Introduction

Every person in this world is surrounded by different kinds of stresses. (Kohler et al., 2006) as cited in (Martos et al., 2012) “stress refers to a dynamic interaction between the individual and the environment. In this interaction, demands, limitations, and opportunities related to work may be perceived as threatening to surpass the individual’s resources and skill”. Stress in my point of view is a pressure which effects our mind and unable us to do our daily activities properly. It affects our mental, psychological, physical and emotional health. According to (Manney, Mk, Paul, & Shashidhar, 2011) students are more porne to stress and it negatively effects on their mental health, educational success, self-grooming and effect on future. The same authors stated medical education as stressful. There are many factors which causes stress and that compromise the well-being of student nurses which will be discuss later in this paper.(O’Donnell ,2009) stated that many nursing student left the program due to unbearable stress.

The rational for choosing this topic is that it’s my own observation and experience that stress is higher in undergraduate nurses. They are always over burden with assignments, regular papers as well as classes, clinical and, group works. All the time they have to sit in front of laptops or books. They have less time for themselves as well as for their families and friends. Other than this many undergraduate nurses end up with mental distress, many tried to do suicidal attempts and many withdraw the nursing career. Stress is the hurdle in the well-being of students, it affects negatively on their academics and social life.

Many theories have been proposed for the better understanding of stress. According to (Cannon, 1929) as cites in (Davidyan, 2008), he talked about response theory. According to him our body works on basic principle of equilibrium (homeostasis). If the external stimulus is strong and body cannot cope with it than it really disturb the normal mechanism of body and causes stress. If the person handle the situation properly than it will be called a balance condition. Another theory given by (Hans selye, 1956) as cited in same article which describe a theory of general reaction of individual to different stressors. He discussed about three stages: Alarm reaction, resistance and exhaustion. In alarm reaction there is a condition of fight and flight and organism try to control the situation by physiological responses. After which resistance stage occurs. Here body builds resistance against stressor. Last stage is exhaustion where all the energy is lost, no further resistance exists and individual ends in chronic stress. It indicates that a person should response appropriately in every stage to prevent complications of stress.

Unfortunately, the prevalence of stress in Pakistani students is very high especially in nursing students. In Pakistan the image of nursing profession is very bad. There is no respect for this noble profession therefore, very little researches and studies has been done on it. According to Khowaja (2009) Pakistan is a discriminating society and there is no value of nursing that’s why there are always issues. A study was done on the prevalence of stress by Kumar and Nancy (2011) in Punjab, Pakistan. According to the study, out of 180 undergraduate nurses, 34.4 % had moderate stress, 32.8 % had mild and maximum stress respectively. Another study was carried in CMH College Lahore on 200 students. The result showed that the mean stress was 30.87, nearly same with result of Punjab college students. It indicates high level of stress in Pakistani nursing students.

What Are the Factors of Stress in Undergraduate Nurses?

There are many factors of stress among undergraduate nurses. For example they have to do lots of assignment, hard work, GPA, frequent exams, clinical both supervised and unsupervised. Moreover, the other factors which lead to stress are fear of faculty, staff, patient and their different disease status, lack of proper guidance and self-awareness. As an undergraduate nurse it’s my own experience and observation that both the supervised and unsupervised clinical are more stressful because students are expected to do many assignment and skills at the same time. Undergraduate nurses have to do assignment given by their faculty, by staff nurse and they have to give holistic care to patients. They are supposed to take care of severe patients with infectious disease and with aggressive behavior which cause stress in student nurses. Many of these factors were also mentioned in literature. Reevea et al., (2013) also highlighted clinical assignment as one of the factor of stress. It is more time consuming and students become socially isolated. The other cause of stress mentioned in the same articles is neglection from patients and from their attaindance, from staff nurse and other health care professionals. According to Abbey et al., (2011) issues from surrounding society, educational, and financial can also lead to stress. In an article written by somani & khowaja (2012) it was mentioned that in Pakistani society work place violence and lower status of nursing profession is also a cause of stress in nurses. Patients and their relatives think this profession is not good and always try to abuse them. Magnavita and heponiemi (2011) mentioned physical and verbal violence as source of stress in nursing students during their clinical placement. Furthermore, international nursing review (2012) three main types of stressors are mentioned: (1) clinical stressors which include anxiety of not achieving expectations and communication gap between patients and hospital members. (2) Academic stressors. For example ongoing assessment and quizzes, not passing the programme and hectic timetable. (3) Personal/ social stressors which means financial issues and issues in home and school works. A cross sectional study was done in Pakistan’s shifa nursing college by Shomail and Faisal (2012). In this study total 78 nursing students participated. The findings of study on score of stress level in different factors were as follow, theory = 2.37, clinical experience =3.5, college environment= 2.39, social environment=251. In my opinion these factors of stress bring tremendous alteration in an individual’s health.

What Are Implications of Stress in Undergraduate Nurses?

