INTRODUCTION:

Nursing education is a planned program comprised of theoretical and practical education which aims to ensure that students acquire the knowledge, attitudes and skills regarding the nursing profession. Nursing students are faced with many personal, academic and clinical stressors from the first day of their education¹.

Shaiji M J. et.al² conducted a comparative study between nursing and B.Ed students which found the nursing students have more stress when compare to many professions.

It is reported in the literature that stress negatively affects the physical and mental health of nursing students, decreases their life quality and increases their tendency to exhibit risky behaviors. High level of stress has a negative effect on critical thinking, problem solving and decision-making abilities of students and reduces academic success³ (Jimenez et al., 2010; McCarty et al. 2018; Rudman and Gustavsson, 2012).

Academic Stress has been identified as a 20th century disease and has been viewed as a complex and dynamic transaction between students and their environments. High levels of stress are believed to affect student health and academic achievements⁴. It has been reported that student nurses are affected with the stressors in academic, clinical, financial, due to parental expectations, competition for grades, and career choices^5,6. In many studies it is stated that academic stress is mental distress with respect to some anticipated frustration associated with academic failure. Academic Stress also an important factor accounting for variation in academic achievement. It contributes to major mental health hazards, problems both physical and mental stress related diseases⁷.

In many literatures it is reported that prevalence of academic stress is very high in health students, especially in nursing and medicine students. The stressors in nursing students causes deleterious effects on cognitive performance and health, i.e., the development of mental disorders such as depression, anxiety, eating disorders, sleep, and substance use, the experience of stress can result in ineffective communication and inefficient at work, decreasing the quality of health-care services⁸.

Archayapandey.R and Challies.N conducted a study on self-esteem and academic stress among nursing students at Kathmandu university. Nearly 78% students have low self-esteem and 74% have high academic stress. Significant variable for high academic stress and low self-esteem were lower the age, lower the education and low perceived family support⁹.

Dilber.R. et.al reported that the stressors student nurses face come from academic factors such as, the demands of proper performance in clinical practice, academic assessments, and future expectations about employment¹⁰. Sharma N kapur A stated that social, emotional, and physical pressures, as well as family and personal problems, affect student’s learning ability and academic performance and predispose the young students to the development of mental disorders such as anxiety and depression¹¹. Many studies reported that the impact of stress on nursing students can affect the nurse–patient relationship; nurses have more interaction during and after an intervention with the patient. Similarly, being exposed to environmental stressors could lead to dissatisfaction and burnout in nursing staff¹².

It is reported in a literature that individuals with a profession compatible with their self-identity are expected to be more successful and efficient while individuals with a profession incompatible with their self-identity are more likely to experience conflicts and dissatisfaction¹³. In this respect, it is highly important that members of the profession have a well-developed identity and a high professional self-esteem so that nursing can be a professional job¹³.

However, literature studies indicate that education stress negatively affects the self confidence and self-esteem of nursing students. A high level of professional self-esteem is an effective factor in coping with the stress experienced by students during their education. Also, the objective of nursing education programs is to train nurse candidates who will provide high quality patient care and have high level of professional self-esteem¹⁴.

Vidhi Patel¹⁵ conducted a structured teaching programme on knowledge regarding academic stress and its management among higher secondary students found that mean pre test knowledge score was 9.625 and post test knowledge was with 14.625 mean difference 5.0. which shows that academic stress is manageable with proper management.

As a investigator experience have seen many students faced lot of struggle to complete their clinical requirements and their academic performance also significantly low. Hence, this intended to take up this study.

STATEMENT OF PROBLEM:

A Comparative study to assess the level of academic stress and self-esteem among nursing students in a selected college, Chennai.

OBJECTIVES:

· To assess and compare the academic stress and self-esteem among 1st and 2nd year B.Sc(N) students.

· To associate the level of academic stress with selected demographic variables.

· To associate the level of self-esteem with selected demographic variables.

NULL HYPOTHESIS:

NH₁: There is no difference between the level of
academic stress and self-esteem among1st and
2nd year B.Sc(N) students.

NH₂: There is no significant association between the
level of academic stress with their selected
demographic variables.

