A Study to Assess the Perceived Stress and Coping Strategies among B.Sc. Nursing Students of Selected Colleges in Pune during COVID-19 Pandemic ...

International Journal of Science and Healthcare Research
                                                                                       Vol.5; Issue: 2; April-June 2020
                                                                                                     Website: ijshr.com
Original Research Article                                                                              ISSN: 2455-7587

 A Study to Assess the Perceived Stress and Coping
Strategies among B.Sc. Nursing Students of Selected
   Colleges in Pune during COVID-19 Pandemic
Deepika Sheroun1, Dapple D Wankhar2, Amita Devrani3, Lissamma PV4, S Gita5,
                            Keka Chatterjee6
  MSc Nursing Student (Psychiatric Nursing), Department of Psychiatric Nursing, College of Nursing, AFMC -
                                                      Pune -40
  Asst Professor (Psychiatry Nursing), Department of Psychiatric Nursing, College of Nursing, AFMC, Pune -40.
            Principal and HoD Department of Child Health Nursing, College of Nursing, AFMC Pune -40
                          Professor and Vice Principal, College of Nursing , AFMC Pune-40
          Professor and HoD, Department of Med &Surg Nursing , College of Nursing, AFMC , Pune-40 .
            Asst Professor , Department of Obs & Gynae Nursing, College of Nursing, AFMC , Pune -40.
                                       Corresponding Author: Deepika Sheroun

ABSTRACT                                                    Results: A total of 427 nursing students
                                                            completed the questionnaire. Male students had
Introduction: The global pandemic has                       more perceived stress score (22.73) than female
proven to be challenging for students in more               students (21.86). Majority of participants were
ways than one. Ever since in-person classes                 between 21-25 years. The maximum mean
moved online and “Stay Home Stay Safe”                      perceived stress score (22.56) was observed in
executive order was implemented; many                       4th year students, and least mean perceived
students have faced a distressing change in their           stress score (20.20) was found in 2nd year
employment status. The present study aimed to               students. On the whole the maximum mean
assess perceived stress and coping strategies               coping score (78.45) was found among 1st years
amidst the COVID 19 lockdown, among the                     and least coping score (71.23) was found among
BSc Nursing students studying in nursing                    4th year BSc Nursing students
colleges located in Pune                                    Conclusion: The present study indicates
Objectives: The objectives of the study are to              moderate level of perceived stress with mean
assess the perceived stress and coping strategies           perceived stress score of the students Nurses
of the BSc Nursing students of all batches in               being 21.88 (+4.30) and the mean coping
regard to COVID 19 lockdown, and to                         strategies score was 74.38 (+12.30). The IV
determine the association of stress and coping              Year Nursing students have the highest stress
with selected demographic variables.                        score with a mean of 22.56 ± 4.207. Hence there
Materials and Methods: This cross-sectional                 is a need to take measures by the authorities to
online study was undertaken from 15th to 20th of            reduce stress among the students.
May 2020. Participants were BSc Nursing
Students (1st -4th year), whose perceived stress            Keywords: COVID 19, Pandemic, Perceived
and coping strategies related to COVID 19,                  Stress, Coping Strategies, Nursing Students,
were assessed using an online questionnaire.                Psychological support
The tool has 3 sections consisting of
demographic data as section A, Perceived Stress             INTRODUCTION
Scale as Section B, and Coping Strategies Scale             ‘History has shown us that courage can
as section C. Score was categorised into three              be contagious and hope can take on a life
parts as good, moderate and low
                                                            of its own’
                                                             -Michelle Obama

                  International Journal of Science and Healthcare Research (www.ijshr.com)                         280
                                         Vol.5; Issue: 2; April-June 2020
Deepika Sheroun et.al. A study to assess the perceived stress and coping strategies among B.Sc. nursing
students of selected colleges in Pune during COVID-19 pandemic lockdown

