Final Research - 2016 Stress - P.B.B.S.C

A STUDY TO ASSESS THE EFFECTIVENESS
OF STRUCTURED TEACHING PROGRAMME

ON STRESS MANAGEMENT TECHNIQUES TO
REDUCE STRESS AMONG SELECTED
NURSING STUDENTS STUDYING IN
SELECTED NURSING COLLEGE
AT SHRIRAMPUR
Submitted by
Second Year Post Basic B. Sc. Nursing student
2015-16
Dissertation submitted to
St. Luke‟s Hospital, College of Nursing
(Affiliated to Maharashtra University of health Sciences, Nasik.)
In partial fulfillment of the Bachelor of Sciences of Nursing
Under the guidance of Mr. Shaikh Ajmoddin R. (M.Sc. Nursing),
Lecturer at St. Luke‟s Hospital, College of Nursing, Shrirampur.
Dissertation submitted to St. Luke’s Hospital, College of Nursing

Shrirampur
2015 - 2016
A STUDY TO ASSESS THE EFFECTIVENESS
OF STRUCTURED TEACHING PROGRAMME
ON STRESS MANAGEMENT TECHNIQUES TO
REDUCE STRESS AMONG SELECTED
NURSING STUDENTS STUDYING IN
SELECTED NURSING COLLEGE
AT SHRIRAMPUR
Submitted By
Ms. Fatima Mary
Second Year Post Basic B. Sc Nursing student
2015-2016 Batch
Dissertation submitted to St. Luke’s College of Nursing, Shrirampur 2015-16

DECLARATION BY THE RESEARCHERS OR INVESTIGATOR
I the student of second year post Basic B. Sc Nursing, St. Luke‟s

hospital, college of nursing, shrirampur, hereby declare that this dissertation
entitled “ A study to assess the effectiveness of structured teaching
programme on stress among selected nursing students studying in selected
nursing colleges at shrirampur” is bonafied and genuine work carried out by
me under the guidance of Mr. Shaikh Ajmoddin R., Lecturer at St. Luke‟s
CON, Shrirampur and the topic was approved by Prof. Smt. M. Joshi,
Chairperson of Research committee.
Date: 03.03.2016
Place: Shrirampur
Name of student: Ms. Fatima Mary Signature of student

CERTIFICATE BY THE RESEARCH PROJECT GUIDE
I hereby certify that this dissertation entitled “A study to assess the

effectiveness of structured teaching programme on stress among selected
nursing students studying in selected nursing colleges at shrirampur” is
bonafied and genuine work carried out by Miss. Fatima Mary, student of
second year post basic B.Sc Nursing in partial fulfillment of the requirement
Degree of Sciences in Nursing.
Date: 04.03.2016
Place: Shrirampur
Research Project Guide

Mr. Shaikh Ajmoddin. R.
Lecturer, St. Luke’s hospital, CON,
Shrirampur.
ENDOCRCEMENT BY HEAD OF INSTITUTE & CHAIRPERSON OF
RESEARCH COMMITTEE OF INSTITUTE
This is to certify that this dissertation entitled “A study to assess the

effectiveness of structured teaching programme on stress among selected
nursing students studying in selected nursing colleges at Shrirampur” is
bonafied and genuine work carried out by one student of second year post
basic B. Sc. Nursing of St. Luke‟s Hospital, College of Nursing, Shrirampur,
as a partial fulfillment of the requirement Degree of Sciences in Nursing
under the guidance of Mr. Shaikh Ajmoddin R., Lecturer, St. Luke‟s College
of Nursing.
Signature Signature
Prof. Smt. Mangla Joshi Sr. Reena George,
Chairperson, Research Committee Resource person of Research Committee
Principal, Associate Professor
St. Luke‟s Hospital, CON. St. Luke‟s Hospital, CON.
Date: 05.03.2016 Date: 05.03.2016
Place: Shrirampur Place: Shrirampur

COPYRIGHT DECLARATION BY RESEARCHERS
I the student of second year Post Basic B. Sc. Nursing hereby declare that St.
Luke‟s Hospital, College of Nursing (affiliated to Maharashtra University of health
Sciences), Shrirampur, Dist. Ahmednagar, Maharashtra, India shall have the all rights to
preserve, store, use and disseminate this dissertation in print or electronic format for
academic| research purpose.
Date:05.03.2016
Place: Shrirampur
Name of student: Ms. Fatima Mary Signature of student:
St. Luke’s Hospital, College of Nursing, Shrirampur, Dist. Ahmednagar,

Maharashtra, India – 413709.
ACKNOLEDGEMENT
“Gratitude is the song of the heart” . I praise and thank to Almighty God for His
abundant graces and blessings upon me and providing me the wisdom and understanding
to complete this manuscript.
I express my heartfelt gratitude to Honorable Rev. Sr. Rosy V., Head of the
Administration Department, St. Luke‟s Hospital, Shrirampur, for providing me an
opportunity to conduct research study under this course in St. Luke‟s College of Nursing.
It gives me immense pleasure with deep sense of gratitude to thank Professor, Smt.
Mangla Joshi, Principal, College of Nursing, for her valuable support in completing the
research study.
I am truly thankful to Sr. Reena George, Associate Professor, Vice Principal, St.
Luke‟s Hospital, College of Nursing, for her sustenance and treasured guidance.
It gives me great pleasure with deep sense of gratitude to thank my research guide,
Mr. Shaikh Ajmoddin R., M. Sc., Lecturer, St. Luke‟s College of Nursing, for his
constant, inspiring guidance, untiring efforts and enormous support in completing the
study under his guidance.
I extend my special thanks to Mrs. Manisha Kadam, B. Phil. (Librarian) for her
support and for valuable remarks to improve the quality of the research work.
I would like to thank the amazing faculty and staff from St. Luke‟s Hospital,
College of Nursing for all of the opportunities that were presented to me during my
undergraduate career.
I express my warm appreciation to all those who have helped me directly and
indirectly for completing this endeavor.
My whole hearted thanks to my family and friends for their love and blessings
throughout the completion of this dissertation.
Student of II Year Post Basic B. Sc. Nursing

St. Luke’s Hospital, College of Nursing,
Shrirampur.
ABSTRACT OF RESEARCH STUDY
Research reveals that highest percentage (50%) of samples had secondary school
education and lowest percentage (12%) samples were Undergraduate and above. Hence it
can be depicted that all samples had school education. According to their family type that
the highest percentage (84%) of samples were living in Nuclear family and lowest
percentage (2%) samples were living in Extended family. occupational status showed that
the highest percentage (46%) of samples were daily wages and lowest percentage (6%) of
samples were had business.as per the marital status of parents of student it is been revealed
that that the highest percentage (84%) of samples had healthy relationship and lowest
percentage (6%) of samples were within the family where parents were separated.
Residential status shows that the highest percentages (56%) of samples were the
residence of Urban areas and lowest percentage (16%) of samples were residence of Semi
Urban areas. highest percentage (44%) of sample‟s parents monthly income was 3000
Rupees to 8000 Rupees per month and lowest percentage (11%) of parents had monthly
income of 18,001Rs and above per month. Highest percentage (72%) of samples were
Christian and lowest percentage (28%) of samples were Hindu‟s.38% of samples had
weight in between 45kg - 49kg and lowest percentage (8%) of samples were had 55kg and
above.48% of samples said that Television and Radio were the source of information and
only 14% samples were using Newspapers as a source of information.
Description of stress assessment declared that highest percentage (48%) of samples

sometimes have a hard time feeling really relaxed and hardly 2% samples said that most of
the time they lose the physical energy. 48% of samples sometimes find difficult to take up
initiative to do things and only 18% of samples have said that almost always they feel
anxious and worried. Highest percentage (42%) of samples said that sometimes they can‟t
really describe the emotional aspect and lowest percentage 4% of samples said that almost
always they feel very tired and disinterested in life.
40% of samples said that sometimes they find difficult to make decisions, lowest
percentage (4%) of samples said that almost always they stutter or get tongue tied when
they talk to people. Highest percentages (16%) of samples were tattling habit. Highest
percentages (98%) of samples were belongs to friendly Environment and only 2% of
participants responded that family and neighbors makes living environment chaotic.
INDEX
Sr. No. Chapter Content Page no.
1. I Introduction
2. Need of the study
3. II Review of literature
4. III Methodology
5. IV Data analysis and presentation
6. V Data interpretation
7. Discussion, Summary, Conclusion, Recommendation, implications.
8 Bibliography
9. Annexure‟s
VI
List of diagrams
F. No. Label of Figures P. No.
1.1 Conceptual framework
1.2 Percentage wise distribution of responses of samples based on their gender.
1.3 Percentage wise distribution of responses of samples based on their

List of tables
Table No. Title of table P. No.
1.1 Percentage wise distribution of responses of samples regarding

List of Annexure
Ann. No. Annexure Page No.
1. Institutional research/ethics committee approval letter
2. Requesting letter for permission to conduct main study
3. Letter for validation of tool
4. Certificate of validation
5. Informed Consent
6. Tool in English
7. List of Experts
INTRODUCTION
INTRODUCTION
Everyone has stress and we face it in our daily life. Student nurses might
be facing interpersonal and environmental stresses. Stress brings advantages and
disadvantages to us, it depends on how nursing students look upon and take over them.
Stresses can cause us to become stressful, feel distress and emotional affected while on the
other hand, stresses give us motivation and evoke us to be more upholding and persistence
in the study in order to reach the optimum target and achieve further success.
Meaning of stress
Stress affects every individual and has a powerful impact on the mind and on an
individual‟s health and well-being (J. Shaw, 2008).1
Stress is defined as a physiological and psychological response to an environmental

demand that occurs after an individual perceives that they are not able to adequately cope
with the present demand (K. Lewis, 2007). Stress reaction can only occur if the individual
perceives the circumstance or event as a stressor.2
Causes of stress:
Nitasha Sharma et al (2010) conducted study to identify the factors contributing to
stress among nursing students. A total of 37 subjects participated in the study. In first
phase, the level of sting a standardized scale .In the second phase, the factors contributing
to stress were assessed using in subjects with moderate and severe stress by using a
validated tool. Researcher has concluded that 97% of the subjects had moderate level of
stress whereas 3% had severe stress. Among the factors contributing to stress, the
environmental factors had maximum contribution (40%) followed by the interpersonal
factors (30%).The academic factors had only 19% contribution whereas the intrapersonal
factors contributed minimally3.
Laurence et al. (2009) conducted a survey of (453) graduate students, (25%)
reported elevated depressive symptoms in their student life, the researcher indicated that
the exams, fear of failing, shortage in clinical time, decrease in self-esteem and prompt
reduction in time spent in leisure activity have been associated with higher stress levels4.
Dapaah et al (2014) conducted a study in order to ascertain the causes of stress