NH₃: There is no significant association between the
level of self-esteem with their selected
demographic variables

MATERIALS AND METHODS:

A comparative descriptive cross sectional research design was adopted. A total of 67 nursing students were selected by using non probability purposive sampling technique in a selected nursing college. The accessible population was nursing students studying in St.Isabel’s College of Nursing. Out of 133 B.Sc(N) and 42 GNM students, 67 students were selected by using non probability purposive sampling.

DESCRIPTION OF THE TOOL:

The research tool consists of 3 parts.

Section A:

Demographic variables Performa consists of age, year of study, order of the child, type of family, parental status, religion, family income, medium of study, place of stay, performance of higher secondary studies, perceived parental and family support.

Section B:

Standardized Academic stress scale was adopted. Academic stress scale comprises of 40 items. Each items had five alternatives varying from the response` No stress to Extreme stress’. Each response carries a score of 0, 1, 2, 3 and 4 respectively. The minimum score is 0 and maximum score is 160. A score of 0-32 indicates no stress, 33-64 slight stress, 65-96 moderate stress, 97-128 high stress, 129-160 extreme stress.

Section C:

Standardized Rosenberg Self-esteem Scale was used. It is a 4 point Likertscale ranging strongly agree to strongly disagree. The score ranges from 0 -30. The minimum score is 0 and maximum score is 30. A score below 15 indicates low self-esteem, 15-25 moderate self-esteem, above 25 high self-esteem.

Ethical consideration:

The study was approved by the St.Isabel’s College of Nursing, Chennai. Necessary permission from the college authority was obtained. Before data collection, written consent was obtained from the samples. Confidentiality and individual anonymity were maintained throughout the study.

Data Collection Procedure:

After formal permission from the college, the self-administrated questionnaire was given to the students and they were informed about the importance of responding very carefully to each statement of the questionnaire. The approximate time taken by students to complete the questionnaire was 15-20 minutes. The collected data were analysed by descriptive and inferential statistics.

RESULTS:

Demographic variables:

Among 67 samples, 36(54%) were in the age group of 19-20 years, 35 (52%) were birth order, 55(83%) were belong to nuclear family, 61(91%) has both parents, 44(66%) were Christian, 26(39%) had family income between 11, 000-20, 000, 36(54%) from Tamil medium, 58(87%) were hostelites, 32 (48%) had good percentage in their higher secondary, 65(97%) had strong family support.

Table 1: Frequency and percentage distribution of the level of Academic Stress among 1st and 2nd yearB.Sc (N) Students

S. No	Level of Academic Stress	1^st Year ( N = 35)		2nd Year (N= 32)
S. No	Level of Academic Stress	f	%	f	%
1.	No stress	4	11	3	9
2.	Slight stress	8	23	6	19
3.	Moderate stress	13	37	11	34
4.	High stress	10	29	11	34
5.	Extreme stress	-	-	1	3

Among 35 samples of B.Sc nursing 1^st year 13(37%) had moderate stress, 10(29%) had high stress, 8(23%) had slight stress, 4(11%) had no stress. None of the samples had extreme stress. Among 32 samples of B.Sc nursing 2^nd year students, 11(34%) had moderate stress and 11(34%) had high stress, 6(19%) had slight stress, 3(9%) had no stress, 1(3%) had extreme stress. Hence, NH1 is rejected. There is a significant difference in the level of academic stress among 1^st and 2^nd year B.Sc (N) students.

Figure 1: Percentage distribution of Academic Stress among 1^st and 2^nd year B.Sc (N) students.

Table II: Frequency and percentage distribution of the level of Self-esteem among 1^st and 2^nd year B.Sc (N) students

S. No	Level of Self Esteem	1^st Year (N=35)		2^nd Year( N=32)
S. No	Level of Self Esteem	f	%	f	%
1.	High self esteem	4	11	_	_
2.	Moderate self esteem	28	80	30	94
3.	Low self esteem	3	9	2	6

Among 35 samples of 1^st year B.Sc nursing students 28(80%) had moderate self-esteem, 4(11%) had high self-esteem and only, 3(9%) had low self-esteem. Among 32 samples of B.Sc nursing 2^nd year students, 30(94%) had moderate self-esteem, 2(6%) had low self-esteem, none of the samples had high self-esteem. Hence, NH1 is rejected. There is a significant difference in the level of self-esteem among 1^st and 2^nd year B.Sc (N) students.