         The world has seen outbreaks of              Uncertainty, poor prognosis, economic loss,
epidemics and pandemic since prehistoric              insecurity, confusion, emotional isolation,
times - 5000 BC China , 430 BC Plague of              stigma, school/work closure, inadequate
Athens , AD 165-180 Antonine Plague , The             resources for medical response, and
Black Death 1346-1353 Asia to Europe ,                deficient distribution of necessities. As a
American Plague 16th century , to the                 result people experience a lot of emotional
present age like Great Plague of London               disturbances such as stress, insomnia,
1665-1666 , Great Plague of Marseille                 frustration, irritability which could lead to
1720-1723 , Philadelphia yellow fever                 psychiatric disorders like depression,
epidemic 1793 , Spanish Flu 1918-1920 ,               anxiety, behavioural changes (substance
Asian Flu: 1957-1958 , SARS pandemic                  abuse), also post-traumatic stress disorder in
2003 , H1N1 Swine Flu pandemic: 2009-                 later stages. [5] Some groups may be more
2010 , West African Ebola epidemic: 2014-             vulnerable than others to the psychosocial
2016 , Zika Virus epidemic: 2015-present              effects of pandemics. In particular, people
day. [1] Covid Pandemic, which is currently           who contract the disease, those at
affecting the world with its origin in Wuhan,         heightened risk for it (including the elderly,
China started in Dec 2019. Affecting nearly           people with compromised immune function,
all the countries in the world it is a historic       and those living or receiving care in
health emergency condition the world has              congregate settings), and people with pre-
ever seen which is even worse than world              existing medical, psychiatric, or substance
war II.                                               use problems are at increased risk for
         The rate of contagion and patterns of        adverse psychosocial outcomes. [6]
transmission is threatening the whole                         The psychological issue can worsen
mankind.                                              with social distancing and the lockdown
Pandemic is the outbreak of a disease that            measures taken by administrations as
occurs over a wide geographic area and                observed in many countries worldwide.
affects an exceptionally high proportion of                   Limacaoco et al (Apr 2020) In a
the population: a pandemic outbreak of a              descriptive study titled Anxiety, worry and
disease. [2]                                          perceived stress in the world due to the
         The occurrence of Pandemic had               COVID-19 pandemic, March 2020 which
increased over the last years with global             was conducted in 41 countries, revealed that
warming, urbanization, globalization, and             significant higher scores of perceived stress
exploitation of natural resources. With the           were observed among women, youth,
previous epidemic and pandemic, the                   students, and among those who expressed
International Health Regulation and WHsO              concern and those who perceived increased
prepared to meet specific standards for               susceptibility to the COVID-19. [7]
detecting, reporting on, and responding to                    Lee J in an article published in
outbreaks. [3] Despite these improvements,            Lancet (Apr 2020) explains the effects of
significant gaps and challenges exist in              COVID 19 pandemic on students. In a
global pandemic preparedness. Pandemics               survey, which included 2111 participants up
not only impact the mortality morbidity but           to age 25 years with a mental illness history
also stagger the economic growth, delays              in the UK, 83% said the pandemic had made
development. There is social disruption,              their conditions worse, 26% said they were
political tension and individual behavioural          unable to access mental health support; peer
changes, such as fear-induced aversion to             support groups and face-to-face services
workplaces and other public gathering                 have been cancelled, and support by phone
places. [4] Pandemic affects the mental               or online can be challenging for some young
health of individual as a total result.               people. [8]
         Pandemics like COVID 19, affects                     According to India Today (07 Apr
the mental health due to numerous reasons –           20) there are three major education

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                                      Vol.5; Issue: 2; April-June 2020
Deepika Sheroun et.al. A study to assess the perceived stress and coping strategies among B.Sc. nursing
students of selected colleges in Pune during COVID-19 pandemic lockdown

