Depression, Anxiety and Stress Levels Among the First Year Nursing Students

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Nursing involves activities and interpersonal relationships that are often stressful. A study done in Iran found that first-year students experienced greater stress than students in subsequent years whereby mean stress was significantly greater in first year than in fourth year nursing students with p = 0.009 4. Coping has been viewed as a stabilizing factor that may assist individuals in maintaining psychosocial adaptation during stressful events. There are many ways to cope with stress. In this study, transference coping strategy (crying, sleeping, eating, listening to music, hang out with friends, take a deep breath, shopping, watch television, take a bath, screaming, internet surfing, sports, punch something and do household chores) was used as the choice of coping strategy. Most of the participants in this study will cry and sleep to cope with their stress, 18.5% will eat, 9.5% will listen to music and 4.2% will hang out with their friends. In a study done in Hong Kong, whereby four types of coping strategies (transference, stay optimistic, problem solving, and avoidance) were used as the choice of coping strategies among nursing students, transference coping strategy was the most frequently used5. This is because, transference coping strategies may be easier and more convenient to use compared with other strategies. Besides that, students have not known or learnt about types of effective or useful coping strategies during clinical practice. Moreover, students' stress may be considered as a temporary symptom because they have less responsibility in caring for patients. Also, they can rely on their clinical supervisors when problems arise. Transference strategies may therefore be effective over a short period5.

According to table 1, 41.1% of students have no depression, while 58.9% of students have depression. Among the depressed student nurses, 32.1% have mild depression, 16.1% have moderate depression, 8.9% have severe depression, and 1.8% have extremely severe depression. This decreasing trend of severity of depression is in keeping with other study6, which revealed that the relation of severity of depression is inversely proportionate to the percentage of nursing students involved. For example, the mildest severity of depression comprises the most nursing students, and vice versa. Depression in students is primarily caused by adaptive difficulties and stresses7-8. Disorientation regarding the university environment in the first year students together with separation from their families, lack of interest in their courses, difficulty with teachers and other students, economic and dormitory problems may all lead to psychiatric problems and failure in academic achievement9.

Based on table 1, 42.3% of students have no stress, while 57.7% of students have stress. Among the stress student nurses, 23.8% has mild stress, 22.0% has moderate stress, 7.7% has severe stress, and 4.2% has extremely severe stress. Therefore, the severity of stress is inversely proportionate to the percentage of student nurses in this study. Based on the study done by Naiemeh et al about the experienced stressors among Iranian nursing students showed that the most frequent academic source of stress was "increased class workload" (66.9%) and the most frequent environmental sources of stress were being "placed in unfamiliar situations" (64.2%)4. Nursing students have the same academic stressors as other college students, such as midterm and final examinations, research papers and other assignments11. In addition, nursing students experience a clinical component, which is highly stressful. Students have a large amount of preparatory work before their clinical assignments. They often must travel long distances to clinical sites and use highly technical equipment11-12. In addition, they must perform procedures that can cause serious harm to their patients, thus enhancing their fear of making mistakes. Studies indicate that nursing students may be...
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