INTRODUCTION:

The word stress is defined by the Oxford Dictionary as “a state of affair involving demand of physical or mental energy”. a condition or circumstances which can distribute the normal physical and mental health of an individual. Stress is the tension and pressure that result when an individual views situation which present a demand that threatens to exceed his or her capabilities or resources. In stress uncertainty over the outcomes and outcomes must be important are the two important issue which must be satisfied. If an average student wants to qualify exam with distinction, it means there is an uncertainty about outcome, but it will be important for that student. Lastly, potential stress of that student becomes actual stress. College students are at a critical period where they will enter adulthood. They are expected to be the elites in the society. Thus, they should enhance their stress management abilities to live a healthy life after entering the society.¹

What goes on in one’s mind influence every part of the body, stress is the inability to cope with perceived (real or imaginary) demands or threat to one’s mental, emotional, or spiritual well-being. Because demands are perceived difficulty based on the person and situation, what is emotionally and psychologically stressful to one person may not be stressful to another. Stress is the non-specific response of the body to any kind of demand made upon it. That is why it is stated that stress is not what happens to us, it is how we respond to situation.²

“Your worst battle is between what you know and what you feel”

Stress is associated with negative situation, but good things can also produce stress. The right kind of stress can sharpen the mind and reflexes. It might be able to help the body perform better to help you escape a dangerous situation. Stress produces physiological reactions in our body. Hormones are released, which result in physical manifestation of stress. These can include slowed digestion, shaking tunnel vision, accelerated breathing and heart rate, dilation of pupils and flushed skin. This process is often referred to us the “fight or flight” response. That is just what sounds like our bodies are poised to either run away from stressor or stick around and fight against it³

The psychologist suggests that student suffer from anxiety, and traumatic disorder relating to fear of examination, the fear factor is the reason why student suffer from anxiety, depression and the following consequences. Most of the nurses are in the age of late adolescent. If asked a college student as to what makes college life stressful one will receive a long list of situations including taking exam, preparing for term papers applying for loans, new friends, failure in exams, more demands on time and mind. College student experience high stress at predictable times each semester due to academic commitment, financial pressure and lack of time management skills, Archo and lamin found that test grades and competition, time demands professor and class environment and concern about future career were major source of academic stress. Student nurses have the same academic stressors as the other college student such as midterm and final exams, research papers other assignment in addition, student nurses experience a clinical component which is highly technical equipment. To understand the stress and its consequences take an example of

PUT THE GLASS DOWN: 

A professor began his class by holding up a glass with some water in it. He held it up for all to see and asked the students,” How much do you think this glass weights?”

50gms! 100gms!’125gms…. the student answered

Professor says my question is…. What would happen if I held it up like this for a few minutes?”

“Nothing” the students said.

“Ok! What would happen if I held it up like this for an hour?” the professor asked

“Your arm would begin to ache”, said one of the students.

“You’re right. Now what would happen if I held it for a day?

“Your arm could go numb. You might have severe muscle stress and paralysis and have to go to the hospital for sure!!”

Ventured another student and all student laughed

“Very good but during all this, did the weight of the glass change?” Asked professor

“No….” The students said

“Then what caused the arm ache and the muscle stress?”

The students were puzzled.

“Put the glass down!” said one of the students.

“Exactly!” said the professor.” life’s problem is something like this. Hold it for a few minutes in your head and they seem okay. Think of them for a long time and they begin to ache. Hold it even longer and they begin to paralyze you.

You will not be able to do anything.”

“It is important to think of the challenges (problems) in your life. But even more important is to put them down at the end of every day before you go to sleep. That way, you are not stressed, you wake up every day fresh and strong and can handle any issue and any challenge that comes your way!”

By worrying so much, do not turn your life to hell. Good luck^.4

Coping is the way one adapts to stressors psychologically, physically, and behaviourally. The ego usually copes by using defence mechanisms to protect the ego and diminish anxiety. Defence mechanisms are method of attempting to protect self and cope with basic drives or emotionally painful thoughts, feelings or events. The purpose of defence mechanism is to reduce or eliminate anxiety. They can be helpful when used in very small doses, and if overused, become ineffective most defence mechanism operates at the unconscious level of awareness. Previous researches showed that student with an active coping style have lower levels of psychological distress. In a view of potential long term benefits of managing stress in a more effective way such skills early in their medical career, stress not only happens at workplace but student is subjected to different kind of stressors, such as the presence of the academics with an obligation to succeed, an uncertain future and difficulties of integrating into the system. As a result, it is important that individual develop different strategies in order to manage stressful situation. In terms of stress management, Lazarus and folk man defined eight separate coping strategies that they believed individuals employed in stressful situation.⁵

