CHAPTER 1

THE PROBLEM AND ITS SCOPE

Introduction
Clinical rotations in different hospitals and health institutions are
integral in honing the student nurses knowledge and skills. It gives nursing
students real world experiences describe in textbook and discussed in
classroom settings. In addition, clinical rotations are designed to help
nursing students transition from learning about nursing to performing
nursing. This rotation typically occurs after the first year of the traditional
classroom education.
As a student, one faces many challenges and stressors. However,
nursing students are more likely to experience even more stress. A study
shows that one third of nursing students experience stress severe enough to
induce mental health problems such as anxiety and depression (Pyrjmachuk,
2004).
In addition to contending with exams, long hours of studying, work,
family and personal commitments, they also faced the challenges of clinical
practice. Clinical practice has been identified as one of the most anxiety
producing components in nursing programs. Lack of experience, fear of
making mistakes, difficult patients, discomfort at being evaluated by faculty
members,

worrying

about

giving

patients

the

wrong

information

or

medication and concern about possibly harming patients are just a few of
the stressors for the beginning student nurse ( Shariff and Masuomi, 2005).
Stress is our bodys response to changes in our life. Since life involves
constant change (ranging from changing locations from home to work each

morning to adapting to major life changes like marriage, divorce, or death of

a love one), there is no avoiding stress. This is why our goal isnt to
eliminate all stress, but to get rid of unnecessary stress, and effectively
manage the rest. Some common causes of stress that many nurses are
experiencing

are

increasing

the

severity

of

clients illnesses,

adjusting to various work shifts, being expected to assume

for

which

one

is

not

prepared,

responsibilities

and inadequate support from

supervisors and peers.

Incorporating practices that can reduce some of the stress associated
with all of the challenges is important, useful and essential to a students
well-being. Stress

management,

self-care

management

and

self-care

practices will help them navigate through nursing school and will also
provide a wonderful foundation for creating a balanced and wholesome life.
The need for stress management techniques for nursing students is
necessary to prevent burnout and also to prevent nurses from leaving the
profession. The stress that student nurses carry can only be of harm to the
profession in the long-term (ORegan, 2005).
When people are confronted with stress, they have a great number of
choices about how to deal with it. To truly address that stress, they need to
put the distractions away and get focused on their goals, priorities, and
actions.
Problem-focused solving which looks at different approaches and
resolutions.
Emotional detachment is putting a barrier between yourselves and the
other person involved. It can either be positive or negative.

Reference to others or seeking social support represents the coping

strategies young people use when they turn for support to external
resources, such as peers and professionals.
Next is focusing on the positive or looking at the bright side of life.
This means being able to accept the current situation a person is in and tries
to have a positive outlook on that certain situation however difficult it may
seem.
Another one is tension reduction wherein a person finds and develops
interests and activities that relieve stress. Example of this is engaging in
exercises or hobbies.
There are also designates strategies that hinder coping. One form of
that is through suppressing tension in which the individual attempts to feel
better by engaging in negative behaviors, such as substance abuse. Second
is keeping to oneselfbeing withdrawn from others, and refuses to
communicate ones concerns and feelings. Another is engage in wishful
thinkinghoping for the best without taking steps to ensure it. Lastly is
blaming oneself and seeing oneself as responsible for the problem.
The researchers would like to identify the most common coping
mechanisms that are being utilized by the third year and fourth year nursing
students of Bukidnon State University both male and female aging 18 years
old and above who are assigned in the different units of Bukidnon Provincial
Medical Center specifically Medical, Surgical, OB, and Pediatric Ward, OR,
DR, ICU, and ER.
Figure 1 of this study presents the schematic diagram showing the
interplay of the variables. The independent variables are the profile of

respondents, age, year level, gender, civil status and area of assignments.
The dependent variables, on the other hand are the coping mechanisms
consisting of the problem-focused solving, wishful thinking, detachment,
seeking social support, focusing on the positive, self-blaming, tension
reductions, suppressing tension, and keeping to self.

Independent Variable

Dependent

Variable

Figure 1: Schematic Diagram showing the interplay of Independent

and Dependent Variables

CONCEPTUAL FRAMEWORK
The popularity of the stress concept in science and mass media stems
largely from the work of the endocrinologist, Hans Selye. In his work, Selye,
the father of stress research, developed the theory that stress is a major
cause of disease because chronic stress causes long-term chemical changes.
In the alarm stage, our body recognizes theres a danger and prepares to
deal with the threat by the fight or flight response. Activation of the HPA
axis, the sympathetic nervous system and the adrenal glands take place.
During this phase the main stress hormones cortisol, adrenaline, and
noradrenaline, is released to provide instant energy.
The second stage is resistance stage. Our body shifts into this second
phase with the source of stress being possibly resolved. Homeostasis begins
restoring balance and a period of recovery for repair and renewal takes
place. Stress hormone levels may return to normal but the body may have
reduced defenses and adaptive energy left.
The last stage is the exhaustion stage. At this phase, stress has
continued for some time. The bodys ability to resist is lost because its
adaptation energy supply is gone. Often referred to as overload, burnout,
adrenal fatigue, maladaptation or dysfunction Here is where stress levels
go up and stay up.
On Lazarus Theory of Psychological Stress, two concepts are central to
any psychological stress theory: appraisal, i.e., individuals' evaluation of the
significance of what is happening for their well-being, and coping, i.e.,
individuals' efforts in thought and action to manage specific demands (cf.
Lazarus 1993).
Coping is intimately related to the concept of cognitive appraisal and,
hence, to the stress relevant person-environment transactions. Most
approaches in coping research follow Folkman and Lazarus (1980, p. 223),
6

who define coping as `the cognitive and behavioural efforts made to master,
tolerate, or reduce external and internal demands and conflicts among
them.'
This definition contains the following implications. (a) Coping actions
are not classified according to their effects (e.g., as reality-distorting), but
according to certain characteristics of the coping process. (b) This process
encompasses behavioral as well as cognitive reactions in the individual. (c)
In most cases, coping consists of different single acts andisorganized
sequentially, forming a coping episode. In this sense, coping is often
characterized by the simultaneous occurrence of different action sequences
and, hence, an interconnection of coping episodes. (d) Coping actions can be
distinguished by their focus on different elements of a stressful encounter
(cf. Lazarus and Folkman1984 ). They can attempt to change the person
environment realities behind negative emotions or stress (problem-focused
coping).

