Pre-registration diploma student nurse stress and coping measures
Introduction
Throughout the last decade nurse education in the Republic of Ireland has undergone tremendous change. It is presently facing its greatest challenge to date, with the implementation of a four-year degree programme (Timmins and Kaliszer, 2002). There is an onus on all practitioners, including educationalists, constantly to review and examine current practice in order to accomplish and strive for quality goals. During this radical period in nurse education, there is an urgent need for educationalists to address issues such as student stress, which can disrupt physiological and psychological health (Sarafino, 1998). Furthermore, it is necessary to identify whether students are equipped sufficiently with effective coping skills to deal with future clinical stress.
It is well recognised that Diploma nurse education produces stress (Hamill, 1995; Lindop, 1999) which can also adversely affect the quality of nursing care (Beck and Srivastava, 1991). Although student nurses are to a greater extent regarded as supernumerary, they do participate in extensive hands-on patient care (Holland, 2002). However, student nurses are currently juggling several roles, which demand a high level of commitment and competence. Much recent research has been replete with suggestions as to how nurse educators might reduce student nurse stress and enable them subsequently to cope more effectively (Sawatzky, 1998; Jones and Johnston, 2000). From an Irish perspective there has only been a scant, anecdotal acknowledgment of the issues pertaining to student stress within the literature.
The study endeavoured to isolate unwanted stress and ultimately to develop curriculum structures which will optimise the educational experience of student nurses from an academic and clinical perspective.
Section snippets
Background
Stress has been identified as the 20th century disease (Bailey, 1980). Previous research has been criticised for failing to clarify its underlying theoretical conceptualisation and definition (Wheeler, 1997). There are three models of stress identified in the literature; the Stimulus Model, the Response Model and the Transactional Model (Bailey and Clarke, 1989).
In the Transactional Model of Stress, stress is viewed as a complex and dynamic transaction between individuals and their environments
Methodology
Research questions were formulated following review of the literature. These questions are detailed below:
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What specific types of clinical and educational stress are student nurses exposed to?
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What are the specific coping strategies student nurses employ when exposed to stress?
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What emotions do student nurses experience when exposed to stress?
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What personality factors help student nurses to carry on during periods of stress?
Clinical stress relates to any stress that arises within the clinical
Results
The Likert stress questionnaire contained a five-point scale with one indicating strong disagreement, two indicating disagreement, three indicating don't know, four indicating agreement and five indicating strong agreement. The coefficient alpha of internal consistency for the questionnaire was 0.94, which indicated significant reliability. For analysis purpose, the one student in the 38–45-age category was eliminated. All constructs; clinical stress, academic stress, emotional responses to
Discussion
The predominant stress factors found in this study arising as result of academic activity, support the findings of Lindop, 1989, Lindop, 1999 studies and also Timmins and Kaliszer (2002) Irish study findings. (i.e. examinations and the intense amount of academic work). A preoccupation with assessment may encourage students to be externally motivated, learning only because they are being assessed. This emphasis, essentially contradicts the present aspirations of molding students who will possess
Limitations
The major limitation of this study was that it represented students in only one higher education establishment in the Republic of Ireland owing to the sampling technique chosen (i.e convenient sampling). The sample size (n=52) unearths a further limitation. The results therefore need to be considered with caution as they are not generalisable. However although this was a relatively small-scale study it did highlight pertinent issues locally in relation to student nurse stress.
Conclusions
It is clear from the results of this study that these student nurses are exposed to a variety of stressors from academic and clinical perspectives, which is not unique when compared to the literature. The emotional consequences of stress are evident, with students in this study experiencing exhaustion and pressure. Nursing students are in a unique position academically and multiple demands are made on them. Curriculum developers need to be cognisant of this.
Nurse educators and curriculum
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