59

Chapter 1IntroductionGlobally, nurses had a normal experience of being overwhelmed from time to time. It is virtually impossible to eliminate times when events conspire and the bodys stress response is triggered, but there are ways that we can quickly reverse our bodys reaction to stress, like buffering the damage to our health and keeping our thinking clear so we can deal more effectively with whats going on in the moment (Carrasco, 2009).In the Philippines, a student may face many challenges and stressors. However, nursing students are likely to experience even more stress than their friends and colleagues enrolled in other programs. To support this statement, a study comparing the stress levels of various professional students by Bautista found that nursing students experience higher levels of stress than medical, social work and pharmacy students (Salazar, 2002).Stress has been defined as a barrier to concentration, problem solving, decision making, and other necessary abilities for students learning.Stress among nursing students becomes a hindrance in managing their time and study and may lead to distress. Complying with a longer academic program and having to contend with clinical duties, makes it impossible for these students to make it out of a stressful environment. Some of the most common stressors are time pressures, workload, making decisions, continuous changes and economic mistakes at work (M.Pulido-Martos phD, Augusto-Landa phD and E.Lopez-Zafra phD). Nursing students have limited time in doing other activities, neglecting their social life and basically having a good time now and then, because they have to deal with their academic standings and sometimes become tired from clinical duties and long hours at school. Although pressure can help in motivating student nurses in doing their tasks, yet too much pressure will give them a breakdown. Despite of dealing with the academic standing, attaining high grades, long hours of studying, another stressor among student nurses is how to survive their clinical requirements. According to Sharif and Masoumi, 2005, clinical practice has been identified as one of the most anxiety producing components in nursing programs.Lack of experience, fear of making mistakes, difficult patients, discomfort at being evaluated by faculty members, worrying about giving patients the wrong information or medication and concern about possibly harming a patient are just a few of the stressors for the beginning student nurse. Managing stress is important for nursing students since their practice involves taking care of sick patients, functioning properly to save lives and studying hard to become future registered nurses. Student nurses should be able to identify the stressors that cause them to become stressed. If they let stressors take over them, their practice will be highly affected and will cause disruption to their mind and body. These are a few key things that nurses can do to help decrease stress in their lives: Take time for themselves, think positive self-thoughts, identify stressors they encounter, collaborate with administration to resolve workplace issues, make the effort to balance their lives and pursue supportive relationships with people outside the job, supporting fellow nurses and acknowledging success also helps reduce workplace stress, eating a well-balanced diet, exercising, meditating, doing yoga therapy and other relaxation techniques (Kirkland, 2003). At Saint Gabriel College, stress among students is prevalent nowadays. Students are striving to get atleast grades above 75%-80%, cramming and procrastinating on assignments, requirements, altered sleep patterns due to clinical duties, limited time in studying, and continuous quizzes everyday are some of the stressors experienced by Saint Gabriel College Nursing students. What these students do to relieve stress is finding time to relax by going out with friends and taking the time for leisure activities.Based on the above premise, this study was conducted to determine how levels of stress and stress management techniques are utilized by student nurses of Saint Gabriel College of Nursing. Statement of the ProblemThis study was conducted to determine the levels of stress and stress management techniques utilized by student nurses of Saint Gabriel College of Nursing. Specifically it will have the following objectives:1. To find out the demographic profile of student nurses such as age, gender, year level, marital status, residence , allowance per week and number of subjects2. To assess the level of stress among student nurses of Saint Gabriel College of Nursing. 3. To identify the stress management techniques utilized by student nurses of Saint Gabriel College of Nursing. 4. To determine the relationship between the profile, the levels of stress to stress management techniques utilized by student nurses of Saint Gabriel College of Nursing.

Theoretical Framework:This study was based on Sister Callista Roys adaptation model and concept of stress. Sister Callista Roys Adaptation model has some characteristics of stress and interaction theories. Roy borrowed and expanded on theories from other, including Seyle (1936), Helson (1964) and Maslow (1970). RAM focuses on the individual (person) as a biopsychosocial adaptive system and describes nursing as a humanistic discipline that places emphasis on the persons own coping abilities to achieve health (Roy 1984). Roy defined stress as a constantly changing point, made up of focal, contextual and residual stimuli which represent the persons own standard of the range of stimuli to which can respond with ordinary adaptive response. Stress for Roy represents the parity of the person in terms of survival, growth, reproduction and mastery. A persons adaption level is determined by combined effect of the three classes of stimuli (input). Health results when adaptation reaches the optimal level of the individuals potential to meet his or her psychosocial and self actualization needs. The individuals use both innate and acquired biological, psychological or social adaptive mechanisms of all three. In this study, stress refers to the physiological and psychological response of the nursing students to the stressors in the academic field and stress management techniques are ways people maintain equilibrium despite the stressors present in the environment. The Bachelor of Science of Nursing requirements has been identified as one of the most stress producing component in the nursing field such as lack of experience, fear of making mistakes, being evaluated by the clinical instructor, major exams and paper works like case studies, thesis reports, concept maps and nursing care plan. It is essential that they learn to utilize successfully the stress management techniques to cope with the stressors to maintain their wellness and to model a healthy behavior. In relation, the regular Bachelor of Science in Nursing Students experiences different levels of stress, the greater the stressors, the greater the stress level, the greater the need for stress management techniques to be utilized.

Conceptual Pardigm:The conceptual framework shows the relationship between the independent and dependent variables. In this study, the independent variables are the levels of stress of the respondents which is classified into high, moderate, and low. while the dependent variable are the stress management techniques. The intervening variable are the personal characteristics of the respondents which identifies the age, gender, year level, marital status, residence, allowance per week, and number of subjects.

LEVELS OF STRESSHighModerate LowIndependent Variable Dependent Variable

STRESS MANAGEMENT TECHNIQUES

PERSONAL CHARACTERISTICSE.g. AgeGenderYear levelMarital status Residence Allowance per week Number of subjectsHours of SleepModerator Variable

Figure 1: Figure 1: The Schematic Diagram showing the relationship between the independent, dependent and intervening variables.

Null Hypothesis:There is no significant difference between stress and stress management techniques utilized by student nurses of Saint Gabriel College.Assumption:All nursing students experience stress. Scope and Limitations The study was focused on describing the relationship between the levels of stress and stress management techniques utilized by regular Bachelor of Science in Nursing Students, enrolled in the Saint Gabriel College. Data which will be utilized in this study was gathered from the nursing students through a modified questionnaire which is originally taken from the study of Dangan (2006) and Nacilla (2006) and modified by the researchers. The study was conducted during the 2nd semester of school year 2012-2013.Limitations of the study includes gathering 20 respondents who are willing to answer the given questionnaires, which was comprised of student nurses from different year levels at Saint Gabriel College, Old Buswang, Kalibo, Aklan.

Significance of the Study:The study will benefit to the following:Nursing StudentsThis study will benefit those nursing students who have been experiencing stress under their academic/clinical program. The result of this study will help them identify the causes of stress, levels of stress and find means in managing the symptoms of stress which settles as a threat for their normal functioning and sense of well-being.