problems that students and educators                  pandemic can be very challenging. As there
currently face due to the Covid-19                    is no current study done in India among
pandemic: 1. Students caught in the cross-            nursing student, the present study attempts
wire. These are those students who are                to explore the perceived stress and the
caught in the limbo on account of education           coping strategies utilized by the BSc nursing
outcomes being withheld due to the Covid-             students in the COVID 19 pandemic
19 pandemic. Some of them do not have a               lockdown.
result because exams either did not happen            Title of the study: A study to assess the
or were left in the middle. 2 .Students one           perceived stress and coping strategies
year away from school or college-leaving              among BSc Nursing students of selected
exams. 3. Education disruption. In response           colleges in Pune during covid 19 pandemic
to the Covid-19 scare, many schools and               lockdown.
colleges have moved online and parents                Objectives:
seem to have assumed the role of teachers.            1. To assess the perceived stress of the BSc
Again, while there are a ton of fantastic                 Nursing students of all batches in regard
resources which are available, there are not              to covid 19 lockdown.
too many resources which mimic the school             2. To assess the coping strategies adopted
that is, provide for multidisciplinary                    by the BSc Nursing students of all
learning, encourage connections across                    batches in regard to covid 19 lockdown.
different domains and inspire ideas which             3. To find the association of the perceived
help a child develop 21st century skills and              stress level of the BSc Nursing students
prepare themselves for the jobs of the                    with selected socio demographic
future. [9]                                               variable.
         A survey done was by Dartlet et al           4. To find the association of Coping
2020 (US) to assess the effect of COVID 19                strategies adopted by the BSc Nursing
on college students. 4 in 5 students see their            students      with      selected    socio
institutes as trustworthy sources of COVID-               demographic variable.
19 information. 4 in 5 students report having         Inclusion Criteria:
to make large or drastic life changes to              1. All BSc Nursing students can participate
accommodate the current COVID-19                      in the survey
situation. Despite being digital natives, most        2. Age should be 17-25 yrs
students are not fully comfortable with an
exclusive online learning medium. [10] Thus           Exclusion Criteria:
it is obvious that the covid 19 pandemic has          1. Participants residing in other cities than
a negative impact on the student’s life.              Pune city were not included in the study.
         With the imposing stress of COVID
19 on the students, the present study is              Operational Definition:
focused on the perceived stress by the BSc            1. BSc Nursing Students: All students
nursing students . Previous studies from UK           undergoing I , II, III , IV Basic BSc Nursing
and India have revealed that nursing                  course in various Nursing colleges in Pune.
students face comparatively higher level of           2.Lockdown: Restrictions imposed on the
stress as compared to their counterparts in           general public to remain indoors and
other colleges. [11-12]                               maintain social distancing with each other in
         Senturk et al (2018) in Turkey               the outbreak of pandemic.
determined in a descriptive study done on             3. Perceived Stress: Perceived stress is the
the nursing students that the level of stress         feelings or thoughts which the BSC Nursing
faced by them was above moderate level. [13]          students have about how much stress they
         Therefore, dealing with the hectic           are since being under lockdown in the past
student nursing life the drastic lifestyle            one month.
changes imposed due to COVID 19

               International Journal of Science and Healthcare Research (www.ijshr.com)            282
                                      Vol.5; Issue: 2; April-June 2020
Deepika Sheroun et.al. A study to assess the perceived stress and coping strategies among B.Sc. nursing
students of selected colleges in Pune during COVID-19 pandemic lockdown

4. Coping strategies: Coping strategies               and lower levels indicating lower levels of
refer to the specific efforts, both behavioral        stress. [13]
and psychological, that the BSc Nursing               iii) Brief Cope Strategy Scale :
students are employing to master, tolerate,                    The Brief-COPE is a 28 item self-
reduce, or minimize stressful events during           report questionnaire designed to measure
lockdown.                                             effective and ineffective ways to cope with
                                                      a stressful life event. [15] “Coping” is defined
MATERIALS AND METHODS                                 broadly as an effort used to minimize
Design : Cross sectional Descriptive study            distress associated with negative life
Population : College Students                         experiences. The scale can determine
Target population: BSc Nursing students               someone’s primary coping styles such as
Accessible population : BSc Nursing                   Emotion Focused Coping, Problem Focused
Students of various colleges in Pune                  Coping, Adaptive Coping and Maladaptive
Sampling Method : Purposive sampling                  Coping.
Data collection tool : Online Questionnaire           Validity: The Brief-Cope was developed as
consisting of 3 sections                              a short version of the original 60-item
i) Sociodemographic data                              COPE scale (Carver et al., 1989), which was
ii) Modified Perceived Stress Scale                   theoretically derived based on various
iii) Modified Brief Coping Strategies Scale           models of coping. The Breif-Cope was
i) Sociodemographic Data :                            initially validated on a 168 participant
It conists of 10 questions – Gender , Age ,           community sample whom had been
Year of study , Basic qualification ,                 impacted by a hurricane (Carver, 1997), and
Religion , Residing with family or in hostel ,        shown to have adequate factor structure.
Family status , Parents qualification,                Data Measurement : Data measurement
Comorbidity in the family and Source of               was done by self administered online survey
information about COVID 19 .                          Method of data collection :
ii) Perceived Stress Scale                            1. Permission was taken from the
Perceived Stress Scale was developed by                    psychiatric department to conduct the
Sheldon Cohen in the year 1983. [14]                       study and ethical clearance was
The Perceived Stress Scale (PSS) is the                    obtained.
most widely used psychological instrument             2. Participants who were meeting the
for measuring the perception of stress. The                inclusion criteria were selected by
scale also includes a number of direct                     convenient sampling.
queries about current levels of experienced           3. Consent from the participants were
stress. The items are easy to understand, and              obtained and the purpose of the study
the response alternatives are simple to                    was explained to them through online
grasp. Moreover, the questions are of a                    survey questionnaire.
general nature and hence are relatively free          4. The self administered questionnaire
of content specific to any subpopulation                   consisted of socio demographic data,
group. The questions in the PSS ask about                  Perceived Stress Scale and Brief Coping
feelings and thoughts during the last month.               Strategies Scale.
In each case, respondents are asked how               5. An email was provided to the
often they felt a certain way.                             participants to give their comments or to
        Stress among nursing students was                  write to the authors.
measured using a previously validated                 6. Participants who were unwilling to
(Cronbach's α coefficient of internal                      complete the questionnaire due to
consistency 0.85) perceived stress scale                   personal reasons were free to withdraw
(PSS). The scale yielded a single score, with              from the study .
high scores indicating higher levels of stress

