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CHAPTER I THE PROBLEM AND ITS BACKGROUND

INTRODUCTION Throughout its distinguished history, nursing has had a significant effect on people‟s lives. As rapid change continuous to transform the profession of nursing and healthcare delivery system with which it is indicate linked, nurses embrace broader opportunities to influence human well-being. Today, nurses bring knowledge, leadership, spirit, and vital expertise to expanding roles that afford increase participation, responsibility, and rewards. However, nursing continuous to evolve, underlying all is time-honored, fervent and profound commitment to caring. This profession requires academic and clinical training. The clinical duties that the nursing students have to undergo are an integral part of the course. Related Learning Experiences (RLE) is required in the nursing curriculum. The RLE training is necessary to all nursing students in order that their clinical exposure becomes an in-depth experience, meaningful and early appreciated when they are in actual hospital situation. Any nursing student who does not undergo sufficient clinical duties maybe considered ill prepared to undergo further hospital training and may fail miserably in the major nursing course. Every nursing student needs to be given sufficient duties in the different hospital wards/ areas as well as in the different types of hospital services in order to broaden his/her learning experiences while undergoing his or her RLE program. It is in this respect where the clinical duties plays a vital role in the development of proper skills, attitudes, and behavior among nursing students so that when they graduate, take the board examination and become professional nurses in the future their conducts and work ethics will be greatly influenced by what they have experienced during clinical duties. As the nursing profession continuously emerges, there is always a question on how a healthcare provider renders service to humanity. Many things that someone is experiencing can give rise to what kind of nurse he/she could be. As these nursing students undergo clinical duties, they will meet some kinds of stressors that produce discomfort and irritation conducive to stress that if not given proper attention may affect their learning experiences and their future professional practice because stress interferes with learning. It is in this context that the study is focused to help the nursing students identify some stressors during their clinical duties and to recommend possible solutions on how to manage this stress most importantly. Stress is our body‟s 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 isn‟t 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 responsibilities for which one is not prepared, and inadequate support from supervisors and peers.

There are different types of stress that range from Eustress, which is a positive and exciting form of stress, to Chronic Stress, which has been linked to many serious health issues, and is the type of negative stress most often mentioned in the news. While we want to manage or eliminate the negative types of stress, we also want to keep positive forms of stress in our lives to help us remain vital and alive. Stress affects us in different ways, not all of which are negative. In fact, the stress of an exciting life can actually serve as a good motivator and keep things interesting. However, when stress levels get too intense, people will experience its negative effect. Some of it are headaches, irritability and „fuzzy thinking‟. These effects are evident that we‟re under too much stress. However, not everybody who is under stress will experience these specific symptoms. We all feel overwhelmed from time to time; that is normal. It is virtually impossible to eliminate times when events conspire and the body‟s stress response is triggered, but there are ways that we can quickly reverse our body‟s reaction to stress, like buffering the damage to our health and keeping our thinking clear so we can more deal effectively with what‟s going on in the moment. It may seem that there is nothing we can do about our stress level. However, we have a lot more control than we might think. In fact, the simple realization that we are in control of our life is the foundation of stress management.

STATEMENT OF THE PROBLEM This study was conducted to analyze the “Stress management performed by the level III and IV nursing students of World Citi Colleges Antipolo with Regards to their Clinical Duties: Basis for a Proposed Effective Quality Nursing Care”. Specifically, this study aims to answer the following questions: 1. How may the profile of the level III and IV nursing students of WCC Antipolo be described in terms of the following: 1.1age 1.2gender 2. What are the different stressors encountered by the level III and IV nursing students of WCC Antipolo with regards to their clinical duties? 3. What are the different stress managements performed by the respondents with regards to their clinical duties? 4. What are the implications of this study to nursing practice in rendering effective quality nursing care?

SCOPE AND DELIMITATION This study was entitled “Stress Management Performed by the Level III and IV Nursing Students of World Citi Colleges Antipolo with regards to their Clinical Duties: Basis for a Proposed Effective Quality Nursing Care”. The primary focus of this study was directed toward the different stress management that the third year and fourth year nursing students usually utilized and performed to alleviate their stress and to render effective quality nursing care to their patients. The data however were limited from those gathered from the nursing students from World Citi Colleges Antipolo as respondents of the study during the second semester of school year 2012-2013.