among nurses in the Greater Accra Region of Ghana. The study adopted a descriptive
survey design. Convenient sampling technique was used to sample 369 respondents for the
study. One research question was formulated to keep the study in focus. A questionnaire
was used in collecting responses from the nurses. The researcher found out that the most
predominant cause of stress was the number of hours that nurses use to work. This was
followed by financial difficulties and the death of patients. It was recommended that more
programmes such as workshops, seminars and symposia should be undertaken by
counsellors and other stakeholders in the nursing profession to address the causes of stress
of nurses5.
A. Redhwan (2009) conducted study which aimed to explore the associated factors
related to causes of stress and coping strategies among 39 university students, Malaysia.
Researchers found that total of participants were 39 students, their age ranged from 21 to
26 years. 43.6% of the students were 21 years old and the majority were female 79.5%.
Most important causes of stress reported by the students were financial, lack of sleep, and
family problems. Lack of sleep, financial, and family problems were the most causes of
stress among students. The students were able to identify some strategies to cope with
stress6.
Yogesh Saxena et al(2014)conducted a study to determine the prevalence of

stress levels in 100 first year medical students and to explore the sources of stress & it„s
relationship across the male and female students. Findings have stated that stress perceived
was more in male students (82.2%) as compared to females (61.8%) and their MSSQ
index score was significantly different. Moderate to high academic stress was present
among 79% of students more so in males with the academic domain score significantly
different from that of females. Researcher concluded that Females perceived more stress in
inter personal domain (12.7%) with the score significantly different from males. Group
and Teaching stress was equally present in males and females7.
Abeer Saad Eswi (2013) et al conducted a study to investigate perceived stress
and stressors among baccalaureate Saudi nursing students in King Saudi Bin AbdulAziz
University of Health Science, College of Nursing- Jeddah. As regards stressors among
baccalaureate Saudi nursing students in terms of recent life experiences,the academic
factors had the maximum contribution in causing stress (52%) followed by environmental
factors (28%) while interpersonal factors had the least contribution in causing stress
(20%). The researcher concluded that For Academic stressors (57.0%) of the students
reported a lot of responsibilities as the most common stressor thet are experiencing and
considering as part of their life and too many things required at the same
time(42.0%).Environmental factors were the second common sources of stress as
(43.0%)of the students reported8.
.
Sangeeta Patil (2014) has conducted a study to assess the level of stress among and
coping strategies parents of neonates and to co-relate stress and coping strategies among
parents of neonates. -Descriptive approaches with 40 samples were selected with
convenient sampling technique. Results majority belonged to age group18-23years
(57.50%).and (57.50%) were found in secondary education. 28(70%) majority of mothers
had moderate stress and 12 (30%) had severe stress Assessing the stress level of mothers
in neonates. While 35 (87.50%) mothers of neonates were in average coping and 5(12.5%)
were in good coping. The researcher concluded that the main outcome of the study that
mother always in stress because of babies admission in NICU. So any interventional
programmes on stress were help the mother to minimize the stress and she will develop
certain coping strategies9.
Xabier Zupiria Gorostidia et al (2007) has conducted a cohort study in order to

evaluate the evolution of nursing students‟ perception of stressors associated with clinical
practice . 69 students answered the questionnaire at four stages of their studies. The most
powerful stressors identified by students both at the beginning and at the end of their
studies were: lack of competence, uncertainty, being harmed by the relationship with
patients, emotional involvement, lack of control in relationships with patients, contact with
suffering, relationships with tutors and companions, and overload10.
Gibbons C. et al (2008) conducted a study in Norway to assess the psychological
distress among nursing, physiotherapy and occupational therapy students. A longitudinal
and predictive study, in this study a longitudinal data was presented on changes in
psychological distress among 232 Norwegian undergraduate students of nursing,
physiotherapy and occupational therapy. Psychological distress was assessed by applying
the 12 item version of the general health questionnaire. The researcher concluded that
nursing students became substantially more distressed during 3years of their programme,
compared to physiotherapy and occupational therapy students11.
P.K. Gupta (2006) conducted urban community survey in India which states that,
in India a very large, populous and typical developing country. Community surveys have
documented that between 3 & 6 decades, prevalence of hypertension has increased by
about 30 times in urban dwellers over a period of 55 years, and by 10 times among rural
inhabitants over a period of 36 years. The researcher concluded that these are due to
consequences of urbanization, diet and stress12 .
Laurisse Sossah (2015) stated that Nursing profession, as the other health
professions is known for the overwork of its professionals. Actually, it has been proven
that the work environment of health care is a permanent source of stress and that the stress
level among health professionals is higher than that of other workers13.
Signs and symptoms of stress:

Admi H (2007) conducted a study in Brazil on 1 st, 2nd, & 3rd year B. Sc. nursing
students to assess depression among students associated with their self-esteem. There were
224 subjects included based on the data obtained. The study adopted a descriptive
qualitative approach using psychometric resources, which includes tests, inventories,
questionnaires and scales. The researcher found that, highlighting 1 case of serious
depression, 14were with moderate depression, 28 were with mild depression and 181 were
without signs of depression14.
Abeer Saad Eswi (2013) et al conducted study to investigate perceived stress and
stressors among 100 baccalaureate Saudi nursing students in King Saud Bin Abdul Aziz
University of Health Science and study revealed that (72.0%) students reported feeling
nervous or stressed fairly often to very often in the previous month; (61.0%) students
reported being angry because of things that were outside of their control, (50.0%) students
reported being upset because of something that happened unexpectedly. As for the
stressors among college students in terms of recent life experiences, (57.0%) of the
students reported a lot of responsibilities as the most common stressor they are
experiencing and considering as very much part of their life, other stressors were also
reported as very much part of students‟ life such as; lower grades than hoped for (43.0%),
not enough sleep (43.0%), too many things required at the same time (42.0%)15.
Aldwin C.M et al (2005) conducted a research on Center for disease and

prevention, research has shown that women are more likely to report symptoms and seek
health care than men. The researcher concluded that Females were found to rate 14 or 20
stressors more than males16.
Han K, et al (2004) conducted a study to “identify the factors influencing

Symptoms of Stress among hospital staff nurses”. Data was collected by questionnaires
from 249 hospital staff nurses in three multi-specialty Hospital. The score of the symptoms
of stress showed a significantly positive correlation with the score of work stress. The
most powerful predictor of symptoms of stress was social support and the variance
explained was 16%. A combination of social support, ways of coping, and work stress
account for 32% of the variance in symptoms of stress among hospital staff nurses. The
researcher suggests that social support, ways of coping, self-efficacy, hardiness, and work
stress are significantly influencing factors on symptoms of stress among hospital staff
nurses17.
Dahlin M, Joneborg N et al (2005) stated that Stress can have a significant effect
on adolescent's long term physical and mental well-being. The adolescents may become
irritable, show lack of concentration, decreased academic performance, poor interpersonal
relations, insomnia and absenteeism18.
Adachi H et al (1999) has conducted a study to assess “Mental health and stress
coping among specialty hospital nurses”. A self-administrated questionnaire including
questions on nursing work, the General Health Questionnaire (GHQ) as well as the Stress
and Stress Coping questionnaire (SSCQ) was used. Subjects of this study were 225 female
nurses. The subjects whose working experience was 10 years had higher scores in the
SSCQ. Researchers suggested that because working conditions have a negative influence
on mental health, educational system for both inexperienced and experienced nurses is
needed to develop an effective stress-coping style in medical institutions19.
Globle J (2007) has conducted a study on laughter therapy to investigate the effect
on laughter therapy on stress among Cancer patients. He used randomized, pre-posttest
with comparison group design. Setting was Indiana state university Sycamore nursing
center. Result showed that, stress decreased for subjects in the Laughter group, compared
with those in the distraction group. Subjects who scored greater than 25 on the Laughter
response scale had increased immune function post intervention and compared with the
remaining participants. Researcher concluded that laughter reduces the stress activity20.
Mahat G et al, (2008) have conducted a study in U.S.A to identify stressful events
of first year nursing students in the clinical setting and to determine how they cope with
the stressful events. The method used was a descriptive study and sample consisted of 104
nursing students. The result of the study indicated that interpersonal relationship, initial
experiences, feeling helpless and most of the students utilized 'seeking social support' as
category of coping21.
Grobler A. (2007) has conducted a study on therapy in India to assess the effect of
laughter therapy on stress level among staff of IT companies. Changes in stress levels were
measured before and after 3 weeks of unconditioned laughter sessions for staff of three
separate IT companies. Researchers carefully measured physical psychological and
emotional indicators of stress. The laughter group showed significant decrease in stress
level reflected in reduced heart rate, blood pressure, and cortisol levels and an 11%
decrease in perceived stress levels. Other indicators confirmed that all participants showed
significantly lower stress levels after 3 weeks of laughter sessions22.
Rajesh kumar (2011) conducted a descriptive study in a private nursing institute of
Punjab affiliated with Baba Farid University of Health sciences, Faridkot to assess stress
level and coping strategies among nursing students. Total of 180 students participated in
the study. Perceived Stress Scale -14 (PSS-14) was used to assess stress level and ACOPE
was used to identify the coping strategies. Researcher revealed that 34% students were
having moderate stress and 33% each were having mild and severe stress. Class of the
students and their courses were found to be significantly associated with the stress level of
nursing students. Majority of subjects tend to use more of healthy coping strategies as
compared to negative or un-healthy ones. "Seeking diversion" is the most common and
"Seeking professional support" is the least common coping strategy identified in nursing
students23.
NEED FOR STUDY
Stress is a prevalent and costly problem in today‟s world, in today‟ fast-paced and
hectic society, the cumulative effects of stress are literally killing people, it is a sad and
fortunate reality. The prevalence of stress has been addressed in almost all ages from
childhood to old age - (2013) S. Shaly. 24.
Morbidity due to stress

