The Problems and Adjustments Encountered by the Nursing

Sophomore Students of Calamba Doctors Colleges School Year

2009-2010

Chapter 1The Problems and Its BackgroundIntroduction:

Nursing is generally defined as caring for the sick and disabled and promoting good health practices. It is one of

the health care professions. Nurses administer treatments as prescribed or authorized by physicians.

Nursing care ranges from simple tasks to complex procedures. Compared to other fields such as

engineering, nursing has lots of special areas where nurses can enhance potentials, skills and abilities. There

are staff nursing, operating room nursing, public or community health nursing, occupational or industrial

nursing, military nursing and school nursing. All of these special areas have one and only one focus and it is the welfare of an individual. Therefore, the goals of nursing practices are not only to promote health, prevention of illness, alleviation of sufferings but also restoration of

health to a highest possible level.Entering and choosing nursing as a course is not that easy,

one should complete the requirements before being admitted to take the course. A student should pass the

examination and interviews conducted by one of the members of the administration. Moreover, one should have also passed the other medical requirements or

physical tests.

Nursing as a course requires a lot of time, effort, and money. Financial problem for the nursing

student is not new. It is a big barrier or hindrance. For instance, failure to send himself to the affiliation program required by the school

in order to enhance his skills and abilities in clinical area might develop for him negative

attitudes towards work and studies. Different references, paraphernalia’s as well as affiliation

fees are required in this course. One should learn to budget his money and prioritize his

needs accordingly. Another area of conflict is on schedules. Students should learn hoe to adjust their schedules. The nursing course follows a

very hectic schedule and includes a lot of activities among these are paper works, actual

demonstrations, research as well as nursing related learning experience (or clinical duty). On the whole, nursing students should know how to cope with these various problems and to make

the necessary adjustments.

Calamba Doctors Colleges sees to it that its students are properly equipped with knowledge, training and

experience. The College sends students to medical related establishments. Where it is affiliated like Philippine Orthopedic Center, National center for

Mental Health and San Lazaro Hospital. In these areas, students easily correlate theories to actual situations.

In this way, students enhance and widen their knowledge for future needs. Society nowadays keeps

changing. Calamba Doctors Colleges sees to it that their students are up-to-date with these changes. The

College sponsor educational programs which can enrich the knowledge of their students. However, despite the

concentrated efforts of the administration, teaching and non-teaching staff, student’s still encounter

problems which can affect their studies and personalities.

Level 1 or the first year of college education is just like their senior year in high school. Level 2, however, is considered as the most critical period. Most of the

sophomore students fall under the period of adolescence. At this stage “storm and stress” came

out. As such problems greatly affect their performance in school and off-school. Moreover, when problems arise they cannot separate home from school and

affiliated hospitals which unknowingly affected their performances.

This was the basic reason why the researchers selected the sophomore nursing students as their subjects for

the study.

Theoretical Framework

All person experience conflicts in life. In fact they produce some coping mechanisms in order to treat these conflicts. In this

study; the researchers were only interested to know the problems which the adolescents encounter. They particularly

chose the Sophomores among our nursing students because it is on this level of the nursing students curriculum where the students are for the first time exposed to the hospital setting

where problems are most likely to occur.In 1950, Ross L. Mooney assisted by Leonard Gordon, both

working with the Bureau of Educational Research of Ohio State University studied the problems affecting the college

students. According to Mooney, students in college often face trouble, some problems in areas of health, money, social life, relations with people, religion, studying, selecting courses,

and the like. They come up with the Mooney Problem Checklist. This was adapted by Layog, Peconcillo in his study on the Adjustments of Selected Sophomore Nursing Students of Ortañes University and likewise used by the researchers in

this study. When problems/conflicts arise different coping mechanisms are

done so as to treat these problems. Murphy emphasized that coping process vary with what is called for in the coping adjustment process. Achieving gratification, eliminating threat, overcoming frustrations or making the most of

challenge require appropriate action of some sort.

Conceptual Framework

In this conceptual model two boxes can be seen, one on the left and the other is on the right. The left one contained the problems which were classified into eleven areas. The arrow pointing towards the student which means that these problems.

Statement of the ProblemThe present study attempted to investigate the

problems and adjustments encountered by the Sophomore Nursing Students in various areas for the school year 2009-2010.