They can also relate to internal elements and try to reduce a

negative emotional state, or change the appraisal of the demanding situation

( emotion-focused coping).

Statement of the Problem

The study aims to determine how the fourth year and third year
student nurses deal with the stress that they encountered on their clinical
rotation.
This study sought to answer the following inquiries:
1. What is the profile of the respondents in terms of the following:
1.1 Age
1.2 Year level
1.3 Gender
1.4 Civil Status
1.5 Area of Assignment
2. What are the five most common coping mechanisms that the third year
and fourth year nursing students are using:
2.1 Problem-focused solving
2.2 Wishful Thinking
2.3 Detachment
2.4 Seeking Social Support
2.5 Focusing on the Positive
2.6 Self-blaming
2.7 Tension Reduction
2.8 Suppressing Tension
2.9 Keeping to self

3. Is there a significant difference between the profile of respondents

and their common coping mechanisms?

Significance of the Study

The researchers believe in the merits of this study to the following:
Researchers. This will enable them to determine what coping
mechanisms to manage stress have been utilized by most of the nursing
students of Bukidnon State University and if these have been helping them
cope with the stressors encountered on their clinical duties.
Nursing Students. This will let them acquire knowledge on the
stressors,

problems

and

challenges

they

will

have to overcome

all

throughout their clinical performances which are and will always be part of
their chosen career. This understanding will help them enhance their coping
abilities and self-confidence.
Clinical Instructors. This study will make them determine if their
students are managing stress from clinical rotations effectively. In addition,
they will be able to create measures on how the student nurses will be able
to appreciate their related learning experiences by being able to learn more
and perform procedures with confidence.
College of Nursing and school administrators of Bukidnon State
University. For them to know if the education that was being provided by
the school is enough to produce future nurses who embodied the five Cs:
competence, compassion, caring, commitment and conscience.
Parents.For them to see how their children have been doing in the
hospital. In addition, they can also provide the necessary support that the
student nurses need to be able to work through with all the stressors.
9

Patients. Who deserve to be rendered with quality service that will

help promote their health, prevent further complications of their disease and
if all these are not possible, aid them in dying with dignity, all the while
maintaining their privacy and confidentiality.

Scope and Limitation of the Study

The study is conducted on third year and fourth year student nurses of
Bukidnon State University. There are 50 respondents, 25 people each from
the two year levels. These students were chosen because they were already
been on duty in a hospital for a longer period of time and the training is
more rigid compared to those in the first year and second year levels whose
competency is still on vital signs taking. In addition, the study has only listed
the nine most common types of coping mechanisms due to time constraints
in gathering and analyzing the data.

Definition of Terms

10

Area of Assignment or Clinical Placement. It provides the opportunity

for students to observe role models, practice, develop their skills and
problem-solving abilities, and reflect on what they see, hear and do.
Clinical Area This pertains to the hospital setting where in the nursing
students apply and practice what they are learning in terms of rendering or
applying nursing care and focusing on the holistic care of the patient.
Clinical Instructor- a registered nurse who teaches, guides and supervises
the student nurses on their clinical duties.
Clinical duties These refer to the exposure of the nursing students in
different hospital wards/areas as well as in different types of hospital
services in order to broaden their learning experiences while undergoing the
Related Learning Experience program.
Clinical Rotation - A period in which a nursing student in the clinical part
of his/her education passes through various clinical areas.
Coping mechanisms- defined as ongoing cognitive and behavioral efforts
to manage specific external and/or internal demands that are appraised as
taxing or exceeding the resources of the person.
Detachment - can mean two different things. In the first meaning, it
refers to an "inability to connect" with others emotionally, as well as a
means of dealing with anxiety by preventing certain situations that trigger it;
it is often described as "emotional numbing". In the second sense, it is a
decision to avoid engaging emotional connections, rather than an inability or
difficulty in doing so, typically for personal, social, or other reasons.
Focusing on the positive - looking on the bright side
Keeping to self - withdrawn from others, refuse to communicate ones
concerns and feelings

11

Problem-focused solving- looks at different approaches and resolutions.

Related learning Experience This pertains to the clinical exposure
nursing students have to undergo. It is required to all nursing students in
order for them to have an in-depth and meaningful experience and are easily
appreciated when they are already in actual hospital situation.
Seeking Social Support - share problems, talk to others
Self-blaming - see oneself as responsible for the problem
Suppressing Tension - attempting to feel better by engaging in negative
behaviors, such as substance abuse.
Stress - body's way of responding to any kind of demand. It can be
caused by both good and bad experiences.
Stressor - is anything that is perceived as challenging, threatening or
demanding.
Tension reductions- wherein a person finds and develops interests and
activities that relieve stress.
Time management - the act or process of planning and exercising
conscious control over the amount of time spent on specific activities,
especially to increase effectiveness, efficiency or productivity.
Wishful thinking - hoping for the best without taking steps to ensure it

CHAPTER 2

12

REVIEW OF RELATED STUDIES AND LITERATURE

This chapter presents a review of literature and studies on the coping

mechanisms of nursing students and nurses.
Local Literature
A nursing students life will always be laborious and compelling.
Intellectual,

physical,

and

sometimes

emotional

demands

can

be

encountered in the Nursing discipline. Most Registered Nurses at present had

experienced the same predicaments and challenges, in varying degrees,
before becoming the great nurses they are today. The prime way on how to
deal with the BSN life is to have this realization: Its never easy to become a
nurse.

One

must

pour

on

great

deal

of

hardwork.

(http://nurses.definitelyfilipino.com/index.php/2010/12/a-bsn-studentsguide-to-nursing/).
In the article stated above, it says that being a nurse is not an easy
job. It requires passion, effort, and patience. Its normal for nurses to have a
very stressful routine. But because of individual differences of people, we all
have our own ways of dealing with stress, some of us want to eat or maybe
meet friends after school or work, sleep. Its a definitely a fact. We have our
own individuality.
Local Studies
Even at the early beginning of life, stress is being encountered. It
appears to be a universal condition which everyone young or old, married or
unmarried, Filipino or foreigner, poor or rich, learned or not learned
experiences or develops. In other words, it affects all kinds of people from

13

different walks of life. There are many events in life that can cause stress. It
could be generic, physical, chemical, psychological, cultural, ecological or
occupational

in

nature.