SIGNIFICANCE OF THE STUDY The researchers believe in the merits of the study especially to the following: The researchers, conducting this kind of study brought a learning experience for them. It handed them the pulse of the major level III and IV nursing students when it comes to stress management they performed with regards to their clinical duties, which was hardly known without survey. The nursing students, who may acquire greater insights of the stressors, problems and challenges they may encounter all throughout their clinical performances which is part of their chosen career. This knowledge will give them better and wider perspective about their profession and aid them in enhancing their coping abilities and self-confidence. The Clinical Instructors, the findings may provide them understanding why nursing students behave like they do. This study will also provide them hints of what remedial measures they need to institute to lessen the learning difficulties of their students while undergoing clinical exposure. Further, it will eventually help them to build a better relationship with the students, promote educational growth, and improve human and public relations with the identified clinical area of operation. The school administrators and faculty, who may help to work out solutions and course of action that will improve the students‟ performance and to lessen their burden in their clinical duties while on the learning process. It also gives them the chance to improve the quality of nursing education for the benefit of the students and the institution as well. The parents, this study will gives insights to the parents about the stressors encountered by their siblings and to prepare them nor strengthen them by means of giving emotional and moral

supports in ways that may help them how to face and manage their stress during their clinical duties. The patients, they are the recipients of the healthcare services given by the nursing students. The future researchers, this study can serve as reference material to those students who will conduct exactly the same or related studies.

DEFINITION OF TERMS To convey clearly the meaning of the words used in this study, the researchers defined the terms used operationally, as follows: Clinical Area - This pertains to the hospital setting wherein the nursing students apply and practice what they have learned in terms of rendering or applying nursing care and focusing on the holistic being of the patient. Clinical Instructors - These refer to persons who impart knowledge to the students. Clinical Duties - These refer to the exposure of the nursing students in different hospital wards/areas as well as its different types of hospital services in order to broaden his/her learning experiences while undergoing the Related Learning Experience program. Coping - This refers to the adaptation to stress events. Management - This refers to the act or art of managing the whole system of care and treatment of a sick individual. Nursing Students- These refer to the students enrolled in the College of Nursing in World Citi Colleges. Related Learning Experience (RLE) - This pertains to the clinical exposure, which the 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 easily appreciated when they are already in actual hospital situation. Stressors - This pertains to the factors affecting the performances of the nursing students. World Citi Colleges –

CHAPTER II THEORETICAL ORIENTATION AND REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the theoretical orientation and review of related literature and studies by the researchers that are relevant to the present investigation. THEORETICAL INFORMATION According to Richard Lazarus and Susan Folkman (1984) stress could be thought of as resulting from an “imbalance between demands and resources” or as occurring when “pressure exceeds one's perceived ability to cope”. Stress management was developed and premised on the idea that stress is not a direct response to a stressor but ratherone's resources and ability to cope mediate the stress response and are amenable to change, thus allowing stress to be controllable. In order to develop an effective stress management program it is first necessary to identify the factors that are central to a person controlling his/her stress, and to identify the intervention methods which effectively target these factors. Lazarus and Folkman's interpretation of stress focuses on the transaction between people and their external environment (known as the Transactional Model). The model conceptualizes stress as a result of how a stressor is appraised stressor-stress link by proposing that if stressors are perceived as positive or challenging rather than a threat, and if the stressed person is confident that he/she possesses adequate rather than deficient coping strategies, stress may not necessarily follow the presence of a potential stressor. The model proposes that stress can be reduced by helping stressed people change their perceptions of stressors, providing them with strategies to help them cope and improving their confident. Stress is a condition in which the person responds in the normal balanced state. Most of the concerns and worries are commonly repetitive, ongoing, extreme and in most cases, out of proportion to the actual situation. Some of these things are relationships, work, health or family‟s health and finances. Because of these worries, the person experiences very high level of stress on regular basis. CONCEPTUAL FRAMEWORK Research paradigm is shown on Figure 1. This included the input, the process, and the output. The input contains the profile of the level III and IV nursing students of World Citi Colleges Antipolo. The different stressors they encountered, and the different stress management they performed to alleviate their stress. In the process, questionnaires were distributed and observations were conducted to gather pertinent information from the respondents. It also included the analysis and evaluation of the gathered data and information from the respondents using statistical treatment such as frequency count, percentage, average mean, weighted means, and analysis.

