YNEDT-03044; No of Pages 6

Nurse Education Today xxx (2015) xxx–xxx

Contents lists available at ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/nedt

Coping, stress, and personality in Spanish nursing students:

A longitudinal study☆,☆☆
Joana Fornés-Vives a,⁎, Gloria Garcia-Banda b, Dolores Frias-Navarro c, Gerard Rosales-Viladrich d
a
Department of Nursing and Physiotherapy, University of Balearic Islands, Spain
b
Department of Psychology, University of Balearic Islands, Spain
c
Department of Methodology of the Behavioural Sciences, University of Valencia, Spain
d
Association for Mental Health “Estel de Llevant”, Manacor (Illes Balears), Spain

a r t i c l e i n f o s u m m a r y

Article history: The purpose of this study was to examine the dominant stress coping style in nursing students, its relationships
Accepted 5 August 2015 with stressful life events and personality traits, and the students' changes during their academic training. A
Available online xxxx non-experimental two-wave longitudinal design was carried out in 199 nursing students recruited from three
Spanish nursing schools. The Stressful Life Events Scale, NEO-FFI, and COPE questionnaire were administered
Keywords:
at the beginning (T1) and end (T2) of their nursing studies. Descriptive statistics, Anova(s), NPar tests, and Pearson
Coping
Nursing students
correlations were carried out. Results show that nursing students' dominant coping style was emotion-focused
Personality coping, both at T1 and T2. Highly significant correlations between emotional coping and the neuroticism trait
Stress were found. Coping, stress, and personality changed positively during the training program. At T2, the use of
problem-focused strategies increased, and participants became more extroverted, agreeable, and conscientious.
Coping and personality changes experienced by nursing students throughout their degree program seem to mirror
the professional competences needed by future licensed nurses.
© 2015 Elsevier Ltd. All rights reserved.

Introduction can guide nursing educators in designing specific course credits to

improve curricula, ensuring that nurses are well prepared to enter the
Research in nursing students reveals that they are significantly nursing workforce. Along these lines, and from the perspective of the
stressed (for a review, see Lim et al., 2010), although the sources of stress-coping transactional theory, this two-wave longitudinal study is
stress studied are usually limited to the academic context (Gibbons carried out to examine nursing students' dominant coping style, its
et al., 2011). In an attempt to control and reduce their stress levels, relationship with stressful life events and personality traits, and the
students use different coping strategies (Yamashita et al., 2012; students' changes during their academic training.
Klainin-Yobas et al., 2014). However, few studies have explored the
association between coping and personality traits (Deary et al., Background
2003; Watson et al., 2008); to our knowledge, in the last decade no
studies have related coping strategies, stressful life events, and The transactional theory of psychological stress and coping (Lazarus
personality traits in nursing students. and Folkman, 1984) defines coping as a dynamic, changing process
Identifying students' dispositional tendency to handle everyday life between a person and his/her environment. During this process,
stress and determine its potential relationship with personality traits the person tries to solve problems by changing the environment
(problem-focused coping), or the meaning of the event, in order to reduce
the negative feelings associated with the problem (emotion-focused
☆ The authors would like to thank all the students who participated in this longitudinal coping). However, the distinction between these two coping strategies
study for their time and commitment through the years.
is too simple (Carver et al., 1989). Actually, emotion-focused coping
☆☆ This study was supported by Department of Research, Technological Development
and Innovation of Balearic Islands Government Grant AAEE 0097/08 awarded to Joana strategies are often quite different in nature (e. g. denial, positive
Fornés-Vives. reinterpretation, escape-avoidance, accepting responsibility, or seeking
⁎ Corresponding author at: Department of Nursing and Physiotherapy, University of social support), and, therefore, will have different consequences in
Balearic Islands, Edifici Guillem Cifre de Colonya, Ctra de Valldemossa, km 7.5, 07122 responding to stress (Folkman et al., 1986).
Palma de Mallorca (Illes Balears), Spain. Tel.: +34 971 172662; fax: +34 971 173190.
E-mail addresses: [email protected] (J. Fornés-Vives), [email protected]
Cross-sectional studies have shown that emotion-focused coping
(G. Garcia-Banda), [email protected] (D. Frias-Navarro), [email protected] is less effective in reducing stressful demands than active or problem-
(G. Rosales-Viladrich). focused coping among professional nurses (Rowe, 2006) and nursing

http://dx.doi.org/10.1016/j.nedt.2015.08.011
0260-6917/© 2015 Elsevier Ltd. All rights reserved.