These are confrontation seeking social support, planned problem solving self-control, accepting responsibility, distancing positive reappraisal and escape/avoidance therefore studying student use to deal with it can have important implication for higher education administrator. According to WHO report worldwide 66 million suffers from depression, 24 million affected from alcohol related problems, 1 million people commit suicide each year (rates for attempted suicide are 10-20 times higher). 1 in 4 people is affected by mental or neurological disorders at some point of his or her life this means such disorders are the fourth leading cause of ill health and disability worldwide mental disorders are expected rank in 2^nd in 2020. Behind ischemic heart disease⁴A study on psychiatric morbidity in college and illiterate youth in India revealed that about 10% to 30% of university student have emotional problem and nearly 30% of them have left college or university studies.⁶

The type of emotional disorder in the college and the university students include severe mental disorders including psychosis (1-2%) Personality disorder (4-6%) sexual problem (8-10%) and depression (3-4%) thus academic stressors cover the whole area of learning and achieving, as well as adjusting to a new environment in which a great deal of content must be assimilated in a seemingly inadequate period of time.⁷

Moreover, Excessive stress may lead a student to drop out of college if a stress is not dealt effectively, feeling of loneliness, nervousness as well as sleeplessness and excessive worrying may result.it is to identify the stressors specific to college student. Student’s perception high stress level can lead to poor academic performance depression attrition and serious health problems. Method to reduce student stress often include effective time management social support, positive reappraisal, and engagement in leisure pursuits

NEED OF THE STUDY:

“Failure is not the opposite of success is the part of success”

As BSc nursing student we should be proud that we are learning a top hardest courses in India, nursing rank 2^nd in hardest course after engineering it is because high requirement for the subject as well as is in need of higher secondary education that includes proficiency in biology, physics and chemistry. It is also important to gain insights of building interpersonal relationship while understanding the human behaviour. On taking up the course one must dedicate a solid 3-4 hours in studying on a daily basis if they wish to excel in it⁸.

A growing problem is not only in India but all over the globe that student is more stressed than ever in fact, India has one of the highest rate of suicide among people aged between 15-29 Although the reason is myriad but failure is some of the reason why people put their life at risk. Take a latest example of Khushbu Kumari (20), a first-year student of IGIMS College of Nursing, hanged herself on 4 December 2018 after she failed in four of the six subjects in the internal assessment examination⁹

There have been many incidences in the present where student committed suicide during exam and on the result day but what can be so extreme that student decides to end their life?

The best time of the life that students are supposed to enjoy and cherish the time, they are pushed to extreme level which can be overwhelming for many. In India, the precedent years have responded about 600% increment in the figure of suicide among teenagers. Adolescent in India attempts to commit suicide in every 90 minutes there is the only tip of iceberg, there are many cases which to remain under the cover. However, it must be noted that teenagers who suffering from depression are not even mentioned in the statistics. In general, everyone experiences stress, but student is group of people who are at the transitional nature of the student life; because they need to adjust themselves with the life environment which requires compliance with new social norms and new friends.¹⁰

In a strange incident, a student wrote his suicide note in his examination paper stating that he was unable to cope with the pressure of his studies. A girl studying for intermediate chopped off her hands by laying them under the wheels of a train. She later died due to excessive bleeding. Her reason was that she had done badly in Maths and was scolded at home. Such cases show the rising level of stress in students in India. What is causing this stress? Usually, if it is a student, we immediately relate it to study and exam pressure. But is it only exam pressure that is causing depression in students today? This idea of research is brain storming; Researcher personally felt that stress, so he wants to do research in it, because nobody was there who can help the researcher and he used unhealthy coping strategies, researcher felt that this should not happen with other students. Various methods of healthy coping strategies can be used by students to deal with academic failures, and this is the need of the hour to have a healthy body mind relationship and today’s generation is not able to handle stress effectively so this research is helpful for those who are stressed.¹¹

AIM OF THE STUDY:

To assess the mental stress among nursing student who failed in university examination and coping strategies utilized by them in selected colleges of Pune city

OBJECTIVES:

1. To assess mental stress among failed student

2. To assess the coping strategies Utilized by the student

3. To plan a structured teaching program for student regarding healthy coping strategies

ASSUMPTION:

1. Nursing students may have mental stress who have failed in university examination

2. Nursing students may not have mental stress who failed in university examination

RESEARCH DESIGN:

Research design implied for this study was nonexperimental descriptive research design was used to achieve the aim of the study.

