Elsevier

Nurse Education Today

Volume 45, October 2016, Pages 102-107
Nurse Education Today

The impact of a sense of self-efficacy on the level of stress and the ways of coping with difficult situations in Polish nursing students

https://doi.org/10.1016/j.nedt.2016.07.004Get rights and content

Highlights

  • the need for increase faculty awareness of student stress and coping

  • the process of teaching should strengthen a sense of self-efficacy

  • the reduction of stress in students will allow them to work to their full potential

Abstract

Introduction

During their first practical classes at a clinical ward nursing students face a new environment; they take on new roles which is associated with stress and a need to handle it.

Objective

The aim of this study was to evaluate the effect of a sense of self-efficacy on the level of stress and the ways of coping by Polish nursing students during the first practical classes at a clinical ward.

Material and Methods

The study included 394 undergraduate subjects studying nursing at two universities in Southern Poland. The study used the method of diagnostic questionnaire and estimation. The research tools included: an original questionnaire, Stress Scale (PSS10), Inventory to measure coping with stress (Mini Cope) and Generalized Self-efficacy Scale (GSES). Data analysis was performed using the IBM Statistical Package for Social Sciences, version 21 for Windows. The verification of differences between variables was performed using χ2 independence test, Kruskal-Wallis test, and Spearman rank correlation coefficient. The level of significance was accepted at α = 0.005.

Results

The level of stress and a sense of self-efficacy in majority of tested nursing students were high. The people with low levels of perceived stress had a significantly higher sense of self-efficacy (rhoSpearman =  0.196; p = 0.0001). The people with a higher sense of self-efficacy significantly more often used active strategies in stressful situations, such as Active coping (rhoSpearman = 0.284; p < 0.0001), Planning (rhoSpearman = 0.318, p  0.0001), Positive revaluation (rhoSpearman = 0.228, p < 0.0001), Acceptance (rhoSpearman = 0.188; p = 0.0002), Seeking Emotional Support (rhoSpearman = 0.123; p = 0.0143).

Conclusions

A sense of self-efficacy had a significant impact on the level of stress and the ways of coping with difficult situations in nursing students.

Introduction

Practical classes are an important part of the nursing educational program. Its purpose is to prepare students to competently fulfil their role and professional functions. The first practical classes are held within the subject called basics of nursing, at the first year of studies. They are the basis for all subsequent practical classes. These activities are carried out in clinical wards, where students put in practice and improve their nursing skills acquired in lab/skill workshops (Zarzycka et al., 2003, Szyszkowska et al., 2005). During these classes a student of nursing is required to contact patients, those who suffer, those in need of help, emotional commitment and a sense of responsibility for the health and lives of others. Such a huge amount of expectations may cause difficulties because the student is still in the process of acquiring personality competence.

Scientific literature often considers difficult or stressful situations as new situations. The first practical training in a hospital abounds in such circumstances (Gugała, 2004, Głowacka and Nowakowska, 2006). Difficult situations, which a student may encounter during practical classes include, among others: situations of tiredness, emergencies, difficulties, conflicts, deprivation. Difficult situations cause a set of reactions that result in the psycho-physiological arousal, frustration, psychological stress; they may be physiological or psychological (Dudek, 2005, Huber, 2010, Dudzińska et al., 2007, Święcicka and Starun, 2005). The psychological effects of stress can lead to behavioural, emotional and cognitive changes. The effects of stressful situations can also have the positive character (Więcikowska, 2008, Mesjasz, 2005). Mild levels of stress can have a positive effect on students by increasing motivation (Ross et al., 2005).

Stress is especially pervasive in the lives of nursing students. They experience higher level of stress than other college students (Golf, 2011, Wolf et al., 2015). Students must deal with interpersonal interactions with clinical instructors and nursing staff, but they also are stressed by their lack of knowledge, insecurity with clinical skills or fear of failure (Gibbons, 2010, Jimenez et al., 2010).

Among the factors responsible for the severity of the nursing stress list: the amount of content to be learned, not knowing how to prepare for examinations and the requirement to successfully pass a nursing course. Other examples were frequent examinations, role conflict with physicians, perceived lack of clinical knowledge, clinical experiences, trying to remain impersonal with patients or discussing sensitive issues with patients (Dutta et al., 2005). Wolf et al. (2015) identified stressors such as clinical incompetence, problematic relationships and time management issues. Predictors of stress included history of depression, year in the program, emotional support, and self-esteem. In an attempt to control and reduce stress levels students use different coping strategies (Yamashita et al., 2012, Klainnin-Yobas et al., 2014, Tomczak, 2009). Studies also revealed that use of positive coping strategies lessens students stress (Hegge and Larson, 2008).

The mechanisms of coping with difficult situations, which are activated in difficult situations, are very important (Dudzińska et al., 2007, Mesjasz, 2005). Coping with stress is usually reported in the literature as a strategy or style. A strategy is understood as a specific way of coping and can be positive or negative. The style in turn is a relatively fixed tendency of a person to use specific ways of coping. The type of style and strategy stems from person's personality traits, the psychophysical condition, gender, education, age and a sense of self-efficacy (Walas et al., 2006). Following Juczyński and Ogińska-Bulik (2012) the authors of the study adopted coping strategies such as Active coping, Planning, Positive revaluation, Seeking Emotional Support, Seeking Instrumental Support, Taking psychoactive substances, Cessation of actions, Blaming oneself, Dealing with something else, Denial, Release, Turn to religion, Acceptance and Sense of humour.

