The Relationship between Stress and Social Support in Baccalaureate Nursing Students

Nursing students experience high levels of stress throughout their college career. When it comes to managing this stress, the use of social support as a coping mechanism may be a factor. The purpose of this study was to examine the relationship between social support and stress in undergraduate baccalaureate nursing students and to compare social support and stress across levels of education. The study was guided by the Transactional Model of Stress and Coping. This study used a non experimental descriptive design and a cross sectional data collection with an online survey. The sample was a convenience sample of second, third, and fourth year nursing students at a large Midwestern public university. Stress was measured with the Student Nurse Stress Index (SNSI) and social support was measured with the Social Support Appraisals (SS A) Scale. Data was analyzed using a Pearson's r and ANOVA. This study found that while there was not a significant relationship between stress and social support, students of the senior level had less stress and more social support. These findings implicate that underclassmen may be in need of more support and tutoring early on in the program. STRESS AND SOCIAL SUPPORT IN NURSING STUDENTS 3 The Relationship between Stress and Social Support in Baccalaureate Nursing Students The term "stress" was first coined by Hans Selye who defined it as "the non specific response of the body to any demand for change" (Selye, 1956) Stress is not a definitive term when it comes to science because of its high degree of subjectivity (Selye, 1956) Richard Lazarus defined stress as the feeling experienced when a person perceives that the demands of a situation exceed the resources the individual is able to use (Lazarus, 1966) Though stress is widespread throughout many different ages, college students are a particularly stressed population because of the change and transition to college life (Ross, Neibling, Heckert, 1999) Twenty first century college students experience a multitude of stressors including financial and academic issues, fear of the future and peer pressure, all while juggling many roles at once. Along with taking a full schedule of classes, students are working, volunteering, building their resume, spending time with friends, and possibly caring for their family. For traditional students, college is one step further into adulthood, which can increase stress in those of late teens. Among college students, excessive stress may harm academic performance and lead to dropping out of school (Shields, 2001) It has been found that high levels of stress reduce grade point averages (GPAs) and lead to increased symptoms of psychological and somatic disorders (Shields, 2001) Further, excessive levels may cause mental health problems and depression, which can lead students to drink or use drugs (Khajehei, Ziyadlou, Hadzic, Kashefi, 2011) In particular, nursing students are prone to feelings of stress because of direct involvement in the clinical settings as undergraduates (Chernomas Shapiro, 2013) This increased stress in nursing students can come from fear of making mistakes, feeling unprepared for practice, the gap between theory and practice, witnessing pain and suffering, difficult relationships with clinical teachers and nursing staff, being observed and evaluated, STRESS AND SOCIAL SUPPORT IN NURSING STUDENTS 4 communicating with physicians and hospital staff, and lack of familiarity with the hospital environment (Chernomas Shapiro, 2013) Alongside of these clinical experiences, nursing students also must juggle academic workloads, which can include many written and practical exams. Nursing students are expected to know and retain information in class to utilize in clinical practice, which is also another aspect of pressure and stress. Ways to relieve stress, or positive coping mechanisms, are an important component of staying healthy and avoiding the negative impacts of stress (Reeve, Shumaker, Yearwood, Crowell, Riley, 2013) Because of varying personalities, different people experience different ways of stress relief, one of which is having social support from friends, family and classmates (Shields, 2001) The hustle and bustle of nursing school may cause nursing students to be more focused on schoolwork and less concerned with utilizing or maintaining social support, which may then contribute to high stress. The purpose of this study was to examine the relationship between social support and stress in undergraduate baccalaureate nursing students and to compare stress and social support across grade levels of nursing school, from sophomores to seniors. The following research questions were answered: What are the levels of stress experienced by student nurses? How do these levels compare between sophomores, juniors and seniors in the nursing program? What are the levels of social support experienced by student