**Stress in Nursing University Students and Mental Health Health**

**Stress in Nursing University Students and Mental** 

DOI: 10.5772/intechopen.72993

Frank Pulido-Criollo, Jonathan Cueto-Escobedo and

Frank Pulido-Criollo, Jonathan Cueto-Escobedo and Gabriel Guillén-Ruiz Gabriel Guillén-Ruiz Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.72993

#### **Abstract**

Stress is a physiological response that impacts the cognitive, emotional, behavioral, and social components. It also involves the adaptation of the organism, the coping resources, and the environment. In young people, stress can be triggered by social interactions or school requirements. This chapter is a narrative review analyzing scientific bibliography from the main databases (NIH, Scielo, Redalyc) that explored the main stressors and their effects on nursing students. These stressors include the care of patients, assignments and workloads, academic evaluations, and negative or hostile social interactions. Data include the deleterious effects of stress in nursing students as anxiety, depression, inhibiting learning, and burnout, which negatively impact their academic development and health. Finally, some interventions to reduce the impact of stress are discussed. Conclusion: Stress responses in nursing students vary in duration and intensity during their academic training; final effects depend on the coping mechanisms, individual resources, and hospital environment. The effects of stress on nursing students impact on academic performance but could also trigger several psychiatric disorders as depression or anxiety, as well as other associated problems such as sleep disorders, alcohol, and psychoactive drug consumption, which in the short and long term may affect the patient care.

**Keywords:** nursing students, stress, psychiatric disorder, scholar stress

## **1. Introduction**

The term stress comprises the physiological and psychological responses that prepare the organism to cope with stimulus called stressors that are interpreted as challenging to the individual [1]. Deleterious effects of stress have been observed from the first scientific description of stress by Selye [2]. Traumatic events can trigger intense stress response on the organism,

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

while daily routines as job, economical, or academic pressures can elicit mild responses of stress during prolonged periods of time; in both cases, stress responses can be altered producing deleterious effects on health [3]. Although today the concept of stress has been extensively used and discussed, at least two different perspectives of stress must be mentioned: one is organic and the other is psychological [4]. **Table 1** shows the main similarities and differences of these two perspectives.

Another point of view proposed that stress occurs due to demands that exceed individual resources, affecting the adaptive, cognitive, and emotional capacities of the subject [5]. From this perspective, psychological stress has three types of cognitive assessments. In the first cognitive evaluation, the subject discards or recognizes the threatening, beneficial, or insignificant situations based on personal beliefs, self-efficacy, goals, and situational factors. In the secondary cognitive evaluation, the subject estimates the own resources of coping, including the skills to change the situation or reducing the aversive impact. In the last cognitive stage, the subject perceives and reinterprets the stressful situation; that is, there is a reevaluation of a situation that originally was considered threatening and is reinterpreted as benign. In nursing students, stress can be produced when the demands are perceived as excessive and uncontrollable, and its effects are related to health problems [6, 7]. **Table 2** describes the classification and impact of stress on health.

the symptoms of stress. The customer's internal and external resources are used to reinforce internal resistance, reduce reaction, and increase resistance factors. Tertiary prevention takes place after active treatment or the secondary prevention phase; it aims to ensure that the

and even suicide

Emotional agony; muscle, stomach, and intestinal problems; and transient over-excitation

Prolonged agitation, severe and persistent headaches, migraines, hypertension, chest pain, and heart disease

Violence, nervous breakdowns, heart attacks, strokes, cancer,

Loss of a loved one

Stress in Nursing University Students and Mental Health http://dx.doi.org/10.5772/intechopen.72993

> Individuals with personality type A (DSM-V) and people who develop in hostile environment

33

Traumatic experiences of childhood and suffering some

illness

In summary, stress should be seen as the result of the interaction between the environment and the individual; in the case of nursing students, the specific stressors are related to factors of academic life and hospital practices, which are often intense, repetitive, and exhaustive (see

**Figure 1.** Model stress in nursing student. Note: This figure illustrates the interaction between the nursing student and

patient recovers the optimal stability of the system in Neuman's model [9, 11, 12].

**Kind Description Impact on health Examples**

Acute It comes in daily life environment, is

Episodic This type of stress is intense and

Chronic Intense, repetitive, and exhausting

skills

as chronic

diseases

Adapted from: Herrera [8].