Please cite this article as: Fornés-Vives, J., et al., Coping, stress, and personality in Spanish nursing students: A longitudinal study, Nurse Educ. To-
day (2015), http://dx.doi.org/10.1016/j.nedt.2015.08.011
2 J. Fornés-Vives et al. / Nurse Education Today xxx (2015) xxx–xxx

students (Lo, 2002; Gibbons et al., 2011). Similarly, students who and effective coping strategies (Knoll et al., 2005). Regarding other
regularly use problem-solving methods report lower levels of personality dimensions, openness to experience and conscientiousness
distress, while those who show high levels of distress use emotion- have been found to be related to active and less evasive coping
focused coping (Tully, 2004). Moreover, in a two-wave longitudinal (Lee-Baggley et al., 2005).
study, Deary et al. (2003) found significant increases in the use of Of the few longitudinal studies that have investigated the relationship
emotion, avoidance, and distraction coping strategies as the nursing between coping, stress, and personality traits in nursing students, Deary
study program progressed. These less functional aspects of coping at et al. (2003) found that neuroticism and emotional coping at T1 (entry
T1 were related to different sources of stress (clinical stress, confidence to program) were associated with increased stress at T2 (12 months
stress, educational stress and financial stress) at T2 (12 months later). later). Moreover, Watson et al. (2008), in their two-wave study (with
Moreover, another longitudinal study exploring the effects of coping 7 months between T1 and T2), found that neuroticism was positively
and stressful life events on anxiety found that stress and emotion- related to stress and emotional coping, while conscientiousness, extra-
oriented coping before the clinical training predicted anxiety at the version, and openness were positively related to problem coping.
end (Shikai et al., 2009). After several decades of studies on the impact of stress and coping
Stress seems to be an almost inevitable spin-off of modern life (Jones strategies, substantial gaps and inconsistencies still remain (see
and Bright, 2001). Psychological stress is considered by Folkman et al. Connor-Smith and Flachsbart (2007) for a meta-analysis). Thus, the
(1986) to be a personal response that appears after perceiving an imbal- aims of this study were: 1) to identify the dominant coping style of
ance between environmental demands and the resources available to nursing students; 2) to ascertain the relationships among the response
address them. Several studies have shown that nursing students are to coping styles, stressful life events, and personality traits; 3) to find
under high levels of academic stress and the resulting distress (Beck out whether the coping strategies used vary during their 3-year
and Srivastava, 1991; Deary et al., 2003; Goff, 2011; Yamashita et al., academic training and are accompanied by changes in stress and
2012). Moreover, student health professionals are also exposed to personality.
demands from the interface between personal and extracurricular
factors (Jones and Johnston, 1999; Pryjmachuk and Richards, 2007). Methods
While academic stress has been extensively investigated, the personal
stressors need further enquiry. In our opinion, when there is not yet a Design
commitment to the work context, stressful life events would be
especially relevant in the lives of nursing students (Wolf et al., 2015), A non-experimental longitudinal design was used with nursing
and quite similar to the adult population (Kardum and Krapić, 2001). students recruited from Spanish nursing schools in three geographically
If these episodic stressors are not effectively managed, they may diverse universities (University of Balearic Islands—UIB, University of
become chronic and affect psychological and physical health in the Cantabria—UC and University of Granada—UG), located in the north,
long term (Shikai et al., 2009; Cheng and Li, 2010). south, and east of the country, respectively.
Longitudinal studies have shown that nursing students' stress
increases during their educational training, finding higher stress levels
Participants
at the beginning of their third year (Edwards et al., 2010; Timmins
et al., 2011). Moreover, Watson et al. (2008), in 158 nursing students
In the first year of the study, participants were 249 nursing students
in Hong Kong, showed an increase in academic stress 7 months after
(94 from UIB, 67 from UC, and 88 from UG) with an age range of
entering their nursing program and prior to undertaking clinical
17–43 years, and a mean of 20.97 ± 5.13 years. Three years later
practice. Likewise, in an initial sample of 168 Scottish nursing students,
(at the end of their studies), the final sample was composed of 199
Deary et al. (2003) found increasing levels of psychological distress,
students (79.92% response rate), and the majority of the participants
assessed by the GHQ, as the program progressed. However, Lo (2002)
were women (87.96%).
obtained a decrease in the stress percentage among Australian nursing
students (44.2% first-year, 28.4% second-year, and 21.8% third-year),
and Jiménez et al. (2010) found similar stress levels in all three training Procedure
years in Spanish nursing students. In light of these contradictory
findings, there is a need for more data about the longitudinal course of First-year students from three nursing schools were invited to
stress and coping in student nursing. participate in a longitudinal survey spanning their 3 years of nursing
DeLongis and Holtzman (2005) have pointed out that coping strate- training. Prior to administering the batch of questionnaires, a full expla-
gies vary depending on characteristics of the individual and contextual nation of the project aims was provided. Informed consent was obtained
factors (stress). Personality has been conceptualized as more or less from all the students who agreed to participate. Likewise, to guarantee
stable and enduring dispositions (thoughts, feelings, and behaviors), confidentiality, participants were assured that no information would
which may explain why some people are more vulnerable to stress be published individually. Moreover, they were given the opportunity
than others (Ryckman, 2004). A widely used personality model is the to withdraw from the study at any time. Participants completed the
Five-Factor-Model (FFM; Costa and McCrae, 1992), based on a taxonomy questionnaires in a regular lecture class at the beginning of nursing
with five dimensions: Neuroticism (N), Extraversion (E), Openness to training (T1, 2007) and at the end of their studies (T2, 2010). On both
Experience (O), Agreeableness (A), and Conscientiousness (C). The FFM occasions, students were asked to return the completed questionnaires
approach has been particularly useful in understanding dispositional by hand to the office of the professor in charge of the study within
coping, which involves typical responses to a broad range of stressors 15 days.
(see Connor-Smith and Flachsbart, 2007 for a meta-analysis). Most
research examining the role of personality in coping strategies has Measurement
focused on N and E traits, whereas other personality dimensions have
remained relatively unexamined in the literature (DeLongis and Stress was measured with the Stressful Life Event Scale (SLE; Holmes
Holtzman, 2005). Studies have shown that individuals with persistent and Rahe, 1967), adapted for the Spanish population by Labrador
stress (Niiyama et al., 2009) or high N (Burgess et al., 2010) choose (1992). This scale contains 57 potentially stressful events, and individuals
ineffective strategies – mainly focused on emotion – to cope with must indicate whether they have been exposed to them in the two
stressful situations, such as ignoring the problem, distracting, preceding years and the importance the events had for them (0 = not
venting or avoidance. Meanwhile, individuals with higher E use active important, 4 = maximum importance). In our sample, the T1–T2

