A comparison of learned helplessness levels of first-year and final-year Turkish nursing students

Emel Bahadır-Yılmaz¹*, Emine Aydın-Pekdemir², Burçin Atamer³, Büşra Cakmak³,

Yeşim Celebi³, Günay Iyim³, Kübra Kabak³

¹Assistant Professor, Health Sciences Faculty, Giresun University, Eren Street No: 25, Piraziz 28340, Giresun, Turkey.

²Lecturer, Health Sciences Faculty, Giresun University, Eren Street No: 25, Piraziz 28340, Giresun, Turkey.

³Final-Year nursing student, Health Sciences Faculty, Giresun University, Eren Street No: 25, Piraziz 28340, Giresun, Turkey.

*Corresponding Author Email: ebahadiryilmaz@yahoo.com

ABSTRACT:

Objectives: Nursing training is stressful process and nursing students have both internal and external stress sources. To cope with these stressors, nursing students must have a strong sense of learned helplessness. Also low level of learned helplessness may lead to ineffective patient care. This descriptive study was planned in order to compare the learned helplessness levels of first-year and final-year nursing students. Methods: Sample of study was consisted of one hundred and seventy-one (171) nursing students who had been training at Giresun University, Faculty of Health Sciences. The data were collected by using the ‘Learned Helplessness Scale’. ANOVA and t-test were used in data analysis. Results: Nursing students in both classes were above average in learned helplessness mean scores. No significant difference was found between the learned helplessness mean scores of first-year and final-year nursing students (p>0.05). But significant difference was found in learned helplessness mean score of students according to being between 23 and ↑-year age range and having a deceased father (p<0.05). Conclusion: Results suggest that learned helplessness levels of nursing students should be increased by empowerment and counseling programs. The factors affecting the learned helplessness should be studied.

KEYWORDS: learned helplessness, Turkish nursing students, class level.

INTRODUCTION:

Nursing training is stressful process and nursing students have both internal and external stress sources related to clinic environment, theoretical training, social life, and personal traits [1]. In several studies investigating the perceived stress levels of nursing students, they had higher stress levels and stress sources [2-4]. Nursing students who reported higher level of stress were more likely to experience poor physio-psycho-social health [5].

The sources of stress for nursing students can be grouped as academic, intrapersonal, interpersonal, and enviromental [6]. The most common sources of stress are academic workload, fear of unknown situations, mistakes with patients or handling of technical equipment [7], not knowing how to communicate with patients and how to discuss patients’ illness with teachers or medical and nursing personnel, lacking the care skills [8], stress from peers and daily life [9], restrictive environment, lack of quality free time, difficulty in time management, and inconsistent faculty responses to their concerns [10], gap between theory and practice, and lack of clinical supervision [11].

To cope with these stressors, nursing students must have a strong sense of self-efficacy [12]. The consequence of feelings of low self-efficacy may be a sense of learned helplessness and the feelings of helplessness may lead to ineffective patient care [13]. In a previous study, it was found that the use of helpless approach was associated with unsufficient behavioral communication skills [14].

Learned helplessness is a passive behavior. It means ineffective problem solving and loss of control in one’s life and stressful events [15]. According to Cubukcu (2008) it refers to students’ beliefs that they cannot control their own behavior and there is no relationship between their behavior and an outcome [16]. Numerous studies indicate that one of the coping ways of nursing students was helpless approach. The feeling of helpless may be a consequence of meeting palliative care patient, giving care to pediatric cancer patients [17], effect of verbal, physical, sexual, and academic abuse experienced [18], meeting a psychiatric patient who was negative towards nursing students [19].

MATERIALS AND METHODS:

Aim

This study was an attempt to compare the learned helplessness levels of first-year and final-year nursing students in North-East Turkey.

Study setting and design

A descriptive survey design was used to compare the learned helplessness levels of first-year and final-year nursing students. Participants were all first-year and final-year students in the Bachelor of Nursing Science Degree at the Giresun University, Turkey. One hundred and seventy one (171) nursing students were enrolled in this study. No sampling method was used and the research population consisted of the first-year and final-year nursing students.

Instruments

Two instruments were used for gathering data. The first instrument, Personal Information Form was designed by the researchers and which included some sociodemographic variables of the students (age, gender, family structure, father’s and mother’s education level, father and mother alive or deceased, place of residence, perceived socioeconomic status, exposure to domestic violence and psychological abuse by clinical educator or staff in clinical practice).

The second part included the Learned Helplessness Scale (LHS). The LHS is a 20-item scale developed by Quinless and Nelson (1988) [20]. The Turkish translation of the instrument and validity and reliability study was implemented by Boysan among university students (e.g. Boysan A, 2006, unpublished data). It uses a four-point scale of 1 (strongly disagree) to 4 (strongly agree). Higher scores indicate higher levels of learned helplessness. Probable range of scores is between 20 and 80. Cronbach alpha value of the scale were found to be 0.73.