(http://www.jpsimbulan.com/2007/11/19/stress-

and-the-working-nurse/)
Nurses are not far exempted from facing many stressful things. It has
been recognized that the world he lives is a potent source of stress. Nursing
is a profession that demands high level of responsibility because it promotes
individualized, sensitive, relevant and effective nursing care to patients.
Thus, levels of stress are associated with the jobs that are too varied and
demanding. Nurses are very much capable of developing a great deal of
stress causing either physical or psychological responses in terms of
accomplishing the jobs in the hospital settings, as well as in meeting their
responsibilities in their respective home because of these hectic activities
they have less opportunities for social interaction. Therefore, there is a great
for need for studies in order to determine the sources of stressful factors
that the behavior of nurses. When a certain individual for example,
experiences a stressful situation, that person may try to cope up by making
an effort to change the situation into a good one and avoids intolerable
situations. Almost all literature claims that work factor produces stress in
different levels and that the people vary in their ability to cope with them. In
recent years, researcher had begun to investigate costly consequences of
occupational stress burnout. Burnout is a state of physical and emotional
exhaustion that occurs gradually over a period of time. First described in
1974 by Freudenburger, the burned-out are usually professionals who work
in people-intensive jobs that are emotionally demanding which is primarily
nurses and social workers are likely to be affected. Physical symptoms
typically include chronic fatigue and frequent minor illness, such as colds,
that resolve slowly. Burned out people spend an overabundance of time at
work but are disorganized, easily angered and accomplish little. The most

14

distinguishing characteristic of burnout is the way burned out distance

themselves from clients in which distancing is accomplished through
depersonalization manner. The burned-out are professionally committed,
highly idealistic individuals who over identify in their personal life. Believing
their work will make a significant social difference and be financially as well
as emotionally rewarding. And these individuals are unprepared for the day
to day realities of their jobs that results from suffering stress-related
illnesses.
As it is commonly used, stress is referred as a burden or load under
which a person survives or cracks. It was also been defined as any internal
or external influence that interferes with satisfaction of basic needs or
somewhat a thing, which disturb homeostasis. This may be a disturbance in
the body homeostasis, general or severe enough to produce a coordinated
body response. These responses include renal, respiratory, metabolic,
sympathetic and circulatory reactions. A well-known psychologist, Hans
Selye, also a world renowned authority defined stress as the non-specific
response of the body to any demand made upon it. He coined stressor as a
factor or agent that produces stress. He further stated that the bodys
response to stress is non-specific because it occurs without regard to and
very much independently of, the specific stressor; thereby non-specific
response to stressor is the essence of stress.
Human beings are viewed as an open system which is constantly
reacting to his internal and external environment. There will always be
occurrence of influential factors that could cause great response of threats to
the constancy and stability of the person. During early 1980s, psychologists
had come up of listing stress and had developed certain scales to be
stressed and can prepare for this occurrence. The person must be able to
adapt himself and master his coping behaviors satisfactory, in a manner to
maintain homeostasis. Walter Cannon pointed out that the purpose of

15

homeostasis is freedom in which it allows the person to reach his potentials

as human. Homeostasis is also associated with the persons state of health,
it is believe that when person is healthy, he is said to be in state of
equilibrium. Health according to Wolff, is the absence of illness had become
entrenched in many peoples minds and that the aspects of human holistic
view is a very vital consideration not only the physical aspects as an
outcome.
In other words, stress deals with how the body could adjust to the
demands of life. These demands could either be threat, challenge or change
that requires the body to respond, either, on the positive or negative side.
Thus when the body is able to adapt to a certain demand and serves as a
motivator, it is said to be responding positively. Whereas, when the body
fails to adapt, in which there is much effort is released by a stress response,
it is turned inward responding negatively and disrupted homeostasis occurs.
In addition, effective coping is necessary in managing stress such that it is
an integral part of the stress experience. And in order to do these
successfully, an individual must deal with the situation or problem, deal with
the feelings, use available support and reduce the psychological arousal of
stress by appropriate activities such as relaxation, exercise and others.
(http://www.jpsimbulan.com/2007/11/19/stress-and-the-working-nurse/)
Foreign Literature
Nursing is a stressful program to study. Implementing techniques to
cope with stress in a nursing program has an effect on retention and
performance. It has been shown that nursing students perform with less
anxiety when using stress coping techniques such as massage. Increasing
nurses' knowledge about complementary techniques supports retention of
nurses in academic and professional fields.

16

Effectively managing stress is a priority for first-year nursing students.

Overall time management for the students will determine their ability to
successfully negotiate their way through the remaining years of their
program. Including holistic care studies for nursing students have shown to
result in the ability to study better, better sleeping habits and general health
improvement. Requiring stress management within the nursing curriculum
assists nurses with teaching coping techniques to clients and hospital
visitors.
An effective nursing program provides ongoing stress management
workshops during the academic year. There are unique interpersonal and
environmental

stressors

for

nursing

students.

Stressors

specific

to

nursing college students can be addressed by educational administrators.

Administrators can address these with an assigned counseling faculty that
supports at-risk students.
Key benefits to learning stress coping techniques as nurses include the
promotion of these tools among clients and visitors. They are essential for
managing the workload of nurses but can also directly contribute to the care
of their clients. Insufficient knowledge about stress coping techniques is the
primary barrier to

its implementation.

Complementary

medicine and

alternative therapies have proven effective. Implementation of these coping

techniques within an academic program better prepares nurses for a
professional career.
Academic institutions can institute stress management techniques like
massage therapy, meditation, yoga, dance and art therapy activities within
their orientation program. Specialized training opportunities can supplement
coursework for credit and engage nursing students to develop these
opportunities. Including nursing students in developing stress management
workshops and activities will extend retention in the nursing program.