Clinical InstructorsThis study will set as a guide for instructors in planning activities and strategies that would help students in controlling and avoiding stress when involved in the academic or clinical field. School AdministratorsThe study will serve as a basis to encourage them to support and approve school activities which will benefit the students well-being.

Guidance Counsel This study will serve as a basis for guidance counselors to develop activities or programs for those students to release their tension on stress and help them relieve the symptoms of it. Future Researchers For future researchers, this study will benefit as a source or reference for your future outputs and will provide information about the levels of stress and stress management techniques utilized by nursing students in the academic and clinical field.

Definition of Terms:The following terms are defined for clarity:Level of stress refers to the severity of the manifested physical or mental tension resulting from factors that alter an existing equilibrium (Mosby, 2009).In this study, this refers to the state or condition of restrictions, demand, or constraints of nursing students. This will be measured by a 30 items questionnaire by Dangan (2006) which is modified by the researchers about manifestations of stress and scores will be categorized as 0 for (never) did not experience; 1 for (rarely) experience at least once a month; 2 for sometimes; 3 for often; and 4 for always experiencing.

Stress - is the bodys reaction to a change that requires a physical, mental, or emotional adjustment or response (Morrow, 2009). In this study stress refers to the feeling that is experienced by Bachelor of Science in nursing students. Acute stress refers to stress that occurs suddenly, and lasting for a short period of time (minutes). It has a stress level score of 1 to 40.Moderate stress refers to stress lasting for hours and more often. It has a stress level score of 41to 80.Chronic stress refers to an existing stress that lasts for days or longer. It has a stress level score of 81 to 120.Stressor a stimulus that causesstress (Meriam-Webster, 2013) In this study, stressor refers to the causes of stress in Bachelor of Science nursing students. Stress Management - A set of techniques and programs intended to help people deal more effectively with stress in their lives by analyzing the specific stressors and taking positive actions to minimize their effects. (Gale, 2008)In this study, stress management techniques refers to the ways employed by nursing students to avoid stress and stressors such as time management, music therapy, exercise, and allotting adequate hours of sleep.This will be measured by a 30 items questionnaire about stress management techniques by Nacilla (2006) which is modified by the researchers and the scores will be categorized as 0 for not practicing; 1 for rarely practicing ; 2 for sometimes practicing; 3 for often practicing; and 4 for always practicing.

CHAPTER IIREVIEW OF RELATED LITERATUREThis chapter presents the literatures reviewed, which may be utilized in defining the methodology and/or interpretation of data. Literature reviewed includes local and foreign books, local and foreign researches, articles, and internet materials.