SUBJECTS AND METHODS:

RESEARCH SETTING:

The study was conducted on nursing students of the selected colleges of Pune city

SUBJECTS:

100 Nursing students of selected colleges of Pune city.

STATISTICAL ANALYSIS:

The data were computerized and verified using the SPSS (statistical package for social science) version 16.0 to perform tabulation and statistical analysis. Qualitative variables were described in frequency and percentages, while quantitative variables were described by mean and standard deviation.

RESULTS:

The data was analysed and presented in the following sections:

Section 1:

Distribution of subjects in relation to demographic data.

Section 2:

Assessment of mental stress among failed nursing students

Section 3:

Analysis of data related to Assessment of coping strategies utilized by the student

Section 4:

Analysis of data related to coping strategies and mental stress with selected demographic variables.

Table (1): Socio-demographic characteristics of the studied group

Variables

No. (n=100)

Age (years):

17-19

20-22

23-25

62.5

7.5

62.5

7.5

Gender

Male

Female

Transgender

57.5

42.5

57.5

42.5

Religion

Hindu

Muslim

Christian

Buddhist

57.5

12.5

57.5

12.5

Type of Family

Nuclear

Joint

77.5

22.5

77.5

22.5

Type of Residence

Hostelite

Localities

In the present study, (62.5%) were in age group of 17-19 years and 30% of them were in age group of 20-22 years and 7.5% of them were in group of 23-25. Hence it can be interpreted that most of the respondents were in 17-19 age group.

Gender depicts that majority 57.5% were male and remaining 42.5% were female. Hence it can be interpreted that male gender has more percentage than female.

Religion depicts that majority 57.5% were Hindu and 12.5% were Muslim. 15% are Christian and another 15% are Buddhist. Hence it can be interpreted that most of the respondents were Hindu.

Type of family depicts that majority of the students were from Nuclear family (77.5%) and remaining of 22.5% were from Joint family.

Type of residence depicts that majority 72.5% student were localities and 27.5 were Hostelite. Hence it can be interpreted that most of the respondents were localities.

(Table 2): Distribution of mental stress score of nursing students (N=100)

Mental stress score

Mild mental stress (24-56)

Moderate mental stress (56-88)

Severe mental stress (88-120)

Frequency

2.50

85.00

12.50

Percentage

02.50

85.00

12.50

Table (3): Assessment of coping strategies used among failed nursing students (N=100)

Form of Coping	Percentage	Axial	Percentage
Confrontive problem solving	33,30%	Self-improvement	28,57%
Confrontive problem solving	33,30%	Making effort	4,76%
Positive reappraisal	20,24%	Interpreting failure	15,48%
Positive reappraisal	20,24%	Positive thinking	4,76%
Planful problem solving	16,67%	Self-introspection	7,14%
		Planning management	3,57%
		Time management	5,95%
Accepting and Blaming	11,92%	Accepting	2,38%
Accepting and Blaming	11,92%	Blaming	9,52%
Seeking social support	9,53%	Seeking support	8,33%
Seeking social support	9,53%	Seeking help	1,19%
Avoidance	5,96%	Forgetting problem	1,19%
Avoidance	5,96%	Doing something else	4,76%
Close to God	2,38%	Close to God	2,38%

Thematic categorization analysis showed that there are seven forms of coping which performed by nursing students who experienced exam failure. The coping strategies are

(1) Confrontive problem solving,

(2) Planful problem solving,

(3) positive reappraisal,

(4) accepting responsibility and blaming,

(5) seeking social support,

(6) avoidance, and

(7) close to God. (Table 4).

The first form of copings is Confrontive problem solving (33,30%). The majority students in nursing doing Confrontive problem solving in facing the academic failure. This form of coping was done by students as an effort in solving the problem and achieving the goal by direct action. Confrontive problem solving comprises of self-improvement and making effort. Positive appraisal (20,24%) as the second form consists of interpreting failure as a positive experience to be better and positive thinking. Students who face failure in academic perceive the failure as a lesson to improve themselves.

The next form of copings is Planful problem solving (16,67%). This coping consists of self-introspection, planning management, and time management. The Planful problem solving was done by students as a rational problem-solving technique by making a plan, evaluating self, and managing time to prevent academic failure. The fourth form is accepting responsibility and blaming (11,92%). This coping consists of accepting the academic failure and blaming themselves according to the failure that has already happened. Another type of copings which performed by nursing students is seeking social support (9,53%). This coping includes seeking support and seeking help from people around them such as parent, family, or friends. The sixth type of copings is avoidance (5,96%). nursing students doing avoidance coping by trying to not think the problem seriously and even doing something else to distract their attention from the problem. The last form is close to God (2,38%). In this type of copings, when the nursing students experiencing academic failure, they coped their disappointment by being close to God and sincere.