17

For nursing students away from home, creating a support system may
fall last in their list of priorities. Providing support within the academic
system may involve group and individual counseling as well as direct access
to resources. Creating a support system with family and friends is a primary
stress reduction technique because having the ability to enjoy time away
from nursing and studies supports self-care. Nurses must prioritize their own
care amid the other care they are required to provide.
(http://www.ehow.com/way_5646415_stress-coping-techniques-nursingstudents.html#ixzz19t5KsYUX)
Foreign Studies
A study was conducted by Ganga Mahat RN, C, EdD entitled Stress and
Coping: Junior Baccalaureate Nursing Students in Clinical Settings (Article
first published online: 2 AUG 2007). The purpose of this study was to
identify junior baccalaureate nursing students perceived stressors and ways
of coping during the clinical component of nursing education and the use of
coping strategies by students with different ethnic backgrounds. Data were
collected from 107 junior nursing students enrolled in the first clinical
course. Results revealed students frequently perceived stressors in the
clinical setting. The findings also revealed that students utilized two
problem-focused coping strategiesproblem solving and seeking social
support coping strategiesmore frequently than two emotion-focused coping
strategiestension reduction and avoidance coping. Additional findings
revealed that both Caucasian and African-American students used more
problem-focused than emotion-focused coping strategies.
CHAPTER 3
RESEARCH AND METHODOLOGY

18

This chapter deals with the methodology and procedures employed in

this study. Discussion includes the research design, research setting,
respondents, sampling procedures, the research instrument, data gathering
procedure and statistical technique.

Research Design
A descriptive design is used by the researchers to gather and interpret
the data. Surveys are conducted to determine the most prevalent strategies
that are being utilized by the student nurses. This will then be analyzed to
determine how they are dealing with their stressors while taking up the
nursing course.

Research Setting
The research was conducted here at the College of Nursing of
Bukidnon State University, Malaybalay City, Bukidnon.
Bukdinon State University is located in the capital town of Malaybalay
City, Bukidnon and is strategically positioned to serve Region X, Region XI
and CARAGA region and other out laying cities and provinces of Mindanao.

Respondents and Sampling Procedures

19

The respondents are the third year and fourth year nursing students of
Bukidnon State University. They have more experiences on having their
clinical exposure. In addition, their competency is expected to be higher and
wider than those of the first year and second year nursing students.
Samples will be taken through simple random sampling method.

Research Instrument
The Ways of Coping (Revised) is a 66-item questionnaire containing a
wide range of thoughts and acts that people use to deal with the internal
and/or external demands of specific stressful encounters. The revised Ways
of Coping (Folkman& Lazarus, 1985) differs from the original Ways of Coping
Checklist (Folkman& Lazarus, 1980) in several ways. The response format in
the original version was Yes/No; on the revised version the subject responds
on a 4-point Likert scale (1 - Not Used, 2 - Used Somewhat, 3 - Used Quite a
Bit, 4 - Used a Great Deal).
Redundant and unclear items were deleted or reworded, and several
items, such as prayer, were added. Many investigators have asked if the
Ways of Coping can be used to assess coping styles or traits. The measure is
not designed for this purpose; it is designed as a process measure. It is
possible though to look for consistency (style) across occasions by
administering the measure repeatedly and then doing intraindividual
analyses. Each administration, however, is focused on coping processes in a
particular stressful encounter and not on coping styles or traits. In addition,
the researchers have utilized the student sample Ways of Coping from the
same authors because it is more appropriate for use of nursing students.
Forty-one items were omitted because the study only focuses in nine coping
mechanisms.
20

Data Gathering Procedure

The respondents were divided into two groups, the third year and
fourth year nursing students of Bukidnon State University. Both groups are
composed of 25 students randomly chosen. They will be given the same set
of questionnaire. The result will then be computed and analyzed. The coping
mechanisms will then be ranked according to the most commonly utilized up
to the least favored behavior. It will then be analyzed on how it affects the
performance of the nursing students on their clinical duties and studies.
Prior to the distribution of questionnaires to the students, a letter to
the Dean of the College of Nursing was submitted in order for the study to
push through. Upon approval, gathering of data follows.

Statistical Technique
After

the

questionnaires,

distribution,
the

collection

researchers

tallied

and

completion

the

gathered

of

data

distributed
and

used

frequency, percentage, average mean, weighted mean, and interpretation

and ranking
The following statistical computations were accomplished using the following
formula:
For the Percentage
Computation of the percentage was made using the expression:
P=
Where:

21

P= Percentage
F= Frequency
N= Total Number of Respondents
For the Average Mean
Computation of the average mean was made using the expression:
Ave Mean = F x E
Where:
Ave Mean = Average mean
F= Frequency used
E= Numerical equivalent or the degree of response
For the Weighted Mean
Computation of the weighted mean was made using the expression:
WM=
Where:
WM = Weighted mean
= Summation of the degree of response
N = Total number of respondents
F = Frequency of response

The researchers used ranking to determine the position of each variable.

22

Number Value
3.25 4.0
2.50 3.24
1.75 2.49
1.0 1.74

E ( Degree of Response)
4
3
2
1

Interpretation
Used a great deal
Used quite a bit
Used somewhat
Not used

Finally, the findings were summarized conclusions were drawn, and

recommendations were formulated.

CHAPTER 4
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

23

This chapter presents the data gathered in this study which has been
carefully presented, analyzed, and interpreted. These data were gathered by
the researchers to the fifty junior nursing students, 25 from the third year
level and 25 from the fourth year level enrolled at the Bukidnon State
University College of Nursing as of school year 2012 2013.
Problem 1: What is the profile of the respondents in terms of age, year
level, gender, civil status and area of assignment?
Table 1.1
Distribution of Respondents According to Age
Age
18 21
22 25
26 30
Total

Frequency
39
9
2
50

Percentage
78%
18%
4%
100%

Rank
1
2
3

Table 1.1 presents the data of the respondents in terms of their age.
There are 39 or 78% of the respondents who are at ages between 18-21
years old which ranked 1; 9 or 18% of the respondents or 22-25 years
which

ranked

2;

2 or 4%

of

old

the respondents who are 19 years old

which ranked 3.
The data indicate that the respondents are at the right age to consider
as mature individuals capable of managing stress. It also shows that
majority of the respondents are between 18-21 years old.
In a study of Age Differences in the Use of Coping Mechanism by
Robert McCrae, it shows that older people coped in much the same way as

24

younger people and that where they employed different mechanisms, it

appeared to be largely because of the different types of stress they face.

Table 1.2
Distribution of Respondents According to Gender
Gender
Male
Female
Total

Frequency
7
43
50

Percentage
14%
86%
100%

Rank
2
1

Table 1.2 presents the data of the respondents in terms of their

gender. There are 7 or 14% of the respondents who are male and 43 or 86%
of the respondents who are female.
An influential study published in the July 2000 issue of Psychological
Review reported that females were more likely to deal with stress by
"tending and befriending" -- that is, nurturing those around them and
reaching out to others.
In

women,

when

cortisol

and

epinephrine

rush

through

the

bloodstream in a stressful situation, oxytocin comes into play. It is released

from the brain, countering the production of cortisol and epinephrine, and
promoting nurturing and relaxing emotions.
While men also secrete the hormone oxytocin when they're stressed,
it's in much smaller amounts, leaving them on the short end of the stick
when it comes to stress and hormones.