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                                      Vol.5; Issue: 2; April-June 2020
Deepika Sheroun et.al. A study to assess the perceived stress and coping strategies among B.Sc. nursing
students of selected colleges in Pune during COVID-19 pandemic lockdown

7. The questionnaire were taken from the              females. The maximum number of
   participants and analysis was done                 participants were in their final year of study
   further .                                          (31.9%).
8. Confidentiality of the collected data was          Hinduism was the most followed religion
   maintained and used only for the                   (81.0%). Almost all of the participants were
   research purpose .                                 residing in hostel (92.3%) belonging to
9. Data collection was done from 427                  nuclear family (86.2%) and with basic
   participants on in the second week of              qualification of higher secondary school
   May.                                               (82.9%).
                                                      The participants reporting of comorbidity in
Statistical Analysis:                                 the family were only 20.2% and 61.4% of
The collected data were organized as                  the participants parents were government
descriptive, and they included the student’s          employed. Maximum of the participants
age, gender, year of study etc, the data were         received information of COVID 19 through
analysed and tabulated as percentage                  the internet.
distribution (Table 01). The mean score and
SD were tabulated for each of the measures             Perceived Stress Score (PSS) in nursing
under research, year in college, gender, age,         Students:
religion, basic qualification, family type,            The high PSS score was seen in 13.35 %
parents’s occupation, comorbidity in the                 of the participants while 82.67% of the
family and place of residing presently.                  participants     experienced   moderate
Inferential statistical analysis was done for            perceived stress. (Fig 1)
the perceived stress and coping strategies.            Among the years of study, fourth year
The mean score and SD were tabulated. The                students had the highest scores for PSS,
data were analysed using the Statistical                 followed by third -year students.
Package for the Social Sciences statistical              Second-year students had the lowest
software (SPSS -21) .                                    score.
Association between socio demographic                 None of the socio demographic variables
data was analysed using ANOVA and Mann                showed association with the PSS score.
Whitney test                                          Coping Strategies Adopted by the
RESULTS                                                As depicted in Table 2, maximum of the
        A total of 427 responders took the               participants were found to be having
survey from different Nursing Colleges. The              moderate coping strategies score 76.58
study was carried out through online survey              %, while as only 18.5% of the
after the questionnaires were prepared on                participants had high coping strategy
Google form and passed on to the                         scores and 4.9% of the participants had
participants through email and WhatsApp                  low coping strategies.
messages. The main findings of the study               On observing the type of coping strategy
indicate that the mean perceived stress score            style as seen in Table 3 – Maladaptive
among the participants was 21.88 (+4.30)                 coping scores were highest with mean –
and the mean coping strategies score was                 31.5 (+5.19) and adaptive coping being
74.38 (+12.30).                                          the least 9.44 (+2.64).
                                                       Association of age with coping
Demographic         Characteristics:    The              strategies was seen, with age group of
demographic       characteristics   of   the             17-20 years showing higher scores of
participants are presented in Table 01.                  coping strategy as against age group of
Most of participants were of age group 21-               20-25 yrs.
25 years (60.2). Out of total 427                      Significant association was found out
participants, 11 were males and rest                     with the year of study and coping