Local Literature:Coping with Stress For licesned Apruebo, Roxel, A. The Science of Psychology, 1st Edition. Philippines: Educational Publishing House Inc. 2009. Process of Stress Stressful events may occur as sudden, unexpected, potentially life-threatening experiences or traumas qualify as catastrophic events, such as physical or sexual assault, military combat, natural disasters, explosions, plane crashes and accidents fall into this category. Life changes and strains include marital separation, illness in the family, difficulties at work, moving to a new place, and other circumstances that create demand with which people must adjust. Chronic stressors continue over a long period of time like living due to adverse economic conditions, residing in a high-crime neighborhood, being the victim of discrimination, and even enduring years of job pressures. Daily hassles involve irritations, heavy traffics, pressures, and annoyances that may not be major stressors by themselves but such effects aggravate to become significant. This frustration of daily commuting in heavy traffic can become so intense for some drivers display a pattern of aggression. People reactions to stressful events or stressors, such as catastrophic events, life changes and strains, chronic stressors, and daily hassles are contributing components of stress. The use of coping skills reduces inappropriate stress response and improves strategies in response to stress. How Filipino Nursing Students Deal with Stress(http://royfranciscordero.wordpress.com/sample-thesis/): The scenes of smiling and laughing Filipinos, singing and dancing (and drinking) away can be deceptive. Quite often, Filipinos especially the young ones and the students deal with stress by trying to be happy. I put that in quotes because the Filipino term ismasaya, which is really more of an externalized merriment.Masayais social camaraderie, its making cheer and quite often we do it precisely because there have been unhappy events, stressful events. The best example is that of a death our wakes are notorious for its merry-making, but that, precisely, is part of our stress-coping mechanism.We have folk psychology, maybe even folk psychiatry, at work here, Filipinos aware of how dangerous it is to allow stress to consume us. We warn people about excesses as a cause of illness, and that includes the excessive emotions generated by stress.But for all the talk about our communitarian orientation, of helping friends to overcome stress, social pressures in the Philippines can also be counterproductive with the way we sometimes force people to repress the stress. Enjoy! we urge them, not realizing there are limits to resilience.There are power dimensions to all this, such as those found in gender. Contrary to stereotypes about women student being more expressive, Filipinas are actually more prone to dealing with stressful situations throughtiis(endurance) andkimkim(repression). Check out the local scenes of merriment: its usually men students having a good time, bringing out the beer and toasting their problems away, while their women look for ways to make ends meet.Men, students too, are expected to keep their feelings in check, but more out of masculine values of strength and stoicism. Men are generally not allowed to cry, much less to go into hysterics; and this probably helps to explain why more men suffer from cardiovascular disease.According to Dr. Lourdes Ignacio many students will express their stress by complaining about recurring headaches, or abdominal pains, accompanied by dizziness, nausea, fatigue. Doctors used to dismiss these as being all in the mind, but it has become clear the physical pain and distress may be quite real, that the pent-up stress is expressed through the body.The macho imperatives around stress are inevitably tied to alcohol and drugs. Younger male Filipinos especially nursing are particularly vulnerable, given their struggles with identity, masculinity and self-esteem, unable to express their frustrations and resentment. Drugs are one way of dealing with the stress, with all its attendant problems. Its significant though that the most abused drugs are metaphetamines, which are uppers or stimulants. Again, the Filipino response to stress is to look for more stimulation. The nerve cells fire away until, frayed and exhausted, the user develops paranoia (borrowed into Filipino aspraning) and then psychosis.Ignacio said Filipinos have their own natural coping mechanism compared to other nationalities.She said Filipinos strong faith in God, sense of humor and concern for others, are among the mechanisms that help them cope with depression. We are very much crisis-oriented and we have natural ways of coping with it, she said. Ignacio said they consider these as forms of coping with mental disorders even without scientific basis.Reyes said some mental patients could function normally again after being treated. Of course, for example, a bank manager suffered from schizophrenia, he or she cannot go back as a bank manager, but as a clerk. There is some form of regression but in terms of symptoms, they are free from symptoms, but their functioning has already regressed in some form, he said.On the other hand, Ignacio revealed that the Philippines is facing an acute shortage of psychiatrists due to the unabated migration of mental health doctors who seek greener pastures abroad.Stress plays a great part not only on students but on every individuals daily living. Quoting from Arnold Burnout, defined as exhaustion of physical and emotional strength is a term used to describe the end result of prolonged stress. He further states that sustained, intense stress decreases productivity and narrows the individuals perceptions. Too much stress blocks learning and decreases problem-solving ability, (1989:325). Drs. Sally and Rena Lawrence have done extensive study in the area of stress and burnout in nursing. A recent article by these authors reads as follows: Common stressors for nurses are environmental conditions, emotional problems of patients and families, demands of patients and supervisors, working conditions, interpersonal and collegial relationships, and contemporary ethical and moral dilemmas. The list of stressors is endless because of the nature of the nursing profession. Unrealistic self-expectations are perhaps the most critical sources of stress, Sally concurs with the Lawrence statement; he writes, Expecting too much of oneself can lead to burnout faster than any other single stressor,(1980:912). Smyth in her book,Surviving Nursingelaborates on the burnout phenomena: the three major causes . . . are (1) a mismatch between efforts and results leading to disappointment and frustration, (2) a mismatch between nurse and environment leading to role ambiguity and conflict, and (3) a mismatch, between people leading to interpersonal conflict. Storlie adds a final dimension, Disillusionment and burnout follow confrontation with reality in which the human spirit is pitted against circumstances intractable to change.Stress ManagementCuevas, Frances Prescilla L. Public Helath Nursing in the Phiippines, 10th Edition. Philippines: National League of Philippine Government Nurses Inc. 2007. 9 stress management techniques This related literature aids in identifying some of the different stress management techniques that can be used to mange stress. These are: 1. Meditation is a way of reaching beyond the senses. It is very effective method of relaxation. The idea of meditation is to focus ones thoughts on one relaxing thing for a sustained period of time. It gives the body time to relax and recuperate and clear away toxins that may have build up through stress and mental or physical activity. Meditation may have the following effects: a) lowers blood pressure; b) slow breathing; c) gives the body time to eliminate lactic acid and other waste products; d) eliminates stressful thoughts; e) helps with clear thinking; f) helps with focus and concentration; g) reduces stress headache; 2. Self awareness means knowing ones self, getting in touch with ones feelings, or being pen to experiences. It increases sensitivity to the inner self and relationship with the world around. Self awareness is important in evaluating ones abilities realistically, identifying the areas which needs to be improved, recognizing and building strengths, developing more effective interpersonal relationship, understanding the kind of motivations that are influencing such behavior, developing empathy and understanding to recognize both personal needs and the needs of other people. Scheduling: time management time is a source. A source is something that lies ready for use, or something that can be drawn upon for aid. Time is a tool that can be drawn upon to help accomplish results, an aid that can take care of a need, assistance in solving problems. Managing time really refers to managing ones self in such as a way as to optimize the time available in order to achieve gratifying results. 4. Siesta mans taking a nap, short rest, a break or recharging of battery in order to improve productivity. It helps relax the mind and body muscles. It had been proven thru a study that siesta invigorates ones body. Performance of an individual scored high when siesta is observed with a 15-30 minutes nap. It relieves stress tension and one wakes up invigorated and set for the next activity. 5. Stretching are simple movements performed rhythmical and slow pace executed at the start of a demanding activity to loosen muscle, lubricate joints, and increase bodys oxygen supply. It requires no special equipment, no special clothes, and no special skills and it can be done anywhere and anytime. Frequent exercise is probably one of the best physical stress-reduction techniques available. Exercise not only improves health, it also relaxes tense muscles and induces sleep. 6. Sensation techniques the sense of touch is highly a powerful and sensitive form of communication. It is a natural reaction to reach out and touch whether to feel the shape or texture of something or to response to another person, perhaps by comforting them. Massage helps to soothe away stress, unknotting tensed and aching muscles, relieving headaches and helping sleep problems. But massage is also invigorating; it improves the functioning of many of the bodys system, promotes healing and tones muscles, leaving with a feeling of renewed energy. 7. Sports engaging in sports and physical activities like these have been known to relieve stress. It also gives the body exercise it badly needs. 8. Socials a man is a social being who exist in a relationship with his physical environment and in relationship with people and society. Socialization plays a very important role in the development of interpersonal relationships. Through socialization life begins to be meaningful, happy and worthy. On the contrary without socialization life would be boring and unhappy. 9. Sounds and songs music play is an important part in the everyday life of a person. It provides medium of expression for thoughts and emotions. It is also a way to relieve tension. Music adds to the quality of life of a person. Pegues, Deborah Smith. 30 days in Taming your Stress. Philippines: OMF Literature Inc. 2007. Sleep is more important to our survival than water or food. Getting sufficient sleep to restore our bodies is a key factor in coping with day-to-day stress. Further, failure to get enough sleep also increases stress and can make us less able to handle stressful situations. Most adults, regardless of age, need the recommended eight hour us restful sleep a night. But sometimes stress can keep us awake, making matters worse as we find ourselves in a vicious cycle of stressful situation keeping us up and then a lack of sleep causing more stress. Sleeplessness then can be one of many signs that our body is under stress. What about your sleeping habits? Do you have a sleep routine in which you go to bed and get up about the same time, or do you allow events, people, deadlines or other circumstances dictate your sleep schedule? For those of you whose bedtime routine is rather extensive, do you start to wind down in plenty of time to allow yourself to complete it, or does the routine itself become stressor? Ever thought about completing it hours before your bedtime? Most of us think of sleep as some passive process in which we drift off into oblivion and wake up several hours later well rested. The truth of the matter is that sleep is an active state. Many metabolic and other restorative processes occur during the various stages of sleep. If we do not sleep long enough for our system to be rejuvenated, we will most likely find ourselves irritated by the smallest things and battling a whale of an appetite. The excess hunger is just our bodys cry for the energy that was supposed to be supplied by a good nights sleep. Nourish your body You will be able to manage your stress much more effectively if you know how the foods you consume affect your bodys ability to cope with daily pressures. Despite the many books on the market today that adequately explain how to properly fuel our bodies, nutritional ignorance seems to be the norm as the rate of obesity continues to rise. When the pressure is on, many find refuge and comfort in food. Nourishing our bodies properly is a lifelong endeavor and we would do well to become as nutrition-conscious as possible. If you have the physical stress symptoms of poor concentration, fatigue or a ferocious appetite, you may be tempted to get a quick fix by eating junk food. The items of choice usually contain caffeine, sugar or something salty with a crunch. Do your find it interesting that when spelled backwards, s-t-r-e-s-s-e-d is d-e-s-s-e-r-t-s? Have you noticed that you never tend to crave foods like carrots, apples, or lean meats, even though they may be better for you in the long run? But therein is the answer: the long run. It takes a healthy food choice longer to raise our blood sugar to the point where we feel satisfied, whereas the junk food delivers an immediate result because its refined ingredients are quickly assimilated. Further, they cause your brain to release serotonin, a hormone that helps you to relax for a brief time. The time is so brief that youll need another hit of carbohydrates to recover from the precipitous drop in your blood sugar. This time youll probably have to consume even more carbohydrates because your blood sugar drops even lower than it was originally after the first carbohydrate, so your body is going to have to work harder to get your sugar level back to normal. Is this beginning to sound like a drug addiction scenario? Through all of this activity, there is a good chance that you are not really hungry but rather feeding whatever the emotion the stress generated. A 10 to 15 minute nap may be the best solution. Of course, if you were diligent to make sure that you eat the right foods frequently throughout the day, then your blood sugar would stay at a level that would eliminate those cravings. Nutritional and homeopathic supplements also play a vital role in helping us to cope with stress, tension or anxiety. However, before you begin a herbal program, you should at least make a call to your medical doctor to make sure that certain herbs do not interfere with your current medications. It is a known fact that during time of stress, more vitamin C is depleted from the body. Therefore, an extra dose to replenish it may be needed. Prolonged stress can cause our internal systems to breakdown. We need to keep our insides strong by selecting foods that nourish us rather than work against us. Get Physical activity is an excellent stress-buster and is critical to normalizing your body after a stressful event. When your brain senses a threat or danger, it quickly releases