According to labrague (2013), stress has adverse outcomes not only on physical, psychological and social health but as whole well-being. (Shirom, 2003) as cited in (Martos et al., 2012), stress lead to physical, psychological and behavioral impairment in an individual. I have seen many people with stress who cannot sleep without medications and they left to take proper diet. (Chang et.al 2006) as cited in (Lim, Bogossian and Ahern, 2010) reported consequences of stress on physical health that is increased pressures, sleep disturbance and tiredness. In another literature it says stress in nursing students creates issues in memory, in judgmental skills and in coping styles, Goff (2011). The students, who encounter stress, mainly have poor thinking and this further aggravate their psychological problems. I witnessed one of my classmate who developed psychological symptoms in second year 2013 due to increased stress in her academics. She was admitted in psychiatric ward for more than 2 months and still she takes medications. I observed the same symptoms in her which are mentioned in the literatures. According to literature, undergraduate nurse end up in mental issues due to increase level of stress. It causes emotional distress that is nervousness, low self-esteem, isolation, aggression, anxiety etc.(Jimenez,Osorio&Diaz, 2010).In Karachi, Pakistan a study was conducted in three medical colleges and students participated were 360. They found gastro intestinal problems especially irritable bowel syndrome in students. It was mentioned in the article that irritable bowel syndrome is because of psychological stress in students. (Naeem et al., 2012). Moreover, (Prasad et al., 2013) also talked about psychological impacts of stress which lead to loss of concentration in educational field, loss of energy which ultimately leads to low output and thoughts of suicide. I also witnessed many cases where people did suicide, left the program, developed loneliness and symptoms like anxiety and drug abuse. O’Donnell (2009) stated that due to increased stress students are unable to focus and complete their nursing degree. They do not pay attention towards their studies which makes their life complicated.Galbraith and brown (2011) mentioned behavior related affects like use of alcohol, smoking and other drugs. Students use drugs as alternative coping strategies. The individual who suffer from violence may develop symptoms that persist for many years. They blame themselves for the incidence, feeling ashamed, and embarrassed. It alters their social life and builds negative thought about their career (magnavita&heponiemi, 2011).Yet another article by Mane et al. (2011) stated stress causes weak performance in education and in their later job life. Moreover they face many problems in their social life and personnel life. In my view stress always hinders in the progression of students whether it is there education, career, and health, their personal or social life.

Strategies and Interventions

There are many interventions and strategies to reduce the factors and negative impacts of stress in undergraduate nurses. According to (humped & caputi, 2011) as cited in “Nurses education today”, student nurses are more exposed to stress and they need to build their capacity to balance their thoughts and cope constructively. Lim et al. (2010) found basic education of undergraduates very beneficial in control of stress.(Hubbard et al., 1984) as cited in ( Reevea et al., 2013) ; Yamashita and Miwasaito, 2012), mentioned about social support. According to which a strong support from others (friends and family members) enhance positivity in their health and thinking. Other than this a good relationship between students and their faculty can builds trust and confidence in students to perform their task courageously. (Jimenez ,2010; Yearwood and Riley, 2013), also mentioned that faculties should understand student’s stress so that they can support them in their grooming, progression and a proper guidance in clinical set up also reduce their stress level. In addition (Gibbons, 2010; Shomail & Faisal, 2012), mentioned that the positive regards from teachers and colleague is helpful in stress management. According to Laragia (2013) to decrease stress in undergraduate nurses it is important to assess the cause and level of stress to plan interventions accordingly and help students in their theoretical and practical skill. Mane et al. (2011) highlighted about relaxation therapies and solution to those factors which are more common in students stress. Yamashita et al. (2012) found self-awareness and knowledge of dealing with stress as important strategies in alleviating of stress.

Conclusion and Recommendation

In conclusion every profession is stressful but nursing is more stressful and undergraduate nurses are more vulnerable to stress. There are many causes of stress which impacts the well-being of student nurses. The causes are increase work load in classes as well as in clinical, lack of knowledge, low self-esteem, encountering challenges with staff, patients and clinical placement. Undergraduates face many consequences of stress for example they suffer from psychological, emotional, social, and physical problem. They develop symptoms of suicidal ideation, alter in thought process, self with drawl from social life, high blood pressure, sleep problems, anxiety, frustration and it also impacts on their academics. Furthermore, it is very essential to find the root causes of stress and make proper strategies to reduce it. It is important for students that they should develop positive coping skills and cooperative relationship with faculties, staff and other professionals. Students can also take benefit from their social circle like from their parents and friends. In Pakistan nurses image is very poor and this lead to stress and many other issues in nurses. A proper research is needed to find the causes, prevalence and impacts of stress on the well-being of undergraduate nurses. I would recommend that students and teachers should make support group which will find out or help those students who are in stress. Furthermore, institution should not over burden the students. They should plan such activities which help them in relieving their stress such as sport timing, parties, and psychotherapy and counseling classes. If these strategies are implemented than students will be healthy and ultimately, there will be productive outcome.

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