Specifically it aimed to answer the following questions.

1.What are the problems encountered by Sophomore Nursing Students along the following areas:

1.1 Adjustments to College Work (ACW)1.2 Social Psychological Relations (SPR)1.3 Home and Family (HF)1.4 Curriculum and Teaching Procedures (CTP)1.5 Social Recreational Activities (SRA)1.6 Personal Psychological Relations (PPR)1.7 Health and Physical Development (HPD)1.8 Courtship, Sex and Marriage (CSM)1.9 Finances and Living Conditions (FLC)1.10 Morals and Religions (MR)1.11 Future, Vocational and Educational (FEV)

2. What adjustments do the Sophomore nursing Students make with regards to their problem on:

2.1 Adjustments to College Work (ACW)2.2 Social Psychological Relations (SPR)2.3 Home and Family (HF)2.4 Curriculum and Teaching Procedures (CTP)2.5 Social Recreational Activities (SRA)2.6 Personal Psychological Relations (PPR)2.7 Health and Physical Development (HPD)2.8 Courtship, Sex and Marriage (CSM)2.9 Finances and Living Conditions (FLC)2.10 Morals and Religions (MR)2.11 Future, Vocational and Educational (FEV)3. is there any significant difference in the problems encountered by the

Sophomore Nursing Students when grouped according to their:3.1 Age;3.2 Sex:3.3 Birth order; and, 3.4 Number of Siblings in the familyNull HypothesisThere is no significant difference in the problems encountered by the

Sophomore Nursing Students when grouped according to their: 1. Age;2. Sex:3. Birth order; and, 4. Number of Siblings in the family

Scope, Delimitations and Limitations of the Study

The study focused on the problems and adjustments encountered by the Sophomore Nursing Students of Calamba Doctors’ College. The respondents were limited only to thirty

(30) Sophomore Nursing Students of Calamba Doctors’ College who shared their perceptions about their problems

and how they adjust to them.The problems were on the following areas: a)Adjustments to

College Work (ACW) b)Social Psychological Relations (SPR) c)Home and Family (HF) d)Curriculum and Teaching

Procedures (CTP) e)Social Recreational Activities (SRA) f)Personal Psychological Relations (PPR) g)Health and

Physical Development (HPD) h)Courtship, Sex and Marriage (CSM) i)Finances and Living Conditions (FLC) j)Morals and Religions (MR) k)Future, Vocational and Educational (FEV). Moreover the present study is focused only for the school

year 2009-2010.The interview and the questionnaire prepared did not affirm to

give exact findings the only purpose is to give results that could serve as basis for further researcher in this matter. The

study wished to determine various problems of the Sophomore Students and their ways of adjusting to each

problem. It did not promise to give generalized results since the respondents are in themselves limited.

Significance of the StudyThe researchers decided to present this study in order to serve as a mediator among the students,

clinical instructors and academic instructors to build a harmonious relationship among

themselves. Moreover, when conflicts in the clinical area and academic subjects are pin

pointed and identified, the College of Nursing maybe able to present a program that would help

nursing students to adjust or cope with their problems.

This study can also serve as a guide for future studies related to nursing and nursing education as it will involve their responsibilities they have

to face. Hence, this study serves as a fitting manifestations for all the hopes, dreams and goals of a typical nursing students. The said

study also contains the fruitful years that we had in this institution

Chapter 2

REVIEW OF RELATED LITERATURE

This chapter presents various studies and literature both local

and abroad. Researchers went to various places and establishment

to gather some information related to the present study.

RELATED STUDIES IN THE PHILIPPINES

According to Mendoza (2003), conflicts and frustration may causes a person to develop feelings of tensions and

anxieties. In dealing with these problems an individual must try to adjust to various situation. The data gathered by the researcher revealed that nursing students are not

exceptions to this problem.

Mendoza conducted a study on the problems met by the student nurses in the clinical areas at the University of

Santo Tomas. The most serious problem met by the students was unprepared ness in handling hospital

equipment. He also observed that the students complained of knowledge and inability of personal to demonstrate to them how to use hospital equipment. students became

tense and nervous in the clinical area.Genciana (2005) states that the other problems met by the

students nurses in the clinical area during affiliation were the big contrast between the theories learned and the work

required in the clinical area, fear of trying out different techniques in nursing procedures, fear of being

reprimanded by superior infant of the patients, and feeling of insecurity regarding heavy work assignments.

