Purpose: To examine the effect of the Self-Care Education for Nursing Students (SCENS) program on self-care efficacy, coping, sleep, disordered eating and alcohol use among junior nursing students.
Methods: Undergraduate nursing students are fiercely driven students, but along with this drive to achieve comes a significant amount of stress and anxiety. Often these students develop unhealthy coping mechanisms such as alcohol use, disordered eating, and sleep disturbances (Barry & Piazza-Gardner, 2015; Carvalho Bos, et. al, 2013; Gaultney, 2010; Hershner & Chervin, 2014; Schaumberg, Anderson, Reilly & Anderson, 2014). Nursing students can lack healthy self-care and effective coping strategies while learning to care for others. Lack of appropriate self-care practices can lead to deviations in health status which can have detrimental effects on the physical and mental well-being of nursing students as well as their academic performance (Carvalho Bos, et. al, 2013; Hershner & Chervin, 2014; National Eating Disorders Association, 2015). It is therefore necessary to identify effective intervention programs that will improve self-care practices, healthy coping, and self-care efficacy which in turn leads to increased overall general health and well-being in these students.
The sample consisted of 70 junior nursing students beginning the traditional nursing program at a college in Upstate New York. The Self-Care Education for Nursing Students Program (SCENS) is a mandatory part of the nursing program and consists of three meetings with a graduate counseling student. These meetings took place in the first, eighth, and final week of classes. Meetings consisted of groups of approximately 25 students each. The first meeting focused on how healthy eating and sleeping aid in stress management and self-care. The second meeting covered use of drugs and alcohol and how they can hinder self-care and impair coping. The third meeting included healthy coping strategies. For each of the three meetings, students were directed to on-campus resources for help if needed. The study was explained to the nursing students and if a participant chose to participate, they signed a consent form and completed the questionnaires. There was no penalty for non-participation. The following instruments were utilized: AUDIT-Enhanced measured alcohol; the Exercise of Self-Care Agency Scale (ESCAS) measured self-care agency; the Coping Self-Efficacy Scale (CSES) measured coping self-efficacy; the Eating Disorder Diagnostic Screen (EDDS), questions 1 – 5 and 15 – 18, measured disordered eating, and; the Sleep Difficulty Index measured sleep difficulties. Data were analyzed using descriptive statistics and paired t-tests utilizing SPSS version 22.0.
Results: A final sample size of 65 students participated in the study. Participants were mostly Caucasian female students (75.9%, 88.9% respectively) with an average age of 20.8 years old. Most were never married and without a partner (59.3%) and half of the students were working. The vast majority were not caregivers (92.6%) and did not engage in volunteer activities (85.2%). Only 32.5% reported that they spent time each week on supporting their spiritual needs. Participants had a mean pre-program sleep difficulty score of 7.82 (SD 2.169) and a mean post-program score 8.46 (SD 2.187). However, 18.5% had scores from 11 to 13 indicating significant difficulty sleeping. Higher scores reflect greater difficulties with sleep. The majority of the students (62.9%) reported having suffering from sleeplessness from 1-2 times a month to more than once a week. Students also reported that the sleeplessness did affect their ability to work (66.1%) and most reported having difficulties falling asleep (75.8%) and having woken up in the night and not being able to go back to sleep.
The mean pre-program AUDIT-Enhanced score was 5.52 (SD 4.023) and the mean post-program score was 6.53 (SD 5.173). A score of 8 or greater indicates harmful or hazardous drinking. The majority of the students reported drinking alcohol (90.3%) with 66.1% reporting drinking between 1 to 4 drinks on the occasions that they were drinking, 25.4% drinking 5 or 6 drinks, 6.8% having 7 to 9 drinks and 1.7% 10 or more drinks. Approximately 64% reported having drank 5 or more drinks on one occasion at least monthly, with 19.4% reported weekly. Several students (32.2%) reported feeling guilt or remorse after drinking and 35% reported being unable to remember what happened the night before because of drinking. Students 23% reported drinking alone (23%), while depressed (19.7%), when they felt nervous (27.9%) and reported drinking to forget their problems (23%).
The pre-program mean score for the questions 1-4 of the Eating Disorder Diagnostic Scale was 12.03 (SD 7.485) and the post-program mean score was 15.05 (SD 9.054). A significant percentage of students (79%) reported feeling slightly to extremely fat and 54.8% had a moderately to extreme fear of gaining weight (54.8%), with 16.1% reported extreme fear of gaining weight. Several students (48.5%) also reported that weight has influenced how they think of themselves, and 55.6% have reported consuming an unusually large amount of food on occasion in the past 6 months. However, none reported having made themselves vomit or use laxatives as a way to prevent weight gain although 11.2% did report fasting or skipping meals at least once a week to prevent weight gain and 19.4% report having exercised excessively to prevent weight gain.
The mean pre-program score for the Coping Self-Efficacy Scale was 178.06 (SD 35.01) and the mean post-program score was 176.15 (SD 39.79). The mean pre-program score for the Exercise of Self-Care Agency Scale was 154.50 (SD 13.826) and post-program score was 154.53 (SD 14.083). Higher scores reflect greater coping self-efficacy and exercise of self-care agency. There were no statistically significant differences in scores between the pre-program measures and the post-program measures.
Conclusion: Results of the study indicate that junior nursing students have self-reported difficulties with sleep including sleeplessness. Students also have significant issues with some disordered eating patterns related to body image perception and alcohol use, with a small percentage reporting binge drinking. This finding is consistent with the literature regarding alcohol use among nursing and health care students (Barry & Piazza-Gardner, 2015; Carvalho Bos, et. al, 2013). Students did have higher levels of perceived coping, self-care efficacy and exercise of self-care agency. Although there were no statistically significant differences in the pre and post program scores, the findings highlight the continued stressors faced by nursing students as they progress through the nursing program. These factors may contribute to unhealthy and ineffective coping strategies and ultimately affect academic performance and achievement. Further studies need to be conducted to develop effective programs to help address these issues for nursing students.