Analysis of data related to coping strategies and mental stress with selected demographic variables.

Comparison was done by ANOVA test there is no significant association of self-esteem with the demographic variables.

DISCUSSION:

The result showed that there were seven types of coping strategies which performed by nursing students after experiencing the academic failure. The seven forms of coping can be categorized into two types of coping according to their function in managing problem. The first type is problem focused coping and the second is emotion focused coping. This finding is consistent with Lazarus (2014) that emphasize on two forms of coping, problem-focused and emotion-focused coping. The problem-focused coping consists of Confrontive problem solving and Planful problem solving. That two forms focus on how to solve the problem by doing an action so that it categorizes as problem-focused coping. It consistent with the grant theories from Lazarus and Folkman (2014)¹²which revealed that problem-focused coping was the strategies which focus on the problem. In Confrontive problem solving, students solve the problem by improve themselves and make more effort. Meanwhile in Planful problem coping, the students solve the academic failure by evaluating or introspect themselves in order to make the better plan to achieve a better achievement in future. It also parallels with Folkman and Lazarus, (2018)¹³which explained that there were two types of problem-focused coping, Confrontive and Planful problem coping. The emotion-focused coping comprised of positive reappraisal, accepting responsibility and blaming, seeking social support, avoidance, and closer to God. That types of copings focus on how managing the distress emotion by doing many kinds of activities. It consistent with Lazarus and Folkman (2014)¹² which revealed that emotion focused coping was the strategies which focus on managing the distress emotion. In positive reappraisal, the students managing the emotion by interpreting and thinking positive on their failure. Nursing students also face the academic failure by accepting responsibility and blaming to reduce their guilty feelings. In maintaining positive emotion, Javanese students also seek social support from people around them to comfort them. Besides that, some of the nursing students manage their distress by avoiding the problem such as do not think problem seriously or do something else. The last, some nursing student close to God by praying to make them ease. These findings are a bit different prior the grant study of coping strategies from Folkman and Lazarus (2014)¹² which differentiated coping strategies into two types, problem-focused coping and emotion-focused coping. Especially in the emotion-focused coping types. In the grant theory of coping, emotion-focused coping consisted of distancing, escape avoidance, accepting responsibility or blame, exercising self-control over the expression or feeling, seeking social support, and positive reappraisal (Folkman et. al, 6; Folkman & Lazarus, 2014). The main difference is “close to God” as coping strategies on nursing students after experiencing academic failure. Even if it can be categorized in emotion-focused coping, it is a bit unique. The action which related to close to God is being sincere and close to God. According to Suseno (2015),¹⁴nursing culture emphasizes on respect among human, human with nature, and human with God. Even if there is a different, there are a similarity in some aspects, such as Confrontive and Planful problem as problem-focused coping. Then positive reappraisal, accepting responsibility and blaming, seeking social support, and avoidance as emotion-focused coping.

CONCLUSION:

Mental stress:

It is clear from the results of this study that these student nurses are exposed to moderate amount of stress. Effectively managing stress is a priority for failure student nurses. Overall time management an effective nursing program provides ongoing stress management workshops during the academic year. There are unique interpersonal and environmental stressors for student nurses. Stressors specific to nursing college students can be addressed by educational administrators.

COPING STRATEGIES:

There are seven forms of coping in nursing students after experiencing academic failure; (1) Confrontive problem solving, (2) Planful problem solving, (3) positive reappraisal, (4) accepting responsibility and blaming, (5) seeking social support, (6) avoidance, and (7) closer to God. The seven forms of coping can be categorized as two types of coping according to the function in managing the problem. The first type is problem focused coping which focus in solving the problem. It consists of Confrontive and Planful problem solving. The second type is emotion-focused coping which focus on reducing distress emotion. It includes positive reappraisal, accepting responsibility and blaming, seeking social support, avoidance, and close to God. In this research, we found close to God as a unique form of coping in nursing students.

SUGGESTIONS AND RECOMMENDATIONS

For Students

1. The best way to handle stress is to not get more stressed about being stressed. If you're stressed out, admit it and figure out how to handle it. Focusing on it will only make things seem worse.

2. Being in college means your sleep schedule is, most likely, far from ideal. Getting more sleep can help your mind refocus, recharge, and rebalance. Sometimes, one good night's sleep can be all you need to hit the ground running amidst a stressful time.