Table 1.3

25

Distribution of Respondents According to Year Level

Year Level
Third year
Fourth year
Total

Frequency
25
25
50

Percentage
50%
50%
100%

Rank
0.5
0.5

Table 1.3 presents data of respondents in term of their year level.

There are 25 or 50% of the respondents who are third year which rank 0.5;
25 or 50% of the respondents who are fourth year which ranked 0.5.
This indicates equal of number third year and fourth year respondents.

Table 1.4
Distribution of Respondents According to Civil Status
Civil Status
Single
Married
Total

Frequency
46
4
50

Percentage
92%
8%
100%

Rank
1
2

Table 1.4 presents data of respondents in terms of their status. There

are 46 or 92% of respondents who are single which ranked 1; 4 or 8% of
the respondents who are married which ranked 2.
This indicates that majority of the respondents are single and therefore
not yet burdened by responsibilities of managing a family.

Table 1.5
Distribution of Respondents by Area of Assignments

26

Area of
Assignment
Medical
Surgical
OB
ER
OR
Pedia
DR
ICU

Frequency

Percentage

Rank

45
40
38
32
40
37
40
3

90%
80%
76%
64%
80%
74%
80%
6%

1
2.3
5
7
2.3
6
2.3
8

Table 1.5 represents the data of the distribution of respondents by

area of assignments. 45 or 90% of the respondents were rotated in the
medical ward which rank 1; 40 or 80 % of respondents were rotated on the
surgical ward, OR, and DR which rank 2.3; 38 or 76% of respondents were
rotated on OB ward which rank 5; 37 or 74% of respondents were rotated
on the Pedia ward which rank 6; 32 or 64% of respondents were rotated on
the ER which rank 7; And only 3 or 6% of the respondents were rotated on
the ICU which rank 8.
This indicates that the respondents were not distributed equally on
each area of assignments. Studies found that stress level was significantly
higher in junior nurses than in senior nurses. There are also studies
reporting that the longer the nurses had worked in their units the more likely
they were to experience stress, regardless of their seniority (Lee 2003:87).

Problem 2: What are the five most common coping mechanisms that
the third year and fourth year nursing students are using?
Table 1.6
Coping Mechanisms Utilized by the Third Year Nursing Students
Coping Mechanisms
27

WM

Verbal

Interpretation
PROBLEM-FOCUSED SOLVING
1. I go over in my mind what I will say or
do.
2. I know what has to be done, so I am
doubling my efforts to make things work.
3. I try not to act too hastily or follow my
first hunch in solving a problem.
4. Im making a plan of actions and
following it.
5. I try to see things from the other persons
point of view
6. I try to keep my feelings from interfering
with my responsibilities too much.
7. I try to analyze the problem in order to
understand it better.
Overall average
WISHFUL THINKING
1. I wish that I can change what is
happening or how I feel during our duty.
2. I wish that the situation would go away or
somehow be over with it.
3. I daydream or imagine a better time or
place than the one I am in.
4. I have fantasies or wishes about how
things might turn out.
Overall average
DETACHMENT
1. I try to forget the whole thing about our
clinical duty.
2. I go on as if nothing is happening.
3. I accept my situation, since nothing can
be done
Overall average
SEEKING SOCIAL SUPPORT
1. I talk to someone about how Im feeling
with regards to my mistakes on our
duties.
2. I let my feelings out somehow whether
Im feeling happy or frustrated with our

28

3.36

Used a great deal

3.28

Used a great deal

3.12

Used quite a bit

3.36

Used a great deal

3.2

Used quite a bit

3.12

Used quite a bit

3.48

Used a great deal

3.27

Used a great
deal

3.32

Used a great deal

3.32

Used a great deal

2.84

Used quite a bit

2.76

Used quite a bit

3.06

Used quite a bit

Used somewhat

2.08
2.88

Used somewhat
Used quite a bit

2.32

Used somewhat

3.52

Used a great deal

3.16

Used quite a bit l

duties.
3. I pray.
Overall average
FOCUSING ON THE POSITIVE
1. I look for the silver lining, so to speak;
try to look on the bright side of things.
Overall average
SELF-BLAMING
1. I criticize or lecture myself.
2. I make a promise to myself that things
will be different next time.
Overall average

3.28
3.32

Used a great deal

Used a great
deal
l

3.52

Used a great deal

3.52

Used a great
deal

3.08
3.24

Used quite a bit

Used quite a bit

3.16

Used quite a bit

2.6

Used quite a bit

SUPPRESSING TENSION
1. I got away from our clinical duties for a
while; tried to rest or take a vacation.
2. I try to make myself feel better by eating,
drinking, smoking, using drugs or
medication, etc.
Overall average

Used quite a bit

2.8

Used quite a bit

TENSION REDUCTION
1. I jog or exercise.
Overall average

2.28
2.28

Used somewhat
Used somewhat

2.32
2.52

Used somewhat
Used quite a bit

2.42

Used somewhat

KEEPING TO SELF
1. I try to keep my feelings to my self
2. I keep others from knowing how bad
things are
Overall average

Table 1.6 presents the coping mechanism used by the third year
nursing students of Bukidnon State University. For the focusing on positive,
got an overall average weighted mean of 3.52 and was interpreted as used
a great deal. It ranked number 1 based on the findings presented above.

29

For seeking social support, it has a weighted mean of 3.32. It was

interpreted as used a great deal and it ranked number 2.
For problem focused solving, it has overall average weighted mean of
3.27 and was interpreted as used as a great deal. It ranked number 3 in all
the scale of coping mechanism.
For self-blaming, it has overall average weighted mean of 3.16 and
was interpreted as used quite a bit. It ranked number 4 in all the scale of
coping mechanism.
For wishful thinking, it has a weighted mean of 3.06. It was
interpreted as used quite a bit and it ranked number 5.
For suppressing tension, got a weighted mean of 2.8 and was
interpreted as used quite a bit. It ranked number 6 base on the findings.
For keeping to self, it ranked number 7 and got an overall average
weighted mean of 2.42. It was interpreted as used somewhat.
For detachment, it has a weighted mean of 2.32 and was interpreted
as used somewhat. Base on the findings, in ranked number 8 in all the
scale of coping mechanism.
For tension reduction, it ranked number 9 and has a weighted mean of
2.28. It was interpreted as used somewhat.

