Coping Mechanisms

The complexity of human activities causes a lot of effects to the lives of every individual. Whatever the effect of these activities, favorable or not, man is affected particularly in the aspect on how every activity is to be carried out using his physical strength thus making him stressed eventually. It is normal for people to experience stress but when it comes, every person should be ready to handle it in order for its effect to become favorable on his part.

Though generally, its effects are negative. In the view of many people, on the other hand, it can benefit others in some ways.

No one can live without experiencing some degree of stress at all times (Selye1987). Stress nowadays plays a great part not only on students but also in each person’s daily living, it occurs when there is an imbalance between the demands of life and our ability to cope with them. Most people know something about stress.

One may think that only serious disease or intensive physical or mental injury can cause stress, this is false (Selye1978). Job pressures, school works, family arguments, financial pressures and not having enough time are just few of the stressors that people at the present day society faces daily.

In fact, it has been accepted in the society that everyday stress is part of modern living (Murray and Pizzorno, 1998). Everyone thinks that taking up Bachelor Science of Nursing as a course needs a lot of patience and hard work. Students must take it seriously because time, effort and money are really at stake.

If you are not decisive enough or hasty, it would be better to stop and don’t pursue it at all. Everyone has a dream, if you don’t have something to hold on to reach your goal, you should think not only once or twice.

What differs of taking BS Nursing as a course from the other courses is that it demands a lot of patience and effort. Enlisted below, are the top difficulties that a student may encounter while pursuing this endeavor. Financial predicaments. We are not only talking about tuition fee that ranges twenty to forty five thousand pesos, but also the allowance needed for a student to survive a day that includes transportation, meals, photocopy for hand outs, books and other supplies and paraphernalias. Time. Clashing of schedules can’t be avoided.

When it comes to performing Related Learning Experience outside the Manila Central University, some professors are conducting examinations or quizzes on the schedule given to different groups because not all students could make it, so there should be a clear agreement from the professor and students when it comes to schedule. Punctuality. It is not really a difficulty but a major concern. If a student could only wake up early to avoid traffic or any unreliable excuses, maybe the percentage for make-up duties of students will be low or eradicated. Grading system.

The grading system of Bachelor Science of Nursing is tremendously different from the other courses. Its passing rate is expected to be seventy five percent unlike the others which is fifty percent. The pressure rises here but the advantage of it is that students are forced to excel and strive harder in order to meet its criteria to pass which prepares them in local board examination. Teaching styles competencies. Everyone can teach but not all can be good at this. A professor which is really an expert in his field sometimes have a higher expectation from the students.

He tends to speak fast when discussing without realizing that students couldn’t understand what he was saying so most of the student just rely on notes, memorizing but not understanding or put it on their hearts that’s why most of the students fail when it comes to analytical type of examination especially when it comes to multiple choice because of confusion. Students have different personalities and uniqueness to perform strategies in order to cope with these difficulties that they could encounter that’s why in spite of the predicaments stated above, huge number of graduates is still expected.

Some may give up and fail, some fails but still chose to stand up. STATEMENT OF THE PROBLEM This research study was undertaken to determine the difficulties encountered in nursing course and the stress coping mechanisms of selected BSN 4 students of Medical Colleges of Northern Philippines Specifically, this study sought to answer the following questions:

  1. What are the perceived levels of stress among selected BSN 4 students of Medical Colleges of Northern Philippines in terms of: a. ) Studies b. ) Family c. ) Friends d. ) Relationship
  2. Which of these stressors has greatly contributed to the stress felt by the students thus affecting the performance of the nursing students?
  3.  What are the coping mechanisms the respondents used to manage their stress and improve their performance?


This study will serve as a guiding tool for student nurses whenever they encounter difficulties or problems which bring them stress. It will enlighten them about stress coping strategies which they can use. The researchers believe that through this project study and being student nurses themselves, it will be a great help if we could describe and enumerate thoroughly the difficulties encountered in the nursing course and the stress coping mechanisms in a specific pattern so that our fellow selected BSN 4 students of Medical Colleges of Northern Philippines will have additional knowledge on the most common ways of coping in different situations encountered in our daily lives as student nurses. We are aware that every student has their own way of coping in every difficult situation. We just want to ‘dig in’ more deeply. As we all know, being a nurse is a very hard job.