Chandrashekhar T. S. et al (2006) conducted a cross-sectional, questionnaire-based
survey among the undergraduate medical students of Manipal College of Medical
Sciences, Pokhara, Nepal. Researchers found that 75.8% (407 out of 525 students). The
overall prevalence of psychological morbidity was 20.9% and was higher among students
of basic sciences, Indian nationality and whose parents were medical doctors25.
Roger Watson et al (2004) conducted a study in Hong Kong to assess stress and
burn out among 158 nursing students. At the end of the study the researcher revealed that
students suffered greater levels of stress, and this was explained by emotion -oriented
coping. The study concluded that undertaking a nursing program leads to increased levels
of stress, burn out and psychological morbidity and is largely related to individual
personality and coping traits26 .
Kane P.P. (2009) conducted cross sectional study among 106 staff nurses and
Researcher found the results that 26.42% had mild stress, 66.04% had moderate level of
stress and 7.55% had severe level of stress. Main home stressors are dependent relative
(52.8%) and work disturbs home life (36.8%). The work related stress include not
finishing work at time (78.3%), backache due to standing for long hours (61.3%), shortage
of staff (58.5%) and night duty (20.8%). Major type of psychosomatic problems addressed
by the nurses are headache (60.5%), acidity (54.5%), back ache and stiffness (47%),
tiredness (40.6%), depression (14.2%) and crying (21.7%)27.
Pafic Moraa and Kennedy BR. (2005) did a survey on teachers and declared that
40% of respondents reported having visited their doctor with a stress-related problem in
the previous year. 20% considered that they drank too much and 15% believed they were
alcoholics. 25% suffered from serious stress related health problems including
hypertension, insomnia, depression and gastrointestinal disorders28.
Kennedy BR et al (2005) stated that In addition to reducing job effectiveness,

rising levels of stress in nurses can affect retention through “burnout,” or the appearance of
psychiatric morbidity in association with long-term stress. In the study, which
administered the Nursing Stress Scale and the Burnout Inventory to 125 registered nurses,
licensed practical nurses, and Nursing assistants in a long-term care facility the researcher
found that the number of sick days taken by this group of nurses correlated significantly
with higher scores on both the stress scale and the burnout inventory29.
Hannigan B, et al (2000) stated that Among 301 mental health nurses surveyed in
Wales, more than half turned in burnout inventory scores indicating that they were
suffering emotional exhaustion to the point of being a “high-burnout risk.” Just over one
third of these nurses returned General Health Questionnaire results indicating some
psychiatric morbidity30.
Jone Parry (2014) conducted a survey regarding work related stress. Recent survey
showed that 70% - 80% of us feel stressed at work and outside. The proportion of nurses
scoring higher than norms established by the developers of a „burn out‟ inventory were
highest in U.S.A (43.2%) and lowest in Germany (15.2%) ,Canada, England and Scotland
had moderate proportion of high burn out scores (36%, 36.2% &29.1%) respectively. The
researcher found that Globally 1/3rd of workers report increased levels of stress, 1/4 th view
jobs as number one stressor in life; stress is the major cause of turnover in organizations31.
Omigbodun O (2004) conducted a study on stressors in nursing students.

Multivariate analyses showed that the student‟s level of psychological distress at the
beginning of the study was the most important predictor of psychological distress at the
end of the study. Researcher concluded the Other significant predictions were qualities of
individual students personal life, clarity in educational structure, subjective experiences of
study workload and level of support in student milieu32.
National centre for health statistics (2005)found that Post traumatic stress affects
5.2 million adult Americans, about 3.6% of U.S.A adults ages 18 -54 years have post-
traumatic stress during the course of given year. The researcher concluded that about
9,791,999/year, 8,15,999 per month, 1,88,307/week, 26,877 per day, 1,117 per hour and
18 per minute are subjected to post traumatic stress. The life time prevalence of depressive
disorders due to stress is 15% for men and 24% for women33.
L.S. Zegans (2008) conducted a study to investigate the effects of job stress on the
physical health, mental health personal and work behaviors of 153 nurses in public
hospitals in Ibadan Metropolis, Nigeria. Researcher established that job stress has
significant effect on physical and mental health of the nurses. It also established that there
was a significant difference in personal and work behavior of highly stressed nurses and
less stressed nurses34.
Kerlinger G.N. et al (2003) stated that Stress and burnout are concepts that have
sustained the interest of nurses and researchers for several decades. These concepts are
highly relevant to the workforce in general and nursing in particular. Many studies of
stress in nurse in developed countries have shown chronic stress as a major contributor to
suicide or suicidal thoughts, smoking, excessive coffee consumption, and alcohol intake35.
Complications due to stress:
K.L. Obaya (2006) conducted study and found that stress related disorders
encompass a broad array of conditions, including: Psychological disorders such as
depression (affects 15% in men and 24% in women worldwide), anxiety, post-traumatic
stress disorder. Emotional strain such as dissatisfaction, fatigue, tension, etc. Maladaptive
behaviours such as aggression, substance abuse (accounts for 30% - 60% of individuals
with stress). Cognitive impairment such as concentration and memory problems, Poor
work performance, Sleep disturbances (affects 50% - 75% of persons with
stress).Headaches and stomach upset(affects 30% -70% of individuals with stress).Cardio
vascular disorders such as hypertension, coronary artery diseases (affects 34% of
individuals). Musculoskeletal disorders (affects 8% of individuals). Death in extreme cases
(7.14 million deaths worldwide) 36.
V.P.Gupta et al (2003) stated that Incidental studies have shown increasing
prevalence of cardiovascular diseases among young in India. Younger people in India are
stressed because of heavy competition in academic fields and for employment. Hence it is
possible that young stressed individuals with pre hypertensive levels of BP may be at risk
for heart diseases. The study concluded with special emphasis on young individuals to
avoid progression to hypertension through lifestyle changes, diet and avoidance of urban
stress37.
Role of nurse in managing stress:

Sangeeta Pillay (2014) conducted study to assess the level of stress among parents
of neonates and to co-relate stress and coping strategies among parents of neonates. Study
have revealed that 87.50% mothers of neonates were in average coping and 12.5% were in
good coping. The researcher concluded that the main outcome of the study that mother
always in stress because of babies admission in NICU38.
Brown H. & Edelman R. (2000) said that nurses are responsible for creating the
environment in which nursing is practiced and patient care is given, it is important to
explore interventions that will reduce the stress and burnout experienced by nurses. By
reducing the stressful nature of the nurses‟ work, nurse could be more satisfied in their
positions. This role satisfaction, in turn, could lead to improve the work environment for
staff nurses39.
Every nursing student has to know that they play an important role in health care
service, they have to learn to manage their own stress through stress management training,
and they would not be able to take care of the clients if they cannot take care of themselves
throughout their nursing career. Nursing students need to assess their stress levels and
determine what will decrease their tension.
Since the prevalence of stress is high at all age groups, especially among nursing
students. It is essential to take necessary steps to combat stress in our day to day life
process, as its consequences have serious impact on an individual‟s normal functioning
and quality of life. Prevention is better than the Cure‟- Stress can be avoided and
prevented through various methods. One such method of overcoming stress is through
exercises. Exercises are known to improve quality of life relaxing both body and mind.
RESEARCH
OBJECTIVES
RESEARCH OBJECTIVES
Chapter deals with objectives of research study. Objectives include obtaining
answer to the research questions on testing the research hypothesis, but may also
encompass some broad aims like developing recommendations for changes to nursing
practice best on the study results. Specific achievable objectives provide the researcher
with the clear criteria against which the proposed methods can be assed
Research Statement:
Study to assess the effectiveness of structured teaching programme on stress

management techniques to reduce stress among selected nursing students studying in
selected nursing colleges at Shrirampur.
Research objectives:
1. To assess the level of stress among students nurses studying in selected nursing colleges.
2. To identify the causes of stress among nursing students.
3. To identify the factors disturbing, the mental health of nursing students.
4. To evaluate the effectiveness of teaching on stress management techniques
Operational definitions
Assess:
It refers to the evaluation of the level of stress among first year Nursing Students.
Effectiveness:
It refers to significant reduction in the level of stress after using stress management
techniques among first year nursing students.
Stress:
It refers to the score obtained on psychological distress experienced by the Nursing
students when demands exceed their personal and social resources the individual is able to
mobilize.
Nurses:
In present study word Nurse refers to a qualified nurse having certification of state
Nursing council completed a minimum of Diploma certificate that are eligible to impart
care to clients either in hospitals or community
Students:
Samples studying in 1st year R.G.N.M Nursing College and had willingly
participated in study .
Stress management program:

Stress management program consists of planned instructions on stress and positive
coping strategies, time management, yoga and meditation.
Nursing college:
A physical set up where people of different ages learn and gain an education on
nursing.
Research Assumptions:
1. Student may have mild, moderate or high levels of stress.
2. Stress level may vary from individual to individual
3. Stress management techniques will help students to cope better with their day
today life stressors.
4. The reduction in stress among the students may show effective practical and
preventive measures.
Delimitation of research study:

1. Study is delimited to students of selected course
2. Study is delimited to students of selected college
3. Study is delimited to students who know English
4. Study is delimited to students of age group 18-20years.
5. Study is delimited to 30 samples.
6. Period of study will be limited to 3 weeks.
7. Study is limited to first year nursing students.
Significance of study
1. Study will help to identify the level of stress and coping strategies of student
nurses during their initial clinical practice.
2. Study will pave the way for first year R.G.N.M Nursing students to express their
stress and emotional status during initial clinical practice.
3. Study will help student nurses to better understand about the phenomenon of stress,
coping and adaptation, thereby promoting the quality of clinical practice.
Summary:
This chapter has briefly dealt with the objectives, operational, definition, hypothesis,
assumptions, delimitations and scope of the study.
CONCEPTUAL
FRAMEWORK
CONCEPTUAL FRAMEWORK
Present research study is to identify the causes of stress factors among R.G.N.M. Students
of selected Nursing Colleges at shrirampur.
Conceptual frame work is interrelated concepts or abstracts that are assembled together
in some rational scheme by virtue of their relevance to common theme. Theoretical frame
helps to stimulate research and the extension of knowledge by providing both direction and
impetus.
i. Input:
Research study was conducted in selected Nursing College at Shrirampur, District