Please cite this article as: Fornés-Vives, J., et al., Coping, stress, and personality in Spanish nursing students: A longitudinal study, Nurse Educ. To-
day (2015), http://dx.doi.org/10.1016/j.nedt.2015.08.011
 J. Fornés-Vives et al. / Nurse Education Today xxx (2015) xxx–xxx 3

3-year temporal stability was r = .25, reflecting the episodic nature of contrast, cognitive escape and use of alcohol/drugs obtained percent-
these events. ages below 7% (Fig. 1).
Personality traits were measured using the Spanish version of the We found significant gender differences in coping styles: emotional
NEO Five-Factor Inventory (NEO-FFI; Costa and McCrae, 1999), which coping was more common in women at T1 [F(1,198) = 8.375, p = .040,
is a 60-item questionnaire widely used to assess five personality traits d = 0.64, 95% CI 0.21 to 1.07], while alcohol/drugs consumption was
(neuroticism, extraversion, openness, agreeableness, and conscien- more common in men at T2 [F(1,198) = 7.740, p = .010, d = −0.57,
tiousness). Participants answered on a five-point scale (1 = strongly 95% CI −1 to −0.14].
agree, 5 = strongly disagree), rating the similarity of each item to
their own usual thoughts and actions. Cronbach's α's were .85 in T1 Associations between coping styles, stress, and personality traits
and .75 in T2.
Coping styles were assessed using the COPE Questionnaire (Carver In response to our second objective, significant correlations among
et al., 1989) — adapted for the Spanish population by Crespo and coping styles, stress, and personality were found (Table 1). Emotional
Cruzado (1997). It consists of a 60-item checklist divided into six coping was associated with less adaptive personality traits: positively
subscales that contain a wide range of actions and thoughts individuals with neuroticism (T1: r = .289, p b .001; and T2: r = .329, p b .001),
use to deal with stressful situations. The six subscales are based on and negatively with agreeableness (T1: r = − .176, p b .05; and T2:
Lazarus' coping theory: two subscales assess problem-focused coping: r = .162, p b .05) and conscientiousness (T1: r = − .146, p b .05).
1) problem behavioral coping; 2) problem cognitive coping; and the Behavioral escape, cognitive escape, and use of alcohol and drugs were
other four assess emotion-focused coping: 1) emotional coping, also related to neuroticism (r = .140, p b .05; r = .211, p b .01; r =
2) behavioral escape, 3) cognitive escape, and 4) using alcohol/drugs. .183, p b .01, respectively) at T2. Finally, using alcohol and drugs was
The response scale ranged from 0 (don't do this at all) to 3 (do this a related to stressful life events at T1 (r = .196, p b .01), but not at T2.
lot). Cronbach's α's were .85 in T1 and .85 in T2.
Changes in coping styles, stress, and personality traits from T1 to T2
Data analysis
Our third aim was to examine whether there were changes in coping
Data analysis was performed using the IBM Statistical Package for strategies, level of stress, and personality traits during the students'
Social Sciences (IBM SPSS), version 21 for Windows. To ensure univariate academic training (Table 2). Nursing students at the end of their degree
normality, Kline (2005) suggested cut-off scores with absolute values of program (T2) showed better strategies to cope with stress than at the be-
3.0 and 8.0 for skewness and kurtosis, respectively. Absolute values of ginning (T1). Although the effect size was small, they used more frequent
skewness and kurtosis for most scores on the measurement instruments behavioral coping [F(1,198) = 8.260, p = .004, d = 0.18] and less cogni-
were within the acceptable range of the normal distribution (univariate tive escape coping [F(1,198) = 19.30, p b .001, d = −0.33], and they also
skewness ranged from −0.07 to 2.4, and univariate kurtosis ranged experienced significantly less stress [F(1,198) = 7.54, p = .007, d = 0.20]
from 0.01 to 5.14). The Alcohol/Drugs mean variable in T1 surpassed at T2 than at T1. Moreover, at the end of their studies, nursing students'
skewness criteria with a value of 3.39, and kurtosis with a value of personalities changed toward a prosocial profile: extraversion and consci-
11.94. Therefore, Alcohol/Drugs was analyzed with the Wilcoxon NPar entiousness were significantly higher [F(1,198) = 120.82, p b .001,