hormones carrying an urgent message via the bloodstream to the adrenal glands (which sit atop the kidneys). The message says, Lets prepare to resist or run now! The adrenal glands produce excess stress chemicals, cortisol and adrenaline and rush them into the bloodstream, where they get delivered to various parts of the body via nerve fibers. The body responds with increased strength, raised blood pressure and other assistance needed to resist or run. There have been countless stories of people who exhibited unusual strength in a crisis. I heard of a petite young mother who actually lifted the back of a car under which her child had been trapped. Of course a crisis is not limited to threats of physical danger. The threat of losing a job or a loved one, or even the excitement of a happy occasion can cause the brain to put the body on high alert. The adrenal glands do not attempt to distinguish between negative or positive excitement. Once the crisis is over, the excess hormones need to be dissipated out of the bloodstream. This is where exercise plays a critical role. Regular physical activity helps to burn these extra chemicals so your body can return to normal. Imagine their buildup if you tend to live in a period of stress day in and day out. In addition to its positive impact on stress, physical activity provides us with numerous other benefits, including better resistance to illness, stronger bones, more energy and stronger muscles. What activity is best? The best form of exercise is the one you enjoy and find the most convenient. These are the two biggest reasons why most of us fail to be consistent in following an exercise program. First, we either lose interest in the activity because we dont really get a lot of satisfaction out of doing it. I have had beginning lessons in almost every sport two or three times for some. Secondly, we tend to not be consistent in an activity if it requires too much time or effort to access. Whether a brisk walk or a high-energy fitness class almost any physical activity will help you let off steam, distract you from your source of stress and improve your mood. It also relaxes and reenergized your body. The duration of the exercise should be a minimum of 30 minutes of physical activity a day at least five days a week. Doing more is even better. Some fitness gurus suggest that if you cannot carve out 30 minutes at a time, grab 10 minute segments throughout the day. There are also other benefits to making exercise the center of your stress-busting program. People who are routinely active tend to eat better. In addition, physical activity can help you lose weight, keep it off and feel better about yourself. Feeling physically inadequate can be a stressor in itself. Stress can wear your body down mentally and physically; however, a healthy body can cope with stress better than an unhealthy one. Schedule your day wisely Each new day presents us with 1440 minutes to use at our discretion. If we dont consciously decide how we will spend them, we will look up and realize they passed us by without our ever starting the tasks we desired to complete. The best approach to manage stress is to prepare and follow a wisely prioritized to-do list. I should warn you up front that the list itself can become a source of stress if you include too many tasks. I use an electronic calendar and I categorize every activity by its importance. Every activity is not equally important. You really can put off until tomorrow those insignificant things that would stress you if you were to do them today. If you are not in the habit of developing a to-do list, you may wander aimlessly throughout the day without a sense of focus. A simple handwritten list will provide the same sense of accomplishment as you strike off the completed items. As you plan your schedule, do not plan on doing too many things at the same time. Studies have linked chronic, high-stress multitasking under intense pressure to short term- memory loss. Further, experts have concluded that multitasking actually makes a person more inefficient because it reduces the brain power needed to perform each task. If you feel you must be productive during all of your waking minutes, its time to redefine productive. Solitude is productive. Taking a mental time out while waiting in line is productive. Praying for each member of your family while sitting in traffic is productive. Solidify your support system No man is an island. No man stands alone. Just as God created our physical bodies in such a way that our various internal systems support each other, so it is in our relationships. Everybody needs a support system. Resolve Conflicts There are few things I find more stress generating than unresolved conflict. It keeps my adrenaline on high alert and consumes my thoughts until I have resolved it. Consequently, I try to confront offenses and misunderstandings right away. If we are going to manage the stress in our lives, we must develop the skills needed to address the conflicts which are sure to arise for conflicts are inevitable. Further, the problem with failing to confront an issue is that it is likely to occur again. Strife is stressful and it is to our advantage to keep it at bay. We cannot eliminate conflicts from our lives because we are all unique individuals with different backgrounds, communications styles and preferences. However, we can confront the issues, resolve them and grow as a result. Admit your mistakes and shortcomings Im sorry I was wrong. My mistake! I dont know. These are words that some people find hard to say. Staying blameless is a hard and stressful position to maintain. Everybody makes a mistake, misjudges an issue or otherwise messes up something at some point. Its called being human. Oddly enough, mistakes are one of the major ways we learn. However, because of our fear of being judged negatively or losing face, we often try to cover up our mistake which opens the door wide for stress. On the other hand, admitting a mistake is a surefire stress-buster. It is a relief to yourself and an inspiration to others when you show the courage and the confidence to acknowledge you mistake without defining yourself by them. The only real tragedy about mistakes is if you dont learn anything from them. Refusing to admit a mistake closes the door for growth. In addition to creating stress, there is another downside to an attempt to be blameless. When you deny your shortcomings and mistakes, people are likely to label you as arrogant and proud. The irony is that others connect with you better and will declare you humble when you admit your weaknesses. Humility is one of the traits that people admire most in others; pride is detested even by other proud folks. Humans make mistakes. They have blind spots. Peace comes when we start confessing our faults to one another. Taking a time-out short breaks are essential in managing stress. Longer breaks are equally critical. You have to begin to deem your leisure time as important as any other commitment. Time-outs wont happen without a firm resolve and careful planning. Release your tension In addition to walking, running or other physical activities; we must practice ways to release the tension that builds up in us when we experience temporary stress. I have set forth a few strategies: Take a deep breath. Taking a deep breath can do wonders in diffusing the tension you may be feeling. Deep breathing relaxes you because it lowers your heart rate and circulates extra oxygen to various parts of the body. Squeeze an antistress ball or gadget. Simply squeezing it as tightly as youd like relieves tension. Sing. Like in the Bible, when Paul and Silas were jailed for preaching the gospel, they chose to sing. I have found that a nice worship song ushers me into the presence of God and floods my soul with peace. Self-massage. Learn to massage you tense areas yourself. Laugh Humor has been a key stress reliever for me for as long as I can remember/ In fact, many people have told me they assumed I had no problems because I always seem so happy/ What they do not realize is that if I thought about it or more than a minute, I could find something to cry about each day. Rather than focusing on what isnt Ive made a conscious decision to maintain a merry heart. The impact of laughter on stress is well documented Studies show that laughter lowers blood pressure and reduces hypertension. It reduces stress hormones and cleanses the lungs and body tissues of accumulated stale air because laughter empties more air out than it takes in. It boosts immune functions in the body. In addition to all of the preceding benefits, laughter triggers the release of endorphins those feel good chemicals in the brain that make you feel good and elated. Swap jokes with friends. Let people know you enjoy a good laugh. Dont be shy about sharing your most embarrassing moments. Laugh at your mistakes especially on the job. Be a good sport. Laughter can also take your mind off whats stressing you. Maintain a positive outlook Maintaining appositive outlook requires not only faith but also mental discipline. While you may believe that God is in control of your life, oftentimes the reality of a situation can overwhelm your mind and threaten to negate your faith. As you arrest those negative thoughts, fix your thoughts on what is true and honorable and right. Think about things that are pure and lovely and admirable. Think about things that are excellent and worthy of praise. The amount of stress you experience in a situation will be determined by your attitude toward what is happening. If you start confessing that you are overwhelmed, then you will experience what you have heard, for faith comes hearing. A positive attitude will not only minimize how much stress affects you but also has a direct correlation to how our bodies respond to diseases. Numerous studies have shown that optimistic people who are diagnosed with terminal illness tend to live way beyond the normal predicted life span A relaxed attitude lengthens life. Exploring Brain and Behavior Correlates of Stress ManagementWhen individuals are stressed, the sympathetic nervous system stimulates the body to release adrenalin and cortisol in preparation for a "fight or flight" response to actual or perceived alterations in the surrounding environment. By virtually effecting the entire body and mind with neurohormonal and neurochemical level shifts, this often overlooked primitive brain function has significant power over perceptions of crisis situations and subsequent decision making. For those experiencing chronic stress, the body is continually activating the sympathetic nervous system which can exhaust the body, result in repetitive response patterns to emergent and effectively charged situations, and ultimately result in health problems such as those previously described. The brain is responsible for interpreting events and psychosocial situations as stressful or not; therefore, when the brain perceives stress, the nervous system reacts with a stress response. Conversely, when individuals effectively gain control over affective and behavioral responses to events through stress-management techniques, the brain subsequently has become able to examine the event, interpret it within a proactive frame of possible solutions, including previously established self-soothing techniques, and alternate effective responses follow (APA, 2004; Benson, 1975).Stress and CopingKozier, Barbara et al. Fundamentals of Nursing, 7th Edition. Stress and Coping. Philippines Pearson Education South Asia PTE LTD. 2004.Stress is a universal phenomenon. All people experience it. Parents refer to the stress of raising children, working people talk of the stress of their job, and students at all levels talk of the stress of school. Stress can result from both positive and negative experiences. The concept of stress is important because it provides a way of understanding the person as a being who responds in totality (mind, body, and spirit) to a variety of changes that take place in daily life.Stress is a condition in which the person responds to changes in the normal balanced state. A stressor is any event or stimulus that causes an individual to experience stress. When a person faces stressors, responses are referred to as coping strategies, coping response, or coping mechanisms.There are many sources of stress. They can be broadly classified as internal or external stressors, or developmental or situational stressors. Internal stressors originate within a person, for example, cancer or feelings of depression. External stressors originate outside the individual, for example, a death in the family, or pressure from peers. Developmental stressors occur at predictable times throughout an individuals life. Within each developmental stage, certain tasks must be achieved to prevent or reduce stress. Situational stressors are unpredictable and may occur at any time during life.Stress can have physical, emotional, intellectual, social, and spiritual consequences. Usually the effects are mixed, because stress affects the whole person. Physically, stress can threaten a persons physiologic homeostasis. Emotionally, it can produce negative or non-constructive feelings about the self. Intellectually, stress can influence a persons perceptual and problem-solving abilities. Socially, stress can alter a persons relationship with others. Spiritually, it can challenge ones belief sand values. In Stimulus-Based Model, stress is defined as a stimulus, a life event, or a set of circumstances that arouses physiologic and/or psychological reactions that may increase the individuals vulnerability to illness. While according to the Response Based Model, Selye (1956-1976) defined stress as the non-specific response of the body to any kind of demand made upon it. Schafer (2000) defined stress as the arousal of mind and body in response to demands made upon it.Cosmopolitan, January 2009 Edition. Philippines: Cosmo Summit Media; Get a LifeBy: Zo AguilaStress is an epidemic today, and to make it worse, we are in a situation where we are clueless about what is bugging the life out of us. According to the Foundation for Integrated Research in Mental Health in 2007, more than three out of five doctor visits all over the world are for stress related problems. And, while Filipinos are among the happiest people in the world, according to a study by World Value Survey, we are still subject to a lot of stress and suffer illnesses caused and made worse by it: high blood pressure, stroke, diabetes, ulcer, and heart disease.Todays stressors are so real and so self-created that you wonder why they are there in your life at all (Ashima Puri, R.N.). And, the problem expectedly is, we all end up lamenting the symptoms instead of the main issue by bad moods and temper tantrums, lost appetites, nail biting and nasty headaches, and a million by-products in between.Stress is not all bad news. A certain level of pressure is good for us. The buzz of new challenges or the excitement of a new relationship keeps life interesting. What we call stress is more often than not, not really stress. According to the Encyclopedia of stress, stress is one of the most frequently used but ill defined words in the English language.Stress can affect our physical capabilities by giving us headaches, bad tummy or feeling sick, back pain, trembling, sweating, sleeping difficulties, colds, or infections. It can also change our mental status such as feelings of panic or anxiety, irritability, depression, poor concentration, feeling helpless, lacking confidence, and not wanting to socialize. Thats why this article sited 5 Save Your Soul Strategies: a.) Cognitive Behavioral Therapy (CBT), b.) Stress management programs, c.) Aromatherapy, d.) Biofeedback, and e.) Swedish and Shiatsu Massage.