It is very stressful. And knowing that not all people have the same personalities and attributes, every person has their own way of relaxing or unwinding. We would like to study further the ways of our fellow students on their stress coping mechanisms. And to sum it up, the researchers would enumerate different situations/difficulties a nurse or a student nurse may encounter in the classroom and in hospital duty. Scope and Delimitations This study will discuss the different difficulties or problems encountered and the ways of coping of student nurses.

The researchers believe that being a registered nurse and being a student nurse has its differences. The researchers would like to focus more on students, knowing that student nurses not only have hospital duties but lecture days as well. The difficulties of registered nurses are more serious in the sense that they have bigger responsibilities than student nurses. This study was conducted last September to October 2013. The sample population is limited to BSN 4 students of the College of Nursing. The scope will be about The most commonly used coping mechanisms.


This study will aim to explore the lived experiences of a nursing senior student about the difficulties that they encountered in the nursing course and the stress coping mechanisms that they do. The research questions that will be addressed in this study guided the development of the following hypothesis: Conceptual/Theoretical Framework Sister Callista Roy developed the Adaptation Model of Nursing in 1976. This model comprises the four domain concepts of person, health, environment, and nursing and involves a six step nursing process. Andrews & Roy (1991) states

that the person can be a representation of an individual or a group of individuals. Roy’s models see the person as “a bio-psychosocial being in constant interaction with a changing environment” (Rambo, 1984). The person is an open, adaptive system who uses coping skills to deal with stressors. Roy sees the environment as “all conditions, circumstances and influences that surround and affect the development and behavior of the person” (Andrews & Roy, 1991). Roy describes stressors as stimuli and uses the term ‘residual stimuli’ to describe those stressors whose influence on the person is not clear (Andrews & Roy).

Originally, Roy wrote that health and illness are on a continuum with many different states or degrees possible (Rambo, 1984). More recently, she states that health is the process of being and becoming an integrated and whole person (Andrews & Roy). Roy’s goal of nursing is “the promotion of adaptation in each of the four modes, thereby contributing to the person’s health, quality of life and dying with dignity” (Andrews & Roy). These four modes are physiological, self-concept, role function and interdependence.

Roy employs a six-step nursing process which includes: assessment of behavior, assessment of stimuli, nursing diagnosis, goal setting, intervention and evaluation. In the first step, the person’s behavior in each of the four modes is observed. This behavior is then compared with norms and is deemed either adaptive or ineffective. The second step is concerned with factors that influence behavior. Stimuli are classified as focal, contextual or residual (Rambo, 1984). The nursing diagnosis is the statement of the ineffective behaviors along with the identification of the probable cause. In the fourth step, goal setting is the focus.

Goals need to be realistic and attainable and are set in collaboration with the person (Andrews & Roy, 1991). Intervention occurs as the fifth step, and this is when the stimuli are manipulated. It is also called the ‘doing phase’ (Rambo). In the final stage, evaluation takes place. The degree of change as evidenced by change in behavior, is determined. Ineffective behaviors would be reassessed, and the interventions would be revised (Andrews & Roy). Source: http://en. wikipedia. org/wiki/Adaptation_model_of_nursing Operational Definition of Terms The following are terms defined by the researchers to ensure clearer

understanding and appreciation of the study: Adaptation- The process or state of changing to fit new circumstances or conditions, or the resulting change (Encarta Encyclopedia) Affectivity- This means causing a result, especially the desired or intended result. (Encarta Encyclopedia) Competency- The ability to do something well or to a required standard (Encarta Encyclopedia) Coping mechanisms- It is a behavioral tool which may be used by individuals to offset or overcome adversity, disadvantage, or disability without correcting or eliminating the underlying condition. Coping skills are also sometimes called work-arounds.

Virtually all living beings routinely utilize coping skills in daily life. These are perhaps most noticeable in response to physical disabilities. (Encarta Encyclopedia) Stress- It is a strain felt by somebody: mental, emotional, or physical strain caused, for example by anxiety or overwork. It may cause such symptoms as raised blood pressure or depression. (Encarta Encyclopedia) Stressors- These are something that causes stress: an activity, experience, or other situation that causes stress, for example lack of water to a plant or overwork to a person (Encarta Encyclopedia).

CHAPTER II Review of Related Literature and Studies Local Literature

The following is a summary of the difficulties encountered and stress coping mechanisms of nursing students locally: A nursing student’s life will always be laborious and compelling. Intellectual, physical, and sometimes emotional demands can be encountered in the Nursing discipline. Most Registered Nurses at present had experienced the same predicaments and challenges, in varying degrees, before becoming the great nurses they are today.

