@2024 Afarand., IRAN

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ISSN: 2228-5468    Education Strategies in Medical Sciences 2015;8(5):287-294

Background
… [1-22] Coping styles play important roles to reduce stress [23]. Coping is a set of mental, emotional, and behavioral attempts in facing with psychological pressures to overcome or endure the stress effects, or make them least [24]. … [25-28]
Previous Studies
The nurses highly use the avoidant coping styles [29]. In contrast, based on another study, problem-solving coping and active coping styles are prevalent among the nurses [30].
Aim(s)
The aim of this study was to determine the stressful resources of clinical education and the coping styles in the nursing students.
Research type
This is a descriptive-analytical study.
Research society, place and time
Except the 1st semester students, all nursing students of Urmia Nursing and Midwifery Faculty were studied in 2014.
Sampling method and number
309 students were selected via Census method.
Used devices&materials
Data was collected using a demographic characteristics form, the perceived stress scale (PSS), and Lazarus and Folkman Coping Skills Questionnaire. The demographic form assesses age, gender, semester, total GPA, job, educational level of parents, monthly income, type of residence, and life status of the parents. PSS was used to investigate the students’ stress levels and types of the stress resources. The scale contains twenty nine 5-choice questions scoring as “never” (zero score), “very low” (1 score), “sometimes” (2 scores), “often” (3 scores), and “always” (4 scores) in six aspects. The aspects are stress caused by patient care (8 questions), stress caused by the teachers and nursing staff (6 questions), stress caused by homework and work load (5 questions), stress caused by other students and daily life (4 questions), stress caused by professional skills and knowledge (3 questions), and stress caused by clinical environment (3 questions). The higher the score, the higher the level of stress is. Lazarus and Folkman Coping Skills Questionnaire was used to investigate the students’ coping styles. The questionnaire includes 66 phrases and 8 scales. The scales are dealing, avoiding, continence, seeking for social support, responsibility, escape and avoidance, and positive reappraisal. The questionnaire measures two main coping styles including problem-solving focused coping style (seeking for social support; responsibility; problem-solving; positive reappraisal) and emotion focused coping style (dealing; avoiding; escape and avoidance; continence). Cronbach’s alpha for PSS has been computed 0.87 [31]. Validity of Lazarus and Folkman Coping Skills Questionnaire has been confirmed [28, 32]. In an Iranian sample, Cronbach’s alpha of the coping styles test has been 0.93 [33]. Data was analyzed by SPSS 20 software. ANOVA and Kruskal-Wallis tests were used to compare mean scores and mean ranking of the scores of the perceived stress and the students’ coping styles based on parametric and non-parametric data, respectively. Spearman test was used to determine the correlation between the comprehended stress scores and the aspects of the students’ coping styles. … [34]
Findings by Text
Mean age and GPA of the students were 21.74±1.94 years and 15.38±1.17, respectively. 50% of the students were male. The lowest and the highest population percentage of the students were the first year (9.7%) and the third year (37.5%) students, respectively. 83.2% of the students were without any job. The education level of 71.8% of mothers and 54.14% of fathers was under diploma. The family income of 83.5% of the students was in moderate level.68% of the students were not native. The parents of most of the students were alive. Stress caused by the teachers and nursing staff and stress caused by patient care received the first and the last rankings. Positive reappraisal was used by the students more than other coping styles. Escape and avoidance was the least coping style used by the students. Problem-focused coping styles were used by the nursing students more than the emotion-focused coping styles. There were significant differences in the mean scores of the aspects of stress caused by other students and daily life and stress caused by the clinical environment (p<0.0001) and total stress score (p=0.033) between female and male students. There were significant differences in the coping styles including responsibility, positive reappraisal, problem-solving focused coping, and total scores of the coping styles between female and male students (Table 1). There were significant differences between the mean scores and the mean rankings of the comprehended stress scores in all aspects between the students of different academic years (p<0.05). There were significant differences in the total score of the coping styles and all aspects of the students’ coping styles between the students of different academic years, excluding dealing aspect (p<0.05; Table 2). There were significant differences in the comprehended stress between the students of first and third, second and third, and third and fourth academic years, comparing the mean rankings of the comprehended stress and the students’ coping styles, in pairs (p<0.05). The mentioned signification model was true in the coping styles. In addition, there were significant differences in the coping styles between the students of second and fourth academic years (p<0.05). There was a positive and significant correlation between total stress score and emotion-focused style (p=0.0001; r=0.3).
Main comparison to the similar studies
Total stress score of the students was moderate. Some studies show moderate stress level [31, 35-37]. However, there is a low stress level in the nursing students [38]. … [39] Stress caused by patient care was in the least level and other aspects of stress were moderate including stress caused by the teachers and nursing staff as one of the main stressors. Similar with the present results, stress caused by patient care is in the least level and stress caused by the teachers and nursing staff is one of the main stressors [40]. Stress caused by the teachers and treatment staff is one of the main stressors for the nursing students [41]. Stress caused by homework and work load is highly detected by the students, related to their curriculum. In addition, stress caused by low knowledge and professional skills is another stressor [31]. The level of the perceived stress varied with academic year; and the higher the academic year, the lower the stress level in the students was, excluding the third academic year. The stress level of the students of the last academic year is lower than the third-year students do [31, 40], which is a result consistent with the present results. Both coping styles were moderate, but there were more utilizations of the problem-focused style than emotion-focused style. The result is consistent with some studies [41-43]. The problem-focused style is used by most of the students than the emotion-focused style [44]. … [45] There was a positive and significant correlation between the level of the comprehended stress of clinical training and emotion-focused style, while the correlation between the comprehended stress level of clinical training and problem-focused style was week and insignificant. Similar results are reported in the correlation between the comprehended stress and the coping styles [46].
Suggestions
Greater sample size should be studied in other universities. New educational methods should be used by the teachers to reduce the gap between theoretical materials and functions.
Limitations
Differences in the students’ comprehensions of the clinical experiences and stressors were of the limitations for the study.
Conclusions
The most effective stressor in the clinical educations on the nursing students is stress caused by the teachers and nursing staff. In addition, there is more utilization of the problem-focused coping styles by the nursing students than the emotion-focused coping style.
Acknowledgments
Research Deputy of Urmia University of Medical Sciences and the participating students are appreciated.
Conflict of interest
There was no conflict.
Ethical Permissions
The study was confirmed by Ethics Committee of Urmia University of Medical Sciences.
Funding Sources
The study was funded by Urmia University of Medical Sciences.

TABLES and CHARTS

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