               International Journal of Science and Healthcare Research (www.ijshr.com)            284
                                      Vol.5; Issue: 2; April-June 2020
Deepika Sheroun et.al. A study to assess the perceived stress and coping strategies among B.Sc. nursing
students of selected colleges in Pune during COVID-19 pandemic lockdown

     strategies score with F value of 7.93 at                             Association of coping strategies was
Deepika Sheroun et.al. A study to assess the perceived stress and coping strategies among bsc nursing students
of selected colleges in Pune during covid-19 pandemic lockdown

stress, anxiety, worry etc With COVID19                  stress is higher in students than employed or
having psychological impact on college                   unemployed individuals co-relating to the
students like anxiety and distress; [14]                 findings of the present study. [7]
nursing students do not remain untouched                          The second aspect explored in the
with this gigantic problem. The aim of the               study is the coping strategies adopted by the
study was to assess the perceived stress and             students. "Coping is the process of
coping strategies adopted by the BSc                     managing demands that are appraised as
Nursing students during COVID 19                         taxing or exceeding the resources of the
pandemic.                                                person." (Shelley E. Taylor, 2003). [21] Thus,
         Perceived stress is a measure of the            coping is not a one-time action that
degree to which situations in one’s life are             someone takes; rather, it is a set of
appraised as stressful.This survey revealed              responses, occurring over time, by which
that as much as 82.67 % of the students had              the environment and the person influence
moderate level of perceived stress score and             each other’s. [22]
13.35% had high perceived stress scores                           Coping helps individual to adapt to
because of COVID 19 outbreak and                         new and challenging situations and is
lockdown. Lockdown and social distancing                 important for stabilization. In the times of
were undertaken throughout the country in                lockdown and COVID 19 pandemic it
order to prevent the spread of infection and             important to adapt ourselves to the new and
due to the devastating effect on health due              modified routine. In the present study Brief
to increasing mortality and morbidity as                 Cope was used to assess the Coping
seen in many other countries. [16] The state             Strategies of the students using ‘Brief Cope
of lockdown which was followed in many                   – By Carver ‘.
parts of the world has leads to changes in                        The study revealed that 76.58 % of
everyday routine life. With the spread of                the participants had moderate Coping
COVID19 anxiety, worry and stress has                    Strategies, while as 18.5 had high Coping
increased among the masses, including in                 Strategies and only 4.92 % had low Coping
India. [17] The shortage of sanitizers, medical          Strategies. Maximum of the participants
supply, the overwhelming and sensational                 utilized maladaptive coping as compared to
news headlines, and erroneous news reports               the other types of emotion focused ,
have also added to anxiety and fear. [18]                problem focused and adaptive coping .
         Social distancing amidst the crisis                      Analysis of variance revealed that
has contributed greatly to the perceived                 the socio demographic variable like age
stress as reduction in interpersonal                     were significantly associated with Coping
communication leads to increase in                       strategies utilized by the participants. Age
psychological distress. [19] Maximum of the              group of 17-20 had maximum coping
students (92.3%) had been residing in                    strategies.     Religion,     gender,    basic
hostels away from home (Table 01) which                  qualification, type of family of the
could be contributing factor to stress in                participants, co morbidity in family and
students. This stress adds on to the already             sources of information regarding COVID
stress perceived by nursing students who                 19, was not associated with the coping
experience stress related to assignments and             strategies. The year of study was associated
clinical work. [20]                                      significantly with coping strategies, with I
         Analysis of variance reveals that               year adopting maximum coping strategies,
there is no association between perceived                followed by III year and least by IV year.
stress and any of the socio demographic                  Maximum coping was showed by those
variables. This is in contrast with study by             participants who were residing with
Limacao 2020, where age (less than 30                    relatives than those staying in hostel or
yrs), and sex (females) was associated with              home. Those participants whose parents
higher perceived stress. However perceived

                 International Journal of Science and Healthcare Research (www.ijshr.com)                 286
                                        Vol.5; Issue: 2; April-June 2020
Deepika Sheroun et.al. A study to assess the perceived stress and coping strategies among bsc nursing students
of selected colleges in Pune during covid-19 pandemic lockdown

were private employees showed maximum                    ACKNOWLEDGEMENT
coping.                                                  We thank the nursing students who have
        Coping strategies in the pandemic                actively taken part in this study. We are greatly
and lockdown have been utilized by the                   indebted to the valuable contributions made by
masses indifferent ways, along with the                  the faculty of other nursing colleges who have
                                                         co-operated in the survey carried out.
mentioned coping styles; the behavioural
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of selected colleges in Pune during covid-19 pandemic lockdown

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