The output was consisting of the findings about the stress management performed by the respondents. Research Paradigm

INPUT   Student’s Profile The different stressors encountered by the level III and IV in World Citi Colleges Antipolo with regards to their duties. The different stress management performed by respondents to alleviate their stress.   

PROCESS Distribution of questionnaire Observation Analysis and evaluation using statistical treatment. Frequency Count Percentage Average Mean Weighted Mean

OUTPUT STRESS MANAGEMENT PERFORMED BY THE LEVEL III AND IV NURSING STUDENTS OF WORLD CITI COLLEGES WITH REGARDS TO THEIR DUTIES: BASIS FOR A PROPOSED EFFECTIVE OF QUALITY NURSING CARE

1. 2. 3. 4.



Figure 1

Research paradigm used in this study is illustrated in Figure 1. It shows the steps adopted by the researchers in order to come up with the output of the study. It best describes the idea of the procedural design used by the researchers.

RELATED LITERATURE Foreign Literature Stress is a feeling that is created when we react to particular events. It is the body's way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina, and heightened alertness.

The events that provoke stress are called stressors, and they cover a whole range of situations everything from outright physical danger to making a class presentation or taking a semester's worth of your toughest subject. The human body responds to stressors by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the bloodstream. These hormones speed up heart rate, breathing rate, blood pressure, and metabolism. Blood vessels open wider to let more blood flow to large muscle groups, putting our muscles on alert. Pupils dilate to improve vision. The liver releases some of its stored glucose to increase the body's energy. Moreover, sweat is produced to cool the body. All of these physical changes prepare a person to react quickly and effectively to handle the pressure of the moment. This natural reaction is known as the stress response. Working properly, the body's stress response enhances a person's ability to perform well under pressure. However, the stress response can also cause problems when it overreacts or fails to turn off and reset itself properly. (Wikipedia, 2008. "Stress (biological)" http://en.wikipedia.org/wiki/Stress_(medicine)) Rebecca J. Frey(2009) said that stress in humans results from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well-being. The element of perception indicates that human stress responses reflect differences in personality, as well as differences in physical strength or general health. Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social variables. These factors include lack or loss of control over one's physical environment, and lack or loss of social support networks. People who are dependent on others (e.g., children or the elderly) or who are socially disadvantaged (because of race, gender, educational level, or similar factors) are at greater risk of developing stress-related illnesses. Other risk factors include feelings of helplessness, hopelessness, extreme fear or anger, and cynicism or distrust of others. Selye explained that stress is non-specific response of the body to pay demand made upon it under ordinary circumstances, the body‟s reaction to specific stimulus anticipates because of its repetitive pattern. Therefore, a person experiences pain. When the body is warm, it perspires and when it is used the body shivers. All human exhibits uniform response to stimulus because of homeostasis. When response is erotic and does not uniform to the usual reaction expected from the application of the stimulus, the body is said to be in stress. (“The Nature of Stress” http://www.icnr.com/articles/thenatureofstress.html) Walter Cannon (2009) in the meantime said that the human body reacts either positively or negatively to a stress factor producing two kinds of possible reaction. When the human body tries to flee from stress situation, negative reaction is exhibited. Positive reaction comes about

