CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter provides numerous evaluations of chosen international, national, and

local literature and research that significantly support the current study presented in this

study. It offers a wealth of information and supporting data on the subject and its allied

fields. To facilitate a thorough and in-depth analysis, topics are separated into many

categories. This chapter's thematic presentation covers the following topics: academic

performance and mental health.

Mental Health Condition

A student’s mental health condition, to an extent, can be a cause of a student’s

grades going up or down. As having a good or bad mental health condition can

significantly affect one’s performance not only in school but our day to day lives. The

term "mental health" encompasses much more than only the absence of mental illnesses

or diseases. According to the World Health Organization (2018) mental health is a state

that enables people to cope with the stresses of life, realize their abilities, learn and work

well, and contributes to their community. Students with greater mental health are better

able to study and are more likely to reach their full potential. In the end, those who have

good mental health are better equipped to collaborate, form bonds with others, and make

choices. During the COVID-19 pandemic, psychological health is vital to nursing

students' mental health and influences their decisions to continue in the nursing field.

Young adults suffer from a high frequency of mental diseases, and among this
demographic; students are particularly vulnerable, particularly in the health sciences

fields (Ruiz et al., 2018). In particular careers like nursing require a lot of their students

on a physical, intellectual, and emotional level.

This is especially true during their last year of training, when they are subjected to

intense emotional stress and fatigue. In addition, social, emotional, and physical

pressures, as well as family and personal problems, affect student’s learning ability and

academic performance and predispose the young students to the development of mental

disorders such as anxiety and depression (Escobedo, 2018).

Mental health conditions have been found to be prevalent among nursing students,

with studies reporting rates of depression, anxiety, and burnout. Cuttilan et al. (2017)

found that 27.3% of nursing students in a Malaysian public university experienced

depression, with academic stress, financial difficulties, and family problems being

identified as contributing factors. Similarly, Kalkhoran et al. (2017) reported a prevalence

of 32.5% for mental health disorders among Iranian nursing students, with academic

stress, family problems, and financial difficulties identified as predictors. Meanwhile, a

systematic review and meta-analysis by Oyekanmi et al. (2020) revealed that 31.7% of

African nursing students experienced anxiety, and 24.3% experienced depression, with

female students and those with financial difficulties being at higher risk.

In addition to affecting mental well-being, mental health conditions have also

been found to have implications for academic performance. For example, Pagnin et al.

(2017) found that medical students with burnout had a higher prevalence of sleep

disorders, which could impact their ability to learn and retain information. Similarly,

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Rotenstein et al. (2016) reported that depression, depressive symptoms, and suicidal

ideation were prevalent among medical students, which could affect their academic

performance and overall well-being. Overall, these findings underscore the importance of

addressing mental health concerns among nursing and medical students to promote

academic success and well-being.

Academic Performance

An academic performance is the compiled results of a student’s performance in

school this can show a student their strength and weakness to different subjects, however,

solely relying on the result cannot determine cannot determine a student’s result as there

could be an underlying factor for one’s performance. According to Wentzel (2017),

“relationships with peers are of central importance to children throughout childhood and

adolescence. They provide a source of companionship and entertainment, help in solving

problems, personal validation and emotional support, and a foundation for identity

development, In turn, children who enjoy positive relationships with peers appear to

experience levels of emotional well-being, beliefs about the self, and values for prosocial

forms of behavior and social interaction that are stronger and more adaptive than do

children without positive peer relationships.” This study discusses that really having a

connection with people most importantly starting from childhood has an effect on how

they perceive problems, having good relationships makes a person confident and has

more belief to oneself.

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 Wentzel (2017) further states that, “an additional finding is that children who

enjoy positive relationships with their peers also tend to be engaged in and even excel at

academic tasks more than those who have peer relationship problems. Children's social

competence with peers has been related consistently and positively to academic

accomplishments throughout the school-age years.” This gives further proof that having

good peer relationships over the years can positively affect a person’s performance in

school.

Academic performance is an essential component of nursing education and has

been the subject of several studies in recent years. Adel et al. (2018) investigated the

academic performance of nursing students in Egypt and found that students' performance

was significantly affected by factors such as gender, educational level of parents, and

academic year. Similarly, a study by Galmidi et al. (2019) examined the academic

performance of nursing students in Greece and found that factors such as age, marital

status, and the presence of children affected academic performance.

In addition to demographic factors, several studies have identified academic and

non-academic factors that impact academic performance among nursing students. For

example, a study by Kalaitzidis et al. (2019) found that academic factors such as the type

of teaching method and the number of hours of study per week were significant

predictors of academic performance among nursing students in Greece. Meanwhile, a

study by Yang et al. (2020) identified non-academic factors such as sleep quality and

perceived stress as significant predictors of academic performance among nursing

students in China.

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Relating Factors to Students Academic Performance

There are different factors across our lives that could potentially affect how we

operate each day, having financial problems can cause a person’s performance to

decrease as their mind is clouded with problems rather than focusing on work, or in this

case, the student would not be able to focus on their school which may result to a lower

academic performance. According to MacCann, Jiang, Brown, Double, Bucich and

Minbashian (2020), “schools and universities devote considerable time and resources to

developing students’ social and emotional skills, such as emotional intelligence (EI). The

goals of such programs are partly for personal development but partly to increase

academic performance.” This tells us that another form or way of improving someone’s

intelligence not only relies on them studying but it also affects how they interact with the

world around them, they mentioned that emotional intelligence can increase a person’s

performance academically. They have also stated that, “relative importance analysis

suggests that EI is the third most important predictor for all three streams, after

intelligence and conscientiousness. Moderators of the effect differed across the three EI

streams. Ability EI was a stronger predictor of performance in humanities than science.”