30

Table 1.7
Coping Mechanisms Utilized by Fourth Year Nursing Students
Coping Mechanisms

WM

Verbal
Interpretation

3.56

Used a great deal

3.52

Used a great deal

3.24

Used quite a bit

3.28

Used a great deal

3.28

Used a great deal

3.36

Used a great deal

3.84

Used a great deal

3.44

Used a great
deal

3.36

Used a great deal

3.24

Used quite a bit

Used quite a bit

3.08

Used quite a bit

PROBLEM-FOCUSED SOLVING
1. I go over in my mind what I will say or do.
2. I know what has to be done, so I am
doubling my efforts to make things work.
3. I try not to act too hastily or follow my first
hunch in solving a problem.
4. Im making a plan of actions and following it.
5. I try to see things from the other persons
point of view
6. I try to keep my feelings from interfering
with my responsibilities too much.
7. I try to analyze the problem in order to
understand it better.
Overall average
WISHFUL THINKING
1. I wish that I can change what is happening
or how I feel during our duty.
2. I wish that the situation would go away or
somehow be over with it.
3. I daydream or imagine a better time or place
than the one I am in.
4. I have fantasies or wishes about how things
might turn out.

31

Overall average:
DETACHMENT
1. I try to forget the whole thing about our
clinical duty.
2. I go on as if nothing is happening.
3. I accept my situation, since nothing can be
done
Overall average
SEEKING SOCIAL SUPPORT
4. I talk to someone about how Im feeling with
regards to my mistakes on our duties.
5. I let my feelings out somehow whether Im
feeling happy or frustrated with our duties.
6. I pray.
Overall average
FOCUSING ON THE POSITIVE
1. I look for the silver lining, so to speak; try to
look on the bright side of things.
Overall average
SELF-BLAMING
1. I criticize or lecture myself.
2. I make a promise to myself that things will
be different next time.
Overall average
SUPPRESSING TENSION
1. I got away from our clinical duties for a
while; tried to rest or take a vacation.
2. I try to make myself feel better by eating,
drinking, smoking, using drugs or
medication, etc.
Overall average
TENSION REDUCTION
1. I jog or exercise.
Overall average
KEEPING TO SELF
1. I try to keep my feelings to myself.
2. I keep others from knowing how bad things
are.
Overall average

32

3.17

Used quite a bit

2.2

Used somewhat

2.52
3.12

Used quite a bit

Used quite a bit

2.61

Used quite a bit

3.52

Used a great deal

1.84

Used somewhat

3.88
3.08

Used a great deal

Used quite a bit

3.32

Used a great deal

3.32

Used a great
deal

3.0
3.56

Used quite a bit

Used a great deal

3.28

Used a great
deal

2.12

Used somewhat

2.28

Used somewhat

2.2

Used somewhat

2.04
2.16

Used somewhat
Used somewhat

2.76
1.76

Used quite a bit

Used somewhat

2.26

Used somewhat

Table 1.7 presents the coping mechanisms used by the fourth year
nursing students to effectively manage stress.
Problem-focused solving has a weighted mean of 3.44 and is
interpreted as being Used a great deal. It has the highest weighted mean
and is ranked first among the nine coping mechanisms listed.
Focusing on the positive ranked second with a weighted mean of 3.32
and is used a great deal.
Self-blaming follows with a weighted mean of 3.28 and is interpreted
as being used a great deal.
On the fourth rank is Wishful Thinking with a weighted mean of 3.17
and is used quite a bit.
Next is Seeking Social Support with a weighted mean of 3.08 and is
also used quite a bit.
Sixth in rank is Detachment with a weighted mean of 2.61 and is
interpreted as being used quite a bit.
Seventh is Keeping to Self with a weighted mean of 2.26 and is used
somewhat.
Next is Suppressing Tension with a weighted mean of 2.2 and is used
somewhat.
Lastly is Tension reduction with a weighted mean of 2.04 and is used
somewhat.

33

COMPARISON:
The top five coping behaviors of the third year are focusing on the
positive, seeking social support, problem-focusing solving, self-blaming and
wishful thinking.
The fourth year nursing students, on the other hand, have the
following coping mechanisms: problem-focused solving, focusing on the
positive, self-blaming, wishful thinking and seeking social support.
This indicates that both the third year and fourth year has the same
coping behaviors, only the ranking of it differs.
Problem-focused solving looks at different approaches and resolutions.
Problem-focused coping is generally found in research to be the most
positive to overall health. This kind of coping is appropriate when there are
elements of a stressful situation that they have actual influence over that

34

is, they are changeable. When they apply problem-focused coping to stress
that cant be changed, they tend to feel frustrated, defeated, or disillusioned.
Problem-focused coping is necessary to help them move through hard times.
Although it is found in research to be the most positive to overall health, it is
extremely unpopular in practice, and very hard to do. Solving problems
takes planning, impartial assessment of needs, and a willingness to act upon
decisions. End result the actions that will make them healthier in the long
run, become very difficult to take.
Reference to others or seeking social support represents the coping
strategies young people use when they turn for support to external
resources, such as peers and professionals. Knowing how and when to get
help from others and how to get along with others are skills that contribute
to success in life. Such strategies are indicative of emotional intelligence.
This indicates that the respondents are open to others to let their feelings
out. Making contact with others can help reduce feelings of distress. When
there is somebody who is willing to listen it makes them feel better. By
letting out the problems, it helps them ease the heaviness that they carry in
their hearts. It also indicates that the respondents are always praying to give
comfort for their selves. They believed that God is always in there that
willing to listen in terms of difficulties and happiness. That God gives them
strength to pursue in their life even the obstacles that they have to face.
Praying is one of their ways to release the stresses they have.
Next is focusing on the positive or looking at the bright side of life.
This means being able to accept the current situation a person is in and tries
to have a positive outlook on that certain situation however difficult it may
seem. This indicates that the respondents are using this ability to stay
positive even in times of difficulty and crisis. It gives them strength and the
ability not to feel despair. Being a positive thinker helps them focus on the
solution rather than waste time and energy on negative emotions. This
35