test (F of Anova was also robust, obtaining the same result in the two d = − 0.78; F(1,198) = 119.18, p b .001, d = − 0.77], with a large ef-
tests). Parametric inference tests were used with the remaining variables. fect size, and they showed an increase in agreeableness [F(1,198) =
To test our hypotheses, we performed Anova(s), Wilcoxon's test, 57.78, p b .001, d = − 0.54], but with a medium effect size.
and Pearson correlations among the study variables. A pretest–posttest
repeated measures (GLM) design was used to test the hypotheses. Discussion
Cohen's d effect size (1988) was estimated as standard paired differences
using Comprehensive Meta-Analysis software (version 2.0; Borenstein The aim of this two-wave longitudinal study was to identify the
et al., 2009). Positive effect size values indicate a higher score on the dominant coping style in nursing students, its relationships with stressful
post-test (T2). In keeping with Cohen (1988), we considered d = 0.2 life events and personality traits, and possible changes in coping styles,
small, d = 0.5 medium, and d = 0.8 large effect sizes. Cohen's d stress, and personality during their academic training. Our findings
standardized mean difference was chosen because the corrected effect indicate that emotional coping was the dominant coping style at the
size is the most widely used statistic in health-related meta-analysis beginning and end of the nursing training. Moreover, we also found
(Navarro et al., 2000; Monterde-i-Bort et al., 2006). strong associations between emotional coping and the neuroticism trait
We planned a minimum sample size by hypothesizing that the at both times. Coping strategies, level of stress, and personality traits
anticipated effect size would be at least d = 0.2 in Cohen's (1988) changed positively during the training program. At T2, the use of
terms, with a statistical power of 0.8 and an α value of 0.05 (bidirectional problem-focused strategies increased, cognitive escape and levels
hypothesis). Thus, the sample size required was 199 participants, based of stress decreased, and participants became more extroverted,
on the GPower program results (Faul et al., 2007). conscientious, and agreeable than at T1. It seems that 3 years of nursing
studies were able to provide students with more adaptive coping styles
to manage stress better and help to develop prosocial traits.
Results Participants in our study showed a combination of emotion- and
problem-focused strategies to cope with their daily stress at both
To assess attrition bias, we compared the T1 coping style, stress, and times. However, the predominant coping style at T1 was emotional
personality trait means of students who remained in the study with coping, also observed in nursing students by Lo (2002) and Gibbons
those who dropped out, and no significant differences were found. et al. (2011); in our study, problem coping (behavioral and cognitive)
was widely used at T2.
Dominant coping style Women used significantly more emotional coping than men, while
men used alcohol/drugs (escape–avoidance strategies) more often
To address the first aim, item responses on the COPE questionnaire than women. Sasaki et al. (2009) also found a greater use of emotional
were grouped into two categories: slightly used (nothing and few) coping in women, although they detected a higher use of problem-
and widely used (quite often and a lot). Emotional coping was the focused coping in men. There is some evidence that escape–avoidance
most highly used style at both times (T1 = 55.8%; T2 = 53.3%). By coping functions as a strong predictor of adverse well-being, even

Please cite this article as: Fornés-Vives, J., et al., Coping, stress, and personality in Spanish nursing students: A longitudinal study, Nurse Educ. To-
day (2015), http://dx.doi.org/10.1016/j.nedt.2015.08.011
4 J. Fornés-Vives et al. / Nurse Education Today xxx (2015) xxx–xxx

Coping, Stress, and Personality

55,8%

52,8% 53,3%
51,8%

46,2%

42,2%
42,2%
40,7%

6%

3%
2%
1%

Fig. 1. T1 and T2 percentages of coping styles highly used (quite often and a lot) by nursing students. Note: T1 = time 1; T2 = time 2; BehC = problem behavioral coping; CogC = problem
cognitive coping; EmoC = emotional coping; BehEs = behavioral escape; CogEs = cognitive escape; Alc/Drug = using alcohol/drugs.

