistically representative of a population. Instead respondents are selected on the basis of characteristics or experiences that are directly related to the research question (Matthews & Ross, 2010).
The total number of participants for this study is 14.They are all nurses that graduated in the last five years from an accredited university program Madonna University Elele. In order to participate in this study the participants needed to meet the criteria noted above The participants of the study were selected using snowball sampling method, and the practitioners were selected using purposive sampling method. All the necessary data from the participants were collected using data collecting instruments prepared for the study.
CHAPTER FOUR
DATA ANALYSIS AND FINDINGS
This chapter analyzes the responses from the administered interviews. The demographics of the participants were examined, however, the emphasis was to address the ten major questions and the purpose of the study as stated in chapter 1. This analysis focuses on the stress levels students experience while completing their nursing graduate studies and the advice they provide to current and future students.
CHAPTER FIVE
CONCLUSION AND RECOMENDATION
Conclusion
Stress has long been seen as an integral part of nursing practice and the notion that nursing is an inherently stressful profession is not new. Stress and burnout are perpetual problems for nursings and they are regularly required to deal with emotionally challenging and complex situations and a wide range of diverse service users (Moran & Hughes, 2006 &NASW,2008).Therefore training in stress management and burnout prevention is crucial in order to protect the emotional well-being of nursing professionals (Dziegielewski et al.2004).
This project was designed to gain a broader understanding of the sources of stress of recent nursing graduates while in nursing school with the objective of ascertaining suggestions and advice for effective stress reduction for current and future nursing students. This study also had the objective of gaining a deeper understanding of the amount of additional stress that was experienced by students due to the recent state of the economy being high cost of living. Given the amount of pressure and role-strain experienced by nursing students, the researcher felt that it was pertinent to investigate these issues for the benefit of current and future students. Although the findings of this qualitative study may not have added statistically significant data, the results of this study offers a more in depth understanding of the experiences and stressors of recent nursing graduates.
The researcher analyzed the sources of stress that were identified by the participants including, but not limited to, working full-time, course load, internship, and the challenge of balancing all three responsibilities. The stress theory applies to the students’ perception of situational stress experienced in nursing school in that the stressful event,
“….becomes a psychological stressor when the individual reacts to the stressful event or condition based on cognitions that the event will adversely affect his or her personal well-being. This perception of the event as psychologically stressful is the vital component necessary to define the event as a psychosocial stressor in the human stress response. Over time, the strain of responding to stressful situations, whether mentally or physically, can be cumulatively detrimental”. (Matthieu & Ivanoff, 2006, p. 340) My findings contribute to the Nursing Department and future students in regards to identifying the types of stressors they may encounter and coping methods to address these stressors. Based on the responses provided by the research participants, the top stressors while completing the nursing program were reported as follows: balancing coursework, internship, thesis/project, and work responsibilities, personal problems (i.e. divorce, living far from home)/lack of social support, financial problems, lack of preparation for work and internship, and health problems.
Most participants reported that their greatest stressor was derived from challenges in balancing coursework, internship, thesis/project, and work responsibilities. When asked what were some of the greatest stressors during nursing school, one participant stated, “work load, with school, internship, thesis. They each needed time and energy which was running low.”
Secondly, multiple participants reported that personal problems and lack of social support was their greatest stressor. Some indicated that they experienced serious health problems, went through divorce, illness or death in the family, and lacked social support. One participant in particular had major back surgery, which hindered her ability to sit long periods in class, and made it difficult to fulfill her eight-hour internship responsibilities. Furthermore, others indicated that they faced some form of financial problems due to increase in tuition, housing costs, and not being able to work due to course load and internship. While others stated that they did not feel as if they were prepared enough through their coursework for their internships and jobs.
The advice provided to current and future students from recent graduates in regards to how to cope with stressors related to the nursing program were as follows: balance of work and play, maintain social life, vent to supportive people, self-care, maintaining perspective, maintain peer and family relationships, and stay organized. When asked what advice they would offer to future students, one participant suggested, “Sharing your experiences and stresses with other who can appreciate them and help you through them is key. This also opens up the possibility of others offering you effective suggestions for coping.
The themes of stressors that are supported by the findings in the literature were work schedules, field placement, course load, and personal factors.
Recommendations
Although there were significant findings that were derived from the research of this study, there were also certain limitations. One of the limitations of this study was the number of participants interviewed, which were 14 in total from Saint Mary Nursing students. For future research related to this subject it would be beneficial to interview a larger amount of participants from a larger geographic area to acquire more statistically significant findings.
Additionally, female students composed the majority of the participants interviewed in this study, although this is representative of the sample population. Given the small sample of participants, we were further limited given that two of the participants’ responses failed to answer the interview questions thoroughly, which made it challenging to maximize the quality of the findings. Had there been a larger pool of participants, responses that failed to fully answer the interview questions would not have had as much of a significant impact.
This study was especially interested in analyzing the impact the recent state of the economy had on the participants interviewed. However, the researcher found that most of the participants had graduated prior to the recession after the data was collected. The researcher assumed that students that graduated within the last five years would have had some form of impact on their stress levels due to the economy; however the findings show that the only participants that felt the impact were those that graduated in 2013 and 2014, while those that graduated before 2011 noted no impact. Along with having a larger pool of participants, future research would benefit from ensuring that at least half of the participants graduated in 2013 and after, while the other half of participants graduated before 2013 in order to conduct a comparative analysis.
Finally, this research failed to look at how stress impacted student’s health and other biological factors. Further research can investigate or question nursing graduates about the impact the stress they experienced had on their health.
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