3. Go eat something balanced and healthy: fruits and veggies, whole grains, protein.

4. Have the time to exercise. Fair enough, but if you're feeling stressed, it may be that you need to squeeze it in somehow. Exercise doesn't necessarily have to involve a 2- hour, exhausting workout at the campus gym. It can mean a relaxing, 30-minute walk while listening to your favourite music. In fact, in a little over an hour, you can 1) walk 15 minutes to your favourite off-campus restaurant, 2) eat a quick and healthy meal, 3) walk back, and 4) take a power nap.

5. Don't forget that your brain is like a muscle, and even it needs a break every once in a while! Take a break and see a movie. Grab some friends and go out dancing. Having a social life is an important part of your college experience, so don't be afraid to keep it in the picture when you're stressed. It could be when you need it most!

6. You may be stressed about one thing: You basically just need to sit down and plough through it. If this is the case, try to figure out how to make it a little more fun and enjoyable.

7. Figure out which things are causing you the most stress and how you can take a step back from each. And then, most importantly, take that step.

8. If you're afraid of dumping too much on a friend, most colleges have counselling centres specifically for their students. Don't be afraid to make an appointment if you think it will help.

For College Authorities:

1. The colleges need to develop a stress free and academic conducive environment for learning. To overcome the problem of stress among students, colleges should employee more qualified and experienced lecturers to recover the staff shortage.

2. Colleges try to carry out the facilities of internet and computer station for the students which help them in submitting assignments, presentation and other related tasks. Management colleges should also conduct some time management seminar which help students of management manage their time wisely.

3. Colleges or institute assign faculty mentors who encourage students or help them in the career prospects and motivate to do better performance. These mentors also help students‟ subjects which they find more difficult. These mentors not only help their mentee in academic life, but they also give suggestion on their problems related to personal life.

4. Colleges should conduct some sessions or seminars with the help of experts on stress reduction which include both conceptual as well as experimental stress problem and their remedies.

5. Apart from academic stress colleges should also try to minimize the interpersonal conflict among students. Of course, it will be very difficult task for those students who are not residing in the college hostel. But, if the college administration should try to minimize the interpersonal conflict of holsters, it will help to other students also.

6. However, it is true that academic activities will never run without stress. But colleges try to minimize the potential sources of stress among students like overcrowded lecture halls, inconvenient computer lab, lots of assignment etc. which often create stress among students.

REFERENCES:

1. Aldwin, Corolyn M. “Stress coping and development – An Integrative Perspective”, The Guilford Press.2007.

2. "Stress". Mental Health America. 2013-11-18. Retrieved 2018-10-01.

3. https://www.webmd.com/balance/stress-management/stress-and-the-body#1

4. http://www.english-for-students.com/put-the-glass-down.html

5. student guide to surviving stress and anxiety in college and beyond learn psychology http://www.studyin-uk.in/study-guide/why-indian-students-are-more-stressed-ever/

6. Acton G. S., Revelle W. (2004). Evaluation of ten psychometric criteria for circumplex structure. Meth. Psychol. Res. 9, 1–27. 10.1207/s15327752jpa7903_04 [CrossRef] [Google Scholar]

7. Health behaviors & problems among young people in India: Cause for concern & call for action

8. Adolescent health and development. WHO Regional office for South-East Asia. [accessed on January 8, 2013]. Available from: http://www.searo.who.int/entity/child_adolescent/topics/adolescent_health/en/index.html.

9. A descriptive study of perceived stress among the North Indian nursing undergraduate students. Iran J Nurs Midwifery Resv.18(4); Jul-Aug 2013PMC3872872

10. Begum S, Rao KN. Psychiatric morbidity in college and illiterate youths. Indian journal of psychiatry 1994; 36 (3)

11. Stress, depression take toll on IIT (https://www. indiatoday.in/india/north/story/iits-suicide-cases-stress-level-students-141157-2011-09-14)

12. Lazarus and Folkman (2014), the dynamics of stressful encounter: cognitive appraisal, coping and encounter outcomes, journal of personality and social psychology, 50, 992-1003.

13. Folkman and Lazarus, (2018), the relationship between coping and emotion, implications for theory and research, social science medicine, 26 (3), 3018-17

14. Suseno (2015), Academic Stress and its Sources Among University Students. Biomed Pharmacol J 2018; 11(1).

Received on 03.05.2020 Modified on 22.05.2020

Int. J. of Advances in Nur. Management. 2020; 8(3):197-203.

DOI: 10.5958/2454-2652.2020.00047.5