means they get themselves back on track faster and start thinking about
what they can do instead of staying in a disempowering state. Rather than
repeating the same negative emotions of irritation, regret and anger in their
head, they now focus on the lessons learned and get into a creative flow in
finding a solution. Through practicing positive thinking, they are creating a
positive reality for their selves. This is because when they focus on positive
things, they will have positive actions. And consistently having positive
actions can only lead to the achievement of desired results.
Wishful thinking is hoping for the best without taking steps to ensure
it. students have been trying to distract themselves to lessen or avoid the
impact of stress, however, wishful thinking does not guarantee that it will
make a person more determined and committed to do well because more
often, they are just contented with daydreaming than taking steps to ensure
it.
Self-blaming is seeing oneself as responsible for the problem. This
indicates that the respondents evaluate themselves so that they well know
what is lacking on them. By assessing themselves they may know more of
who really they are. It well helps them to identify how they react in different
kinds of crisis that they may encounter. It is one way of reminding
themselves to improve, do their work or job better next time, what they will
going to do in terms of crisis and how to handle problems base on what they
experience. Criticizing themselves will also be helpful in analyzing on what
are the right things to do.
The

remaining

respondents.

36

coping

behaviors

are

not

often

used

by

the

Emotional detachment is a psychological term that can refer to either a

positive or a negative behavior. When emotional detachment is negative, it
presents as an inability to really connect with other human beings; this
person might remain emotionally unavailable in all relationships, even
though he or she is physically present in the relationship, which can lead to
problems. The second type of detachment, which is a positive psychological
behavior, is the ability to recognize and empathize with other people's
feelings without compromising one's own personal boundaries, emotions, or
sense of self. The second practice is one that can be cultivated and improved
upon, and can be beneficial to relationships, whereas the first is usually
detrimental.
Suppressing tension ranked 6 and the overall interpretation is that it is
used quite a bit. This indicates that some respondents relieve stress by
taking a vacation or engaging in eating, drinking liquors, smoking and using
drugs or medications.
Keeping to self is being withdrawn from others, and refuses to
communicate

ones

concerns

and

feelings.

This

indicates

that

the

respondents are not fond of keeping problems on their own. They let it out
by telling it to others because it is more relieving rather than keeping it by
self. When someone knows what they feel, that person will give comfort to
ease the tension that they felt because of the problems they have. For them
keeping problems by self is less effective in reducing or managing stress.
Tension reduction ranked ninth in both year levels. This indicates that
the respondents do not really engage themselves in exercise. They didnt
give more time in exercise to reduce their stress. It is also means that the
respondents are not fond of using exercise as a way of reducing tension.
Because of busy schedule they tend to forgot to give time in doing physical

37

activity. Doing exercise will also be helpful to us by strengthening our body

and relaxing our mind, but most of the respondents find another way in
relieving stress rather than engaging in exercise.

Problem 3: Is there a significant difference between the profile of

respondents and their common coping mechanisms?
There is a significant difference between the profile of respondents and
their common coping mechanisms. However, the way they cope with stress
depends on the type of stressors they are facing.

CHAPTER 5
SUMMARY, CONCLUSION AND RECOMMENDATIONS

This

presents

the

summary

of

the

study,

formulated

conclusion and recommendations offered.

Summary of the findings

This study is all about Coping Mechanism of the Third year and Fourth
Year Student Nurses of Bukidnon State University. The descriptive method
of the research was utilized and the questionnaire serves as the principal
data gathering instrument. There are 50 respondents who fill up the survey
questionnaire. The results were tabulated and interpreted.

38

The following are the summary of the findings of the study based from
all the data presented, analyzed and interpreted.
1. Most of the respondents are in 18-21 years of age
2. Most of the respondents are female.
4. In the data gathered from the questionnaires majority of the
respondents are single.
5. Regarding to the areas of assignments majority of the respondents
were assigned in the medical area.
6. The top five coping behaviors of the third year are focusing on the
positive, seeking social support, problem-focusing solving, self-blaming and
wishful thinking.
The fourth year nursing students, on the other hand, have the
following coping mechanisms: problem-focused solving, focusing on the
positive, self-blaming, wishful thinking and seeking social support.
7. This indicates that both the third year and fourth year has the same
coping behaviors, only the ranking of it differs.
8. There is a significant difference between the profile of respondents
and their coping behaviors.
CONCLUSION
Based on the findings of the study, the researchers arrived at the
following conclusions:
1. The five most common coping mechanisms are as follows: Seeking
social support, focusing on the positive, problem-focused solving, selfblaming and wishful thinking. The first three are considered to be positive

39

ways of coping. It shows that the third year and fourth year nursing students
are managing stress effectively.
On the other hand, suppressing tension, detachment, keeping to self,
and tension reduction are not popularly used.
2. The result of the study stands benefit to the nursing practice in
rendering

effective

quality

nursing

care.

The identification of the most

common coping strategies of the third year and fourth year students
provide

them

will

adequate academic and clinical knowledge on how to

effectively manage stress. This study will serve as a guide to them on how to
manage their stress with regards to their clinical duties. This will also provide
information to the Clinical Instructors, healthcare team in the hospital, and
school administrators on how they can help the students upon dealing with
stress properly in order for students to be competent enough in different
clinical area and to render quality and effective nursing care to the patients.
RECOMMENDATIONS
After the conclusions were drawn, the researchers of the study hereby
recommended that:
It is recommended that the third year and fourth year respondents of
Bukidnon State University College of Nursing should have monthly stress
management workshop. This is to help them further harness and learn new
positive stress coping mechanism and to let them change their old negative
stress mechanism to new and positive ones.
Weekly morning stress exercises should also be implemented because
this type of tension reduction is only used somewhat. Exercise will not only
help the body to improve its endurance to the daily stress that a nursing
student encounters, it will also help the body to stimulate endorphins which
will help in relieving stress that a person is experiencing.

40

Finally, conducting
bigger sample

frame

another
should

study

be

using

considered

to

more
arrive

variable
at

and
more

comprehensive and meaningful conclusion.

BIBLIOGRAPHY

Books
Barbara Kozier MN, RN, GlenoraErb BSN, RN, Audrey Berman Ph. D., RN,
MAN Funadamental of Nurszing 7th Ed.
Deborah Antai-Otonget. Al, Thomson Asian Ed. Psychiatric Nursing Book
Stress (2008).Encyclopedia
Deluxe

Edition. Chicago:

Britannica.Encyclopedia Britannica

2007

Encyclopedia Britannica.