when the body makes the principle of homeostasis apply the body to overcome stressful situation which is known as adaptation or coping. He advocated that while the concept of stress is an absolute fact, its presence and intensity reception are all relative in accordance with the physical and psychological makeup of the individual. All people therefore, experience stress but the way stress is present and is handled by each individual is unique for each other. A little difficulty is hardly felt by another. By understanding, we can more easily identify stress factors and their effects on who need or seek healthcare. Each individual is experiencing stress, in her own particular manner. How the individual adopt or fails to adopt depend on several factors: personality and conditional make past experiences dealing with stress. It is important to remember that stress syndrome can be both positive and negative. Any change or alteration in the balance of life can create stress. We are all unique individual, we respond differently to various stressors. Thus, its neither does nor matter. Whether, it is positive or negative light or severe. What matter is how we developed adoptive mechanism to cope with these stressors and can be translated as the ability to withstand stress and create a life experiences that do not work against you. The implication of stress theory is by being able to withstand stress and by coping with it. Diluting it when occurs and eliminating it, you can actually affect your life. You are not programmed for premature aging. The fact is you control your own health. The quote of the journal of American Medical Association says, “Nature did not intend to grow old and ill, we were designed to die young in old age but free of disease”. Schafer (2000) defined stress as the “arousal of mind and body in response on the demand made upon them”. The concept of stress is important because it provides a way of understanding the person as a human being who responds in totality (mind, body and spirit) to a variety of changes that takes place in daily life.

Local Literature According to Maraya de Jesus Chebat stress is here to stay. What people must do is to learn more about its nature, sources and alternatives so that people used the energy positively and work in the best possible way. Orlandi stated, “Your ability to tolerate stressors depends on the number of stressors in your life”. People who can handle stress use their coping mechanism, which is powerful tool to use, to analyze events objectively and observe calmly. Gather information at the state of equilibrium, understanding of what to produce the tension that helps you feel that the stress is alleviated.

Miranda specified that the most effective way of managing stress are through relation and exercise which ironically are extremely aesthetical acts which involved dynamics of the mind and body. People who are always stress survivors stay healthy throughout their lives. They consider stressful situation opportunist for growth.

RELATED STUDY Foreign Studies: According to Ann Marriner Tomey et. Al,(2004) Stress is a part of every student's daily life. Leaving home or commuting daily managing, finances, living with roommates, and juggling work, classes, and relationships all contribute to the normal stress of being a student. In addition, it is not uncommon for students to feel stressed and anxious about wasting time, meeting high standards, or being lonely. Stress can also come from exciting or positive events. Falling in love, preparing to study abroad, or buying a car can be just as stressful as less-happy events. One of the most important things you can do is to recognize when your stress levels are building. The amount of stress that you can tolerate before you become distressed varies with your life situation and your age. A critical first step in coping with stress is taking stock of the stressors in your life. Whenever stress is present, your body reacts. It acts like an alarm system that prepares your body to depend yourself. A little stress is good. It helps you think faster and harder and makes you put that extra bit of effort to meet in the challenge of life. On the other hand, Lether and Woolfolk say that the relaxation is the very valuable stress management technique that can soothe the emotional turmoil and suppress problematic psychological arousal. While Martin and Lefcourt, suspected humor might be worthwhile coping response. Empirical evidence to that effect has emerged only recent years. For them good humor functions as buffer to lessen the negative impact of stress.

Local Studies According to Calderon, people who experience a high level of stress for a long time and who cope poorly with this stress may become irritable, socially withdrawn, and emotionally unstable. They may also have difficulty concentrating and solving problems. Some people under intense and prolonged stress may start to suffer from extreme anxiety, depression or other severe emotional problems. Odrigo G. Ancheta says that, “Stress gives us energy to cope with the demanding activity of life. It is true that stress is a normal constant part of our life because it involves changes,

challenges an emotions. Try to imagine life without stress. You would not have any challenges anything to affect your emotions and anything new and exciting. It gives as energy because it activity involves physically and emotionally. Stress might be considered as a problem because we often bear about stress in a negative light that people may only associate‟s bad experiences with stress. How you perceived and handled stressors will determine whether the stress is good or bad for you. A situation that seems extremely stressful to you could leave very calm to somebody. Flores (2000) said that a person who is stressed typically less anxious thoughts and difficulty concentrating or remembering. Stress can also change outward behaviors. Teeth clenching, hand wringing, pacing, nail biting, and heavy breathing are common signs of stress. People also feel physically different when they are stress. Butterflies in the stomach, cold hands and feet, dry mouth and increase heart rate are all physiological effects of stress that we associate with the emotion of anxiety.