when used infrequently (Gibbons et al., 2011). By contrast, problem solv- during times of stress. Therefore, in addition to examining traditional
ing has been related to high professional efficacy in hospital nurses strategies (problem-and emotion-focused), we think it would be interest-
(Sasaki et al., 2009), and to positive outcomes in the physio- ing to include this new coping style, relationship-focused coping, in future
psychosocial status of nursing students (Sheu et al., 2002). research on nursing students because social relationships are predomi-
Our correlation findings emphasize a stable relationship between nant in the professional context where nurses carry out their work.
emotional and cognitive escape strategies and neuroticism at both T1 With regard to our third objective, significant and positive changes
and T2, congruent with results from Lee-Baggley et al. (2005) and were observed in coping strategies, stress, and personality, when
Burgess et al. (2010). One possible explanation is that distress associated comparing the beginning and the end of the nursing studies. Although
with neuroticism may interfere with successful problem solving by the most highly used strategy was emotional coping, the data showed
hampering flexible coping across situations and by increasing disengage- that at the end of their training, students increased problem-focused
ment (Carver and Connor-Smith, 2010). Nevertheless, the association coping and decreased cognitive escape strategies. Students' stress levels
between low emotional coping and high agreeableness at both times, fell significantly at the end of their training, similarly to the results
and between low emotional coping and conscientiousness at T1, suggests obtained by Lo (2002). This decrease could be attributed to the acquisi-
that affable and conscientious people may be more skilled at obtaining tion of skills during their academic training because approximately 6%
social support than the general population (Carver and Connor-Smith, of the 240 total nursing credits specifically addressed stress management
2010). In the study by Lee-Baggley et al. (2005), an additional coping and coping topics.
strategy, called relation-focused coping style, appears to be associated Similarly, our findings indicated an increase in some prosocial traits
with high agreeableness and high conscientiousness. Relation-focused (extraversion, conscientiousness, and agreeableness). Thus, students
coping refers to strategies aimed at managing or preserving relationships became significantly more sociable, accountable, and helpful at the

Table 1
Pearson's correlations between coping styles, stress, and personality traits at T1 and T2 (n = 199).

T BehC CogC EmoC BehEs CogEs Alc/Drug

Stress 1 0.107 0.027 0.061 0.060 −0.024 0.196⁎⁎

2 0.125 0.129 0.084 0.036 0.027 0.086
NEO-FFI neuroticism 1 −0.048 −0.133 0.289⁎⁎⁎ 0.131 0.153⁎ 0.002
2 0.083 −0.062 0.329⁎⁎⁎ 0.140⁎ 0.211⁎⁎ 0.183⁎⁎
NEO-FFI extraversion 1 −0.009 −0.032 −0.057 −0.034 −0.054 −0.064
2 −0.018 −0.078 −0.019 −0.075 −0.022 0.012
NEO-FFI openness 1 0.083 0.088 0.071 0.119 0.020 −0.075
2 0.144⁎ 0.056 0.053 0.058 −0.004 0.043
NEO-FFI agreeableness 1 −0.100 −0.089 −0.176⁎ −0.088 −0.109 −0.177⁎
2 −0.118 −0.043 −0.162⁎ −0.065 −0.087 −0.132
NEO-FFI conscientiousness 1 0.012 −0.101 −0.146⁎ −0.120 −0.116 −0.088
2 0.114 −0.064 −0.136 −0.009 −0.152⁎ −0.145⁎
⁎ p b 0.05; ⁎⁎ p b 0.01; ⁎⁎⁎p b 0.001.
Note: T = time; BehC = problem behavioral coping; CogC = problem cognitive coping; EmoC = emotional coping; BehEs = behavioral escape; CogEs = cognitive escape; Alc/Drug =
using alcohol/drugs.

Please cite this article as: Fornés-Vives, J., et al., Coping, stress, and personality in Spanish nursing students: A longitudinal study, Nurse Educ. To-
day (2015), http://dx.doi.org/10.1016/j.nedt.2015.08.011
 J. Fornés-Vives et al. / Nurse Education Today xxx (2015) xxx–xxx 5

Table 2
Means, standard deviations, p-value, effect size, and confidence interval for coping styles, stress, and personality traits in nursing students at T1 and T2 (n = 199).

Time 1 Time 2 p-Value difference T1–T2a dc 95% CI

Mean (SD) Mean (SD)

Stress 793.35 656.09 0.007 0.20 0.05 to 0.34

(636.02) (505.53)
COPE problem behavioral coping 1.43 1.49 0.004 0.18 0.04 to 0.32
(0.35) (0.31)
COPE problem cognitive coping 1.51 1.50 0.799 −0.02 −0.16 to 0.12
(0.45) (0.37)
COPE emotional coping 1.51 1.52 0.794 0.02 −0.12 to 0.15
(0.61) (0.64)
COPE behavioral escape 1.42 1.39 0.467 −0.07 −0.21 to 0.07
(0.44) (0.42)
COPE cognitive escape 0.73 0.6 b0.001 −0.33 −0.47 to −0.19
(0.47) (0.4)
COPE alcohol/drugs 0.15 0.15 0.904 0 −014 to 0−14
(0.42) (0.34)
NEO-FFI neuroticism 22.78 21.67 0.042 0.15 0.01 to 0.29
(5.83) (8.25)
NEO-FFI extraversion 25.4 32.41 b0.001 −0.78 −0.94 to −0.62
(7.67) (6.68)
NEO-FFI openness 26.87 27.93 0.037 −0.15 −0.29 to −0.01
(6.22) (6.98)
NEO-FFI agreeableness 28.45 32.09 b0.001 −0.54 −0.69 to −0.39
(5.56) (5.78)
NEO-FFI conscientiousness 25.12 32.35 b0.001 −0.77 −0.93 to −0.62
(7.88) (5.93)