Foreign Literature(http://libportal.medilam.ac.ir/documents/10129/36342/A+longitudinal+study+of+stress+and+self-esteem+in+student+nurses.pdf)Stress and Self Esteem Among Nursing StudentsMore recently, studies among Project 2000 students (Brown andEdelmann, 2000; Evans and Kelly, 2004; Hamill, 1995; Jones andJohnston, 1997, 1999; Timmins and Kaliszer, 2002a; Tully, 2004) have identied specic academic and clinical stressors throughout the program of study. A number of academic stressors for rst year students which included lack of free time, long hours of study, college response to student need and fear of failing (Jones and Johnston, 1997).Several studies have reported academic stressors for students in their nal year and these include not being treated as an adult learner, confusing assignment guidelines and the amount of self directed learning (Hamill, 1995), nancial concerns and relationships with teaching related staff (Timmins and Kaliszer, 2002a). Where studies have investigated academic stress throughout the entire program of study the issues that caused them stress included examinations (Evans and Kelly, 2004; Lindop, 1999), the intense amount of work (Evans and Kelly, 2004; Tully, 2004), nding the academic work difcult, being faced with study (Evans and Kelly, 2004) and nancial concerns (Brown and Edelmann, 2000). The clinical stressors identied by research studies for students in their rst year of study were lack of practical skills, negative attitudes of ward staff and misunderstanding of supernumerary status (Hamill, 1995), whereas for nal year students the stressors were identied as death of a patient and relationships with clinical related staff (Timmins and Kaliszer, 2002a). Where studies have investigated clinical stress throughout the entire program of study the issues that cause them concern have been identied as the theory to practice gap, atmosphere among clinical staff, being reprimanded in front of staff and patients (Evans and Kelly, 2004) and the death of a patient (Rhead, 1995). The most recent study conducted found that stress in nursing students arises from a combination of personal and extracurricular factors rather than from the educational programme itself (Pryjmachuk and Richards, 2007). While there are signicant number of studies showing levels and contributors to stress among students, there is little evidence of how these levels change over time. The one longitudinal study to examine this issue (Deary et al., 2003) found increasing levels of stress and use of emotion-oriented, avoidance and distraction coping strategies, as the programme progressed. Stress was measured at baseline and at the end of the rst year whereas all other variables were measured again during the second and third year. Burnard et al. (2008) reported data from a series of cross-sectional surveys in student nurses in each year of training, and found no evidence of changes in the intensity of stress during the course of training. Accordingly, there is need of a longitudinal study of student stress over time. Self-esteem has long been identied as an important predictor of adjustment to stress (Lazarus and Folkman, 1984). Now considered a multidimensional construct that can change over time in response to a variety of external and internal inuences (Greenier et al., 1995), high levels of self-esteem are considered important in terms of both managing the demands placed on nurses during their training and for developing a strong and therapeutic relationship with a patient (Ohlen and Segesten, 1998). Although a number of studies have shown how self-esteem varies over the course of the training period, there is little consensus within the data (Begley and Glacken, 2004; Lees and Ellis, 1990; Randle, 2003; Sasat et al.,2002). Different aspects of self-esteem (social, personal and general) in nursing students were investigated across three years of nurse training programmes in two countries and no relationship as found between self-esteem and year of study (Sasat et al., 2002).The three longitudinal studies conducted in the UK provided conicting evidence. Randle (2003)found that although the majority of students commenced their nurse training with average levels of self-esteem as classied by the Tennessee Self Concept Scale, by the time they nished their education their self-esteem had fallen to the point that 95% of the students perceived themselves as anxious, depressed and unhappy. By contrast, Begley and Glacken (2004) found that students self-esteem rose as they neared the end of their education programme, although their overall self-esteem levels at their highest were only average. Lees and Ellis (1990) revealed that self condence and self-esteem was higher at the beginning of the nursing program and decreased with each subsequent year.In view of these contradictory or preliminary ndings, there is a clear need for more data concerning the longitudinal course of both stress and self-esteem in student nurses. This study provides such data. The aim of the study was to investigate nursing students experiences of stress and levels of self-esteem during three years of their undergraduate nursing programme and whether changes occur over this time. The is the rst study of its kind which has explored stress and self-esteem. The study was longitudinal and prospective, and followed an entire year-of-entry cohort at one University (including nurses from adult, child and mental health training pathways).