Data collection

The data was collected during lessons of Fundamental Nursing and Public Health Nursing of nursing students during the 2013-2014 academic year in this study. Before the questionnaires were administrated, written consent was obtained from the director of Health Sciences Faculty. The study carried out in classes at the beginning of each lesson. Verbal permission was obtained from the responsible lecturer of the lesson. The aim of the study was described to students. Verbal consent was obtained. Nursing students completed questionnaires within approximately 15 min.

Data analysis

Data were analyzed using SPSS 16.0 for Windows (SPSS, Chicago, IL, USA). Descriptive statistics (including means, standard deviations, frequencies and percentages) were applied for demographic characteristics. Independent Samples t-Test and ANOVA were used to assess the mean differences in learned helplessness in relation to the demographic characteristics. Statistical significance level was set at P<0.05.

Ethical considerations

The study was approved by the nursing school administration. Verbal consent was obtained from students participating in the research. All participants were informed of purpose and design of the study. Participation in the study was voluntary.

RESULTS:

Sociodemographic data

While 67.0% (n=77) of first-year nursing students were between 17 and 19 years old, 85.1% (n=46) of final-year nursing students were between 20 and 22 years old. Table 1 showed sample demographics. Both first-year nursing students and final-year nursing students who composed the samples consisted primarily females (81.2%, 77.8% respectively).

Table 1. Sample demographics

Demographic characteristics		First-year students (n=117)		Final-year students (n=54)
		n	%	n	%
Gender	Male	22	18.8	12	22.2
	Female	95	81.2	42	77.8
Family structure	Nuclear	99	84.6	45	83.3
	Extended	18	15.4	9	16.7
Place of residence	Village	17	14.7	8	14.8
	Town	35	30.2	23	42.6
	Country	65	55.1	23	42.6
Perceived socioeconomic status	High	19	16.2	9	16.7
	Moderate	91	77.8	42	77.8
	Low	7	6.0	3	5.6
Father’s educational level	< High school	77	65.8	36	66.7
	≥ High school	40	34.2	18	33.3
Mother’s educational level	< High school	95	81.2	47	87.0
	≥ High school	22	18.8	7	13.0
Father alive or deceased	Alive	115	98.3	50	92.6
	Deceased	2	1.7	4	7.4
Mother alive or deceased	Alive	116	99.1	53	98.1
	Deceased	1	0.9	1	1.9

84.6 % (n=99) of first-year students had nuclear family structure, place of residence of 65students (55.1%) were country, 91 students (77.8%) perceived moderate socioeconomic status, father’s and mother’s education level of them (65.8%, 81.2% respectively) were < high level, and most of their father and mother were alive (98.3%, 99.1% respectively).

Family structure of 45 final-year students (83.3%) were nuclear, place of residence of 85.2% (n=46) were town and country, 77.8% (n=42) perceived moderate socioeconomic status, father’s and mother’s education level of them (66.7%, 87.0% respectively) were < high level, and most of their father and mother were alive (92.6%, 98.1% respectively).

Exposure to domestic violence and psychological violence in clinical practice

Only 15.2% of all students exposed to domestic violence. Exposure to domestic violence was not differ according to gender. 14.7% (n=5) of male students and 15.3% (n=21) of female students exposed to domestic violence. Nearly 83.0% of final-year students reported that they exposed to psychological abuse by clinical educator or staff in clinical practice. But no significant difference was found in learned helplessness mean scores according to exposing to domestic violence and psychological violence in clinical practice (P>0.05).

Table 2. The differences in learned helplessness levels of students according to demographic characteristics

Demographic characteristics		Mean ± SD	Test value	P value
Class size	First-year	57.36 ± 6.87	t=-0.420	0.435
	Final-year	57.85 ± 7.31
Age	17-19	58.14 ± 5.97	F=3.526	0.032
	20-22	56.25 ± 7.39
	23 and ↑	61.70 ± 8.98
Gender	Male	56.00 ± 8.27	t=-1.419	0.739
	Female	57.89 ± 6.62
Father’s educational level	< High school	57.91 ± 6.44	t=1.020	0.258
	≥ High school	56.75 ± 7.97
Mother’s educational level	< High school	57.68 ± 7.21	t=0.537	0.509
	≥ High school	56.88 ± 6.05
Father alive or deceased	Alive	57.55 ± 6.66	t=0.303	0.001
	Deceased	56.66 ± 14.40

^*t score by independent t-test. F score by one way ANOVA.

Learned helplessness mean scores of students according to demographic characteristics

When demographic characteristics affecting the students’ learned helplessness levels were examined, it was found that age significantly influenced the Learned Helplessness Scale scores. The average scale score of students in 23 and ↑-year age range was higher than that of students in 17-19- and 20-22-year age range (F=3.526, P=0.032) (Table 2). Post-hoc analysis compared the groups pair wise and showed that the differences were statistically significant between 20-22 and 23 and ↑ years old (p<0.05).

The learned helplessness level showed statistically significant difference according to father alive or deceased (t=0.303, P=0.001). The average scale score of students having a deceased father was lower than that of students having an alive father.

The average learned helplessness score of first-year nursing students was 57.36 ± 6.87 and the average learned helplessness score of final-year nursing students was 57.85 ± 7.31. A statistical difference was not found in learned helplessness mean scores of students according to class level (P>0.05). Also no significant difference was found in learned helplessness mean scores according to gender, mother’s and father’s education, and mother alive or deceased (P>0.05).

DISCUSSION:

The first prominent finding of the present study pointed out that there was no significant difference in learned helplessness mean scores according to class level (p>0.05). In line with our findings, Yaman et al. (2011) found that there was no significant difference between learned helplessness and class level [21]. According to the findings obtained from a limited number of studies, locus of control which is an important indicator of learned helplessness, was not found to be associated with class level of both midwifery and nursing students [22,23]. The results of our study revealed that nursing education did not affect the learned helplessness levels of students.

Also the results of the present study indicated that students in both classes were above average in learned helplessness mean scores (Table 2). This findings may be related to stressful nursing education. Because nursing students perceived and determined a considerable number of sources of academic and clinical stress in previous studies [7-11]. These stressors may be affected their problem solving skills [22], locus of control [24], resilience levels [25], and feelings of helplessness [26]. Also learned helplessness levels of the students in present study may be influenced by negative attitudes of nursing staff and gap between theory and practice [11]. Because the students consistently expressed negative attitudes displayed by nursing staff.

Another finding of the present study revealed that a statistically significant result was found in the learned helplessness mean scores according to the age (p<0.05). Learned helplessness was higher in the older age students. Considering the fact that learned helplessness is a coping way, learned helplessness in the older age can be associated with burnout [27], unsufficient coping skills [28], academic load [10], low level of self-esteem and poor interpersonal relationships [29], lack of support [30]. These results suggest that the effects of older age in learned helplessness levels of nursing students should be determined and learned resourcefulness levels of the students should be increased by empowerment and counseling programs.

An important finding of the present study indicated that average scale score of students having a deceased father was lower than that of students having an alive father (p<0.05). This finding is not congruent with a study which was conducted by Erdogdu (2006) that the learned helplessness level of students having a deceased father was not differ significantly than that of students having an alive father [31]. But compared with students having an alive mother, those who had a deceased mother experienced more learned helplessness. This results may be related to parent-child interactions [32]. Because in a study conducted by Erden and Ümmet (2014) it was shown that parental attitudes had predictive power on locus of control which is the main indicator of learned helplessness [33]. Also experiencing the loss of a parent may have influenced the attachment style of students. Because it was found that there was a strong relationship between attachment style and locus of control [34].

Finally, in the present study it was found that there was no significant difference in learned helplessness mean scores according to gender (p>0.05).The present finding is accordance with previous reports that learned helplessness levels of students according to gender were not statistically meaningful [21,35,36]. But the present finding is not congruent with a previous report that compared with female students, male students had higher level of learned helplessness [31].

One of the important reasons of learned helplessness in Turkish society is traditional gender roles. As an outcome of traditional gender roles, women experience learned helplessness more than men. But according to a handful of studies investigating the traditional gender roles of Turkish university students, male students had more traditional views on gender roles than female students [37-39]. Males also may be affected by unfavourable traditional gender roles because of restricting life and traditional sex role expectations. For this reason, contrary to what we thought, male students may have high level of learned helplessness.

STUDY LIMITATIONS:

This study had several limitations. The study was conducted with only first-year and final-year nursing students and the findings cannot be generalized to all nursing students who are studying in nursing department in Turkey. Another limitation of the present study is that the sample consisted of only nursing students. For future studies, a similar study should be compared of learned helplessness levels of nursing students and other department students such as medical, dentistry students.

CONCLUSION:

It was found that both first-year and final-year nursing students had high level of learned helplessness and that there was no significant difference in learned helplessness mean scores according to class level. Also, learned helplessness was higher in the older age students and in students who had a deceased father. But no significant difference was found in learned helplessness mean scores according to gender, mother’s and father’s education, family structure and other variables.

RECOMMENDATIONS:

These points can be suggested as results of this study: learned helplessness levels of nursing students should be increased by empowerment and counseling programs. The factors affecting the learned helplessness should be studied. Furthermore, this study should be repeated with in larger samples and it should be assessed according to coping ways, problem solving, resilience, and learned resourcefulness.

ACKNOWLEDGEMENTS:

The authors are grateful to all the first-year and final-year nursing students who participated in the study.

CONFLICT OF INTEREST:

None to declare.

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Received on 03.07.2015 Modified on 26.08.2015

Accepted on 20.09.2015 © A&V Publication all right reserved

Asian J. Nur. Edu. and Research 5(4): Oct.- Dec.2015; Page 531-536

DOI: 10.5958/2349-2996.2015.00109.3