Note: dc = Cohen effect size; CI = coefficient interval.

a
All comparisons were based on t-test for related samples.

end of their training. In fact, their agreeableness and conscientiousness professional competences needed by future licensed nurses. Therefore,
values were four points above the population mean of reference in T2. nursing training programs would benefit from including course credits
In addition, neuroticism, one of the traits most associated with ineffective addressed to increasing students' levels of proficiency in coping and stress
coping (DeLongis and Holtzman, 2005; Connor-Smith and Flachsbart, management, as occurs in the Spanish degree program. Although some of
2007; Burgess et al., 2010), also decreased significantly at T2 (ranking the personality changes seen can be a consequence of maturity (Lüdtke
below the population mean). Although these personality changes can et al., 2011), the large increase in extraversion is a remarkable result
be a consequence of transition from adolescence to young adulthood, that seems to go beyond the maturity hypothesis. Moreover, some of
and, therefore, an index of psychological maturity (Lüdtke et al., 2011), these new credits could be aimed at developing students' prosocial traits.
the large increase in extraversion is a noteworthy result that surpasses Based on our personality change results, we think that including some
the extension of the maturity hypothesis. Nursing students at the end of contents related to developing students' self-awareness and -control,
their training seem to become more assertive and energetic, and experi- emotional regulation, and empathy would be advisable in order to
ence positive emotions more often, than at the beginning. All these increase their emotional stability and decrease their emotional reactivity.
characteristics are likely to maintain their emotional stability and help However, future studies should differentiate the issue of gaining maturity
to preserve healthy relationships when dealing with colleagues. over time from the knowledge provided by coping and stress manage-
In sum, students' coping and personality patterns after 3 years of ment course credits in nursing.
training got closer to the “ideal” health professional personality profile:
a professional who uses more planful problem solving, engages in less References
avoidance or denial coping, and behaves in a more cheerful (extra-
version), reliable (conscientiousness), and helpful (agreeableness) Beck, D.L., Srivastava, R., 1991. Perceived level and sources of stress in baccalaureate
nursing students. J. Nurs. Educ. 30 (3), 127–133.
way. This professional profile may also play a protective role when
Borenstein, M., Hedges, L.V., Higgins, J.P.T., Rothstein, H.R., 2009. Introduction to
facing the demands that patients and relatives can place on nurses, Meta-analysis. John Wiley & Sons, Chichester, United Kingdom.
as Burgess et al. (2010) pointed out. Burgess, L., Irvine, F., Wallymahmed, A., 2010. Personality, stress and coping in intensive
care nurses: a descriptive exploratory study. Nurs. Crit. Care 15 (3), 129–140.
Our study has certain characteristics that limit the generalization of
http://dx.doi.org/10.1111/j.1478-5153.2009.00384.x.
the results; for example, the self-reported nature of the data and the Carver, Ch.S., Connor-Smith, J., 2010. Personality and coping. Annu. Rev. Psychol. 61 (1),
recruitment of a voluntary sample. However, our multicenter sample 679–704. http://dx.doi.org/10.1146/annurev.psych.093008.100352.
and the high response rate at T2 are relevant strengths. The characteristics Carver, C.S., Scheier, M.F., Weintraub, J.K., 1989. Assessing coping strategies: a theoretically
based approach. J. Pers. Soc. Psychol. 56 (2), 267–283. http://dx.doi.org/10.1037/0022-
of the participants (young people and mainly women) could, neverthe- 3514.56.2.267.
less, represent a bias. However, the longitudinal design can be considered Cheng, S.-T., Li, K.-K., 2010. Combining major life events and recurrent hassles in the
our major strength because such designs can reveal changes in variables assessment of stress in Chinese adolescents: preliminary evidence. Psychol. Assess.
22 (3), 532–538. http://dx.doi.org/10.1037/a0019579.
within the same cohort. Cohen, J., 1988. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Erlbaum
Associates, Hillsdale, New Jersey.
Connor-Smith, J.K., Flachsbart, C., 2007. Relations between personality and coping: a
meta-analysis. J. Pers. Soc. Psychol. 93 (6), 1080–1107. http://dx.doi.org/10.1037/
Conclusions
0022-3514.93.6.1080.
Costa, P.T., McCrae, R.R., 1992. NEO PI-R professional manual: Revised NEO Personality
The present study significantly extends prior research on associations Inventory (NEO PI-R) and NEO Five-Factor Inventory (NEO-FFI). Psychological
and changes in students' coping, stress levels, and personality traits Assessment Resources, Odessa, Florida.
Costa, P.T., McCrae, R.R., 1999. Inventario de Personalidad Neo Revisado (NEO-PI-R) and
throughout the nursing degree program. Changes in coping experienced Inventario Neo Reducido de Cinco Factores (NEO-FFI). NEO Personality Inventory
by nursing students during their degree studies seem to mirror the Revised (NEO-PI-R) and NEO Five Factor Inventory (NEO-FFI). TEA, Madrid, Spain.

