Sheu et al. (2002) found that the most common coping behaviour in response to stress of nursing students during their initial clinical experience was to stay optimistic, followed by transference (the redirection of emotions to a substitute) and problem solving. Ineffective coping behaviours such as avoidance behaviour were found to be the least frequently employed response. The five most common coping behaviours of students were; to cry, to feel moody, sad and helpless; to keep optimistic and have a positive attitude in dealing with everyday life; to have
confidence in performing; to save time for sleep and maintain good health in order face stress and to relax (Sheu et al. 2002). Among the coping behaviours exhibited by nursing students during the initial period of clinical practice, avoidance
status while both problem solving behaviour and an optimistic attitude had positive effects (Sheu et al. 2002). Sheu et al. (2002) found that the physio-psycho-social response occurred during the initial clinical placement ranging from ‘rare’ to ‘sometimes with social behavioural symptoms being the most common response to stress followed by emotional symptoms and physical symptoms (Sheu et al. 2002)
Shaban et al. (2012) study had similar findings to those of Sheu et al. (2002). The most common coping behaviours utilized by students during the initial clinical placement were problem solving followed by staying optimistic and transference, with avoidance behaviour found to be used least often. Shaban et al. (2002) found that avoidance coping actually had a positive effect on stressors, in relation to
stressors in the clinical environment, patient care and daily life. Shaban et al. (2012) explains that these findings suggest that even though students may be informed about potentially effective coping strategies there is no guarantee that they will use them in an appropriate manner (Shaban et al. 2012).
In contrast to Shaban et al. (2010) findings, Gibbons et al. (2010) found that avoidance coping and the ‘hassle’ factors were predictors of less healthy well-being. They suggest that even when used infrequently, avoidance coping can have adverse effects and that students should be taught to become aware of their coping styles along with strategies to promote effective coping. Gibbons et al. (2010) suggests that even small positive changes in awareness and reaction to stress can help to improve student well-being (Gibbons et al. 2010)
Furthermore, Gibbons et al. (2010) study highlights the role of tutors in helping students cope with stress. Interestingly, students commented that tutors that were seen to be more effective in helping students manage their stress did not give excessively or any more time, but rather it was the quality of the interaction that made the difference. Negative comments regarding staff where most likely due to staff seeming unapproachable to students and instead of feeling supported, it was a feeling of being criticized, which students found further added to the stress of course demands.
The third theme of McKenna and Plummer (2013) qualitative study’s was “using coping strategies”, and this was further divided into two sub-themes:
“responses to stress” and “coping strategies”. Individual responses to stress varied, but generally students would respond physiologically and psychologically. Sleep deprivation, altered appetite and headaches were common physiological responses, while panic, anxiety, sadness, sensitivity, withdrawal, mood changes and being upset were psychological responses. In regards to coping strategies, a variety of
approaches to dealing with stressful experience were reported; such as, using social support by talking and expressing feelings, practicing relaxation techniques,
spiritual activities as well as ignoring assignments and turning to avoidance coping (McKenna & Plummer 2013)
Chen & Hung’s (2014) descriptive cross-sectional study explored the relationships between perceived stress, coping behaviours, personality traits, and physio-psycho-social responses. Lai’s personality scale (Lai & Lai 2004) The
Perceived Stress Scale (Cohen et al. 1983) The Coping Behaviour Inventory (Litman et al. 1983) and the Physio-Psyhco-Social Response Scale (Sheu et al. 1997) were used as measurements with a sample size of 105 and response rate of 96%. This study found that perceived stress, gender and personality were the predictors of nursing students’ physio-pyscho-social responses during clinical placement; with a significantly positive relationship noted between perceived stress and physio- psycho-social responses. This may indicate that when students perceive a high level of stress they are at risk of suffering from physical or psychiatric illnesses or
demonstrating poor social behaviours (Chen & Hung 2014). Interestingly, this study also found significant differences in physio-pyscho-social responses across the four different personality categories, which might be a useful technique for students in terms of improving self-awareness of how they respond to stress. In terms of coping behaviours, students were found to use problem solving the most, followed by optimism, transference and lastly, avoidance coping.
Jimenez et al. (2009) study found that the most common responses to stress concerned ‘psychological symptoms’ (psychiatric anxiety, cognitive symptoms and depressive symptoms), whereas ‘physiological symptoms’ (common symptoms, somatic anxiety and neuro-vegetative symptoms) were less frequently described. It was then reported that the three most common symptoms reported during clinical
practice were; ‘I tend to be worried and nervous’, ‘I am not optimistic about my future’ and ‘I tend to be nervous and anxious lately’, with second year students found to have more psychiatric anxiety and displaying worse health as well as scoring higher on physiological symptoms than those in first and third year. Jimenez et al. (2009) suggest that this finding could be explained by second year students having a perceived heavier workload during clinical practice and perhaps struggling to balance academic and clinical demands. This finding is significant as it highlights a vulnerable stage for students during their programme, one which nurse educators should be aware of in order to support these students.
In support of Jimenez et al. (2009), Edwards' et al. (2012) study
demonstrates that students at the end of their training had lower levels of self- esteem compared to when they were 8 months in to their training, and students with lower self-esteem were found to have higher stress levels. When encountering stress, those with higher self-esteem have a higher sense of personal worth, which acts as a buffer against the negative impact of stress.
This section highlights the importance of nursing students developing effective strategies to cope with stress, as it can be seen that negative physio- pyscho-social symptoms can occur. Furthermore, it is argued that support in acquiring these strategies should be initiated early on in nursing education. This could allow students time to develop these strategies in order to effectively combat potentially increasing stressors and maximize eustress throughout their studies and nursing careers.
2.4 Discussion and Critical Overview