Ahmednagar. By using Non purposive random sampling method 30 R.G.N.M. students of
selected Nursing Colleges were selected for the present study. Research participants had
been explained well the aim and process of research. Written consent had been taken.
Input phase of research mainly consist of two sections:
Assessment of demographic variables:
a) Investigators have selected demographic variables following independent variables such

as education of parents, type of family, occupational status, marital status of parents,
residence of student, religion of student, monthly income of parents, nutritional status of
student.
b) Extraneous variables of present research includes sources of information, peer group,

habits of students, habits of parents, family environment of students.
c)Research tool development:
Structured rank order questionnaire was developed to identify the factors causes
stress in selected students of educational institute. Rank order questionnaire consist
headings such as stress in personal life, stress in family life, parenting, stress due to social
life, stress due to academic issues, learning difficulties, economical factors causing stress,
environmental causes of stress, impact of social media.
Each question of questionnaire had four options and participants were asked to
choose one option as answer and the response of samples was measured as per scoring
system of tool.
ii. Throughput: It consist health education and implication of post test
Health education:
Investigator has explained in detail the concept of stress and its causes, how it
affects academic performance of student. Researcher has planned need based health
education and conducted a health teaching use of stress management techniques. Feedback
was taken carefully and in depth discussion was emphasized after health education. Each
sample was interviewed by researchers and obtained data was kept confidential.
iii. Output:
Data obtained from selected samples was analyzed by descriptive inferential

statistical method. Average and percentage of each category of questionnaire was
calculated and presented in diagrammatic format and tables. Based on the obtained
information from samples investigators interpreted the information and measured level of
stress. Based on the collected data made final conclusion were made.
Significant causes of stress have been seen in students. Findings of obtained data
explained in detail in data interpretation chapter of research. Health education is delivered
as per the research findings.
INPUT THROUGHPUT OUT PUT
Demographic variables Identification sources of stress factors Causes of stress identified
Personal life related cause

Section A: Demographic variables:
Age, Gender, Education, Marital status, Occupation,
FamilyIncome, Habits,
life related Religion, Family type, Health resources
cause
Section B: Extraneous variables: Sources of information, peer group, habits, family environment
Parenting
Common stressors:
Social life related cause Poor parenting, economical status, Social support, Learn
Academic performance
Rank order
Learning difficulties questionnair e is used
Economical cause
Research tool
Environmental causes
Section: C: Social media

Developing structured rank
order questions to assess Psychological health
the causes of stress
Physical health
Figure No. 1.1.Health belief model shows the planned steps of determining the stressors in student’s life and its effect on academic
performance of students.
Summary
With the available sound background of literature and key concepts of health
belief model were followed. Framework shows Plan of assessment of stress factors among
students and health education based on the needs of students .
Review of Literature
Review of Literature
Review of literature is a key step in the research process. The typical purpose
of analyzing a review of existing literature is to generate questions and to identify
what is known and what is unknown about the topic. The major goals of review of
literature are to develop a strong knowledge base to carry out research and non-
research scholarly activity.
Review of literature is an extensive, exhaustive and systematic examination of

publications relevant to research project. One of the most satisfying aspects of the
literature review is the contribution it makes to the new knowledge, insight and
general scholarship of the researchers B.T Basavanthappa40.
Review of literature serves as the key step in research process. It helps in many
ways starting from selection and formulation of problem, providing conceptual
framework for the study, assess feasibility, providing methodology for comparison
and replication, avoiding obstacles and making generalization.
Review of literature pertaining to the present study is aimed at assessing the

effectiveness of callisthenic exercises in reducing stress among first year nursing
students in a selected college of nursing at Shrirampur.
Knowledge among students:
Jones D.H. et al (2000) conducted a study on the association of knowledge of

health risks, living arrangements, and perceived stress with health-risk behaviors was
examined in a sample of college students. It is found that knowledge was not
associated with participation in physical activity or smoking, the study found that
students who knew more about the harmful effects of alcohol drank less, and those
with greater knowledge of health risks practiced fewer risky behaviors. Students living
independently were more likely to smoke, and those living in residence halls were less
like to do so41.
Jyothi Prince (2014) conducted a descriptive cross sectional survey to assess
the knowledge and practices of nurses regarding stress management in Vijay Marie
Hospital, Hyderabad. One group pre-test design, 20 women were selected by
purposive sampling technique. Tools consist of structured questionnaire in two
sections. Part A: consists of demographic characteristics of participants, Part B:
Structured knowledge and Practices questionnaire. Data was analysed using
descriptive and inferential statistics. Researcher found that Majority (60%) of sample
had poor knowledge scores on stress Management; whereas majority of the sample
(55%) had good practice scores. while none of them had poor practice scores which
reveals knowledge42.
Stress among children:

Brobeck E. et al (2007) conducted a study on specific stressors in children, for
which 23 children age group between 8-12 years were recruited for the study. The
researcher of the study revealed that 6 boys and 7 girls with stress related symptoms,
further comparison was made between the sex, the study concluded that majority of
girls were found to have more stress than boys. In the study more girls (41.2%) than
boys (16.2%) rated their stressor as it upset me a lot43.
Among women:
Aldwin C.M, and Revenson T.A (2005) stated that center for disease and
prevention 2005, research has shown that women are more likely to report symptoms
and seek health care than men. Females were found to rate 14 or 20 stressors more
than males44.
Among adolescent boys:

Boscarino J.A. (2005) conducted a study at Saudi in 2000 to determine rates
and severity of depression, anxiety and stress among adolescent boys. The study
recruited 1,723 male students out of which 59.4% had at least one of the three
disorders, 40.7%had at least two and 22.6% had all the three disorders. Moreover one
third of the participants (38.2%) had depression, while 48.9% had anxiety and 35.5%
had stress. Further the researcher made a conclusion that depression, anxiety and
stress were strongly, positively and significantly correlated45.
Among teachers:
Griffith et al (2004) interviewed 780 primary and secondary school teachers,
aiming to assess the associations between stress, coping responses and social support.
High levels of stress were associated with low social support and the use of
disengagement and suppression of competing activities as coping strategies.
Interestingly, stepwise multiple regressions revealed that coping style not only
mediated the effects of environmental stressors, but also influenced teachers'
perceptions of their environment as stressful46.
Among nursing students:
Seyed fatem et al (2007) has conducted a study in 2007 to investigate the

perception level and sources of stress across academic years among B. Sc. nursing
students, 94 students were recruited for the purpose. The findings of the study
revealed that psychiatric problems were more prevalent in nursing students than the
general population. Many items ranked as stressful among nursing students were also
identified in general population. In addition, the researcher concluded that nursing
students had the feelings 0f inadequacy, difficulty in relationship with faculty, were
given multiple assignments, have to devote long hours to study and lacked free time,
timely feedback and faculty response to student‟s needs47.
Jones M C et al (2007) has conducted a study in Scotland to assess the level of

affective distress, sources of stress and coping strategies in first year student nurses
and author found that 50% of students suffered significant affective distress indicates
problem with student distress around an initial series of general/surgical and psycho-
social ward placements48.
Roger Watson et al (2008) conducted a study in Hong Kong in 2004 to assess

stress and burn out among 158 nursing students. Study revealed that students suffered
greater levels of stress, and this was explained by emotion -oriented coping. The
researcher concluded that undertaking a nursing program leads to increased levels of
stress, burn out and psychological morbidity and is largely related to individual
personality and coping traits49.
B. Nancy and Kumar R et al (2011) conducted a study to assess Level of stress
and coping Strategies among nursing Students .Data was obtained from 180 nursing
students using Perceived Stress scale. Results shows Majority 62 (34.4%) had
Moderate stress .This study Supports present study as Majority 60.4 % of the Students
experienced moderate stress level50.
Mostafa A et al (2011) conducted a Cross sectional study to assess Stress

among a Mansoura (Egypt) baccalaureate nursing student. Data was obtained from373
Students using self-administered questionnaire. Tool was Socio- demographics, list of
possible stressors, perceived stress, physical wellbeing factors, and anxiety and
depressive symptoms. Researcher found that Prevalence of 40.2% high stress level.
Study Contraindicates present study as Majority 60.4 % of the Students experienced
moderate stress level51.
Effectiveness of various relaxation techniques:
Hirokawa, Yagi et al (2002) conducted a study on stress management which

showed that stress management training based on the meditation could significantly
reduce the anxiety level of the nursing students in the intervention group compared to
before the intervention. Besides, this program caused a significant reduction in stress
level of the nursing stress in comparison to before the intervention52.
Ms. Palak Patel (2014) conducted a study to assess the Effectiveness Of

Progressive Muscle Relaxation Therapy on Stress among Staff Nurses Working In
Selected Hospitals at Vadodara City and findings of the study revealed that in pre-test most
of the nurses 53.3% had moderate stress, 40.0% had mild stress and s6.7% had severe
stress. In post-test most of the nurses had mild stress 73.3 % and no stress 26.7 %.
Researcher concluded that therapy is effective in reducing the stress level of the staff
nurses53.
Heravi et al (2007) conducted a study assess the effects of relaxation training
which evaluated the effect of relaxation practices on anxiety level of the nursing
students' exams. In the mentioned study it was indicated that relaxation training
programs (progressive muscle relaxation and diaphragm breathing practices) caused
reduction in anxiety level in the intervention group from 46.5% (before intervention)
to 17.5% (after the intervention)54.
Kemper K et al (2011) conducted a study on an anonymous email survey

among 342 North American nurses interested in mind-body training to reduce stress
and survey revealed that 96% were women and 92% were Caucasian. Most (73%)
reported anxiety (49%); back pain (41%); GI problems such as irritable bowel
syndrome (34%); or depression (33%). Nearly all (99%) reported already using one or
more mind-body practices to reduce stress: intercessory prayer (86%), breath-focused
meditation (49%), healing or therapeutic touch (39%), yoga/tai chi/qi gong (34%), or
mindfulness-based meditation (18%). The greatest expected benefits were for greater
spiritual well-being (56%); serenity, calm, or inner peace (54%); better mood (51%);
more compassion (50%); or better sleep (42%). Most (65%) wanted additional
training; convenience (74% essential or very important), was more important than the
program's reputation (49%) or scientific evidence about effectiveness (32%) in
program selection. Most (65%) were willing to participate in a randomized trial of
mind-body training; among these, most were willing to collect salivary cortisol (60%),
or serum biomarkers (53%) to assess the impact of training55.
Davazdahemami et al (2009) conducted a study which results titled as

