Stress and Coping Strategies among Undergraduate Nursing Students in University of Calabar, Nigeria

Monday, 9 November 2015

P. E. Samson-Akpan, PhD, MPH, BSc, RN/RM, RNE, FWACN1
Mildred E. John, PhD, BSc, RN, RM, RNE, FWACN1
Olaide Bamidele Edet, BSc, MPH, PhD, RN, RM, RNE, FWACN2
Regina E. Ella, PhD, MEd, BSc, RN, RM, FWACN3
(1)Department of Nursing Science, University of Calabar, Calabar, Nigeria
(2)Department of Nursing Science, Faculty of Allied Medical Sciences, College of Medical Sciences,, University of Calabar, Cross River State, Nigeria, CALABAR, Nigeria
(3)Faculty of Administration Management and Education (FAME), West African College of Nursing, Calan, Nigeria


Stress commonly occurs among health workers and medical students including undergraduate nursing students (Amr et al. 2011; Rajesh Kumar, 2011; Shamar & Kaur, 2011; Eswi, Radi & Youssri, 2013). Different kinds of stressors affect students such as the pressure of academics with the responsibility to succeed, not knowing the future outcome and inability to integrate into the system. Students grapple with social, emotional, physical and family problems which may interfere with academic performance (Shamar & Kaur, 2011). A high level of stress can cause physical and mental health problems, reduced self-esteem and result in low academic achievement. Studies within and outside the country have examined stress among medical students, radiography students (Ugwu & Ugwumba, 2013); diploma nursing students (Rajesh Kumar, 2011; Shamar & Kaur, 2011), undergraduate nursing students in Egypt (Amr et al. 2011) but there is no study in Nigeria addressing undergraduate nursing students’ stress. Therefore, the main aim of the study was to assess the level of stress and the coping strategies used by the undergraduate nursing students in the University of Calabar, Nigeria.


A descriptive study was undertaken in the Department of Nursing Science, University of Calabar, Calabar, Nigeria. The study population consisted of all nursing students in the department. A purposive sampling technique was used to select a sample of 154 students in the third to fifth year of study in the Bachelor of Nursing Science Degree Programme. The instrument for data collection was a Perceived Stress Scale (PSS) developed by Cohen, Kamarek, & Mermelstein, (1983) and Nursing Students Coping Orientation for Problems (NUSCOPE) modified from Adolescent Coping Orientation for Problem Experiences (ACOPE). ACOPE was developed by Patterson and McCubbin (1987). PSS which has 14 items on Likert Scale was modified by the researchers to ensure that it was sensitive to the needs of the students. The items were increased from 14 to 15; and the instrument has a content validity index of 0.87 and a test retest reliability coefficient of 0.78. NUSCOPE content validity index was 0.80 while a test retest reliability of the instrument was 0.82. Data collection was done face to face by the researchers.   Data analysis was done using SPSS version 20. Statistical analysis utilised descriptive statistics, Independent t test and One-way analysis of variance. Ethical approval was given by Cross River State Ministry of Health Ethical Committee.


The mean age of the respondents was 28.91+7.61; majority were females 136(88.3%); mostly admitted through University Matriculation Examination 88 (57.1%) while 63 (40.9%) were Direct Entry Students. The mean of perceived stress within the last one month was 39.15+7.13 while the respondents 101(65.6%) experienced moderate stress and 52 (33.8%) had high or severe stress. The findings of this study is supported by Amr et al. (2011); Rajesh Kumar (2011); Shamar & Kaur, (2011). The most commonly used coping strategies were: seeking diversion 27.73+4.27; self-reliance 18.05+3.43; avoiding 17.71+3.90 while the least commonly used was being humorous 4.07+1.63. These results are also in consonance with the findings of Rajesh Kumar (2011).  However, there was no significant statistical difference in gender with regards to stress (p<0.05). One way analysis of variance showed that there was a significant difference in mode of entry, level of students and the level of total stress (p<0.05).


It was concluded that majority of the respondents suffered from stress, therefore, there is need for stakeholders to design programmes that will reduce stress, health educate and encourage the students to utilize other healthy coping strategies to enhance health promotion.