Nursing involves activities and interpersonal relationships that are often stressful. A study done in Iran found that first-year students experienced greater stress than students in subsequent years whereby mean stress was significantly greater in first year than in fourth year nursing students with p = 0. 009 4. Coping has been viewed as a stabilizing factor that may assist individuals in maintaining psychosocial adaptation during stressful events. There are many ways to cope with stress.
In this study, transference coping strategy (crying, sleeping, eating, listening to music, hang out with friends, take a deep breath, shopping, watch television, take a bath, screaming, internet surfing, sports, punch something and do household chores) was used as the choice of coping strategy. Most of the participants in this study will cry and sleep to cope with their stress, 18. 5% will eat, 9. 5% will listen to music and 4. 2% will hang out with their friends.
In a study done in Hong Kong, whereby four types of coping strategies (transference, stay optimistic, problem solving, and avoidance) were used as the choice of coping strategies among nursing students, transference coping strategy was the most frequently used5. This is because, transference coping strategies may be easier and more convenient to use compared with other strategies. Besides that, students have not known or learnt about types of effective or useful coping strategies during clinical practice. Moreover, students’ stress may be considered as a temporary symptom because they have less responsibility in caring for patients.
Also, they can rely on their clinical supervisors when problems arise. Transference strategies may therefore be effective over a short period5. According to table 1, 41. 1% of students have no depression, while 58. 9% of students have depression. Among the depressed student nurses, 32. 1% have mild depression, 16. 1% have moderate depression, 8. 9% have severe depression, and 1. 8% have extremely severe depression. This decreasing trend of severity of depression is in keeping with other study6, which revealed that the relation of severity of depression is inversely proportionate to the percentage of nursing students involved.
For example, the mildest severity of depression comprises the most nursing students, and vice versa. Depression in students is primarily caused by adaptive difficulties and stresses7-8. Disorientation regarding the university environment in the first year students together with separation from their families, lack of interest in their courses, difficulty with teachers and other students, economic and dormitory problems may all lead to psychiatric problems and failure in academic achievement9. Based on table 1, 42. % of students have no stress, while 57. 7% of students have stress. Among the stress student nurses, 23. 8% has mild stress, 22. 0% has moderate stress, 7. 7% has severe stress, and 4. 2% has extremely severe stress.
Therefore, the severity of stress is inversely proportionate to the percentage of student nurses in this study. Based on the study done by Naiemeh et al about the experienced stressors among Iranian nursing students showed that the most frequent academic source of stress was “increased class workload” (66. %) and the most frequent environmental sources of stress were being “placed in unfamiliar situations” (64. 2%)4. Nursing students have the same academic stressors as other college students, such as midterm and final examinations, research papers and other assignments11. In addition, nursing students experience a clinical component, which is highly stressful. Students have a large amount of preparatory work before their clinical assignments. They often must travel long distances to clinical sites and use highly technical equipment11-12.
In addition, they must perform procedures that can cause serious harm to their patients, thus enhancing their fear of making mistakes. Studies indicate that nursing students may be more prone to stress than other students. Beck and Srivastava (1991) performed a study to investigate the perception level and sources of stress across academic years in 94 nursing students enrolled in a baccalaureate nursing program at one university. Psychiatric symptoms were more prevalent in these students than in the general population13. The majority of nursing students (35. %) have moderate anxiety followed by Normal (21. 4%) and extremely severe anxiety (17. 9%). In contrast, a study by Sahar G. Behilak from King Faisal University in Saudi Arabia, however, found that the majority of their female nursing students have low anxiety, accounting for 70. 9% 14. This is alarming as there is a higher percentage of nursing students in University Malaya who experience moderate anxiety as compared to Saudi Arabia, which is also an Asian country. This may represent the difference in coping mechanisms between the two countries.
Nevertheless, it is important to note that a substantial percentage of our nursing students have extremely severe anxiety, which cannot be ignored as extremely severe anxiety is associated with depression. This necessitates an intervention from an early stage. The differences in the mean scale of depression, anxiety and stress between those in a relationship and those who are not in a relationship are found to be not significant. Generally, having a close relationship will give us extra social support so that problems can be shared and discussed.
This is somehow true as Brown, Bhrolchain ; Harris (1975)15 have found that intimate social relationship may afford some protection against the onset of depressive illness in women. However, close relationship does not always mean happiness. Findings from a study by Abbey et al. (1985)16 suggest that the presence of conflict is most detrimental to the provision of support in a person’s closest relationship. Ratings of support and conflict associated with this most intimate relationship were strongly negatively correlated.
Based on diagram 2, the proportion of students to join nursing school based on their own decision comprises of the large majority of them, as shown by 65. 50%, as compared to those who join nursing school based on their family’s decision, with a portion of 34. 50%. Most of the students have no depression, including those who joined nursing school based on own decision and those who joined based on their family’s decision, as shown by 40. 9% and 41. 4% respectively. This is followed by those who suffered from mild depression, as seen by 34. 5% of students who made their own decisions and 27. % of those who joined due to family’s decision. Minority of them suffered from extremely severe depression. Decision-making does not affect the levels of depression in nursing students. Both groups of nursing students suffered from moderate anxiety, as shown by 35. 5% of those who made their own decision into nursing school and 36. 2% of those who joined based on family’s decision. In contrast, 18. 2% of students who made their own decision into nursing school and 17. 2% of students who entered nursing school suffered from extremely severe anxiety.
Only about 20% of the students are normal without anxiety. Levels of anxiety experienced by nursing students are not influence by decision-making of themselves or family because there is not much difference in each level of anxiety in relation to the groups of students. Vast majority of students are normal with no stress. More than 45% of students suffered from mild and moderate stress, including those who made their own decision and those who based on family’s decision to join nursing school. Hence, decision-making does not affect the stress level of students in nursing school.
Detection of potential depression among nursing students is crucial since depression can lead to low productivity, minimized quality of life, and suicidal ideas. Identifying factors affecting depression among students can help nursing educators to find ways to decrease depression. Stress was positively related to depression, whereas emotional support and self-esteem were negatively related to depression17. This supports the fact that decision making, ie as emotional support does not affect the depression, anxiety or stress level felt by those nursing students.