The prime way on how to deal with the BSN life is to have this realization: It’s never easy to become a nurse. One must pour on a great deal of hard work. Tina (http://nurses. definitelyfilipino. com/index. php/2010/12/a-bsn-students-guide-to-nursing/) is a well organized blog for Filipino Nurses. [1] In the article stated above, it says that being a nurse is not an easy job. It requires passion, effort, and patience. It’s normal for nurses to have a very stressful routine.

But because of individual differences of people, we all have our own ways of dealing with stress, some of us want to eat or maybe meet friends after school or work, sleep. It’s a definitely a fact. We have our own individuality. Even at the early beginning of life, stress is being encountered. It appears to be a universal condition which everyone young or old, married or unmarried, Filipino or foreigner, poor or rich, learned or not learned — experiences or develops. In other words, it affects all kinds of people from different walks of life. There are many events in life that can cause stress.

It could be generic, physical, chemical, psychological, cultural, ecological or occupational in nature. Simbulan (http://www. jpsimbulan. com/2008/11/19/stress-and-the-working-nurse/) is a site for researches in local nursing and other fields. [2] Nurses are not far exempted from facing many stressful things. It has been recognized that the world he lives is a potent source of stress. Nursing is a profession that demands high level of responsibility because it promotes individualized, sensitive, relevant and effective nursing care to patients.

Thus, levels of stress are associated with the jobs that are too varied and demanding. Nurses are very much capable of developing a great deal of stress causing either physical or psychological responses in terms of accomplishing the jobs in the hospital settings, as well as in meeting their responsibilities in their respective home because of these hectic activities they have less opportunities for social interaction. Therefore, there is a great for need for studies in order to determine the sources of stressful factors that the behavior of nurses.

When a certain individual for example, experiences a stressful situation, that person may try to cope up by making an effort to change the situation into a good one and avoids intolerable situations. Almost all literature claims that work factor produces stress in different levels and that the people vary in their ability to cope with them. In recent years, researcher had begun to investigate costly consequences of occupational stress burnout. Burnout is a state of physical and emotional exhaustion that occurs gradually over a period of time.

First described in 1974 by Freudenburger, the “burned-out” are usually professionals who work in people-intensive jobs that are emotionally demanding which is primarily nurses and social workers are likely to be affected. Physical symptoms typically include chronic fatigue and frequent minor illness, such as colds, that resolve slowly. Burned out people spend an overabundance of time at work but are disorganized, easily angered and accomplish little. The most distinguishing characteristic of burnout is the way burned out distance themselves from clients in which distancing is accomplished through depersonalization manner.

The burned-out are professionally committed, highly idealistic individuals who over identify in their personal life. Believing their work will make a significant social difference and be financially as well as emotionally rewarding. And these individuals are unprepared for the day to day realities of their jobs that results from suffering stress-related illnesses. As it is commonly used, stress is referred as a “burden or load” under which a person survives or cracks.

It was also been defined as any internal or external influence that interferes with satisfaction of basic needs or somewhat a thing, which disturb homeostasis. This may be a disturbance in the body homeostasis, general or severe enough to produce a coordinated body response. These responses include renal, respiratory, metabolic, sympathetic and circulatory reactions. A well-known psychologist, Hans Selye, also a world renowned authority defined stress as the non-specific response of the body to any demand made upon it. He coined “stressor” as a factor or agent that produces stress.

He further stated that the body’s response to stress is non-specific because it occurs without regard to and very much independently of, the specific stressor; thereby non-specific response to stressor is the essence of stress. Human beings are viewed as an open system which is constantly reacting to his internal and external environment. There will always be occurrence of influential factors that could cause great response of threats to the constancy and stability of the person. During early 1980’s, psychologists had come up of listing stress and had developed certain scales to be stressed and can prepare for this occurrence.

The person must be able to adapt himself and master his coping behaviors satisfactory, in a manner to maintain homeostasis. Walter Cannon pointed out that the purpose of homeostasis is freedom in which it allows the person to reach his potentials as human. Homeostasis is also associated with the person’s state of health, it is believe that when person is healthy, he is said to be in state of equilibrium. Health according to Wolff, is the absence of illness had become entrenched in many peoples’ minds and that the aspects of human holistic view is a very vital consideration not only the physical aspects as an outcome.