This further suggests that improving a student’s emotional intelligence makes them better

at their performance in their respective courses.

According to Zada (2021), “Scientific interest in student’s mental health

experiences has been increasing in the last years due to their influence on students’

learning processes, academic performance, and recently, the suicidal news of a student at
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a private university due to her mental health condition in Lahore Punjab, Pakistan,

captured public attention. That incident also shifted researchers and scholars’ attention on

the much underexplored and tabooed sphere of the broader public health domain. Hence,

the current study aimed to explore the relationship between mental health problems and

Pakistani university students’ academic performance.” One of the things that are being

researched upon is the connection of mental health problems as it has become more

prevalent over the years and has been growing unseen from the public eye causing

problems. Zada (2021) further states that, “mental health problems negatively affect the

academic performance of university students. The findings of the current study were

beneficial for shedding light on the ignor-ant area within the broader public health

domain; the results are also helpful in raising awareness for not only students but also the

parents and university administration to plan and design effective intervention strategies

to provide proper mental health that resultantly promote academic excellence.” The

finding of this study just as the same study as others will help shed light to the

importance of handling a person’s mental health conditions or just the mere fact of

knowing a person’s mental health condition can help that person to go through their

problems.

Social interaction is an essential component of the nursing profession and has

been found to be important in academic performance among nursing students. A study by

Liu et al. (2018) explored the relationship between social interaction and academic

performance among nursing students in China and found that social interaction had a

positive impact on academic performance. The study also identified factors such as class

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size, frequency of communication with teachers, and engagement in extracurricular

activities as significant predictors of social interaction. Similarly, a study by Al-Hussami

et al. (2019) investigated the relationship between social support and academic

performance among nursing students in Jordan and found that social support from peers

and faculty members had a positive impact on academic performance. The study also

found that perceived stress and lack of social support were significant predictors of poor

academic performance. Another study by D'Souza et al. (2017) examined the relationship

between social support and academic performance among nursing students in India and

found that social support from family, friends, and faculty members had a significant

positive impact on academic performance. The study also identified factors such as

academic stress and financial difficulties as significant predictors of poor academic

performance.

Factors That Affect Academic Performance

Academic performance is influenced by a wide range of factors, including

individual, family, and environmental factors. Or simply, a students motivation towards

learning as other students maybe enrolled to a course they do not want and having no

other choice. A study by Shaukat and Ijaz (2018) examined the impact of personality

traits, motivation, and study habits on academic performance among university students

in Pakistan. The study found that personality traits, specifically conscientiousness, had a

positive impact on academic performance. Motivation and study habits were also

identified as significant predictors of academic performance. Similarly, a study by

Weerahandi and Herath (2019) investigated the relationship between family background

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and academic performance among university students in Sri Lanka. The study found that

parental education, family income, and family size had a significant impact on academic

performance. Students from higher-income families and with parents who had higher

levels of education tended to perform better academically.

Another study by Abdulai and Asadu (2018) explored the impact of

environmental factors, such as classroom size, teacher-student ratio, and availability of

learning resources, on academic performance among senior high school students in

Ghana. The study found that classroom size and teacher-student ratio had a significant

impact on academic performance, with smaller class sizes and lower teacher-student

ratios associated with better academic performance. The availability of learning

resources, such as textbooks and computers, was also found to be a significant predictor

of academic performance.

A study by Hu, Li, and Zhang (2018) examined the impact of academic stress on

academic performance among Chinese high school students. The study found that high

levels of academic stress were associated with lower academic performance. In

particular, the study found that stress related to academic workload and competition were

the most significant predictors of poor academic performance. Another study by Schmitt

and colleagues (2018) investigated the relationship between physical activity and

academic performance among university students in Germany. The study found that

students who engaged in regular physical activity had higher academic performance than

those who did not. The researchers suggest that physical activity may improve cognitive

functioning and reduce stress, which could contribute to better academic performance.
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 A study by Liu and colleagues (2020) explored the impact of smartphone use on

academic performance among university students in China. The study found that

excessive smartphone use was associated with lower academic performance. The

researchers suggest that smartphone use may interfere with students' ability to

concentrate and negatively impact their sleep patterns.

Overall, these studies provide valuable insights into the prevalence and predictors

of mental health conditions among nursing and medical students, and how these

conditions can impact academic performance. The findings highlight the importance of

addressing mental health concerns among nursing and medical students through

interventions such as counseling, stress management, and social support. These studies

highlight the importance of understanding the factors that impact academic performance

among nursing students to develop effective interventions and support strategies. By

addressing these factors, nursing educators and institutions can help promote academic

success among nursing students and prepare them for their future roles as healthcare

professionals and this suggests that social interaction and social support play a crucial

role in the academic performance of nursing students. Nursing educators and institutions

should focus on promoting social interaction and social support to improve academic

performance among nursing students.

These studies suggest that academic performance is influenced by a range of

factors, including individual characteristics, family background, and environmental

interventions to improve academic performance among students.

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