**Table 2.** Classification of stress.

short in duration, and has no severe effects on health. This type of stress helps the individual develop coping

repetitive without being established

and leads to the development of

**Figure 1**).

the stressors.

Another theoretical perspective on stress is Neuman's model, which considers stress as the product of the instability of a client system (individual-environment-staff), in which stressful elements join in [9–12]. Although some stimuli that are generated within the limits of the client's system are stress-producing, they trigger a result that can be positive or negative; it makes necessary to explore the results that stress produces in nursing students during academic training. The stressors that nursing students face daily would be the following: (a) Intrapersonal forces occur within the individual, such as conditioned responses, thoughts, and sensations. (b) Interpersonal forces refer to negative relationships between students, patients, and staff, e.g., the expectations of the patient or student about the role in a hospital. (c) Extra-personal forces occur outside the individual, such as the student's economic circumstances [9, 10]. Thus, interventions to reduce stress should be routed in three directions. The goal of primary prevention is to reduce the possibility of facing a stressor or reduce the possibility of a reaction. In secondary prevention, intervention is made after the client responds to


**Table 1.** Perspectives of the concept of stress.


**Table 2.** Classification of stress.

while daily routines as job, economical, or academic pressures can elicit mild responses of stress during prolonged periods of time; in both cases, stress responses can be altered producing deleterious effects on health [3]. Although today the concept of stress has been extensively used and discussed, at least two different perspectives of stress must be mentioned: one is organic and the other is psychological [4]. **Table 1** shows the main similarities and differences

Another point of view proposed that stress occurs due to demands that exceed individual resources, affecting the adaptive, cognitive, and emotional capacities of the subject [5]. From this perspective, psychological stress has three types of cognitive assessments. In the first cognitive evaluation, the subject discards or recognizes the threatening, beneficial, or insignificant situations based on personal beliefs, self-efficacy, goals, and situational factors. In the secondary cognitive evaluation, the subject estimates the own resources of coping, including the skills to change the situation or reducing the aversive impact. In the last cognitive stage, the subject perceives and reinterprets the stressful situation; that is, there is a reevaluation of a situation that originally was considered threatening and is reinterpreted as benign. In nursing students, stress can be produced when the demands are perceived as excessive and uncontrollable, and its effects are related to health problems [6, 7]. **Table 2** describes the clas-

Another theoretical perspective on stress is Neuman's model, which considers stress as the product of the instability of a client system (individual-environment-staff), in which stressful elements join in [9–12]. Although some stimuli that are generated within the limits of the client's system are stress-producing, they trigger a result that can be positive or negative; it makes necessary to explore the results that stress produces in nursing students during academic training. The stressors that nursing students face daily would be the following: (a) Intrapersonal forces occur within the individual, such as conditioned responses, thoughts, and sensations. (b) Interpersonal forces refer to negative relationships between students, patients, and staff, e.g., the expectations of the patient or student about the role in a hospital. (c) Extra-personal forces occur outside the individual, such as the student's economic circumstances [9, 10]. Thus, interventions to reduce stress should be routed in three directions. The goal of primary prevention is to reduce the possibility of facing a stressor or reduce the possibility of a reaction. In secondary prevention, intervention is made after the client responds to

> Stress as an adaptive process and the development of the organism's

abilities

**Perspective Differences Similarities**

and individual that is emphasizing the cognitive part and the response of the organism to the stimulus, not only by

Organic Stress like an uncontrolled response by the organism that can be pleasant or unpleasant

Psychological Stress seen as a process of transaction between environment

physiological reactions

Adapted from: Holahan [4].

**Table 1.** Perspectives of the concept of stress.

of these two perspectives.

32 Health and Academic Achievement

sification and impact of stress on health.

the symptoms of stress. The customer's internal and external resources are used to reinforce internal resistance, reduce reaction, and increase resistance factors. Tertiary prevention takes place after active treatment or the secondary prevention phase; it aims to ensure that the patient recovers the optimal stability of the system in Neuman's model [9, 11, 12].

In summary, stress should be seen as the result of the interaction between the environment and the individual; in the case of nursing students, the specific stressors are related to factors of academic life and hospital practices, which are often intense, repetitive, and exhaustive (see **Figure 1**).

**Figure 1.** Model stress in nursing student. Note: This figure illustrates the interaction between the nursing student and the stressors.