Luo and Wang (2008) found that by improving students' coping skills, problem solving ability improved. Development of adaptive coping mechanisms by nursing students results in students who are less likely to use maladaptive strategies (Reeve et al., 2013). Research conducted by Fornés-Vives et al. (2015) showed that coping and personality changes experienced by nursing students throughout their degree program changed positively and seem to mirror the professional competences needed by future licensed nurses. Wolf et al. (2015) found that main coping strategies used by nursing students included positive thinking and social support.

Identifying students' dispositional tendency to handle stress and determine its potential relationship with personality traits as sense of self-efficacy can guide educators to design specific course to improve curricula.

The aim of this study was to evaluate the effect of a sense of self-efficacy on the level of stress and the ways of coping by Polish nursing students during their first practical classes at a clinical ward.

Section snippets

Material and Methods

The research was carried out using the diagnostic questionnaire method, estimation, and surveying technique. The research tools included: an original questionnaire, Stress scale by S. Cohen, T. Kamarck, R. Mermelstein adapted by Z. Juczyński and N. Ogińska-Bulik, Inventory to measure coping with stress by S. Charles Carver adapted by Juczyński, N. Ogińska-Bulik and Generalized Self-efficacy Scale by R. Schwarzer, M. Jerusalem and Z. Juczyński (Juczyński and Ogińska-Bulik, 2012, Juczyński, 2012).

Results

The mean age of respondents was 20.25 years (SD = 1.22). Men constituted only 3% of the study population. 22.8% of the students declared their preparation to the first practical classes as very good, 63.5% as good, and 12.7% as average. During the first practical classes nursing students usually found difficult discrepancy between theory and practice (N = 208; 52.8%). The difficult situations they also pointed out were as follows: serious health condition of the patient (N = 137; 34.8%); meeting

Discussion

The results of our study showed that Polish nursing students experienced various difficult situations during their first practical classes. These included, among others: discrepancy between theory and practice, the lack of adequate equipment, an insufficient quantity of nursing procedures performed, the serious health condition of the patient, an inability to provide an effective relief, maintaining personal hygiene of intimate parts of the body, communicating with patients, the lack of patient

Conclusions and Recommendations

Nursing students experience high levels of stress due to the emotional demands placed on them, huge amount of expectations when they begin to take the responsibility for patient care. That stress impacts may cause difficulties because the students are in the process of acquiring personality competence.

Communication with patients and discrepancies between theory and practice turned out to be difficult situations that have a significant impact on the stress intensity in nursing students. Besides,

References (39)

  • M. Dudzińska et al.

    Reception of stress and the mechanisms of coping with stress among students of selected universities in Lublin

    Zdrow. Publiczne

    (2007)
  • A. Dutta et al.

    Stress in health professions: myth or reality? A review of the existing literature

    J. Natl. Black Nurses Assoc.

    (2005)
  • W. El Ansari et al.

    Are students' symptoms and health complaints associated with perceived stress at university? Perspectives from the United Kingdom and Egypt

    Int J Environ. Res and Pub Health.

    (2014)
  • F.G. Fernandes Pereira et al.

    Assessment of stress in the inclusion of nursing students in hospital practice

    Investig y Educ. en Enfermeria.

    (2014)
  • M.D. Głowacka et al.

    Wypalenie zawodowe pielęgniarek – niebezpieczeństwa, koszty i sposoby zapobiegania

    Mag Piel. Poł.

    (2006)
  • A. Golf

    Stressors, academic performance, and learned resourcefulness in baccalaureate nursing students

    Int. J. Nurs. Educ. Sholarsh.

    (2011)
  • B. Gugała

    Sytuacje trudne w środowisku pracy pielęgniarek a umiejętności radzenia sobie z nimi

    Zdrow. Publiczne

    (2004)
  • M. Hegge et al.

    Stressors and coping strategies of students in accelerated baccalaureate nursing programs

    Nurse Educ. Today

    (2008)
  • L. Huber

    Style adaptacyjne do sytuacji stresowych w różnych grupach wiekowych, a choroby cywilizacyjne XXI wieku

    Probl. Hig. Epidemiol.

    (2010)
  • Cited by (41)

    • Nursing students’ perceived stress and clinical learning experience

      2022, Nurse Education in Practice
      Citation Excerpt :

      On the other hand, the clinical learning environment was significantly associated with stressors related to teachers/nursing staff, as well as to peers and daily life. Some studies have identified the following stressors as major sources of stress related to teachers and nursing staff: exam preparation, criticism from teachers in the clinical setting (Yilmaz, 2016) and the gap between theory and practice (Bodys-Cupak et al., 2016). The findings of our study also showed the importance of the supportive and coordinating role of the nursing teacher in reducing the discrepancy between theory and practice during student placements.

    • Stress and coping styles among nursing students during the initial period of the clinical practicum: A cross-section study

      2022, International Journal of Nursing Sciences
      Citation Excerpt :

      Previous studies have shown that nursing students’ stress levels during the clinical practicum are closely related to their coping styles. Specifically, nursing students’ stress levels are negatively associated with positive coping styles and positively correlated with negative coping styles [18,19]. There have been many studies worldwide exploring the perceived stressors and coping styles of nursing students during the clinical practicum.

    • Applying the social cognitive model of well-being in the nursing clinical practicum: A structural equation modeling analysis with a Spanish student's sample

      2021, Nurse Education in Practice
      Citation Excerpt :

      It is also consistent with the works of He et al. (2018) and Gibbons et al. (2011), who identified support and self-efficacy jointly as significant predictors of well-being among nursing students. For their part, Bodys-Cupak et al. (2016) found that self-efficacy has a significant impact on stress levels and on how nursing students handle difficult situations. The results of this study, which reinforce the previous research, therefore suggest that initiatives to promote academic support and self-efficacy are likely to have benefits for student well-being.

    View all citing articles on Scopus
    View full text