(http://www.foxbusiness.com/personal-finance/2011/03/31/stress-college-causes-combat/#ixzz2MvQeL4NX)College StressIts no secret that many college students spend most of their time on campus stressed out. Balancing classes, tests, projects, extra-curricular activities and work is enough to make anyone feel overwhelmed, especially with final exams right around the corner.College life has become a lot more competitive--its much harder to get into schools, its gotten a lot more expensive, says Elizabeth Scott, stress management expert. There are a lot of things that are factors that have made society more stressful, and that really translates to college life as well.Having stress in your life is unavoidable, but there are steps students can take to mitigate its effects on their lives and health.Healthy worry is felt in the feeling of uneasiness and concern, saysBarbara Rubel, stress management counselor and speaker. Unhealthy anxiety is when uneasiness and concern fills them with apprehension and they are constantly worried and cannot control their anxiety level.We talked with some stress and health experts about the presence of stress in college and why its important to identify certain types of stress and learn how to cope.

Why College is StressfulGoing off to college involves significant adjustments to your daily routine; your sleeping and eating habits, time-management skills, and stress levels will be altered in one way or another. And even though its been barely three months since you left high school, you are now expected to be more independent and self sufficient.Adapting to this new life stage and the inevitable stress that comes with it (both good and bad) affects students differently. A lot of people are going away to school, so theyre moving away from their social support network and thats a pretty huge change right there, Scott says. At the same time, they have a lot of new things they have to navigate--not just getting around campus and living on their own, but choosing their classes, choosing what direction they want to go in their lives and choosing who to hang out with.Striking a balance between school and personal life takes discipline and strong time-management stills, something that not every student comes equipped with as a freshman.We have more ways to help ourselves and more ways to distract ourselves, says Dr.Gregory Jantz, psychologist and author of How to De-Stress Your Life. We actually create more stress because we end up not being good time stewards.Relationships can also be a source of stress for students. Wishy-washy friends who are supportive one minute and negative and insulting the next adds unnecessary stress, and according to Scott, can be worse for your health than having a completely conflicted relationship with an enemy.Knowing who is toxic to you and safe guarding a little bit [can] keep the stress from happening, she says. Theres going to be conflict in every relationship at some point. Working on conflict resolution skills and communication skills in yourself can really help you manage the conflicts that come along.Effects of StressA constant state of stress can affect all aspects of students bodies: physical, mental, emotional, cognitive, and behavioral functions can go haywire under duress.Scott points out that stress has a profound effect on your immune system and your state of equilibrium. Prolonged stress and sleepless nights can compromise your health, adding another thing for a student to stress about.When people are stressed, they tend to not take care of themselves as well, says Scott. They dont do healthy behaviors like eating right, exercising and even going to the doctor as much as they need to. Youre attacking your health on several different fronts.Stress can also impact relationships in your life, whether its with friends, family, classmates or teachers. Jantz explains that stress distorts emotions, and you may be more irritable and defensive as a result.If you are stressed out, you are not going to be able to form these bonds or you're going to have problems maintaining relationships, says Rubel.Chronic StressWhile it is perfectly normal, and even healthy to feel stressed out from time to time, there is a point where stress crosses the line into what experts call chronic stress.Jantz explains that constant levels of tension can cause adrenal glands to release too much cortisol, keeping the body in a physiological state of stress.Chronic stress diminishes the amount of time you spend in the sleep cycles that we need to stay in [and] affects our digestion and our bodies, he says.Scott says that chronic stress is aggravated by not allowing your body to recover and return to a normal, relaxed state. It can either be because your body is being triggered over and over again in a period of time, or it can be a constant stream of stress and you never recover from it, she says.In addition to strain on your body, Jantz points out that under chronic stress, you may subside to unhealthy behaviors. If they're under chronic stress, maybe they're going to drink more or use [drugs], he says. We tend to look for more destructive outlets alternately.How to Relieve StressThe experts agree that it is important for students to have stress-relief techniques that help them return to a calm and relaxed state of mind, even if the stress is still present.De-stressing techniques vary, and what works for one student might not work for others.Jantz says to restore your sanity, some people may only need something as simple as taking themselves out of their normal setting. Going outside and sitting under a tree can help regroup thoughts and let out some stress.Maybe theres too much stimuli and you have to remove yourself from distraction, he says. Use a different environment to help calm you down.Taking care of your body is also a simple, yet efficient way to curb anxiety and stress overload. Students should schedule in exercise so it becomes a part of your daily routine. If you can, avoid processed foods, too much sugar, and energy drinks, which the experts unanimously agree can agitate stress levels.The body can get dehydrated, so [hydration] is another way of helping your mind, says Jantz. Water improves concentration.If projects, papers and tests are the main source of your stress, Rubel recommends not procrastinating and keeping a tight schedule and organized notes and work area.Although it may seem impossible to reinforce the good things in your life when you feel like tearing your hair out, constructive thinking can help you see the proverbial glass as half-full.Students can change the way they think about things, says Rubel. Maintain an optimistic, positive attitude with high self-esteem. Keep boundaries in place, laugh when you can, and share that laughter with others.

