Investigating sources of stress and strategies to deal with stress in students of Gilan University of Medical Sciences in 2011-2018

To obtain a master's degree in nursing education

(Internal surgery orientation)

Summary

Introduction: Stress is an undeniable reality in human life. Although stress is known as one of the most important factors in the emergence of diseases, the important issue in this regard is how to respond or react to it, which can play a significant role in a person's adaptation; Therefore, the present study was conducted with the aim of determining sources of stress and coping strategies among medical students. Methodology: The current descriptive-analytical cross-sectional study was conducted among 487 medical students using quota random classification sampling method. The tool for collecting information is a three-part questionnaire including personal and social information, the Lazarus Stress Coping Strategy Questionnaire, and the Student Stress Tool. Data analysis was done in spss statistical software version 18 and using statistical methods such as chi-square, Fisher's exact test and multiple logistic regression.

Results: The findings showed that the majority of the research units were female (72%) and were studying nursing (25.9%) and bachelor's degree (61.4%). The most stressful source of the students was the interpersonal stressful source (64.4%), which had the highest frequency among this category of meeting new friends (72.7%), as well as facing new responsibilities (69.8%), being in unfamiliar situations (63%) and heavy homework (73.1%), respectively, were the most frequent among the interpersonal, environmental and educational stressful sources. The findings showed that most students use problem-oriented strategies (79.7%) in dealing with stress. Determining stress coping strategies based on individual and social variables showed a significant relationship between coping strategies with gender variable (p=0.03) and probation record (p=0.05).

Conclusion: In this research, considering the identification of interpersonal stressors as the dominant stressor in students and understanding their coping methods, officials will be able to, knowing the students' needs, find solutions to solve these sources and teach the methods

Keywords: mental stress, students

Research field

Today, stress is an integral part and the main characteristic of human life, so that all humans are exposed to a lot of stress in their daily life and in all dimensions and areas of their lives. have (1) Seliye [1] defines stress as the body's non-specific response to any pressure imposed on it (2). Stress is defined as a negative emotional experience and tension against an internal or external factor (3). In general, there are two types of stress, harmful and beneficial (4). In psychology, the word stress mainly refers to harmful stress(2).

     Stress is experienced by all people and it should be noted that some of it can be effective in increasing and improving performance(5), but its high levels have many consequences, including physical diseases (8,7,6), drop in academic performance (11,10,9,4), the occurrence of complications such as high blood pressure and the occurrence of diseases heart (12, 11, 8), decreased immunity (13, 12, 11) and decreased life span (11). In general, it is estimated that 80% of all diseases of today are caused by stress (1). Also, intense and long-term stress, such as life changes, can affect a person's adaptation, cause depression, and while harming the body, destroy the enjoyment of life (14). Studies have shown that high levels of stress in students can lead to disturbances in the thinking process, understanding and problem-solving ability (15), sleep disturbance and reduced decision-making power (16). Therefore, the study of stress in students is one of the most important topics in recent years (10).

        Students form a large segment of the active population of a country (15). According to the statistics of September 2019, there are 3,790,859 students studying in Iran, of which 177,310 are studying in various fields of medical sciences (17).Research shows that medical students experience a lot of stress during their studies (18, 19). Studies have shown that more than 25% of nursing students in England have left their field of study, and one of the most important reasons is the high stress of this field (20). The research results of Kumar and Nancy (2011) [2] in New Delhi have shown that 32.8% of nursing students experience severe stress and 34.4% experience moderate stress (21). The results of Pourqana's study (2009) on nursing and midwifery students in East Gilan showed that 56.3% of students experience mild stress, 30.24% moderate stress and 13.46% severe stress(6). Also, Akbari's research (2013) on the dental students of Mashhad University of Medical Sciences showed that 52% of the students were under a lot of stress (7).

It should be noted that students face many issues such as problems related to their future career, lifestyle, issues related to friends, family, religion and decision-making, and they have to cope with the expectations of family, professors, friends and other groups (22). Therefore, the stress experienced by them can lead to a decrease in work efficiency (23). Stress causes many damages and losses for individuals and organizations. A study in England has shown that stress-related diseases destroy 180 million working hours every year (24). The worrisome issue about stress in students is its effect on learning. Students under stress act in an unfavorable manner; They are in a state of alertness, which leads to anxiety in them, and they hurriedly choose a solution to end this situation (25). On the other hand, in the educational environment, stressful conditions can create an obstacle in the way of education and affect its efficiency, and as a result, make it difficult to achieve the main goals of education (26). For this reason, proper recognition of stressful sources among students is very important (27). Recognizing stressful sources becomes more important when there is a direct relationship between stress and suicide (28) and depression (29). Awareness of stressful sources in students can help to limit these sources and increase their adaptability to different situations by increasing the level of scientific and professional awareness and provide a suitable environment for their education (30). It is obvious that any defect in the education of these students can have a direct impact on the health of people in society (31). Various studies have identified different sources of stress factors (32). These sources can be environmental, occupational, personal, or caused by interpersonal relationships (33). In his research, Behroozian mentions the exams, the heavy volume of courses, the uncertain career future and the problems related to the dormitory(34), while Abazari mentions the difference between theoretical and practical courses and doubts about the possibility of providing the conditions for progress as stressful factors among students(30). On the other hand, Sadeghian identifies changes in religious activity and sexual problems as sources of stress (25). Pulido-Martos [3], fear of unknown situations (35) and Chan et al. [4] have introduced the lack of knowledge and professional skills (36) as sources of stress for students. The important point is that although avoiding these sources of stress seems impossible for students, their ability to adapt to the needs and deal with these stressors is very important in achieving success in the academic and social environment (10). This is why in the last decade a structure called coping [5] has attracted a lot of attention in psychology texts (37). Coping is the individual's efforts in emotional, cognitive and behavioral fields that are used when facing psychological pressure to overcome, tolerate or minimize the effects of psychological pressure (38). In other words, coping is a conscious approach that a person uses to overcome stressful events through the limiting process (39,40). There are many theories about confrontation, but Lazarus and Folkman have mostly investigated the concept of confrontation and its different methods (41). From Lazarus's point of view, instead of being considered synonymous with problem solving, coping is based on the person, the environment, and his interaction methods in threatening situations (42).