nurses and how do they compare between grade levels? What is the relationship between the levels of stress and social support in student nurses? Review of Literature For this study, the relationship between stress and social support in nursing students was studied. Stress has been studied by numerous researchers who have examined two types of stress: negative stress (distress) and positive stress (eustress) In most cases, negative stress tends STRESS AND SOCIAL SUPPORT IN NURSING STUDENTS 5 to have more predominant effects on a student's well being (Gibbons, Dempster, Moutray, 2011) including mental effects such as depression (Dzurec, Allchin, Engler, 2007) and physical effects such as a lowered general well being and increased sick days (Chipas et al. 2012) Burnout is a condition of exhaustion due to long term stress that is also associated with stress and ineffective coping (Gibbons, 2010) In contrast, one very common stressor, clinical experience, has been shown to lead to eustress effects among students (Alzayyat Al Gamal, 2014) and increased professional identity (Hensel Laux, 2014) In general, a review of literature shows that several studies find four common stress inducing themes: initial clinical experience, differences between academic levels, cross cultural comparisons, and eustress from the clinical experience (Alzayyat Al Gamal, 2014) Negative stress in nursing school can come from many different sources. Two major examples include taking tests (Wang Yeh, 2005) and the challenges of clinical rotations (Al Zayyat Al Gamal, 2014) Studies have been performed for students at multiple levels in nursing schools, including pre nursing students (Wang Yeh, 2005) first year students (Jones Johnston, 1997) (Dzurec, Allchin, Engler, 2007) and even as far as nurse anesthetist students (Chipas et al. 2012) It has been found that these students are at their lowest level of enjoyment in their field at both the beginning and ending of their academic years (Hensel Laux, 2014) Researchers have studied social support more as a component of coping compared to an individual variable (Gibbons et al. 2011) Social support tends to be one of the more useful coping methods used when it comes to stress, leading to significantly lowered levels of social exhaustion (Gibbons, 2010) and better ability to control one's mood (Wang Yeh, 2005) Because nursing students are most likely living away from their homes where they had formed STRESS AND SOCIAL SUPPORT IN NURSING STUDENTS 6 strong social support connections, school can be a time of great concern as their support structures change (Dzurec, Allchin, Engler, 2007) The focus of this study, as stated previously, was to investigate more closely the relationship between stress and social support in nursing students. While researchers have studied social support as one of many aspects of coping with stress experienced due to nursing school, they have not studied solely social support in this population. Even though several studies have shown that social support is related to well being in students (Gibbons et al. 2011) not many of them have focused on investigating the specific relationship between stress and social support in the nursing student population. Few have compared the relationship across academic levels, as well. This study focused more specifically on adding more information regarding this aspect to the literature. Theoretical Framework The Transactional Model of Stress and Coping is a theoretical framework describing the processes of coping with stressful events (Lazarus Folkman, 1984) Based on the model, stress does not exist as its own event but rather is a result of a transaction between a person and their environment (Lazarus Folkman, 1984) Positive stress, or eustress, is a positive cognitive response to stress that is healthy, or gives the individual a feeling of fulfilment (Lazarus, 1966) Negative stress, or distress, occurs when people interpret situations negatively and can lead to health problems if people do not utilize effective coping mechanisms. According to the model, a person makes an initial judgment, or a primary appraisal, about the significance of a certain situation as stressful, positive, controllable, challenging or irrelevant (Lazarus Folkman, 1984) Next a second appraisal follows, where the person assesses what they can do about that particular stressor. Within the model, social support is defined as meaning based coping. This STRESS AND SOCIAL SUPPORT IN NURSING STUDENTS 7 coping process induces positive emotion, which in turn sustains the coping process by allowing emotion focused coping, changing the way one thinks or feels about a stressful situation, or problem focused coping, strategies directed at changing a stressful situation (Lazarus Folkman, 1984) When actual coping efforts are made, and the individual tries to deal with the problem, it gives rise to outcomes in the coping process. The model describes stress and coping which can be