In 2004-2005, Tesaluna conducted a study on the problems of high school students of Collegio de

San Jose Recoletes in Cebu City. The study revealed that the greatest number of problems

of the respondents was found in the area of adjustment to school work. Based on her

findings, she recommended that the teachers must give their full support to the students by

showing approval of well-coordinated projects by encouraging students become independent

thinkers and through skillful questioning and proper motivation.

Likewise, Algoet (2006), in her study of problems and solutions of the junior and senior nursing

students of Saint Theresa’s College, discovered that the greatest number of student problems

were in the areas of personal adjustment, school life and the future.

RELATED STUDIES ABROAD

The concept of defense mechanism is referred to as unconscious Psychological process. Defense mechanism may be regarded as a

coping process, just as avoidance because it is psychological method in dealing with threats and frustrations. Implied in defense that the

threat is reduced only in the mind of the individual and not in reality (Freud, 1959).

Conn and Crowne (2002), interpreted this defense against the threat of disapproval. The

question is extremely difficult to answer because self-awareness is hard to evaluate except by asking the person and he may be

unwilling unable to tell us about it. Theoretically, the person attempts to deceive

himself and those in which the aim is to deceive others.

RELATED STUDIES ABROAD

College students are prone to stress due to the transitional nature of college life. High levels of stress are believed to

affect students' health and academic functions. If the stress is not dealt with effectively, feelings of loneliness,

nervousness, sleeplessness and worrying may result. Effective coping strategies facilitate the return to a

balanced state, reducing the negative effects of stress.Sophomore nursing students are exposed to a variety of

stressors. Establishing a student support system during the first year and improving it throughout nursing school

is necessary to equip nursing students with effective coping skills. Efforts should include counseling helpers

and their teachers, strategies that can be called upon in these students' future nursing careers.

Stress has been identified as a 20th century disease and has been viewed as a complex and dynamic transaction between individuals and their environments. Stressors

can be broadly defined as situations or events that have the potential to affect health outcomes .Stress can be

regarded as a psychological threat, in which the individual perceives a situation as a potential threat .

Academic stress among college students has been a topic of interest for many years. College students, especially freshmen, are particularly prone to stress due to the transitional nature of college life. For example, many college students move away from home for the first time, which can necessitate leaving all previously learned support systems such as parents, siblings and high school friends. Students may

need to develop entirely new social contacts and are expected to take responsibility for their own needs. They may have difficulty adjusting to more rigorous academic expectations and the need to learn to deal with individuals of differing cultures and beliefs. Thus, stress may result from being separated from home for the first time,

the transition from a personal to an impersonal academic environment, and the very structure of the academic experience at the college level. Significant changes in

living conditions, the novel demands of the college academic environment, and the large change in social surroundings are just a few of the potential sources of stress for a college student. College students experience high stress at predictable times each semester due to academic commitments, financial pressures, and lack of time management skills. Moreover, regardless of year in school, college students often

deal with pressures related to finding a job or a potential life partner. These stressors do not cause anxiety or tension by themselves. Instead, stress results

from the interaction between stressors and the individual's perception and reaction to those stressors. Other potential sources of stress for college students include

excessive homework, unclear assignments, and uncomfortable classrooms. In addition to academic requirements, relations with faculty members and time

pressures may also be sources of stress.Stress-inducing academic demands include grade competition; lack of time and issues

relating to time or task management, the need to adapt to new learning environments in terms of the increased complexity of the material to be learned and

the greater time and effort required to do so; and the need to constantly self-regulate and to develop better thinking skills, including learning to use specific learning techniques. Another category that evokes stress is social adjustment, particularly adjusting to university life and separating from family and friends. Finally, there are financial pressures and other technical difficulties. Archer and

Lamnin (1985) found that tests, grades, competition, time demands, professors and the class environment, and concern about future careers were major sources of

academic stress .Stress and the identification of potential stressors among nursing students have

received much attention in the literature .Nursing students have the same

academic stressors as other college students, such as midterm and final examinations, research papers and other assignments. In addition, nursing

students experience a clinical component, which is highly stressful. Students have a large amount of preparatory work before their clinical assignments.