"reviewing the effectiveness of stress management training in cognitive behavioural
technique on blood sugar and depression of patients with type II diabetes" indicated
that stress management training program could reduce the depression mean score of
the patients in the follow-up step, which this reduction was significant as compared
with the control group56.
Antoni et al (2006) has conducted a study which results titled as "How stress
management improves quality of life after the treatment for breast cancer" showed that
depression level of the women with breast cancer had reduced in the intervention
group in the follow-up step and this reduction was significant as compared with the
control group57.
Ram Kumar Guptha (2007) has conducted a quasi-experimental study to
determine the effectiveness of Yoga Nidra on stress level among student nurses (30 in
study group and 30 in control group) in selected nursing institutes of Pune, India.
Findings related to effectiveness of yoga Nidra show that the mean post – test stress
level of the experimental group was lower than the mean pre-test stress level. Keeping
in view of the study, the following recommendations are made: A study can be done
using other alternative methods or techniques. It is also recommended to develop and
implement policies to promote mental well-being of students. This will not only assist
in the prevention of mental health problems but also contribute to a healthy working
environment and reduced levels of stress58.
Park MK et al (2004) conducted a study on 77 junior nursing students to

identify the effect of aroma inhalation on stress responses of nursing students at
N.A.B. University in Korea. This study was a quasi-experimental research using a
non-equivalent pre-test and post-test design to measure body symptoms, the level of
anxiety, and the level of perceived stress. Researcher showed the result that following
the aroma therapy there was a decrease in physical symptoms, their anxiety scores
were low, and their perceived stress scores levels were low. This shows that aroma
inhalation could be a very effective stress management method59.
Jain. S. et.al (2007) conducted a randomized controlled trial to examine the

effects of a 1-month mindfulness meditation versus somatic relaxation training as
compared to a control group in 83 students. Results showed that both meditation and
relaxation groups experienced significant decreases in distress as well as and increases
in positive mood states over a time60.
Bittman B.B. et al (2004) conducted a prospective cross over study, to examine

the impact of a 6-session Recreational Music-making (RMM) protocol on burnout and
mood dimensions as well as Total Mood Disturbance (TMD) among 75 nursing
students from Allegany college of Maryland. Burnout and mood dimensions were
assessed with the Maslac Burnout Inventory and the profile of Mood States
respectively. Researcher found that a statistically significant reduction of multiple
burnout and mood dimensions as well as total mood disturbance scores in first year
associate degree nursing students61.
Amy E. Beddoe et al (2004) conducted a study on baccalaureate nursing
students explored the effects of an 8-week mindfulness-based stress reduction
(MBSR) course on stress and empathy. The course was intended to provide students
with tools to cope with personal and professional stress and to foster empathy through
intrapersonal knowing. A convenience sample of 16 students participated in the
course, used guided meditation audiotapes at home, and completed journal
assignments. Regular home meditation was correlated with additional benefit.
Participants reported using meditation in daily life and experiencing greater well-
being and improved coping skills as a result of the program. The researcher suggested
that being mindful may also decrease tendencies to take on others‟ negative emotions.
Coping with stress and fostering the affective domain are important facets of nursing
education that may be facilitated by mindfulness training62.
Rosy Futtado (2004) said that the rrelaxation techniques include traditional
massage, sound and guided imagery, walking, meditation, Japanese healing energy
work - the application of tuning forks to traditional Chinese acupuncture points on the
body. Creative encounters can be facilitated through guided art walks, clay
workshops, expressive movement classes, journaling, and storytelling sessions, deep
breathing, free writing, massage, sound energy treatment, open dialogue, live music,
art making, journaling, writing poetry, playing with clay, doing yoga, etc63.
Luo Y et al (2008) conducted a study in China to explore the factors affecting

psychological status and stress, coping style and social support of the nursing
student`s during their initial clinical experience. The method adopted was co-relational
study in which 288 nursing students were included and assessed by 'adopting college
seniors stress scale', 'coping style questionnaire' and 'support questionnaire'. Result of
the study was that, positive correlations were found between stressful events and
negative coping style, the negative correlations related to positive coping style and
social stressful factors. Researcher concluded that, to improve the psychological
condition of nursing students, it is very necessary to enhance the social support and
encourage them to adopt positive coping style64.
Sayed F N, et al (2007) conducted a study in Tehran to determine sources of
stress and coping strategies in nursing students studying at Iran faculty of nursing. The
method adopted was descriptive cross sectional study in which 366 students were
included in the study. Student Stress Survey' and adolescent coping orientation for
problem experiences inventory' were used for data collection. The result interpreted
that the frequent stressors were increased class workload and clinical exposure. The
researcher concluded that, first year nursing students are more exposed to a variety of
stressors and establishment of a 'student support system' is necessary for them for their
effective coping65.
Champan R, et al (2001) conducted a study to understand the living experience

of nursing student`s coping with the demands of their clinical practice. The method
adopted was Husserlian phenomenological approach and the data revealed several
strategies that, 14 student nurses utilized to cope with the demands of their
undergraduate clinical programme. The result of the study revealed that, the students
having a strong determination to complete their course and talking things over with
family, friends and other students as a means of coping, helped them to get relief from
stress and also considered other nursing could really understand the feeling and
experience of being as 'student nurse' 66.
Sathiyaseelam M, et al (2007)conducted a cross sectional survey in India with

145 nursing students using General Health Questionnaire 12 the Eysenck Personality
Questionnaire and the Bell`s Adjustment Inventory to investigate psychological
distress, personality problems and coping strategies among nursing students studying
in College of Nursing, Christian Medical College Vellore. The result of the study
indicated that only 30 participants (20.7%) of the 145 students reported high scores on
the General Health Questionnaire and was significantly associated with having
neurotic personality and adjustment difficulties in different areas of functioning67.
Jones M. C. et al (2009) conducted a study in Scotland to assess the level of

affective distress, sources of stress and coping strategies in first year student nurses.
Result has suggested that 50% of students suffered significant affective distress
indicates problem with student distress around an initial series of general/surgical and
psycho-social ward placements68.
Macini J. et al (2003) has conducted a study to determine the effectiveness of
a stress management programme and also to determine personal and professional
stressors experienced, and coping strategies adopted by graduate nursing students. The
stress management programme consisted of practice of relaxation response, imagery,
and diaphragmatic breathing and the subjects were 30 female graduate nursing
students. The method adopted was experimental study in which the students were
randomly assigned to an experimental and a control group .The data collection
consisted of blood pressure measurements, weekly Palmar Sweat Prints (PSP) and a
weekly Self- Report (WSR). The researcher suggested that the control group reported
significantly less strategies for coping with stress than the experimental group69.
Diane K. Leggett (2010) have conducted a study to examine the effectiveness

of a brief mindfulness breathing intervention to decrease stress among 85 first year
nursing 56% of the participants were married and 46% of the participants identified
themselves as parents of children still living at home. Author have suggested that
mindfulness may be of benefit as a method to decrease the risk for depression while
contributing to increased self-efficacy and skills performance in a student nurse
population. Although not all measures achieved statistical significance, the findings
are encouraging for increasing feelings of confidence, leading to a more rewarding
educational experience in nursing students70.
Marjani A et al (2008) conducted a study to estimate the prevalence of

psychological stress and association between the levels of stress and study variables
among Gorgan medical students in Golestan University of medical Sciences. Findings
showed mild, moderate and severe stress among 26.22%, 20.50% and 14.75% study
subjects. 39.35% of medical students had no stress. There was statistically significant
association between year of study and stress levels71.
Summary
Overall the review of literature pertaining to the present study has provided the
investigator with more understanding and broadens her outlook necessary for the
preparation and development of tool and intervention, helped in designing the
conceptual framework, deriving hypotheses and designing the research design and
approach for the study.
METHODOLOGY
Methodology
This chapter deals with the description of methodology, steps undertaken for
collection and organization of data and presenting the findings of the investigation.
The methodology of research indicates the general pattern of organizing the procedure
of gathering valid and reliable data for the purpose of investigation, Kothari C.R,
(2004)71.
Methodology of the study includes the description of research design, the

choice of research approach, setting of the study, population, sample size, sampling
technique, development and description of tool, criteria for inclusion in the study,
methods of data collection and plan for analysis based on the statement and objectives
of the study.
Research design and approach:

Research design is the master plan specifying the methods and procedures for
collecting and analyzing the needed information. Kothari C. R(2004).
As the research aimed at determining the factors causing stress among
secondary school students and its impact on academic performance, the research
design used for the present study was non experimental descriptive study design with
exploratory survey approach.
Variables:
Variable is a character of a person, object or phenomenon which can take on
different values. E.g: age, income, weight etc. These variables are the focus of the
study that reflects the empirical aspects of the concepts being studied. Nirmala V,
Edison J. S and Suni M.S(2011).
The variable under this study is demographic components and knowledge of
nursing students regarding stress and its management.
Independent variable
Independent variable is the cause of the variable that is thought to influence the
dependent variable ; in experimental research it is the variable that is manipulated by
the researcher. Samant K.(2006).
Independent variable of the present study were age, gender, education, type of
family, marital status, religion, income, occupation, nutritional status etc.
Dependent variable
Dependent variable is one which changes in relationship to change in another

variable. (2009).
Dependent variable of the present study was structured questionnaire to assess
the effectiveness of structured teaching programme on stress management techniques
to reduce stress among Nursing students.
Setting of the study

It is the physical location and conditions in which data collection takes place in
the study (Wood and Ross, 2006).
The study was conducted in selected College at Shrirampur, Nursing College,

located in Belapur Road, and approximately 160Km away from Pune city and 45Km
near to Shirdi.
Population
Population is the entire set of individuals or objects‟ or elements having some

common characteristics (Polit D and Beck, 2008).
The population for the present study was Nursing students who were studying
First year R.G N.M Nursing in selected Nursing College at Shrirampur.
Sampling and sampling technique

Sample
Sample is a subset of population selected for a particular study and the
members of a sample are subjects .Burns N.( 1997).
Samples for the present study were the first year R.G.N.M Nursing students
studying in selected Nursing College at Shrirampur.
Sample size
Sample size was comprised of 30 Nursing students studying in selected