Lazarus, R.S., &Folkman, S. (1984). Stress, Appraisal and Coping. New York:
Springer
Stress and Coping Theories by H. W. Krohne
Greenglass, E. Beyond coping:
London: Oxford University Press,

41

Meeting goals, vision, and challenges.

Undergraduate Thesis
Stress Management Performed by the Level III Nursing Students of Nueva
Ecija University of Science and Technology with regards to their Clinical
Duties: Basis for a Proposed Effective Quality Nursing Care.
Stress and Coping Strategies amongst Registered Nurses Working in a South
African Tertiary Hospital
Factors associated with stress among nursing students
Student Nurses Perception of Death and Dying
Nursing Students Learning Experiences in Clinical Settings: Stress, Anxiety
and Coping
Article
A longitudinal study of stress and self-esteem in student nurses by Deborah
Edward, Philip Burnard, Kim Bennett, UnaHebden

Website
http://www.thestressoflife.com/why_men_and_women_handle_stress_.htm
http://my.webmd.com/webmd_today/home/default
http://www.etd.uwc.ac.za
http://www.medind.nic.in
http://www.ohiolink.edu
http://www.spectrum.library.concordia.ca

42

http://www.psych.yorke.ca
http://www.sagepub.com
http://digitalarchive.gsu.edu
http://www.tip.duke.edu
http://www.wisegeek.com
http://www.ukessays.com/essays/nursing/stress-coping-mechanisms-ofselected-junior-nursing-students-nursing-essay.php
http://nurses.definitelyfilipino.com/index.php/2010/12/a-bsn-students-guide-tonursing/

http://www.jpsimbulan.com/2007/11/19/stress-and-the-working-nurse/
http://www.ehow.com/way_5646415_stress-coping-techniques-nursingstudents.html

43

APPENDICES
A.

RESEARCH INSTRUMENT

I. PROFILE OF THE RESPONDENTS

Name (Optional): ______________________________
Age:

18 21 years old

26 29 years old

22 25 years old

30 and above

Year level:

Third Year

Fourth Year

Gender:

Male

Female

Civil Status:

Single

Married

Area of Assignment/s:
Medical

OB

Surgical

ER

OR
Pedia

DR
ICU

PART II.
Please read each item below and indicate, by using the following rating
scale, to what extent you used it during/on your clinical duties.

44

Not Used
Deal
1

Used Somewhat

Used Quite a Bit

Used a Great

Coping Behaviors
PROBLEM-FOCUSED SOLVING
1. I go over in my mind what I will say or do.
2. I know what has to be done, so I am doubling my
efforts to make things work.
3. I try not to act too hastily or follow my first hunch in
solving a problem.
4. Im making a plan of actions and following it.
5. I try to see things from the other persons point of view
6. I try to keep my feelings from interfering with my
responsibilities too much.
7. I try to analyze the problem in order to understand it
better.
WISHFUL THINKING
1. I wish that I can change what is happening or how I
feel during our duty.
2. I wish that the situation would go away or somehow be
over with it.
3. I daydream or imagine a better time or place than the
one I am in.
4. I have fantasies or wishes about how things might turn
out.
DETACHMENT
1. I try to forget the whole thing about our clinical duty.
2. I go on as if nothing is happening.
3. I accept my situation, since nothing can be done
SEEKING SOCIAL SUPPORT
1. I talk to someone about how Im feeling with regards to
my mistakes on our duties.
2. I let my feelings out somehow whether Im feeling
happy or frustrated with our duties.
3. I pray.

45

FOCUSING ON THE POSITIVE

1. I look for the silver lining, so to speak; try to look on
the bright side of things.
SELF-BLAMING
1. I criticize or lecture myself.
2. I make a promise to myself that things will be different
next time.
SUPPRESSING TENSION
1. I got away from our clinical duties for a while; tried to
rest or take a vacation.
2. I try to make myself feel better by eating, drinking,
smoking, using drugs or medication, etc.
TENSION REDUCTION
1. I jog or exercise.
KEEPING TO SELF
1.
I try to keep my feelings to myself.
2.
I keep others from knowing how bad things are.

46

CURRICULUM VITAE

Name: Gladden Pearl A. Badajos

Age: 20 years old
Sex: Female
Current Address: Zone 7, Barangay 9, Malaybalay City, Bukidnon.
Date of Birth: November 16, 1992
Place of birth: Malaybalay City
Hometown Address: Malaybalay City, Bukidnon.
Educational Background
Elementary: Malaybalay City Central School, 1998-2005
High School: San Isidro College, 2005-2007
Bukidnon National High School, 2007-2009
College: Bukidnon State University, 2009 up to present

47

Seminars Attended:
Research Forum
Psychiatric Nursing: Nurturing the Complex Mind Through
Competency-based Care
Forensic Nursing with I.Net
Nursing practice: coping up with its new trends and challenges through
legal and ethico-moral principles
Transforming novice into competent nurses.
Intrapartum Care
Disaster Triaging and Management
ORNAP
Coping up with Public Speaking fear

Affiliations: College of Nursing Student Body Organization, Public

Information Officer SY: 20011-2012, Bukidnon State University Supreme
Student Council, Senator SY: 2012-2013

48

CURRICULUM VITAE

Name: Florsean Mae A. Sala

Age: 20 years old
Sex: Female
Current Address: Mampaalong St, Malaybalay City, Bukidnon
Date of Birth: September 6, 1992
Place of birth: Placer, Surigaodel Sur
Hometown Address: Legaspi St, Hinatuan, SuigaodelSr
Educational Background
Elementary: Hinatuan South Central, 1998-2005
High School: Hinatuan National Comprehensive High School , 2005-2009
College: Davao Doctors College, 2009-2010
Bukidnon State University, 2010 up to present

49

Seminars Attended:
Global Disaster Preparedness Program
Research Forum
Psychiatric Nursing: Nurturing the Complex Mind Through
Competency-based Care
Forensic Nursing with I.Net
Nursing practice: coping up with its new trends and challenges through
legal and ethico-moral principles
Transforming novice into competent nurses.
Intrapartum Care
Disaster Triaging and Management
ORNAP

Affiliations:
UNIFIRE member

50

51