Justification of the Studies The past study discussed in this chapter has given the researcher the concept, theories and principles that pave the way to the ideas of the present study and good starting point for the researcher in assessing the stressors and the stress management performed by the respondents with regards to their clinical duties. The review has enabled the researchers to have a better understanding of ideas of different well known writers which resulted to broadening the researchers own thinking in relation to the present study.

CHAPTER III METHODS, PROCEDURES, AND SOURCES OF DATA

This chapter presents the method of research used, the instruments, the sources of data and the procedures used in gathering of data which employed by the researchers.

Methods of Research The researchers took into consideration the present factors and current conditions of a group of persons, events or a class in finding facts and data to be interpreted. This summary includes in the descriptive method, which was used to accomplish this study. Descriptive research is a study in which bodies of data are collected, recorded and analyzed. It is used to answer questions, satisfy curiosity established a cause and effect relationship. Moreover, descriptive researching is the most popular approach in research. It systematically, factually and accurately describes an area of interest or situation. Description, analysis and interpretation of conditions that exist are involved. Researchers may also deal with comparison and contrast or the discovery of existing relationship between events or groups. In addition, as this method of research was used in the study it describes systematically the nursing course and stress management performed by the level III and IV nursing students of World Citi Colleges Antipolo with regards to their clinical duties: Basis for a Proposed Effective Quality Nursing Care. The study describes also its symptoms, management or treatment and situations in which stress may arise in order to obtain a factual and accurate result of the research in which student could avail.

Research Instruments The researchers used the questionnaire as the primary tool in gathering data. This was made from created materials and statements that could generate the desired result when the correspondents followed correctly the direction given by the researchers for answering. The construction of the questionnaire was preceded by intensive perusal and review of related literature, which provided the researchers insights in forming the questionnaire. The researchers formulated questions based on their readings from various books, manuals, journal and experiences as nursing students.

The questionnaire was first drafted for the approval of their adviser and other members of the faculty who are knowledgeable on the topic. This is composed of 4 problems. Problem no. 1 involves the profile of the level III and IV nursing student of World Citi Colleges Antipolo. Problem no. 2 involves the different stressors encountered by the level III and IV nursing students of World Citi Colleges with regards to their clinical duties. Problem no. 3 is the different stress management performed by the respondents. While, Problem no. 4 is the implication of the study to nursing practice in rendering effective quality nursing care. Then the final draft was reproduced for distribution to the respondents.

Sources of Data The researcher used the level III and IV nursing students of World Citi Colleges Antipolo as their respondents who were randomly selected from eleven sections. They were chosen using single random sampling, each number of the population has an equal chance to be included in the sample gathered. (Ymas Jr, et. al. 2006) Their reactions, opinions and suggestions were analyzed and reported.

Statistical Treatment of Data After the distribution, collection and completion of distributed questionnaires, the researchers tallied the gathered data 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: Percentage (%) = F x 100 N Where: %- Percentage F- Frequency or number of response to every item or question N- Total number of respondent

For the Average Mean Computation of the average mean was made using the expression: AM = F x E (DoR) Where: AM- Average Mean F- Frequency Used E- Numerical Equivalent/ degree of response

For the Weighted Mean Computation of the weighted mean was made using the expression: WM = AM N Where: WM- Weighted Mean AM- Summation of the degree of response multiply frequency (F x E (DoR) ) N- Total numbers of respondents

The researcher used ranking to determine the position of each variable. Number Value 4.20-5.00 3.40-4.19 2.60-3.39 1.80-2.59 1.0-1.79 E (DoR) 5 4 3 2 1 Interpretation Always Often Sometimes Seldom Never

Finally, the findings were summarized and compared with each work; conclusions were drawn, and recommendations were formulated.

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