Nursing College at Shrirampur.
Sampling technique
Non probability Purposive sampling that involves the conscious selected by

the research of criteria subject of element to include in study (Kothari CR. 2004).
Non probability, purposive sampling technique was used for selecting eligible
students as samples, which meets the purpose of the study.
Criteria for selection of sample
Inclusion criteria:
The study was limited to Nursing students of same genders, who were
 Students of Selected Nursing College
 Students of First year R.G.N.M. College of Nursing
 Those who are able to understand and speak English language
 Those who are available during data collection period.
 Willing to participate and co-operate in the study.
Exclusion criteria:
 Students who are studying in 2nd year 3rd year GNM course.
 Students who are not available at the time of study.
 Students who are not willing to participate.
Method of data collection
A structured questionnaire was used to collect data from Nursing students

studying in selected Nursing College at Shrirampur, based on the study objectives.
Data collection Tool :
The following tools will be used to collect the data:
Interview schedule will be prepared to collect socio-demographic data,

questionnaire will be prepared to assess stress and coping among student nurses.
Development of the tool
Research tool used for the study was Structured Questionnaires (multiple choice
questions).
To assess the effectiveness of structured teaching programme on stress

management techniques to reduce stress among Nursing students.
Construction of tool and techniques

Structured questionnaire was prepared to assess the effectiveness of structured
teaching programme on stress management techniques to reduce stress among Nursing
students.
The steps of construction of the tool and techniques were as follows:
a) Review of related literature

b) Construction of the tool and techniques
c) Consultation with experts and guide
1. Review of related literature

Research concepts related books, journals, news paoers, reports,
articles, published and unpublished studies were reviewed and used as a
background and suppliments to develop the tool.
2. Preparation of blue print

Blue print of items pertaining to causes of stress among students was
prepared as per objectives and conceptual framework.
3. Consultation of the experts
Research tool was given to the experts in various fields such as
department of psychiatry, psychiatric nursing, psychology, biostatistics and
education. Their opinion and suggestion were taken into consideration if any.
The Guide was consulted before finalizing the tool.
Description of tool
The tool for data collection has three sections

Section A: It consist of Demographic variables such as Age, Gender, Education,
Marital status, Occupation, Income, Type of family, Residential status, Religion,
Nutritional status, Health resources.
Section B: Extraneous variables such as Sources of Information, peer group, habits,

family environment.
Section C: It consists of items pertaining to the various aspects of life may cause
stress. Each item has four rank order alternatives.
Scoring key and procedure

To determine the causes of stress there is as such no specific scoring system
made. Results of research were analyzed based on the stress factors present in students
life and its impact on academic performance .
Validity
Validity refers to the degree to which on instrument measures what it is supposed be
measure (Polit and hungler, 1999).
Content validity of the tools was established in consultation with guide and
experts like the department of psychiatry, psychiatric nursing, medical surgical
nursing, department of medicine and statistics etc. The tool was modified according to
their suggestion and recommendations.
Preparation of final draft
Final draft of the structured questionnaire (multiple choice questions) was
prepared after testing the validity and consultation with guide for collecting the data
from the Nursing students.
Data collection procedure
Ethical consideration
Prior to collection of data, written permission were obtained from the

Administrator of St. Luke‟s Hospital, College of Nursing, Shrirampur and Principal of
college of nursing Shrirampur to the investigation.
The following steps will be used to collect the data:

1. Formal permission will be obtained from the authorities of selected Nursing
institution.
2. Consent from the first year R.G.N.M student nurses.
3. Conduct pre-test to student nurses.
4. Conducting of stress management programme to student nurses, which includes
planned instructions on stress and positive coping strategies, time management,
yoga and meditation.
Planned for data analysis
Descriptive and inferential statistics were used wherever required for data
analysis. the collected data was organized, tabulated and analyzed by using descriptive
statistics i.e. mean and mean percentage , and to determine the nursing students.
Selected socio- demographic variables and questionnaire was assessed. The data was
planned to be presented in the form of tables and figures.
Summary
A Non experimental, descriptive study design with exploratory approach was

used on 30 purposefully selected College of Nursing Students. The structured
questionnaire was prepared and tested for validity. The data collection was carried out
in three phases and the data was analyzed by using the descriptive and inferential
statistics, to be presented in the form of tables and figures.
ANALYSIS
AND
INTERPRETATION
Data analysis
Data analysis includes the many techniques for summarizing and testing data in order
to answer research questions. Abdellah Levine E (1994)72.
This chapter deals with the analysis and the interpretation of the data collected
from the 50 RGNM students of selected Nursing College, Shrirampur.
Data was collected from RGNM students through quasi experimental design by using
purposive sampling from St. Luke‟s college of nursing, Shrirampur to determine the causes
of stress among students
The data collected was coded and analyzed as per the objectives of the study under
following headings:
Section A: Description of socio demographic characteristics
Section B: Assessment of extraneous variables
Section C: Assessment of causes of causes of stress

Section A: Description of socio demographic characteristics
1. Education of parents
Fig. No.1.2. Percentage wise distribution of students’ parents as per their

education.
Diagram shows percentage wise distribution of nursing students parents according to

their Educational status that the highest percentage (50%) of samples had secondary
school education and second highest percentage(20%) of the samples had primary
school education and third highest percentage (18%)of samples had Higher secondary
school Education and lowest percentage (12%) samples were Undergraduate and
above. Hence it can be depicted that all samples had school education.
2. Type of family
Fig. No. 1.3. Percentage wise distribution of samples according to their family
type.
Diagram shows percentage wise distribution of nursing students according to their

family type that the highest percentage (84%) of samples were living in Nuclear
family and (14%) of samples were living in Joint family and lowest percentage (2%)
samples were living in Extended family. Hence it can be interpreted that most of the
samples (84%) of samples under study were living in Nuclear family.
3. Occupation of parents
Fig. No1.4. Percentage wise distribution of nursing students parents as per

occupation
Diagram shows percentage wise distribution of Nursing students parents

according to their occupational status that the highest percentage (46%) of samples
were daily wages, second highest percentage (26%) of samples were private or
Government Employee and third highest percentage (18%) of samples were farmers
and lowest percentage (6%) of samples were had business and also (6%) of samples
were house wife and unemployed. Hence it can be depicted that (46%) of samples
under study shows had daily wages as their occupation.
4. Marital relationship of parents
Fig. No. 1.5. Percentage wise distribution of nursing students parents as per their
Marital Relationship
Diagram shows percentage wise distribution Nursing students Parents

according to their Marital status that the highest percentage (84%) of samples were
married and had healthy relationship and second highest percentage (10%) of samples
were spouse is no more alive and lowest percentage (6%) of samples were separated.
Hence it can be depicted that most of the samples (84%) under study were married and
their marital relationship was healthy and there was no any divorce.
5. Residents of students
Fig. No.1.6. Percentage wise distribution of Nursing students as per their

Residential status
Diagram shows percentage wise distribution of nursing students according to their

Residential status that the highest percentage (56%)of samples were residence of
Urban areas and second highest percentage (28%) of samples were residence of Rural
areas and lowest percentage (16%) of samples were residence of Semi – Urban areas.
Hence it can be interpreted that major population of samples were residence of Urban
areas.
6. Monthly income of parents
Fig. No. 1.7. Percentage wise distribution of nursing students parents as per their
monthly income
Diagram shows percentage wise distribution of Nursing students parents

according to their monthly income that the highest percentage (44%) of samples had
monthly income of 3000 Rupees to 8ooo Rupees and second highest percentage (22%)
of samples had income of 8001 Rs to 13,000Rs per month and third highest
percentage (12%) of samples had income of 13,001 Rs to 18,00Rs per month and
lowest percentage (11%) of samples had income of 18,001Rs and above per month.
Hence it can be interpreted that most of the samples under study had income between
3000Rs to 8000Rs per month.
7. Religion of students
Fig No. 1.8. Percentage wise distribution of Nursing students as per Religion
Diagram shows percentage wise distribution of Nursing students according to

their Religion that the highest percentage (72%) of samples were Christian and lowest
percentage (28%) of samples were Hindu‟s . Hence it can be depicted that most of the
samples under study were belong to Christian.
8. Nutritional status of students
Fig No.1.9. Percentage wise distribution of Nursing students as per their

Nutritional status
Diagram shows percentage wise distribution of Nursing students according to

their Nutritional status that highest percentage (38%) of samples were in between
45kg -49kg, second highest percentage (34%) of samples were in between 40kg-
44kg and third highest percentage ( 20%) of samples were in between 50kg-54kg and
lowest percentage (8%) of samples were had 55kg and above. Hence it can be
interpreted that most of the samples had moderate Nutritional status.
Section: B: Extraneous variables
9. Source of information about stress:
Fig.No.2.9 Percentage wise distribution of nursing students as per source of

information
Diagram shows percentage wise distribution of Nursing students according to their

source of information that the highest percentage (48%) of samples using Television
and Radio as a source of information and second highest percentage (42%) of samples
had Friends and Relatives as a source of information and third highest percentage
(14%) of samples were using Newspapers as a source of information. Hence it can be
depicted that major source of information was Television.
10. Peer group of students
Fig. No.2.1. Percentage wise distribution of Nursing students as per peer group

peer group that the highest percentage (100%) of samples were Friendly. Hence it can
be interpreted that all the samples under study were Friendly.
11. Habits of students
Fig. No.2.2.Percentage wise distribution of Nursing students as per their Habits

Habits that the highest percentage (78%) of samples were in none of the above Habits
and second highest percentage (16%) of samples were careless and third highest
percentage (16%) of samples were tattling. Hence it can be depicted that majority of
samples under study were belong to none of the above Habits.
12. Family Environment of students
Fig. No.2.3.Percentage wise distribution of Nursing students as per their Family