They often must travel long distances to clinical sites and use highly technical equipment . In addition, they must perform procedures that can cause serious harm to their patients, thus enhancing their fear of making

mistakes. Studies indicate that nursing students may be more prone to stress than other students. Beck and Srivastava (1991) performed a study to

investigate the perception level and sources of stress across academic years in 94 nursing students enrolled in a baccalaureate nursing program at one

university. Psychiatric symptoms were more prevalent in these students than in the general population. Many of the items ranked as stressful by the

nursing students were also identified by other populations, such as amount of material to learn, examinations and lack of timely feedback from faculty. In

addition, the nursing students identified feelings of inadequacy in dealing with acutely ill patients and difficulty in relationships with faculty. Nursing

students had to devote long hours to study, were given multiple assignments, and lacked free time, timely feedback and faculty response to

student needs.In college and university students, some stress is motivating, whereas too high

a level interferes with teaching . Excessive stress can be harmful to a student's academic performance and students who perceive their stress

levels as very high may often become depressed. This depression can lead to other mental health problems, such as excessive drinking or indiscriminate use of other substances . Thus, academic stressors cover the whole area of

learning and achieving, as well as adjusting to a new environment, in which a great deal of content must be assimilated in a seemingly inadequate period

of time. Moreover, excessive stress may lead a student to drop out of college . If stress is not dealt with effectively, feelings of loneliness and

nervousness, as well as sleeplessness and excessive worrying, may result. It is important that stress intervention programs be designed to address stress in college students. To design effective intervention programs, it is necessary

to identify the stressors specific to college students.

Student perception of high stress levels can lead to poor academic performance, depression, attrition and serious health problems. Methods to reduce student stress often include effective time management, social

support, positive reappraisal, and engagement in leisure pursuits .Therefore, studying student stress and the methods students use to deal with it can have important implications for higher education administrators .Although students cannot avoid these stressors, their

ability to adjust to demands and cope with these stressors are important in achieving success in the college academic and social environments .

Coping has been viewed as a stabilizing factor that may assist individuals in maintaining psychosocial adaptation during stressful events. The process of coping is a very complex response that occurs when an

individual attempts to remove stress or a perceived threat from the environment. Thus, the actual reaction to an environmental event may

be as important as the event itself .Coping responses can be described as positive or negative and as reactive

(i.e. reacting to an individual's own thoughts and feelings) or active (dealing with actual stressful situations or events). Active or reactive

coping responses can be positive or negative, depending on the situation and the content of the response . The individual may deal with stress

through several methods, including removing the stressor through manipulating the environment, developing specific responses to help

deal with the stressor or seeking diversion from the stressor . Researchers have found that ethnic, cultural and even socioeconomic

characteristics influenced coping behaviors .Failure to resolve student stress in the long term could have serious professional and personal consequences .The primary objective of the present study was to identify the sources of stress in undergraduate nursing students. We also wished to assess whether there were any

differences between students in different years of nursing school in their experience of stress sources and to determine the most and least

common coping strategies used by these nursing students.

RELATED LITERATURE IN THE PHILIPPINES

The articles and readings related to mental health were reviewed because of their relevance to the present study. The following factors affects in every individual as he/she undergoes the different stages of life.

A.HOMEThe home is the cradle of the child. It is the basic foundation for the

child’s growth and development. It is the first and foremost agency that conditions or take care new born before any

institutions can have a chance to make an impression upon him.Satisfactory family life is absolutely necessary to the adequate

development of the child. It is the emotional atmosphere of the home that the child initially encounters and will determine his

feelings of personal security, safety, and acceptance or of anxiety and defiance of authority.

Personality and environment are quite mutually inclusive and that Family cohesion and disruption are of fundamental importance

to adjustment and personal development. As such break of home can be most damaging influence on the psychological well-

being of the child. The saying “a broken home results in a broken child “, has been found to be true in a majority of

instances Patterns of adjustment, from simple symptomatic behavior such as nail biting, thumb-sucking to the most serious

delinquencies are associated with the break up of the home. Hence, it is necessarily that the child develops on deeps sense

of inner security and belonging which only an affectionate home atmosphere can provide for the child to achieve a wholesome

adjustment and psychological stability. The inadequate parent-child relationship and detrimental practices common among

parents in the home may be characterized as follows:

Emotional rejection of the childRejection may be defined as an overt behavior toward an individual

which leads him to believe that he/she is neither loved nor valued

Rejection causes the child to fear those who willing to abandon him.