Please cite this article as: Fornés-Vives, J., et al., Coping, stress, and personality in Spanish nursing students: A longitudinal study, Nurse Educ. To-
day (2015), http://dx.doi.org/10.1016/j.nedt.2015.08.011
6 J. Fornés-Vives et al. / Nurse Education Today xxx (2015) xxx–xxx

Crespo, M., Cruzado, J.A., 1997. La evaluación del afrontamiento: adaptación española del Lim, J., Bogossian, F., Ahern, K., 2010. Stress and coping in Australian nurses: a systematic
cuestionario COPE con una muestra de estudiantes universitarios. Anál Modif. Cond. review. Int. Nurs. Rev. 57 (1), 22–31. http://dx.doi.org/10.1111/j.1466-7657.2009.
23 (92), 797–830. http://dx.doi.org/10.6018/analesps.29.1.124531. 00765.x.
Deary, I., Watson, R., Hogston, R., 2003. A longitudinal cohort study of burnout and Lo, R., 2002. A longitudinal study of perceived level of stress, coping and self-esteem of
attrition in nursing students. J. Adv. Nurs. 43 (1), 71–81. http://dx.doi.org/10.1046/j. undergraduate nursing students: an Australian case study. J. Adv. Nurs. 39 (2),
1365-2648.2003.02674.x. 119–126. http://dx.doi.org/10.1046/j.1365-2648.2000.02251.x.
DeLongis, A., Holtzman, S., 2005. Coping in context: the role of stress, social support, and Lüdtke, O., Roberts, B.W., Trautwein, U., Nagy, G., 2011. A random walk down University
personality in coping. J. Pers. 73 (6), 1633–1656. http://dx.doi.org/10.1111/j.1467- Avenue: life paths, life events, and personality trait change at the transition to university
6494.2005.00361.x. life. J. Pers. Soc. Psychol. 101 (3), 620–637. http://dx.doi.org/10.1037/a0023743.
Edwards, D., Burnard, Ph., Bennett, K., Hebden, U., 2010. A longitudinal study of stress and Monterde-i-Bort, H., Pascual-Llobell, J., Frias-Navarro, D., 2006. Interpretation mistakes in
self-esteem in student nurses. Nurse Educ. Today 30 (1), 78–84. http://dx.doi.org/10. statistical methods: their importance and some recommendations. Psicothema 18,
1016/j.nedt.2009.06.008. 848–856.
Faul, F., Erdfelder, E., Lang, A.G., Buchner, A., 2007. G*Power 3: a flexible statistical power Navarro, M.D.F., Llobell, J.P., Perez, J.F.G., 2000. Effect size and statistical significance.
analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Psicothema 12, 236–240.
Methods 39, 175–191. http://dx.doi.org/10.3758/bf03193146. Niiyama, E., Okamura, H., Kohama, A., Taniguchi, T., Sounohara, M., Nagao, M., 2009. A
Folkman, S., Lazarus, R.S., Gruen, R.J., DeLongis, A., 1986. Appraisal, coping, health status, survey of nurses who experienced trauma in the workplace: influence of coping
and psychological symptoms. J. Pers. Soc. Psychol. 50 (3), 571–579. http://dx.doi. strategies on traumatic stress. Stress. Health 25 (1), 3–9. http://dx.doi.org/10.1002/
org/10.1037/0022-3514.50.3.571. smi.1217.
Gibbons, C., Dempster, M., Moutray, M., 2011. Stress, coping and satisfaction in nursing Pryjmachuk, S., Richards, D.A., 2007. Mental health nursing students differ from other
students. J. Adv. Nurs. 67 (3), 621–632. http://dx.doi.org/10.1111/j.1365-2648.2010. nursing students: some observations from a study on stress and coping. Int.
05495.x. J. Ment. Health Nurs. 16 (6), 390–402. http://dx.doi.org/10.1111/j.1447-0349.2007.
Goff, A.M., 2011. Stressors, academic performance, and learned resourcefulness in 00494.x.
baccalaureate nursing students. Int. J. Environ. Anal. Chem. 8 (1), 1–17. http://dx. Rowe, M., 2006. Four-year longitudinal study of behavioral changes in coping with stress.
doi.org/10.2202/1548-923X.2114. Am. J. Health Behav. 30 (6), 602–612.
Holmes, T.H., Rahe, R.H., 1967. The social readjustment rating scale. J. Psychosom. Res. 11 Ryckman, R.M., 2004. Theories of Personality. 8th ed. Thomson, Belmont, CA.
(2), 213–218. http://dx.doi.org/10.1016/0022-3999(67)90010-4. Sasaki, M., Kitaoka-Higashiguchi, K., Morikawa, Y., Nakagawa, H., 2009. Relationship