(http://onsopcontent.ons.org/Publications/StudentVoice/Nov04/article5.html)Stress Management is the key during Nursing SchoolOne important thing that I always tell my students is to take care of them. If they cannot take care of themselves, how will they be able to take care of the clients they encounter throughout their nursing career? Nursing is the one profession with the most "dropouts." Nurses change careers because of high stress levels or "burnout," which is synonymous with total exhaustion.Nursing school is very stressful. Students experience increased tension prior to their clinical rotations or their written examinations, especially their finals. The major sources of stress experienced are interpersonal relationships and performance demands. Nursing school is very demanding with its paperwork and skill performance. Multiple stressors combine and result in cumulative stress. Research shows that catastrophic life events correlate more highly with subsequent illness than joyful life events.Nursing students need to assess their stress levels and determine what will decrease their tension. Important ways to reduce stress include avoiding change, blocking time, becoming skilled in time management, and setting goals. To avoid change, we need to try to keep the same routines. I always tell students to eat before a clinical rotation or an examination. Even if they have no time, just taking one minute to place a tablespoon of peanut butter in their mouths will give them some protein and energy to perform better.The second important point is taking time. Take time to address important goals. For a student, setting aside a block of time to study before an examination or setting aside time to complete a client database for a clinical rotation are important. Cramming for the examination or staying up all night to complete a client database will increase anxiety, frustration, and chances for failure. Scheduling fun time is also important. You need to leave the hospital or the nursing school environment behind at times and enjoy something that will bring happiness into your life. This will make it easier to come back to the school or the hospital. Go out, explore creation, and enjoy the sunset, or go home and enjoy your family or a special relationship.Spiritual resources also help the student nurse to adapt to stress. I enjoy singing with my church choir. We always have a special concert before the Christmas Eve service, when all of the choir members dress up in their finery and sing beautiful Christmas music. The choir members support me spiritually and emotionally in many projects that I have completed. My friends were my walking and running mates during the 2002 Relay for Life in Austin, for which I was the chair. In 2003, they helped me plan the Luminaria ceremony [explain what this is?] and participated again during the Relay for Life.The third way to reduce stress levels is time management. Establishing goals and having the time available to accomplish those goals are important. Tasks can be reduced into smaller parts. Tasks not related to school can be delegated to other family members or delayed in favor of more important tasks. Avoid waiting too long to begin a task. This will only increase anxiety and tension. Schedule activities-this will increase positive tensions and promote growth. Forget those all-nighters! Get control over the situation. Make time in your schedule for studying and sleeping at night, and eat during the day. I carry many small snacks such as nuts, cheese, and vegetables (little carrots and tomatoes), which I can eat throughout the day when I know I will not be able to sit down for a meal. You can place snacks in plastic bags the night before a clinical rotation or a long school day.Exercise is a wonderful stress reducer. I have made that the priority in my own life. Schedule 30 minutes of vigorous exercise three times per week, and you will increase your strength and stamina, which are needed in nursing school. I cannot stress enough the importance of taking care of yourself. My family has been a great support to me physically and emotionally. Although my family members live far away, we are close. We call one another often, plan family reunions, and take vacations together. These are very special and joyful times of my life.Create a strong social support network. Friends and family can provide encouragement and emotional support. Create a relationship with someone who can be your mentor, someone who will not only encourage and support you but also give advice about your nursing career and guidance to achieve your goals in nursing school, advice that you will fall back on throughout your nursing career. I have had many incredible mentors throughout my nursing career. I would not be where I am today, a clinical instructor of holistic adult health, without these mentors. Visit your teachers, and ask for feedback about how you are performing. Teachers can help with developing your clinical assessment skills. Use your health resources at school. Visit the skills laboratory to gain competence in your nursing skills. Visit your coordinator of learning enhancement to discuss test taking strategies or help establish goals to reduce stress. Establish supportive relationships with your fellow students. You can help each other to deal with stress, encourage each other, and provide emotional support during those stressful times in nursing school.Do plan ahead for the holiday overload of stress. Make room in your calendar for those important people in your life. Turn down requests and people who make demands on your life. Get plenty of rest and sleep during the holidays, and take care of yourself (Davis, 2004).(http://www.medicalnewstoday.com/releases/160265.php)Significant Sleep Deprivation and Stress Among College StudentsStressabout school and life keeps 68 percent of students awake at night - 20 percent of them at least once a week. Stress affects the quality of their sleep far more than alcohol, caffeine or late-night electronics use, a new study shows.Not only that, more than 60 percent of college students have disturbed sleep-wake patterns and many take drugs and alcohol regularly to help them do one or the other.

The study of 1,125 students appears online in theJournal of Adolescent Health. It found that only 30 percent of students sleep at least eight hours a night - the average requirement for young adults. On weeknights, 20 percent of students stay up all night at least once a month and 35 percent stay up until 3 a.m. at least once a week. Twelve percent of poor sleepers miss class three or more times a month or fall asleep in class.

"Students underestimate the importance of sleep in their daily lives. They forgot sleep during periods of stress, not realizing that they are sabotaging their physical andmental health," said study co-author Roxanne Prichard, an assistant professor of psychology at the University of St. Thomas, in St. Paul, Minn, where the study took place.

Impairments in the immune and cardiovascular systems are health risks associated with insufficient sleep, as is weight gain, Prichard said.

Daniel Taylor, an assistant professor of psychology at the University of North Texas, said, "We know little about the health of this age range even though the consequences - substance use, psychopathology, poor grades, dropout and subsequent unemployment - of sleep disturbance could be greatest."

Of concern to researchers was the students' tendency to use alcohol and drugs to regulate their cycles. Poor sleepers are more likely than good sleepers are to use medication to stay awake or fall asleep, and twice as likely to use alcohol to induce sleep. Alternating between stimulants and sedatives has been associated to a higher risk ofaddiction.