The following are parental practices indicative of parental rejection:

Emphasis on the children’s short comingSevere punishment and negative responses (scold, ridicule,

threats)Rigid disciplineDesertionEviction (to expel by a legal process)Unfavorable comparisons with other childrenDeliberate statements to the indicating that he is unwantedDomination of the parentsSome parents are so rigid and uncompromising with their

standards that considerable anxiety is created in the child. Thumb-sucking, nail biting and bed-wetting which frequently are the results of anxiety and tension in the child. He feels increasingly rejected and is likely to continue is thumb sucking.

Submission to the child A submissive parent is defined as one who capitulates to

unrealistic demands and request, usually following pressures and teasing on the part of

child. An illness of severe nature usually renders the mastering his parents. The strategy most frequently used is that of temper tantrums particularly that type of tantrum in which the child holds his breath to the point becoming blue in the face or other display of emotions he gets what he wants.

Overprotection of the childOverprotection by a parent involves excessive attention and

pampering of the child without offering opportunities to make decisions or to assume responsibilities. Usually, the child is given everything they wants and lets them every they catered to. Children who are thus spoiled are likely to fail in becoming self-reliant and in coping with even minor frustrations they have to face I life. Over solicitude, over protections are usually due to maladjustment on the part of the parents. There are four factors which appear to account for such overindulgence;

Absence of love and affectionate in the parents own childhoodInharmonious marital relationshipFrustrations of personal achievement or wanting of

vocational aspirationsLoss of mate or of another child

B. SCHOOLEducation starts from birth and continues until life. It embraces

Individual the ability to be flexible and responsible with the changing folkways and more. Teachers and students should learn

how to adopt themselves to constant charge and free themselves of rigidity.

The objectives of personal development are the following:To develop a well-adjust personality

To present personality maladjustmentTo help in the readjustment of these who have already

developed personality maladjustment Sound thinking and effective learning characterized by adequate

practical knowledge of the world are the major aspects that sustain the mental health of both the child and adult. The assist the child with his mental health problems just as it endeavors to keep the child well-informed. The school curriculum is from the time being

redesigned in ways that can better promote intellectual development and personality adjustment.(Gaerlan et al, 2006) Emotional disturbances may occur in any stage of person’s

development and in any part of the school system. Some have this origin or at least became more pressing in the secondary school.

Physiological bringing with increased size and strength, sex impulses, responsibilities resulting from approaching maturity-all

are very important instability.Such emotional conditions are after the cause of maladjustment and in

the growth toward “optional maturity” that is in the ability to direct his strong basic emotions into channels that lead to the attainment,

of ends that are socially desirable and individual satisfying. (Cardovan, 2004)

RELATED LITERATURE ABROAD

When thousands of freshmen arrive at college and Universities, many problem an adjustment confront them in their new environment. Most students adjust satisfactorily they find new activities develop new interest and participate in new activities which serve as the outlets for their needs. The analysis of adjustment however is not yet complete. It is not enough merely to know that a person’s copes with threats or frustration. Such as variations in the ways people cope with threat and frustration must be examined carefully in an attempt to understand them.

Luis Murphy and her colleges used the meaning of

the concept of coping more understandably. The new situation Murphy referred to were such experience as going to school or having to deal with the demand as strange laboratory test.

She also recognized four interfering psychological condition Such as threat, challenge, frustration and gratification. She

emphasized that coping / adjustment process. Achieving gratifications, eliminating threat, overcoming frustration or

making the most of challenge appropriate of some sort. (Murphy et al,2005)

Positive adjustment should be learned by an individual to alternatives which must be attractive as much as possible.