In other words, stress deals with how the body could adjust to the demands of life. These demands could either be threat, challenge or change that requires the body to respond, either, on the positive or negative side. Thus when the body is able to adapt to a certain demand and serves as a motivator, it is said to be responding positively. Whereas, when the body fails to adapt, in which there is much effort is released by a stress response, it is turned inward responding negatively and disrupted homeostasis occurs. In addition, effective coping is necessary in managing stress such that it is an integral part of the stress experience.

And in order to do these successfully, an individual must deal with the situation or problem, deal with the feelings, use available support and reduce the psychological arousal of stress by appropriate activities such as relaxation, exercise and others. Simbulan (http://www. jpsimbulan. com/2008/11/19/stress-and-the-working-nurse/) is a site for researches in local nursing and other fields. [3] Another study done specifically with nursing personnel showed similar findings plus other negative conditions in the job and hospital setting.

According to these researchers, stress exists as a major issue in nursing. Factors which their subjects identified as imposing job-related pressures were: staff shortages, increased demands by management, the need for greater knowledge and skills (compared with requirements when first employed), patients who were more critically ill, and an unmanageable work load (in terms of maintaining quality of work). Nurses and student suffered from unrealistic self-expectations, a high-intensity work environment and an increasing number and variety of health workers with whom care of patient was coordinated.

The scenes of smiling and laughing Filipinos, singing and dancing (and drinking) away can be deceptive. Quite often, Filipinos especially the young ones and the students deal with stress by trying to be “happy. ” I put that in quotes because the Filipino term is masaya, which is really more of an externalized merriment. Masaya is social camaraderie, it’s making cheer and quite often we do it precisely because there have been unhappy events, stressful events. The best example is that of a death — our wakes are notorious for its merry-making, but that, precisely, is part of our stress-coping mechanism.

We have folk psychology, maybe even folk psychiatry, at work here, Filipinos aware of how dangerous it is to allow stress to consume us. We warn people about excesses as a cause of illness, and that includes the excessive emotions generated by stress. But for all the talk about our communitarian orientation, of helping friends to overcome stress, social pressures in the Philippines can also be counterproductive with the way we sometimes force people to repress the stress. “Enjoy! ” we urge them, not realizing there are limits to resilience.

There are power dimensions to all this, such as those found in gender. Contrary to stereotypes about women student being more expressive, Filipinas are actually more prone to dealing with stressful situations through tiis (endurance) and kimkim (repression). Check out the local scenes of merriment: it’s usually men students having a good time, bringing out the beer and toasting their problems away, while their women look for ways to make ends meet. Men, students too, are expected to keep their feelings in check, but more out of masculine values of strength and stoicism.

Men are generally not allowed to cry, much less to go into hysterics; and this probably helps to explain why more men suffer from cardiovascular disease. According to Dr. Lourdes Ignacio many students will express their stress by complaining about recurring headaches, or abdominal pains, accompanied by dizziness, nausea, fatigue. Doctors used to dismiss these as being all in the mind, but it has become clear the physical pain and distress may be quite real, that the pent-up stress is expressed through the body.

The macho imperatives around stress are inevitably tied to alcohol and drugs. Younger male Filipinos especially nursing are particularly vulnerable, given their struggles with identity, masculinity and self-esteem, unable to express their frustrations and resentment. Drugs are one way of dealing with the stress, with all its attendant problems. It’s significant though that the most abused drugs are metaphetamines, which are “uppers” or stimulants. Again, the Filipino response to stress is to look for more stimulation.

The nerve cells fire away until, frayed and exhausted, the user develops paranoia (borrowed into Filipino as praning) and then psychosis. Ignacio said Filipinos have their own natural coping mechanism compared to other nationalities. She said Filipinos’ strong faith in God, sense of humor and concern for others, are among the mechanisms that help them cope with depression. We are very much crisis-oriented and we have natural ways of coping with it,” she said. Ignacio said they consider these as forms of coping with mental disorders even without scientific basis.

Reyes said some mental patients could function normally again after being treated. “Of course, for example, a bank manager suffered from schizophrenia, he or she cannot go back as a bank manager, but as a clerk. There is some form of regression but in terms of symptoms, they are free from symptoms, but their functioning has already regressed in some form,” he said. On the other hand, Ignacio revealed that the Philippines are facing an acute shortage of psychiatrists due to the unabated migration of mental health doctors who seek greener pastures abroad.

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