Jiménez, C., Martínez, P., Vacas, C., 2010. Stress and health in novice and experienced between stress coping and burnout in Japanese hospital nurses. J. Nurs. Manag. 17
nursing students. J. Adv. Nurs. 66 (2), 442–455. http://dx.doi.org/10.1111/j.1365- (3), 359–365. http://dx.doi.org/10.1111/j.1365-2834.2008.00960.x.
2648.2009.05183.x. Sheu, A., Lin, H.S., Hwang, S.L., 2002. Perceived stress and physio-psycho-social status
Jones, F., Bright, J., 2001. Stress, Myth, Theory and Research. Pearson Education of nursing students during their initial period of clinical practice: the effect of coping
Limited, United Kingdom, p. 4 (https://books.google.es/books?hles&lr=&id= behaviors. Int. J. Nurs. Stud. 39 (2), 165–175. http://dx.doi.org/10.1016/s0020-
QGsX-N28wjkC&oi=fnd&pg=PR9&dq=Jones+%26+Bright,+2001+stress+ 7489(01)00016-5.
moder+life+spin-off&ots=zXO3byFaVJ&sig=IcZ9BnkhpaGIFow7aaAny3OrMIk#v= Shikai, N., Shono, M., Kitamura, T., 2009. Effects of coping styles and stressful life events
onepage&q&f=false). on depression and anxiety in Japanese nursing students: a longitudinal study. Int.
Jones, M.C., Johnston, D.W., 1999. The derivation of a brief Student Nurse Stress Index. J. Nurs. Pract. 15 (3), 198–204. http://dx.doi.org/10.1111/j.1440-172X.2009.01745.x.
Work Stress. 13 (2), 162–181. http://dx.doi.org/10.1080/026783799296129. Timmins, F., Corroon, A.M., Byrne, G., Mooney, B., 2011. The challenge of contemporary
Kardum, I., Krapić, N., 2001. Personality traits, stressful life events, and coping styles in nurse education programmes. Perceived stressors of nursing students: mental health
early adolescence. Personal. Individ. Differ. 30 (3), 503–515. http://dx.doi.org/10. and related lifestyle issues. J. Psychiatr. Ment. Health Nurs. 18 (9), 758–766. http://dx.
1016/S0191-8869(00)00041-6. doi.org/10.1111/j.1365-2850.2011.01780.x.
Klainin-Yobas, P., Keawkerd, O., Pumpuang, W., Thunyadee, Ch., Thanoi, W., He, H.-G., Tully, A., 2004. Stress, sources of stress and ways of coping among psychiatric nursing
2014. The mediating effects of coping on the stress and health relationships among students. J. Psychiatr. Ment. Health Nurs. 11 (1), 43–47. http://dx.doi.org/10.1111/j.
nursing students: a structural equation modelling approach. J. Adv. Nurs. 70 (6), 1365-2850.2004.00682.x.
287–1297. http://dx.doi.org/10.1111/jan.12283. Watson, R., Deary, I., Thompson, D., Li, G., 2008. A study of stress and burnout in nursing
Kline, R., 2005. Principles and Practice of Structural Equations Modelling. 2nd ed. Guilford students in Hong Kong: a questionnaire survey. Int. J. Nurs. Stud. 45 (10), 1534–1542.
Press, London. http://dx.doi.org/10.1016/j.ijnurstu.2007.11.003.
Knoll, N., Rieckmann, N., Schwarzer, R., 2005. Coping as a mediator between personality Wolf, L., Warner, A., Ross, R., 2015. Predictors of stress and coping strategies of US
and stress outcomes: a longitudinal study with cataract surgery patients. Eur. accelerated vs generic baccalaureate nursing students: an embedded mixed study.
J. Personal. 19 (3), 229–247. http://dx.doi.org/10.1002/per.546. Nurse Educ. Today 35 (1), 201–205. http://dx.doi.org/10.1016/j.nedt.2014.07.005.
Labrador, F.J., 1992. El estrés (The stress). Nuevas Técnicas para su Control (New Yamashita, K., Saito, M., Takao, T., 2012. Stress and coping styles in Japanese nursing
Techniques for Its Control). Temas de Hoy, Madrid, Spain. students. Int. J. Nurs. Pract. 18 (5), 489–496. http://dx.doi.org/10.1111/j.1440-172X.
Lazarus, R.S., Folkman, S., 1984. Stress, Appraisal, and Coping. Springer, New York. 2012.02056.x.
Lee-Baggley, D., Preece, M., DeLongis, A., 2005. Coping with interpersonal stress: role of
big five traits. J. Pers. 73 (5), 1141–1180. http://dx.doi.org/10.1111/j.1467-6494.
2005.00345.x.

Please cite this article as: Fornés-Vives, J., et al., Coping, stress, and personality in Spanish nursing students: A longitudinal study, Nurse Educ. To-
day (2015), http://dx.doi.org/10.1016/j.nedt.2015.08.011