One most work in a relaxed non-threatening environment. As presented by Lewin, adjustment process is instigated by a

deficit mean which procedures disagreeable tension. To reduce the tension, person must react in some ways thus,

action is usually an attempt to overcome a thwarting object or circumstances. After various attempts to reduce tension, sooner or later the person is driven to make a choice. When a person decide to choose a less appealing substitute, goal

is not satisfying original choice. The needs a defense mechanism to soothe his age.

There is a lot of defense mechanism that can be used. The most common is “RATIONALIZATION” whereas we give

socially acceptable reasons for our behavior. Another natural reaction to a frustrating situation is to simply leave the field”. This aspect of reaction is not really a solution.

Tension remains which lead to undesirable behavior. An individual must build up enough confidence to deal to his

own problem. (Lewin,2005).

SYNTHESIS

Home and school are the factors which have significant effects on the development of an individual. The home is the basic foundation for the child’s growth and development the

school on the other hand assist the child with his mental health and keeps him well-

informed. Almost all freshmen and neophytes in college or University are confronted with many problems on adjustment. Conflicts and frustration may causes a person to develop feeling of tensions and anxieties. In dealing

with these problems an individual must try to adjust to various situations. Positive

adjustment should be learned.

CHAPTER 3

MethodologyThis Chapter presents the research

design subjects of study, descriptions of instrument used,

data gathering procedures, validation of questionnaires and

statistical instrument used.

Research Design

This study used the descriptive method of research. The descriptive

type of research encompasses several steps. It goes beyond mere gathering and data tabulation. It

involves interpretation of meaning, implication and significance of what is being described. Moreover, the present study aimed to determine the problems and adjustments of sophomore nursing students both

home and school.

The Sample

The researchers employed thirty (30) sophomore nursing students who were

enrolled in the college of nursing school year 2009-2010 only one of these nursing students is male their age ranged 17 to 19

years old. The survey questionnaires revealed that 27 of them were first born in the family. They were affiliated in Calamba

Doctor’s College in 2009-2010. Since sophomores are first timer in the clinical area which is the foundation are Related

Learning Experience (RLE) the researchers believed that they have problems and

adjustments pertaining to their studies and affiliation.

Instruments and Data gathering ProcedureA. Questionnaire

Based on the researchers reading on related studies and issues, gathering instruments was

partly based. A questionnaire was formulated and submitted to a committee for approval, Permission of the College of Nursing in order to conduct the

study. The data gathering instruments consist of two

specific ranged of their answer which is represented by parts. The first part requires some personal information and questions which require the respondents to choose the number 1 to 3. The

other half of the questionnaire requires the respondents to choose one appropriate

adjustments they do in specific area.

B. ObservationThe researches like wise observe the attitudes and

behavior of the respondents towards their relationships with their classmates and peers. Most of the students willingly expressed their emotions

towards their problems.

VALIDATION OF QUESTIONAIRESThe 300 problems in the Masteral Thesis of

Peconcillo Layog (1986) was used in the study. These were presented to the third year nursing students for pre-testing . they were asked to

underline the problems which a student encounters. Then they were asked to encircle the

number of problems which they think affected them most. The researchers then tallied and

classified these into eleven (11) areas. Each was then trimmed down to five (5) sub problems. The

final draft for the questionnaire about the problems encountered by the Sophomore Nursing Students was written with the following options

whether the student encounters the problem always, sometimes, or never. Likewise, the

second set questionnaire was prepared which is about the adjustments made by the students

regarding each problem are this is in the form of checklist.

STATISTICAL TREATMENT OF DATA

To give valid interpretation of the data, the following statistics were employed.

Weighted MeanThis was used to determine the gravity of the problem and area

presented. To interpret data from responses on the problems encountered by the nursing Students, the following choices were: 1-Always, 2-Sometimes, and 3-Never. To interpret the results verbally, the following scale and categories were used.

RankingThis was used to find out which of the problems of the nursing students

are more likely to be encountered always. This was also used in ranking the adjustments.PercentageThis was used as a descriptive measure together with the frequency

distribution to show the relationship between the magnitude of the item being described and its relation to the whole. The formula is P= x (100/n) where P stands for percentage value, x the number to be computed, 100 is a constant number and n is the total number of cases.

Scale Verbal Description2.51- 3.00 Never1.51- 2.50 Sometimes1.00- 1.50 AlwaysOne-Way ANNOVA- This is used to test the null hypothesis.