Association between level of academic stress with their selected demographic variables:

There is a significant association between the level of academic stress with the selected demographic variables such as age, year of study, birth order, type of family, income. Hence, NH2 is rejected.

Association between level of self-esteem with their selected demographic variables:

There is a significant association between the level of self-esteem with selected demographic variables such as age, birth order, parental status. Hence, NH₃ is rejected.

DISCUSSION:

Regarding levels of stress the present study identified out of 35 samples of B.Sc nursing 1^st year 13(37%) had moderate stress, 10(29%) had high stress and among 32 samples of B.Sc nursing 2^nd year students, 11(34%) had moderate stress and 11(34%) had high stress. The results of the present study are supported by Amol Bhagwat Kanade et.al (2021) reported that majority of 53.33% of students had moderate stress, 31.67% of them had slight stress and 15% of them had high stress¹⁶ and Shrestha S and Ghimire S(2019) reported that out of 116 nursing students more than half of the respondents had high stress i.e. (50.9%)¹⁷

Regarding self-esteem out of 35 samples of 1st year B.Sc nursing students 28(80%) had moderate self-esteem and among 32 samples of B.Sc nursing 2nd year students, 30(94%) had moderate self-esteem. The results of the present study are supported by Safi Alzeyadi and Saja H. Mohammed reported that out of 600 nursing students, majority of nursing students had a self-esteem levels range between average (52.2%) to high level (44.8%)¹⁸.

Considering the association between the level of academic stress with their selected demographic variables, in this present study, the variables age, year of study, birth order, type of family, income had significant association at the level of p= 0.05. Hence the null hypothesis stated NH ₂was not accepted for these variables and accepted for other variables.

The association between the level of self-esteem with their selected demographic variables, such as age, birth order, parental status had significant association at the level of p= 0.05. Hence the null hypothesis stated NH ₂ was not accepted for these variables and accepted for other variables. This finding was supported by the study done by Hiranmayee Sarma and Dr Bibi Bordoloi (2018) among 250 students age was significantly associated with level of self esteem¹⁹.

IMPLICATIONS:

· The nurse educator/student nurses can be can be taught regarding stress, various stressor, stress management techniques, techniques for improving self-esteem etc

· The nursing fraternity in the community and public health, as well as the stakeholders in the community, must conduct stress management programmes and techniques to improve self-esteem for school and college students in the community.

· Researchers can further conduct this study as a comparison between urban and rural school and college students.

· The effectiveness of stress management and interventions to improve self-esteem can also be tested among students.

LIMITATIONS:

The time constraints and small sample size were the limitations of the present study.

CONCLUSION:

The results of the present study revealed that 37% to 29 % of 1^st year nursing students had moderate stress to high stress and 34% of 2^nd year nursing students had moderate and high stress respectively. Level of stress was found to be associated with age, year of study, birth order, type of family, income had significant association at the level of p= 0.05. Level of self-esteem was found to be associated with age, birth order, parental status had significant association at the level of p= 0.05. It is essential for the nurse educators to conduct stress management programme periodically. The nurse educators would also continue to give assistance for the nursing students to complete their academic and clinical requirements, whilst being vigilant and then supporting those students who may be struggling to complete it. “Nothing will ever compare to the fulfillment that improving and saving the lives of others will bring” with this motto will prepare future efficient nurses.

REFERENCES:

1- Alp Yilmaz Figen, Avci D. International Journal of Caring Sciences, 2020; 13(2):1082

2- Shaiji M J, Deepti Khetwal, Diksha Kamboj, Divya Sanga, Jyoti Kamboj, Mukesh Kumar, Mujassim Jahan, Neelam Goswami, Neha Pandey, Nisha Ghaloth, Nisha Parveen, Pradeep Kumar, Rashmi Pawar, Supriya Arya, Varsha Mishra, Nikita Chand. Comparison of Academic Stress among I year B.Sc Nursing and I Year B.Ed Students.Int. J. Nur. Edu. and Research. 2019; 7(4): 529-531. doi: 10.5958/2454-2660.2019.00116.9

3- Jimenez C, Navia-Osorio PM, Diaz CV. Stress and health in novice and experienced nursing students. J Adv Nurs. 2010 Feb; 66(2):442-55. doi: 10.1111/j.1365-2648.2009.05183. x. PMID: 20423427.