Prichard said that physicians, counselors and student health professionals should be more aware of and proactive in helping students realize the importance of sleep.Jones, M.C. & Johnston, D.W. Distress, Stress and Coping in First-Year Student Nurses. Journal of Advanced Nursing. 1997 and Cottrell, S. Occupational Stress and Job Satisfaction in Mental Health Nursing: Focussed Interventions Via Evidence-Based Assessment. The Journal of Psychiatric and Mental Health Nursing. 2000.Stress During Nursing TrainingStress from many sources has been reported for some time by student nurses. Academic sources of stress include examinations, long hours of study, assignments and grades, lack of free time, faculty response to student need and lack of timely feedback (Beck & Srivastava 1991). Specific elements of the academic programme, e.g. palliative care experiential workshops (Lawrence et al. 1985), produce stress reactions in students.Clinical sources of stress include working with dying patients, interpersonal conflict with other nurses, insecurity about personal clinical competence, fear of failure, interpersonal problems with patients, work overload and concerns about nursing care given to patients (Parkes 1985). Learning psychomotor skills, e.g. administering injections (Speck 1990) and performing female catheterization (Bell 1991), have been associated with high levels of anxiety, and a perceived lack of practical skills is a common worry for many students (Hamill 1995).The atmosphere created by clinical faculty, patient care responsibilities, working with HIV/AIDs (Mueller et al. 1992) and supernumery status itself (Wilson-Barnett et al. 1995) are all clinical sources of stress.The setting in which student nurses are placed may also have an impact on affective well-being. Initial ward placements produce greater anxiety for students than for any other period in the early part of training, regardless of whether the experience is in a male/female, or a medical/surgical placement (Parkes 1982). Changes in ward allocation have also been shown to be a source of stress for student nurses (Jack 1992).Examples of this three-level approach can be summarised as follows:Individual perspective: Stress reduction - personal stress profile feedback, time management training, career and training consultations, assertiveness training, communication skills development and psycho-education. Stress management - health lifestyle promotion, reflection, clinical supervision, mentorship,buddysystems, relaxation and home/work interface. Stress treatment - counselling, psychotherapy, occupational health interventions and physical wellness: diet, exercise, addictions, lifestyle work.Team perspective: Stress reduction - team building, team role analysis and boundary clarification. Stress management - group development diagnosis and intervention, clinical team supervision, dependency/skill mix and workload analysis and review. Stress treatment - therapeutic remedial team work and work group role negotiation.SYNTHESIS: StressStress as defined by Arnold Burnout as exhaustion of physical and emotional strength. It plays a great part not only on students but in every individuals daily living. He further states that sustained, intense stress decreases productivity and narrows the individuals perceptions. Too much stress blocks learning and decreases problem solving ability (Burnout, 1989). Stress is a universal phenomenon. All people experience it. Parents refer to the stress of raising children, working people talk of the stress of their job, and students at all levels talk of the stress of school (Kozier, 2004)Stress can result from both positive and negative experiences. The concept of stress is important because it provides a way of understanding the person as a being who responds in totality (mind, body and spirit) to a variety of changes in life. Stress is a condition in which the person responds to changes in the normal balanced state (Kozier, 2004). Stress is the arousal of mind and body in response to demands made upon it (Schafer, 2000).Stress is the non-specific response of the body to any kind of demand upon it (Selye 1956-1976). Stressors A recent article reads as follows: common stressors for the nurses are environmental conditions, emotional problems and management of stress. A stressor is any event or stimulus that causes an individual to experience stress. When a person faces stressors, responses are referred to as coping strategies, coping responses or coping mechanisms (Kozier, 2004). Academic sources of stress among nursing students include examinations, long hours of study, assignments and grades, lack of free time, faculty response to student need and lack of timely feedback (Beck & Srivasta, 1991). Clinical sources of stress among nursing students include working with dying patients, interpersonal conflict with other nurses, insecurity about personal clinical competence, fear of failure, interpersonal problems with patients, work overload and concerns about nursing care given to patients (Parkes, 1985). Levels of StressNursing students need to assess their stress levels and determine what will decrease their tension. Important ways to reduce stress include avoiding change, blocking time, becoming skilled in time management and setting goals. Stress ManagementManaging you stress includes restoring your sanity, some people may only need something as simple as taking themselves out their normal setting. Taking care of your body is also a simple, yet efficient way to curb anxiety and stress overload. Students should schedule in exercise so it becomes a part of your daily routine. If you can avoid processed foods, too much sugar and energy drinks which the experts unanimously agree that it can agitate stress levels. the body can get dehydrated, so hydration is another way of helping your mind, says Janta. Water improves concentration. If projects, papers and tests are the main sources of your stress, Rebel recommends not procrastinating and keeping a tight schedule and organize notes and work area (Rubel, 2005). Students can change the way they think about things. Maintain an optimistic, positive attitude with high self-esteem. Keep boundaries in place, laugh when you can and share that laughter with others (Rubel, 2005).To avoid change, we need to try to keep the same routines. Second, take time to address important goals. Third is time management. Spiritual resources also help the student nurse to adapt to stress. Exercise is also a wonderful stress reducer. Create a strong social support network. Friends and family can provide encouragement and emotional support. Do plan ahead for holiday overload stress. Make room in your calendar for those important people in your life. Turn down request and people who make demands on your life. Get plenty of rest and sleep during the holidays and take care of yourself (Davis, 2004). Chapter IIIMethodologyThis chapter will present the research design, sampling procedure, description of subjects and description of research locale. RESEARCH DESIGN In this study, the design that was applied is the correlational descriptive research which examines the extent of the relationship between the levels of stress and stress management techniques utilized by Bachelor of Science in nursing students of Saint Gabriel College. The study will determine if the relationship of variables will have a direct or indirect relationship. SAMPLING SIZE AND POPULATION The population of regular and irregular Bachelor of Science in nursing students from 1st year to 4th year enrolled in the school year of 2012-2013 is 225, excluding the researcher. The sample size will be 69. Sample size will be computed using the Sloven Formula with 90% level of confidence where in 10% error will be used.

Whereas: N= Populatione= Percentage of Errorn= Sample SizeUsing the formula: = 69

SAMPLING METHOD: The sampling method that was utilized in this study was the non-random sampling method. The sampling design of which will be snowball or networking sampling design. The researcher will gather 69 respondents from different year levels which will be 17 students from each class, approaching those students who meet the inclusion criteria then refer to other students who meet the criteria as well. The students of which will be respondents should be on their free time and become available to the researcher. There will be no manipulation or experimentation that will be involved.

DESCRIPTION OF SUBJECTSThe subjects should be regular students enrolled in Saint Gabriel College, Old Buswang, Kalibo, Aklan taking up the course of Bachelor of Science in nursing. These subjects were chosen because the researcher feels that stress in epidemic in the college today. The inclusion criteria for the subjects includes: being a male and female, with grades not lower than 80%, have a moderate or high academic performance in school and has experienced stress in some point of time. The respondents should be on their free time, with willingness to answer the given questionnaires. DESCRIPTION OF RESEARCH LOCALEThe location of the study will be in the Saint Gabriel College Campus, Old Buswang, Kalibo, Aklan. The private college was established in 1970 and it is known as the pioneer nursing school in Kalibo, Aklan. This location was chosen to determine the levels of stress and stress management techniques utilized by students under the Bachelor of Science in nursing curriculum of this college. There are 4 classrooms occupied by the Bachelor of Science in nursing students in this 4 story building. The researcher will have the availability and time in this location to conduct the study and the participants are known to the researcher.