Environment

Family Environment that the highest percentage (98%) of samples were belong to
Friendly Environment and lowest percentage (2%) of samples belong to Frequent
fights. Hence it can be interpreted that majority of the samples were belong to
Friendly Environment of their family.
Section C: Assessment of causes of causes of stress
Description of item wise analysis of structured questionnaire to interpret

assessed level of knowledge of students
Table No.1.2.Percentage wise distribution of responses of selected RGNM students

reveals regarding the level of stress
Almost Most of Some of

Sr.
Content always the the time
No.
(%) time (%)
(%)
A Physical Aspects
1. I have nervous sweat or sweaty palms. 8% 12% 24%
2. I have a hard time feeling really relaxed 6% 8% 48%
3. I have severe lower back pain. 16% 12% 12%
4. I get severe headaches 20% 12% 38%
5. My stomach feels upset 8% 12% 18%
6. I have problems with my bowels. 8% 8% 14%
7. I feel short of breath after mild exercise 8% 12% 28%
8. I have decreased or increased appetite 4% 18% 28%
9. I get sharp chest pain when I am physically active 6% 6% 18%
10. I lack physical energy 14% 2% 34%
11. I feel palpitation often 8% 18% 20%
12. I feel week and fatigue 6% 12% 36%
13. I miss my meals. 16% 20% 22%
14. I don‟t really plan my meals for balanced 8% 10% 12%
Nutrition.
15. I get angry and irritated 16% 26% 28%
16. I get stomach ulcers 0% 10% 14%
Item wise response of selected RGNM has revealed the level of stress. Data
analyzed exhibits that highest percentage (48%) of samples sometimes have a hard time
feeling really relaxed, 20% of students said that most of the time they miss meals due to
stress, 20% of samples always have headache because of stress.
Lowest percentage (12%) of samples sometimes don‟t really plan their meals for
balanced Nutrition, hardly 2% samples said that most of the time they lose the physical
energy and only 4% of students almost always have change in eating pattern, either
decreased or increased due to stress.
1. Mental aspect of assessment of stress among students
Table No.1.3.Percentage wise distribution of responses of selected RGNM students

Sr.no Content
always the time the time
B Mental indicators
17. I have trouble falling asleep 12% 12% 30%
18. I have nightmares or repeated bad
8% 4% 22%
dreams
19. I wake up at least once in the middle of
10% 14% 22%
the night for no reason
20. No matter how much sleep I get, I
4% 10% 24%
Awake feeling tired
21. I tend to over react to situations 6% 4% 40%
22. I find it difficult to relax 6% 2% 32%
23. I feel downhearted and sad 10% 10% 46%
24. I find difficult to take up initiative to do
16% 16% 48%
things
25. I feel anxious and worried 18% 14% 28%
26. I feel overwhelmed 8% 6% 16%
27. I get easily irritated or frustrated 14% 14% 28%
28. I get cold hands and feet 16% 14% 20%
29. I can‟t remember the right words for
10% 10% 32%
things
30. I find my temperament changes
8% 16% 26%
frequently
Item wise response of selected RGNM has revealed the level of stress. Data analyzed
exhibits that highest percentage (48%) of samples sometimes find difficult to take up
initiative to do things, 16% of students have said that most of the time they find
difficult to take up initiative to do things, and 18% 0f samples have said that almost
always they feel anxious and worried.
Lowest percentage (16%) of samples sometimes feel overwhelmed, hardly (2%) of

samples said that most of the time they find difficult to relax, and (4%) of students
said that almost always no matter how much sleep they get, they awake feeling tired.
2. Emotional aspect of assessment of stress among students
Table No.1.4 Percentage wise distribution of responses of selected RGNM students

Sr.no Content
always the time the time
C Emotional aspects
31. I avoid thinking or talking about problems 16% 16% 38%
32. I have trouble remembering things 14% 16% 26%
33. I feel anxious or frightened about problems 16% 26% 24%
34. I can‟t really describe. 8% 8% 42%
35. I worry a lot 12% 20% 16%
36. It is important for me not to show my
30% 10% 26%
emotions to my family.
37. It is hard for me to relax at home 8% 16% 10%
38. I feel very angry inside 16% 12% 22%
39. I feel hurt often 14% 26% 30%
40. I feel extremely sensitive and irritable. 12% 22% 36%
41. I feel like I really can‟t trust anyone 24% 8% 22%
42. I feel like other people don‟t understand
18% 16% 32%
me.
43. I really don‟t feel good about myself 6% 10% 26%
44. I am not optimistic about my future 6% 10% 16%
45. I feel very tired and disinterested in life. 4% 10% 34%
46. I have felt so bad that I thought of hurting
16% 16% 32%
myself
47. I feel difficult to overcome my emotions 16% 10% 28%
48. I feel difficult to cope up with situations 10% 14% 34%
exhibits that highest percentage (42%) of samples said that sometimes they can‟t
really describe the emotional aspect, (26%) of samples said that most of the time they
feel anxious or frightened about problems and they feel hurt often and (30%) of
samples said that almost always it is important for them not to show their emotions to
their family.
Lowest percentage (10%) of samples said that sometime it is hard for them to relax at
home, hardly (8%) of samples said that most of the time they can‟t really describe
their emotional aspect and they feel like they really can‟t trust anyone, and only (4%)
of samples said that almost always they feel very tired and disinterested in life.
Psychological aspect of assessment of stress among students
Table No.1.5 Percentage wise distribution of responses of selected RGNM students

reveals regarding the level of stress.
Most Some
Almost
Sr. No. Content of the of the
always
time time
D. Psychological aspects
49. I stutter or get tongue tied when I talk to people 4% 14% 20%
50. I feel socially isolated 14% 10% 26%
51. I find difficult to mix with other people 6% 12% 30%
52. I find difficult to express my feelings 18% 14% 36%
53. I find difficult to make decisions 6% 20% 40%
54. I am unable to become enthusiastic about anything 8% 18% 26%
55. I find difficult to complete my assignments 8% 22% 26%
56. I cry easily when I am stressed 42% 24% 22%
exhibits that highest percentage (40%) of samples said that sometimes they find
difficult to make decisions, (24%) of samples said that most of the time they cry easily
when they are stressed and (42%)of samples said that almost always they cry easily
when they are stressed.
Lowest percentage (20%) 0f samples said that sometimes they stutter or get tongue
tied when they talk to people, hardly (10%) of samples said that most of the time they
feel socially isolated, and only (4%) of samples said that almost always they stutter or
get tongue tied when they talk to people.
SUMMARY
AND
DISCUSSION
Discussion, summary, conclusion, implication
Non experimental, descriptive design with exploratory survey approach was used to
collect the data from 50 samples residing at selected areas of shrirampur to identify
the causes of stress factors among R.G.N.M Students of selected colleges of
shrirampur, using structured questionnaire data was collected on 22.1.2016 analysed
by using descriptive and inferential statistics and presented in the form of tables and
figures. This chapter attempts to discuss the findings of the study as per objectives.
This chapter presents the summary of the study. The findings of the study provide
majority of the samples had physical aspect of stress.
Statement problem
A study to identify the causes of stress factors among R.G.N.M. Students of selected
Nursing College at Shrirampur.
Research objectives:
1. To assess the level of stress among students nurses studying in selected
nursing colleges.
2. To identify the causes of stress among nursing students.
3. To identify the factors disturbing, the mental health of nursing students.
4. To evaluate the effectiveness of stress management techniques to reduce the
level of stress.
Summary:
A descriptive design with exploratory survey was undertaken in selected
Nursing College of shrirampur. Data was collected from 50 samples to identify the
causes of stress factors among R.G.N.M. Students of selected Nursing College at
shrirampur. Collected data were analyzed by using descriptive and inferential
statistics.
The findings are summarized as follows:
Demographic variables:
 Highest percentage (50%) of samples had secondary school education.
 Highest percentage (84%) of samples were living in Nuclear family.
 Highest percentage (46%) of samples were daily wages.
 Highest percentage (84%) of samples were married and had healthy
relationship.
 Highest percentage (56%)of samples were residence of Urban areas.
 Highest percentage (44%) of samples had monthly income of 3000 Rs to 8ooo
Rs.
 Highest percentage (72%) of samples were Christian.
 Highest percentage (38%) of samples were in between 45kg -49kg.
Extraneous Variables:
 Highest percentage (48%) of samples using Television and Radio as a source
of information.
 Highest percentage (100%) of samples were Friendly.
 Highest percentage (78%) of samples were in none of the above Habits.
 Highest percentage (98%) of samples were belong to Friendly Environment.
Description of factors causing stress among Nursing Students

 Item wise response of selected RGNM has revealed the level of stress. Data
analyzed exhibits that highest percentage (48%) of samples sometimes have a
hard time feeling really relaxed.
 Highest percentage (48%) of samples sometimes find difficult to take up
initiative to do things.
 Highest percentage (42%) of samples said that sometimes they can‟t really
describe the emotional aspect.
 Highest percentage (40%) of samples said that sometimes they find difficult to
make decisions.
Conclusion
The major conclusion from this study is that the nursing students residing at selected
colleges at shrirampur have most of the time physical aspect of stress, sometimes
mental aspects, emotional aspects and psychological aspects of stress. Thereby health
care professional must focus on improving the level of stress among Nursing Students.
SCOPE, IMPLICATIONS
OF
RESEARCH STUDY
SCOPE FOR RESEARCH STUDY
Nursing Research
 This study finding has provided information about stressors in student‟s life
and factors affecting academic performance of students.
 Findings of this study will help the nursing professional working in hospitals and
community for the reinforcing their knowledge.
 Nurses have major role in administering health education to improve the
mental health, use this information to reduce stress among students.
 From the findings of the study the nurses can give more emphasis on need
based health education.
 This finding helps the nursing professional to plan various community health
programmes.
Nursing Education
 Nursing personals can deduct the health problems and take necessary actions prior
to prepare module or educational material to educate the students and teachers
regarding management and prevention of stressors.
 Nurse educator should educate to student nurses and other health care worker to
improve the knowledge and create awareness regarding prevention of stress
 The findings may improve a critical analysis of nursing professional caring
the students with disturbed metal health
Nursing administration
 Study focus on determining the stressors among students. These findings help the
nurse researcher to develop information booklet , carry out research activities on
various aspect of stress to improve nursing practice and mental health care
 Study findings help nurse to identify the causes of stress and factors affecting
academic performance of students and plan and organize camp for mass
education
IMPLICATIONS OF RESEARCH STUDY
 This study finding guide nurses to develop skills to listen actively to

descriptions of stressors and the stress response.
 Gives nurses an opportunity to speak about stressors and helpful in dealing
with stress overload.
 Nurses teach students to categorize stressors as modifiable or no modifiable.
 Nurse aid students in removing or minimizing some stressors, changing
responses to stressors, and modifying the long-term effects of stress are
all actions that can assist those with diabetes and stress
 Nurses encourage family and social support for secondary school students to
deal effectively with stress.
 Nurses provide health education to students that stressors in highly valued
roles affect physical health only when there is insufficient emotional support
from social networks
 Nurses explore possible therapeutic approaches such as cognitive
behavior therapy, biofeedback, pharmacologic agents, and complementary
and alternative therapies. These types of therapies decrease the
sympathetic nervous system response to stress.
 It helps nurses to plan a spiritual counseling to create awareness of role of
spiritual support in coping with stress for those students who have had
experienced stress and showed symptoms of stress
RECOMMENDATIONS
FOR
RESEARCH STUDY
RECOMMENDATIONS
On the basis of the findings of the present study the following recommendations were
made:
 This study can be conducted on larger samples to yield better results.
 This study can be conducted on different settings like government

institutions, community etc. which will help in comparison.
 A comparative study can be conducted among students of higher Nursing