4- Frank J.C., Bharti Sharma. Level of Academic Stress Among B.Sc. Nursing Ist Year Students, Jammu. International Journal of Advances in Nursing Management. 2022; 10(1):57-0. doi: 10.52711/2454-2652.2022.00015

5- Chanchal Singh, Deepshikha Bhnwaria, Esther Nengzaching, Gurgeet Kaur, Hatneikim Haokip, Hemprabha Jani, Mukesh Chandra Sharma, Mohanasundari SK. A Descriptive Study to Assess daily routine activities and level of Stress among students of B.Sc (Hons.) Nursing students at AIIMS, Jodhpur. Int. J. Nur. Edu. and Research. 2020; 8(1):13-18. doi: 10.5958/2454-2660.2020.00003.4

6- Moses Kandula, P. Karthika, P. Vidya. A Descriptive Study Related to Academic Stress Among Bsc Nursing Students at Geetanjali College of Nursing, Kadapa, and Andhra Pradesh. A and V Pub International Journal of Nursing and Medical Research. 2022; 1(1):1-4. doi: 10.52711/ijnmr.2022.01

7- N. Sasikumar, R. Bapitha. Examination Stress and Academic Achievement in English of Ninth Standard Students in Pudukottai Educational District. American Journal of Educational Research. 2019; 7(9):654-659. doi: 10.12691/education-7-9-9.

8- Frank Pulido-Criollo, Jonathan Cueto-Escobedo, Gabriel Guillén- Ruiz.Stress in Nursing University Students and Mental Health Submitted: June 8^th.September 19th, 2018 DOI:

9- Acharya Pandey R. Chalise HN. Self-Esteem and Academic Stress among Nursing Students.

10- Kathmandu Univ Med J, 2015; 52(4):298-302.

11- Dilber R, Babić D, Vasilj I, Martinac M, Babić R, Aukst-Margetić B. Religiosity and mental health in nursing students. Psychiatry Danub. 2016; 28(2):188-192

12- Sharma N, Kapur A. Factors associated with stress among nursing students. Nursing and Midwifery Research Journal. 2011; 7(1):12-21

13- Uslusoy EC, Paslı G, & Kurt D. Professional self-esteem and colleague solidarity in nurses University Journal of Health Sciences Institute. 2016; 7(1):29-35.

14- Karabulutlu EY, Oruc FG, &Turan GB. The effects of the stress experienced by students on nursing education on their professional self-development. GUSBD, 2019; 8 (1): 10- 17

15- Kilic HF. The relationship between nursing students’ educational stress and professional selfesteem. Journal of Hacettepe University Faculty of Nursing. 2018; 5(1): 49–59.

16- Vidhi Patel. A study to assess the effectiveness of Structured teaching programme on knowledge regarding Academic stress and It’s Management among students of Higher Secondary school of Visnagar city. Asian J. Nursing Education and Research. 2020; 10(4):419-421. doi: 10.5958/2349-2996.2020.00089.0

17- Amol Bhagwat Kanade, Shubhangi Sarwan, Pradnya Said, Suvarna Kadam, Gokul Dhakne, Pramod Gore. A Study to Assess the Academic Stress and Coping Strategies used among the undergraduate nursing students from selected colleges of Pune City. Asian J. Nursing Education and Research. 2021; 11(2):183-188. doi: 10.5958/2349-2996.2021.00045.8

18- Shrestha S, Ghimire S. Stress and selfesteem among nursing students at private medical college, Chitwan. Journal of Chitwan Medical College. 2019; 9(27): 41-46.JCMC

19- Safi Alzeyadi, Saja H. Mohammed, Medico-legal Update, January-March 2020, Vol.20, No. 1. DOI Number: 10.37506/v20/i1/2020/mlu/194415

20- Hiranmayee Sarma, Dr Bibi Bordoloi. Indian Journal of Psychiatric Nursing. 2018; 15(2)

Received on 28.02.2023 Modified on 26.04.2023

Asian J. Nursing Education and Research. 2023; 13(3):189-193.

DOI: 10.52711/2349-2996.2023.00040