Colleges.
 A study can be conducted to find the effectiveness of video assisted teaching

programme to improve level of knowledge of stress
 A study can be conducted to find the effectiveness of counseling sessions

programme to create more awareness of stress
 Study could be conducted specific to various areas of stress such assessment of

knowledge of stress and modes of its prevention
 A comprehensive study can be conducted to assess the knowledge assessment of

youth in the community set up and selected educational institutions.
 An experimental study can be conducted to assess the knowledge of parents and

their teenager children on stressors and its control.
 A follow up study can be conducted on the same population to observe the

improvement or determination of knowledge of stress with time.
 A study can be conducted to assess the impact of family and social support on the
knowledge of stress among common people.
Conclusion
A descriptive research study was conducted to determine the causes of stress among
Nursing students admitted in selected Nursing College at Shrirampur. Researchers
have assessed the causes of stress present in samples.
After analysis of obtained data investigators have concluded that there are
significant causes of stress are present in students, explained well in data
interpretation chapter.
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ANNEXURE
Annexure no.1
Letter seeking permission to conduct the research study
To,
……………………………………………….
……………………………………………….
………………………………………………..
Subject: letter seeking permission to conduct the study
Respected Sir | Madam,
I the second year P. B. B.Sc Nursing student of St.Luke‟s Hospital College of

Nursing conducting a research project on ‘A study to assess the effectiveness of
structured teaching programme on stress management techniques to reduce stress
among selected nursing students studying in selected nursing colleges at Shrirampur
I need your help and permission to conduct the study in our esteemed institution. May
I therefore request you to kindly extend co-operation to my work on the proposed
study at our college of nursing.
The students will furnish further information in this regard, if required personally.
Thanking you,
Yours sincerely.
Annexure no.2
Letter for validation of research tool
From,
Second year Post Basic B. Sc. Student
St. Luke‟s Hospital, College of Nursing
Shrirampur.
To,
……………………………….
……………………………….
Sub:- Request for content validation of research tool.
Respected sir\ madam,
I undersigned, second year P. B. B. Sc. Nursing student of St. Luke‟s Hospital,

College of Nursing conducting a research project on ‘A study to assess the
effectiveness of structured teaching programme on stress management
techniques to reduce stress among selected nursing students studying in selected
nursing colleges at Shrirampur.’ I request you to kindly validate the research tool
and give your valuable suggestion and guidance for reframing and making valid tool
for the project work.
Thanking you,
Yours sincerely
Second Year P. B. B. Sc. Nursing students
Enclosure:
1. Research tool
2. Certificate of validation
Annexure no. 03
Certification of validation
This is to certify that student of second year Post Basic B. Sc. Nursing, St.
Luke‟s Hospital, College of Nursing, conducting a dissertation on ‘A study to assess
the effectiveness of structured teaching programme on stress management
nursing colleges at shrirampur.’ Students have developed tool to collect data, which
have been validated by me and found appropriate.
Remarks:
…………………………………………………………………………………………
Suggestions:
…………………………………………………………………………………………
Signature
Name of the expert
Date :
Place :
Annexure No.04
Consent Form
I , Mr. / Ms./ Mrs: …………………………………………………………………
Hereby give my consent to participate in the study titled ‘A study to assess the
effectiveness of structured teaching programme on stress management
nursing colleges at shrirampur.’
I am informed and prepared to answer the questioner. I have been explained about the
study.
Signature of subject
Annexure No. 05
Research tool:
Section: A: Demographic Variables
Section : B: Extraneous variables
Section : C: Structured questionnaire
Section A
Demographic variables
Instructions to the samples:

Dear participants, the research tool is to identify the causes of stress among
students of selected Nursing colleges at Shrirampur. It has three sections. Section A
includes the socio demographic data, and section B includes extra variables which
may cause stress among students and third section i.e. section C includes structured
questionnaire tool to identify the factors causing stress among Nursing students. Based
on the obtained information from study population the levels of stress will be
categorized and results will be interpreted.
Kindly read the following items given below in three sections and tick mark on
the corresponding option as per your knowledge/view. Adequate time and appropriate
privacy will be provided to answer the questions. Kind cooperation is expected from
samples as samples have participated in the said study voluntarily. The information
collected from you will be kept confidential.
Section : A
Socio demographic data
Sample No:
1. Education of parents
1.1 Illiterate ( )
1.2 Primary education ( )
1.3 Secondary education ( )
1.4 Higher secondary ( )
1.5 Undergraduate and above ( )
2. Type of family
2.1 Nuclear Family ( )
2.2 Joint Family ( )
2.3 Extended family ( )
3. Occupation of parents
3.1 Housewife ( )
3.2 Private or Government employee ( )
3.3 Business ( )
3.4 Daily wager ( )
3.5 Farmer ( )
4. Family status
4.1 Healthy
4.2 Separated ( )
4.3 Divorced ( )
4.4 Spouse is no more alive ( )
5. Residence of student
5.1 Urban ( )
5.2 Semi-urban ( )
5.3 Rural ( )
6. Monthly Income of parents
6.1 5000 rupees to 10,000 rupees per month ( )
6.2 10,001 rupees to 15,000 rupees per month ( )
6.3 15,001 rupees to 20,000 rupees per month ( )
6.4 20,001 rupees and above per month ( )
7. Religion of student
7.1 Hindu ( )
7.2 Christian ( )
7.3 Muslim ( )
7.4 Other religion ( )
8. Nutritional status of student
9.1) 40-45kg ( )
9.2) 46-50kg ( )
9.3) 51-55kg ( )
9.4) 56kg and above ( )
Section B:
Extraneous variables:
9. Source of information about stress
9.1 TV/Radio
9.2 Newspapers
9.3 Friends/relatives
9.4 Not heard about stress
10. Peer group of student
10.1 Friendly
10.2 Humiliation
10.3 Rejecting
10.4 Backstabbing
11. Habits of student
11.1 Lying
11.2 Tattling
11.3 Carelessness
11.4 None of the above
12. Family environment of student
14.1 Disturbing
14.2 Friendly
14.3 Domestic violence
14.4 Frequent fights
Section: C
Structured Questionnaire to identify the causes of stress among selected students
Section ‘C’ of research tool includes structured questions to identify the

sources of stress among Nursing students. All questions are compulsory to answer.
Your identity and the information collected from you will be kept strictly confidential.
Please read carefully and rate yourself on the following questions by writing the
option answer in the bracket as your answer as per your knowledge.
Questionnaire

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A STUDY TO ASSESS THE EFFECTIVENESS

OF STRUCTURED TEACHING PROGRAMME

Under the guidance of Mr. Shaikh Ajmoddin R. (M.Sc. Nursing),

Lecturer at St. Luke‟s Hospital, College of Nursing, Shrirampur.

Dissertation submitted to St. Luke’s Hospital, College of Nursing

Dissertation submitted to St. Luke’s College of Nursing, Shrirampur 2015-16

I the student of second year post Basic B. Sc Nursing, St. Luke‟s

Name of student: Ms. Fatima Mary Signature of student

I hereby certify that this dissertation entitled “A study to assess the

Research Project Guide

This is to certify that this dissertation entitled “A study to assess the

Date: 05.03.2016 Date: 05.03.2016

Place: Shrirampur Place: Shrirampur

Name of student: Ms. Fatima Mary Signature of student:

St. Luke’s Hospital, College of Nursing, Shrirampur, Dist. Ahmednagar,

Student of II Year Post Basic B. Sc. Nursing

Description of stress assessment declared that highest percentage (48%) of samples

Sr. No. Chapter Content Page no.

2. Need of the study

5. IV Data analysis and presentation

7. Discussion, Summary, Conclusion, Recommendation, implications.

1.1 Conceptual framework

1.2 Percentage wise distribution of responses of samples based on their gender.

1.3 Percentage wise distribution of responses of samples based on their

1.4 Percentage wise distribution of responses of samples based on their

1.5 Percentage wise distribution of responses of samples based on their

1.6 Percentage wise distribution of responses of samples based on their

1.7 Percentage wise distribution of responses of samples based on their

1.8 Percentage wise distribution of responses of samples based on their

1.9 Percentage wise distribution of responses of samples based on their

2.0 Percentage wise distribution of responses of samples based on their

2.1 Percentage wise distribution of responses of samples based on their

2.2 Percentage wise distribution of responses of samples based on their

2.3 Percentage wise distribution of responses of samples based on their

2.4 Percentage wise distribution of responses of samples based on their

Table No. Title of table P. No.

1.1 Percentage wise distribution of responses of samples regarding

1.2 Percentage wise distribution of responses of samples regarding

1.3 Percentage wise distribution of responses of samples regarding

1.4 Percentage wise distribution of responses of samples regarding

1.5 Percentage wise distribution of responses of samples regarding

1.6 Percentage wise distribution of responses of samples regarding

1. Institutional research/ethics committee approval letter

2. Requesting letter for permission to conduct main study

3. Letter for validation of tool

Stress is defined as a physiological and psychological response to an environmental

Dapaah et al (2014) conducted a study in order to ascertain the causes of stress

Yogesh Saxena et al(2014)conducted a study to determine the prevalence of

Xabier Zupiria Gorostidia et al (2007) has conducted a cohort study in order to

Signs and symptoms of stress:

Aldwin C.M et al (2005) conducted a research on Center for disease and

Han K, et al (2004) conducted a study to “identify the factors influencing

Morbidity due to stress

Kennedy BR et al (2005) stated that In addition to reducing job effectiveness,

Omigbodun O (2004) conducted a study on stressors in nursing students.

Complications due to stress:

Role of nurse in managing stress:

Study to assess the effectiveness of structured teaching programme on stress

Stress management program: