GAD-7

Over the last 2 weeks, how often have you Not at Several More Nearly
been bothered by the following problems? all days than every
(0) (1) half day.
(Use to indicate your answer) the (3)
days
(2)

1. Feeling nervous, anxious or on edge.

2. Not being able to stop or control

worrying.

3. Worrying too much about different

things.

4. Trouble relaxing.

5. Being so restless that it is hard to sit

still.

6. Becoming easily annoyed or irritable.

7. Feeling afraid as if something awful

might happen.

Total GAD-7 score ________+________+_______+_______=____

 QUESTIONNAIRE

I. Demographic Profile of the Respondents

DIRECTION: Please provide the information being asked for about yourself by
placing a check mark (√) in the space provided that corresponds to your response
where indicated.
1. Age
17-20 years old
21-23 years old
2. Gender
Female
Male
3. Religion
Protestants
Christian
Non-Christian
4. Family monthly income
Less than Php 10000
Php 5001-10000
Php 1001-5000
Php 10000-15000
Php15001-20000
Php 20001-25000
Php 25001-30000
5. Family set up
Nuclear family
Single Parent family
Grandparent family
Extended family
Transnational family
II. The Manifestations of anxiety experienced by respondents
DIRECTION: For each item below, please place a check mark (/) in the column
which best describes how often you felt or behaved this way during COVID-19
pandemic.

Never Almos Sometime Fairly Very

(0) t never s often often
(1) (2) (3) (4)
I. Emotional symptoms
I tend to be worried and nervous
I tend to be nervous and anxious
lately
I often feel depressed and
miserable
I feel afraid without any reason
I feel I am going to have a nervous
breakdown
I feel anxious lately
I cannot calm down
II. Social behavioral
symptoms
I am not optimistic about my
future
My life is not very colorful
I cannot work as usual
I have difficulty in making
decisions
I do not feel needed of valued
I cannot think as clearly as before
III. Physical symptoms
I often feel giddy
I experience nausea and vomiting
I often have vertigo and feel dizzy
I feel pressure in the chest
My fingers and toes feel numb or
painful
I have stomach-ache and diarrhea
I have difficulties in breathing for
no reason
 I catch cold more often

III. Coping Strategies adopted by respondents during the COVID-19 pandemic

DIRECTION: Below is a list of Coping Strategies adopted by respondents during
the COVID-19 pandemic. Please respond to the following questions by placing a
check mark (√) in the space provided that corresponds to your response where
indicated.

I A A I’ve
haven't little mediu been
been bit m doing
doing (2) amount this a
this at (3) lot
all (4)
(1)
1. I've been turning to work or other activities to
take my mind off things.
2. I've been concentrating my efforts on doing
something about the situation I'm in.
3. I've been saying to myself "this isn't real".
4. I've been using alcohol or other drugs to make
myself feel better
5. I've been getting emotional support from
others.
6. I've been giving up trying to deal with it.
7. I've been taking action to try to make the
situation better.
8. I've been refusing to believe that it has
happened.
9. I've been saying things to let my unpleasant
feelings escape.
10. I’ve been getting help and advice from other
people.
11. I've been using alcohol or other drugs to help
me get through it.
12. I've been trying to see it in a different light, to
make it seem more positive.
13. I’ve been criticizing myself.
14. I've been trying to come up with a strategy
about what to do.
15. I've been getting comfort and understanding
from someone.
16. I've been giving up the attempt to cope.
17. I've been looking for something good in what
is happening.
18. I've been making jokes about it.
19. I've been doing something to think about it
less, such as going to movies, watching TV,
reading, daydreaming, sleeping, or shopping.
20. I've been accepting the reality of the fact that it
has happened.
21. I've been expressing my negative feelings.
22. I've been trying to find comfort in my religion
or spiritual beliefs.
23. I’ve been trying to get advice or help from
other people about what
24. I've been learning to live with it.
25. I've been thinking hard about what steps to
take.
26. I’ve been blaming myself for things that
happened
27. I've been praying or meditating
28. I've been making fun of the situation.
 NORTHERN CHRISTIAN COLLEGE

The Institution for Better Life

College of Nursing

Level of Anxiety and Coping Strategies among Nursing Students of Northern

Christian College during COVID-19 Pandemic

An Undergraduate Thesis
 Presented to the faculty of the School of Nursing

Northern Christian College

Laoag City

By:

FERRER, VENUS ALLYSSA W.

BACHELOR OF SCIENCE IN NURSING

CHAPTER I

THE PROBLEM

Rationale

Anxiety is highly prevalent among college students. The top three concerns among
students are academic performance, pressure to succeed, and post-graduation plans (Beiter et al.,
2015). Nursing education has consistently been associated with anxiety among students. Heavy
course loads, stringent examinations, continued pressure to attain a high grade point average
(Chernomas and Shapiro, 2013), complex interpersonal relationships, challenges of the clinical
environment (Chen et al., 2015), caring for chronic and terminally ill patients (Sancar et al.,
2018) result in greater anxiety among nursing students than among students from any of the
other healthcare disciplines. Furthermore, it has been found that the clinical training taking place
during nursing education is more stressful than the theoretical aspect (Labrague, 2013; John and
Al-Sawad, 2015). Anxiety has a negative effect on the quality of students' life, their education
and clinical practice (Sanad, 2019) and may cause drop out from the nursing program (Rafati
et al., 2017).
 Moreover, the pandemic affected all areas of life, including education. The COVID-19
has resulted in schools shut all across the world. As a result, education has changed dramatically,
with the distinctive rise of e-learning, whereby teaching is undertaken remotely and on digital
platforms. This closing of schools, colleges, and universities resulted in a stressful event for
educational administration with highly limited options. Some students without reliable internet
access and/or technology struggle to participate in digital learning. Thus, Online learning can be
challenging for students because of the limited non-verbal communication.

Therefore, pandemic like COVID-19, affects the mental health due to numerous reasons
such as uncertainty, poor prognosis, economic loss, insecurity, confusion, emotional isolation,
stigma, school/work closure, inadequate resources for medical response, and deficient
distribution of necessities. As a result, people experience a lot of emotional disturbances such as
stress, insomnia, frustration, irritability which could lead to psychiatric disorder like depression,
anxiety, behavioral changes (substance abuse), also post-traumatic stress disorder in later stages.
Some groups may be more vulnerable than others to the psychosocial effects of pandemic.

A survey was done by Darlet et al., 2020 (US), he assesses the effect of COVID-19 on
college students. There are 4 in 5 students report having the make large of drastic life changes to
accommodate the current COVID-19 situation. Despite being digital natives, most students are
not fully comfortable with an exclusive online learning medium. Thus, it is obvious that the
COVID-19 pandemic has a negative impact on the student’s life.P

Similarity, last September 11, a 21-year-old, female from Sta. Elena, Iriga City was died.
Her death came as a shock to her parents, Ruben and Rosa, as they were only aware of their
daughter’s struggles with her gadget, signal, and Internet connection. They only found her
lifeless in the middle of night, when they were woken by a crash sound in their home. Thus,
being
Recently, a 21-year-old 3rd year college student hanged himself after worrying that his
family would not be able to afford a laptop necessary for him to pursue his studies through
online classes. The victim went home on Monday, Oct. 5, after attending an online class. The
suicide incident was discovered by the victim’s father at 10 a.m. the next day, October 6. He
found his son already lifeless with a nylon tied around his neck. Before the incident, the victim
asked for a laptop to be used for his online class, but his parents told him they needed time to
look for money. The parents are farmers residing in the village of San Isidro, at least 5km from
the town proper

Therefore, dealing with the hectic student’s life the drastic lifestyle changes imposed due
to COVID 19 pandemic can be very challenging. The present study aimed to assess level of
anxiety and ways of coping during the period of covid19 pandemic and identify association of
coping strategies with characteristics of the students among nursing students in the Northern
Christian College.

Theoretical Framework

This quantitative study is mainly anchored on the Selye’s Theory of stress which was first
developed in the 1930’s. He explained his stress model based on physiology and psychobiology
as General Adaptation Syndrome. According to Selye, stress is a non-specific physiological
response pattern of the body to any demand which focuses on the achievement or maintenance of
homeostasis or stability of physiological systems that maintain life (e.g., body temperature, heart
rate, glucose levels). This idea is elaborated in his General Adaptation Syndrome (GAS) model
which is based on the observation that all living organisms respond to stress as a basic reaction
pattern, and this is always the case, irrespective of the agent used to produce the stress.

The model states that an event that threatens an organism’s well-being (a stressor) leads
to a three-stage bodily response. The first stage is the Alarm/Reaction Phase, in this phase the
rate of all bodily functions of the autonomic nervous system increases dramatically, known as
the “fight-or-flight” response, to give physical strength and mobilize internal forces. In some
instances, its duration may only be a few seconds, though it may last longer. The second stage is
the Resistance/Adaptation Phase, the body begin to repair itself and returns many physiological
functions to normal levels of a stressful event or a fight-or-flight response. If the resistance/
adaptation phase continues for a prolonged period of time without periods of relaxation, sufferers
become prone to fatigue, poor concentration, irritability, frustration, and lethargy, leading to the
third stage known as exhaustion phase. The exhaustion phase, in the stressor environment is
chronic. With this, struggling with the stress for long periods can exhaust an organism’s
physical, emotional, and mental resources, which results to signs of adaptation failure. Systems
begin to break down, and the person becomes more susceptible to a range of biopsychosocial
signs and symptoms. Such as, fatigue, burnout, depression, anxiety, and decreased stress
tolerance. This may even lead to death.

Later, Selye introduced the idea that a stress response can result to positive or negative
outcomes based on cognitive interpretations of the physical symptoms or physiological
experience. When a person tolerates stress and uses it to overcome lethargy or enhance
performance, the stress is positive, healthy, and challenging; this is known as eustress. On the
other hand, when stress is negative and it exceeds one's ability to cope, fatigues body systems,
and causes behavioral or physical problems, it is known as distress.

However, the stress as stimulus model ignores important variables such as prior learning,
environment, support networks, personality, and life experience. Subsequently, in 1978, the
concept of personal interpretation was introduced, suggesting that a change or life event could be
interpreted as a positive or negative experience based on cognitive and emotional factors.
Lazarus (2015), in attempting to explain stress as a dynamic process, developed the
Transactional Theory of Stress and Coping (TTSC), which presents stress as a product of a
transaction between a person including multiple systems such as cognitive, physiological,
affective, psychological, and neurological) and his or her complex environment.

In this study, this theory was utilized to determine the degree of anxiety and coping
mechanisms among Nursing students at Northern Christian College during the COVID-19
pandemic. The Selye’s Theory of stress: General Adaptation Syndrome proposes that students
who perceive that they are susceptible to anxiety and coping mechanisms are more likely to find
ways to reduce their predisposition to the distress, thus they can identify the nature of the stress.
As to perceived severity, people who perceive anxiety as a serious disorder can engage to
different approaches to become aware and will seek ways to be educated. Consequently, people
who does not perceive it as a serious disorder tends to disregard things about it regardless of the
availability of resources. As to perceived benefits, people who perceives that it is beneficial on
their part to be equipped with knowledge about it will more likely to engage in different ways to
learn it’s nature, development and progression. However, perceived barriers are also of vital
importance to consider because this can affect and threaten the level of awareness of people.
Conceptual Framework
 Figure 1 shows the research paradigm of the study. It includes the independent and
dependent variables. Independent variables include the profile of respondents in terms of age,
gender, religion, average monthly income of parents, and family set up. The dependent variables
include the manifestations of anxiety experienced by the respondents during COVId-19
pandemic in terms of emotional symptoms, social behavioral symptoms, and physical symptoms;
and coping strategies adopted by students during COVID-19 pandemic. Figure 2 shows the
relationship between the independent and dependent variable.

Figure 1. The Research Paradigm

Independent variables Dependent variables

Demographic variables What are the manifestations

of anxiety experienced by
1.1 age
1.2 gender respondents during COIVD-19
1.3 religion pandemic in terms of;
1.4 Average monthly income of
 Emotional symptoms
parents
1.5 family set up  Social behavioral symptoms
Statement of the Problem
 Physical symptoms
This study aimed to determine the Manifestations of Anxiety and Coping strategies among
What Coping Strategies
Nursing Students during the COVID-19 pandemic. Specifically, it sought answers to the
adopted by students during COVID-
following questions

1. The Demographic Profile of the Respondents

1.1 Age
1.2 Gender
1.3 Religion
1.4 Family monthly income
1.5 Family set-up
2. The manifestations of anxiety experienced by students during pandemic
2.1 Emotional symptoms
2.2 Social behavioral symptoms
2.3 Physical symptoms
3. The Coping of Strategies adopted by students during pandemic
 3.1 Self-distraction
3.2 Active coping
3.3 Denial
3.4 Substance use
3.5 Emotional support
3.6 Use of informational support
3.7 Behavioral disengagement
3.8 Venting
3.9 Positive reframing
3.10 Planning
3.11 Humor
3.12 Acceptance
3.13 Religion
3.14 Self-blame

4. Is there significant relationship between the variables;

4.1 Demographic profile and manifestations of anxiety experienced by students during
COVID-19 pandemic.
4.2 Demographic profile and coping strategies adopted by students during COVID-19
pandemic.

Null Hypothesis

The following null hypotheses will be accepted or rejected, depending on the results of the
study:

1. Hₒ: There is no significant relationship between profile of respondents and manifestations

of anxiety experienced by respondents?
Hₐ: There is significant relationship between profile of respondents and manifestations of
anxiety experienced by respondents?
2. Hₒ: There is no significant relationship between profile of respondents and Coping
strategies employed by respondents in dealing with their problem?
 Hₐ: There is significant relationship between profile of respondents and Coping strategies
employed by respondents in dealing with their problem?

Scope, Delamination and Limitation of the Study

The research was designed to identify the manifestations of anxiety and coping strategies
during the pandemic of COVID-19 in Philippines, with the results that all participants were
fourth year nursing students S.Y. 2020-2021 in Northern Christian College. Due to the
extraordinary circumstances of the COVID-19 pandemic, in particular the restriction of
movement and the need for social distance, the data collection for this study had to be conducted
via the on-line survey platform (google.doc).

Significance of the Study

The generalization of this present study would be a great contribution to the vast
knowledge in relation to the level of anxiety and coping mechanism associated during the
pandemic. Vital results of this investigation could be highly significant and beneficial specially
to the following:

The Respondents. The respondents will have a self-awareness of the anxiety symptoms so that
they can effectively manage their situations.

The Professors. The result of the study may contribute to making an approach in their way of
teaching primarily, the approach of developing the student’s that could guide students in their
future challenges.

The School. The result of the study will serve as the emphasis of the welfare of the student and
the responsibility of the school also the society.

The Parents. The parents will be able to understand their child regarding their hopes, fear,
aspirations, like, dislikes, attitudes, belief, weakness, skill, and habits.

The Researchers. To deeply understand what are those problems that causes during the COVID-
19 pandemic among students in Northern Christian College.

The Future Researchers. The findings of the study will serve as a reference material and a
guide in formulating another research study that will mostly likely be related to the problems of
nursing students and their coping mechanisms. The results and findings of this research will
bring as a whole.

Definition of Terms

The following terms are defined according to how they were used in study.

1. Anxiety- this refers to the emotional aspects of a person which characterized by feelings
of tension, worried thoughts and physical changes and recurring intrusive thoughts or
concerns.
2. Coping mechanism- this refers to the specific efforts, both behavioral and psychological,
that the nursing students are employing to master, tolerate, reduce, or minimize stressful
events during pandemic.
3. Protestants- this refers to those any western Christian who is not an adherent of a
catholic, Anglican, or Eastern church (Miriam webster). These people who protested
against the practices and beliefs of the church.
4. Christian- this refers to a person who believes in Jesus Christ, an adherent of
Christianity.
5. Non-Christian- this refers to a person who is not Christian.
6. Single Parent family- this refers to the type of family that consist of one parent raising
one or more children on his own. This family may include a single mother with her
children, a single dad with his kids, or a single person with their kids.
7. Nuclear family- this refers to the traditional type of family that consist of two parents
and children.
8. Extended family- this refers to the type of family that consist of two or more adults who
are related, either by blood or marriage, living in the same house. This family includes
many relatives living together such as cousins, aunts or uncles, and grandparents living
together.
9. Transnational family- this refers to the type of family that which a member of family is
separated from each other and live in some other country such as in Canada, Hongkong,
yet hold together and create something that can be seen as a feeling of collective welfare
and unity even across national borders.
10. Self-distraction- this refers to the engaging pleasurable activities to distract oneself from
the stress event such as watching television, exercising, or reading.
11. Active coping- this refers to coping style that is characterized by solving problems,
seeking information, seeking social support, seeking professional help, changing
environments, planning activities, and reframing the meanings of problems. It is
emphasizing the personality trait.
12. Denial- According to Anna Freud, denial is involving a refusal to accept reality, thus
blocking external events from awareness. If a situation is just too much to handle, the
person may respond by refusing to perceive it or by denying that it exists.
13. Substance use- this refers to the usage of the coping strategies by the students such as
consuming sedative drugs and alcohol.
14. Emotional support- this refers to the process of attempting by the students to seek
advice.
15. Use of informational support- this refers to the process of attempting by the students to
seek advice and using consultations with professionals about the situations.
16. Behavioral disengagement- this refers to the coping style reflecting the tendency of
students to give in or reduce their efforts in difficult situations.
17. Venting- this refers to the blowing off steam in which the act of letting something out
strong and sometimes angry emotions.
18. Positive reframing- this refers to the thinking about negative a negative or challenging
situation in a more positive way.
19. Planning- this refers to meet the needs such as thinking about how to confront the
stressors.
20. Humor- this refers to the usage of humor by the students to deal with the situations
21. Acceptance- this refers to the positive reframing that
22. Religion- this refers to the beliefs in God and meditating.
23. Self-blame- this refers to the cognitive process in which an individual attributes the
occurrence of a stressful event to oneself.
 CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter presents various studies and literature related to Level of Anxiety and
Coping Mechanisms among BSN Level II Students in Northern Christian College, Laoag city.
Researchers gather information through primary and secondary literature related to the present
study.

COVID-19 PANDEMIC

The corona (COVID-19) pandemic is defining as a global health crisis of our time and
greatest challenge we have faced since World War II (UNDP, United Nations Develop Program).
In early December 2019, caused by a novel severe acute respiratory syndrome coronavirus 2
(SARS_CoV-2), occurred in Wuhan, Hubei Province, China. On 7 th of January 2020, the
authorities in China declared the isolation of the new CoV type. On 12th of January, 2019-nCoV
was designated by WHO, aid on 11th of February 2020 was assigned COVID-19 name (WHO,
World Health Organization).

The first case was identified, the infection was possible spread from animal to human a
zoonotic agent. A record human to human route by transfer confirmed a surge in cases in Wuhan
and globally after the shutdown of the Wuhan market and relocation of cases in China. Although,
china declared that this is a f—of new cases but have been reported at the beginning of April of
2020 of viral re-emergence (John Hopkins Coronavirus, Resource Center).

This COVID-19 associated with person to person through droplet in contact transmission
is flack of stringent infection control and prevention or no proper protective equipment, and it is
danger to extreme highest level. Since, it is emergence in Asia, the virus has spread all over the
world infecting millions of people and causing hundreds pf thousands of deaths. Every people
are losing jobs, income within way of knowing when normality will return (WHO, World Health
Organization).

ANXIETY

Anxiety is an emotion characterized by feelings of tension, worried, thoughts, and

physical change like increase blood pressure. Therefore, People with anxiety disorder usually
have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry.
They may also have physical symptoms such as sweating, trembling, dizziness, or a rapid
heartbeat (APA, American Psychological Association).

Most worrisome is that nursing student who experience anxiety may be unable to perform
safety and effectively (Cook,2015). Anxiety is highly prevalent among College Student. The
main source of anxiety in nursing student during COVID-19 pandemic was heavy loads,
stringent examinations, continued pressure to attain a high-grade point average
(ChernomasandShapiro,2013), complex interpersonal relationships, challenges of the clinical
environment (Chenetal,2015). Anxiety has a negative effect on the equality of student’s life, their
education and clinical practices (Sanad,2019).
 During pandemic state, nursing student are exposed to additional stressful factors, such as
fear of being infected. A study conducted among nursing students during the SARS outbreak
(2003) showed that nursing students perceived themselves to beat higher risk of infection
(Wongetal,2004).

The study conducted by Bella S, Yifat F, Anat E, Tova H, (2020) related to Anxiety and
Coping strategies among nursing students during COVID-19 pandemic in Isarel (2020). The
study shows that the reflects high levels of anxiety among nursing students during the continuing
COVID-19 pandemic. Males had significantly lower anxiety scores in comparison with females.
Given the fact that females comprise the majority of their study population in nursing students,
that can explain in part high prevalence of anxiety. The reason for this high prevalence of anxiety
is explained by the extremely exceptional living situations and conditions during the continuing
COVID-19 pandemic. These circumstances include social isolation, economic instability,
uncertainty about future, challenges of remote learning, fear of getting infected and more.

A study conducted by Akhtarul I, Sutapa Dey B, Hasin R, Nafiul A.K Tanvir H (2020)
related to anxiety among University Student in Bangladeshi. The study shows that out of the total
389 valid participants were found to had mild to severe anxiety symptoms during the pandemic.
Also, out of the total students suffering from anxiety disorders, females (33.67%) had lower
anxiety symptoms than males, whereas students in the early twenties showed had a higher
anxiety. The study suggests that university students in Bangladesh are experiencing an
unparalleled growth of anxiety under the current global pandemic situation. The study also
suggests that the university students’ involvement in private tuition is a critical factor in
understanding the increased prevalence of anxiety among them.
In 2020, Michael L.T, Cerica A.T, Joseph P.A conducted a study on Psychological
impact of COVID-19 pandemic in the Philippines. The study shows that females are more
affected than males. The less educated, single people, children and adolescents, those who have
no children had the higher levels of anxiety. These subgroups, considered at greater risk for
adverse psychological outcomes during a public health crisis, may be experiencing low social
and emotional support, increased perceived threat to well-being and feelings of fear, isolation
and uncertainty
 The first case in the Philippines involved a 19-year-old Sto. Domingo National High
School Balik-Aral student (someone who resumed studying after a period of inactivity) last June
16. The student was found lifeless in a hut near their family’s Brgy. Fidel Surtida home at 5 AM
that day. According to the mother, the stress came from the cost of purchasing load or internet
fees to participate in online classes.

Following that, a 21-year-old male from the town of Sitio San Antonio, Sto. Domingo,
Albay took his life last August 18. This was after his mother told him to temporarily take a break
from school and not enroll due to the COVID-19 pandemic, and the lack of money to support his
online schooling.
A 21-year-old, this time a female from Sta. Elena, Iriga City, also died last September 11.
Her death came as a shock to her parents, Ruben and Rosa, as they were only aware of their
daughter’s struggles with her gadget, signal, and Internet connection. They only found her
lifeless in the middle of night, when they were woken by a crash sound in their home.
Recently, a 21-year-old 3rd year college student hanged himself after worrying that his
family would not be able to afford a laptop necessary for him to pursue his studies through
online classes. The victim went home on Monday, Oct. 5, after attending an online class. The
suicide incident was discovered by the victim’s father at 10 a.m. the next day, October 6. He
found his son already lifeless with a nylon tied around his neck. Before the incident, the victim
asked for a laptop to be used for his online class, but his parents told him they needed time to
look for money. The parents are farmers residing in the village of San Isidro, at least 5km from
the town proper.

COPING STRATEGY

Coping is defined as the thoughts and behaviors mobilized to manage the internal and
external stressful situations. It is a term used distinctively for conscious and voluntary
mobilization of acts, different from 'defense mechanisms' that are subconscious or unconscious
adaptive responses, both of which aim to reduce or tolerate stress (APA Dictionary of
Psychology, 2016).

When individuals are subjected to a stressor, the varying ways of dealing with it are
termed 'coping styles,' which are a set of relatively stable traits that determine the individual's
behavior in response to stress. These are consistent over time and across situations. Generally,
coping is divided into reactive coping (a reaction following the stressor) and proactive coping
(aiming to neutralize future stressors). Proactive individuals excel in stable environments
because they are more routinized, rigid, and are less reactive to stressors, while reactive
individuals perform better in a more variable environment

When a person perceives an event as unchangeable or irreversible, he/she may employ an

emotion-focused coping strategy to cope with the situation. On the other hand, a problem-
focused coping strategy may be adopted if the person finds the stressful situation as manageable.
Besides, the avoidant types of coping strategies are commonly observed, too. These strategies
may include wishful thinking, self-distraction, denial, or behavioral disengagement, and have
negative impact on the individuals, especially if sustained over a long period of
time (MacNamara, 2020).

In order to assess coping effort systematically, Folkman & Lazarus (2008) developed the
Ways of Coping Questionnaire (WCQ) which measured individuals’ coping effort through eight
different types of coping strategies used, namely confrontive coping, distancing, self-controlling,
seeking social support, accepting responsibility, escape-avoidance, planful problem-solving, and
positive reappraisal. Halamandaris & Power (2010) found that the subscales such as self-
controlling, seeking social support, and accepting responsibility were significantly and positively
correlated with university adjustment among students, while negative relationship was found in
escape-avoidance. Distancing is found to correlate with students’ academic performance, too.

Moreover, as demonstrated by a number of studies (e.g. Aspinwall & Taylor,

1992; Brissette, Scheier, & Carver, 2002; Leong, Bonz, & Zachar, 1997; Quinn, 1997; Rich &
Scovel, 1987; Sarason & Sarason, 2009 ), active coping is found to have positive and direct
effect on university adjustment whereas the stress related to ineffective coping may induce the
development of various psychological symptoms in individuals, e.g. depression, feelings of
hopelessness and sadness, etc. In particular, escape-avoidance coping is related to higher levels
of psychological depression, while both positive reappraisal and planful problem solving are
marginally related to higher levels of psychological well-being (Park & Adler, 2003; Dyson &
Renk, 2006) . Besides adjustment, positive and significant relationships between coping and
students’ grade point average have been observed as well. Hence, coping is an important
psychological preditor of students’ adjustment and academic achievement.

Furthermore, one of the more consistent findings regarding gender and adjustment is that
females tend to have poorer emotional adjustment during the transition than males (Alfeld-Liro
& Sigelman, 1998; Arthur & Hiebert, 1996; Fisher & Hood, 1988; Sinclair, Barkham, Evans,
Connell, & Audin, 2005; Vivona, 2000) . Indeed, it has been observed that women are more
likely to use emotion-focused coping strategies whereas men prefer problem-focused strategies.
On the other hand, there is some evidence to suggest that females have more positive social
adjustment than males because women are more willing to seek social support and are better
socially integrated (Baker & Siryk, 2011; Leong, Bonz, & Zachar, 2007; Halamandaris & Power,
1999) .

The study conducted by Akhtarul I, Sutapa D.B,Hasin R, Nafiul A.K,(2016), Depression

and Anxiety among University Students in Bangladeshi . The study shows that the maximum of
the participants was found to be having moderate coping strategies score 76.58% while as only
18.55 of the participants had high coping strategy scores and 4.9% of the participants had low
coping strategies. On observing the type of coping strategy style, maladaptive coping scores
were highest with mean-31/5(±5.19) and adaptive coping being least 9.44(±2.64).
In the study conducted by Bella S. et al., (2020), Anxiety and Coping strategies among
Nursing Student in Israeel during COVID-19 pandemic. The study shows that the substance use
such as usage of alcohol, sedative drugs and excessive eating was associated with a higher state
of anxiety. usage of humor as was associated in this study with lower levels of anxiety coping.

The study conducted by kwako d a et al., (2019), Sressors and Coping strategies among
students at university of Ghana. The study shows that the majority of learners were using
positive coping approaches such as self-distraction, that is “Doing something like watching TV,
movies, going shopping, listening to music to take my mind off the condition” (M = 4.11,
SD = 0.99), with residents obtaining the highest mean. The rest are active coping like “Doing
something about the situation, act to neutralize stressor” (M = 3.82, SD = 1.22), with residents
(M = 3.84, SD = 1.17) being more active than their non-resident counterparts (M = 3.77,
SD = 1.35). On positive refraining such as “Learning from experience by seeing something good
in the current situation” (M = 3.87, SD = 1.20), residents were more positive (M = 3.90,
SD = 1.17) than non-residents (M = 3.81, SD = 1.22) although there was no significant mean
difference between them. Furthermore, on religion like “Praying/meditating” (M = 3.87,
SD = 0.94), residents (M = 3.95, SD = 0.93) prayed and meditated more than their non-resident
counterparts

oping
In a study conducted by Sami A et al., 2011, Stress and Coping Strategies of Students in
Malaysia. The study shows that the majority of respondents were females (64.4%), aged 21 years
or older (63.0%), and were Malays (68.9%). Forty-six percent felt stress. The most common
stressor was worries of the future (71.0%), followed by financial difficulties (68.6%). Significant
predictors of stress were smoking (OR = 2.9, 95% CI 1.3–6.8, P = 0.009), worries of the future
(OR = 2.1, 95% CI 1.3–3.4, P = 0.005), self-blame (OR = 1.3, 95% CI 1.1–1.5, P = 0.001), lack
of emotional support (OR = 0.8, 95% CI 0.7–0.9, P = 0.017), and lack of acceptance (OR = 0.8,
95% CI 0.6–0.9, P = 0.010). Students used active coping, religious coping reframing, planning,
and acceptance to cope with stress.

john Robert c rilveria (2018), conducted a study on The Development of the Filipino
Coping Strategies Scale. The study shows that the Ninety-six to ninety-nine percent of the
respondents completed the questionnaire. They generally scored high on most of the domains in
the scale except on the substance use domain. This means that the participants are not more
likely to engage in smoking, drinking alcohol, and drug-related activities in order to cope with
stressful life experiences. The top four domains that the participants scored highly would be on
the problem-solving, cognitive reappraisal, relaxation/recreation, and religiosity domains. The
standard deviation of each domain ranges from .37 to 1.0, indicating low variability across the
participants (most scores are clustered around the mean). Interestingly, most of the answers of
the participants who responded to the free item of the Filipino Coping Strategies Scale were
categorized under the relaxation/recreation domain. Examples of the responses they provided
include: listening to music, watching movies, shopping, writing, reading books, dancing, playing
sports or computer games, and so forth which were rated either “most of the time” (3) or
“always” (4).

In a cross-sectional study conducted by Dartlet et al., 2020 titled Coping strategies of

students for anxiety during the COVID-19 pandemic, September 2020 which was conducted in
China, the university students reported that coping strategies and survival techniques were
required due to high levels of anxiety and psychological pressure during the COVID-19
pandemic. Most of the respondents reported the prompt closure of their academic institutions due
to COVID-19. Psychological concerns, such as lack of sleep, emotional support, mental support
and social appeal, were also reported (Nurunnabi et al., 2020). A survey was executed to assess
the effect of COVID 19 on college students. 4 in 5 students see their academy as trustworthy
sources of COVID 19. 4 in 5 students report having to make large or drastic life changes to
accommodate the current COVID-19 situation. 50% of students say COVID-19 won’t stop them
from attending college under any circumstances. Many college students are resilient and taking
this unprecedented closure or classroom format change in stride. with that said, around a quarter
of students say there is at least a slight chance they would delay their education if the pandemic
isn’t resolved by the fall. A plurality of students does not feel comfortable taking classes online.
Despite being digital natives, most students are not fully comfortable with an exclusive online
learning medium. Thereby it is evident that the COVID 19 pandemic has a negative effect on the
student’s life.

Therefore, Coping has been viewed as a stabilization viewpoint that could help a person
in psychosocial adjustment over the span of stressful occasions. Coping strategies utilized more
than once by learners to minimize levels of stress include effectual time management, social
help, constructive reassessment and commitment in comfortable interests. Tolerating
responsibility and self-blame are also coping stratagems useful in the first year of medical school
tertiary education. The pattern is shifted to challenging, intellectual, and strategic problem-
solving in the later years (Ahmadi et al., 2018). Similarly, in order to endeavour to overcome,
reduce or permit stress and disagreement, it is imperative that the individual consciously puts in
enormous efforts in order to solve private and relational challenges (Weiten & Lloyd, 2008). The
efficacy of the coping endeavour is contingent on the type of stress, the person involved, and the
situations at hand. Reactions to coping are partially managed by one’s disposition and the social
setting, especially the inherent features of the stressful atmosphere (Brannon & Feist, 2009;
Carver & Connor-Smith, 2010). Thus, learners with an engagement coping approach can change
the circumstances, bringing about an increasingly versatile result, thereby reporting fewer
symptoms of depression (Tobin, Holroyd, Reynolds, & Wigal, 1989).
 CHAPTER III

METHODOLOGY

This chapter present the research design of the study, locale of the study, population and
sampling, instrumentation, data gathering procedure and tools of data analysis

Research Design

The descriptive correlational research design was utilized in this study. Descriptive
research involves gathering data that describes events and then organizes, tabulates, depicts and
describes the data collection (Glass & Hopkins, 1984) Descriptive studies aimed at finding out
‘’what is’’, observational and survey methods are frequently used to collect, descriptive data and
can include multiple variables for analysis, yet unlike other methods, it requires only one
variables (Borg & Gall, 1989). Likewise, this study was correlational since the relationship of the
study was determined and it demanded the degree which the variables were related to each other
using various statistical instruments also, the researchers determined if a significant relationship
exist between the independent variables and dependent variables of the study

Using descriptive correlational research design, this study was concerned with finding out
the degree of anxiety and coping mechanisms among nursing students in Northern Christian
College.

Locale of the study

The study was conducted at Northern Christian College. Northern Christian College is a
private school in the City of Laoag. The campus is located at Barangay #5 San Pedro Mabini
Street, Laoag City. The said location was identified based on accessibility and the number of
students who are currently studying in this area.

In addition, the location was chosen because of the following reasons: a) chosen area is
accessible to ensure the conduct of the research within the time frame; b) there are sufficient
number of nursing students studying.

Population and Sampling

 The respondents of the study include sixty (60) third year nursing students population
covered in the study. The overall sample size is thirty (30) third year nursing student academic
year 2020-2021 from the Northern Christian College, Laoag City.

This study used the stratified sampling design as data gathering procedure. stratified
sampling is a probability sampling method and a form of random sampling in which the
population is divided into two or more groups (strata) according to one or more common
attributes. Stratified random sampling intends to guarantee that the sample represents specific
sub-groups or strata. Accordingly, application of stratified sampling method involves dividing
population into different subgroups (strata) and selecting subjects from each strata in a
proportionate manner. Which enabled the researchers to answer the objectives of the study this
method of sampling was appropriate in the conduct of the study fir the researchers gathered data
from specific population with certain characteristics that were suitable for the implementation of
the study.

The participants in the study were determined using stratified sampling since the study
focused on nursing students who are within the scope of level of anxiety in Northern Christian
College. An informed consent form was attached to the e-questionnaire, and each participant
consented to participate in the survey after reading the consent form.

Research instrument

The study used questionnaires to gather data. The questionnaire has two parts. Firstly, the
collection of their demographic profile which includes age, gender, religion, family monthly
income, and family set up. Secondly, the questionnaires were structured in different areas.
Followed by probing questions namely: a) manifestations of Anxiety experienced by respondents
b) Coping Strategies adopted by Nursing Student in Northern Christian College.

The questionnaires were made by the researchers and validated by the research adviser.

Anxiety. Anxiety was evaluated by using the Generalized Anxiety Disorder (GAD-7). In
Generalized anxiety disorder – 7 scale

The GAD-7 scale is a 7-item questionnaire to measure the self-reported level of anxiety
in the respondents during the preceding two weeks. Each item is scored from 0 (not at all) to 4
(nearly every day). The scores of all items are added to get the total scores, with a range of 0 to
21. The items were designed to quantify symptoms of anxiety according to the Diagnostic and
Statistical Manual of Mental Disorders-IV-TR. The GAD-7 has adequate psychometric validity,
i.e., convergent validity, diagnostic validity, factorial validity, internal consistency, test-re-test
reliability in various populations. Moreover, the participants responded to the 7-item Generalized
Anxiety Disorder Scale (GAD-7). The GAD-7 includes seven items based on seven core
symptoms and inquires the frequency with which respondents suffered from these symptoms
within the last two weeks (Toussaint et al., 2020). Respondents report their symptoms using a 4-
item Likert rating scale ranging from 0 (not at all) to 3 (almost every day), such that the total
score ranges from 0 to 21(Toussaint et al., 2020). The GAD-7 is a well-validated screening
instrument, and it has demonstrated excellent internal consistency (Cronbach's ɑ = 0.911).

Physio-Psycho-Social Response scale (PPSRS)

Responses to stress were assed using the PPSRS developed by Sheu et.al. The PPSRS
describes nursing student’s responses to and emotions caused by stress during COVID-19
pandemic. It also measures the physio-psycho-social health status of students during COVID-19
pandemic. The PPSRS consists of 21 items and each is rated on a five-point Likert-type scale
(0=never, 1=almost never, 2=sometimes, 3=fairly often and 4=very often). The PPSRS contains
21 items which are divided into three subscales: Physical symptoms, Emotional symptoms’,
Social behavioral symptoms. Both subscale scores and total scores are computed. A higher score
means presence of more and serious symptoms reported and poorer physio-psycho-social health
status. To determine the level of stress, the following scaling was used; 2.67-4.00 for Poor
Health Status, 1.34-2.66 for Good Health Status, and 0-1.33 for Best Health Status.

Reliability and Validity testing of the instruments was done by Sheu et al., 2002. In this
study, the Cronbach’s alpha was 0.82. Both questionnaires were pilot tested before distributed to
the participants enrolled in the investigation.

Brief-COPE

The Brief COPE was created from the Lazarus and Folkman (1984) literature on coping.
The original COPE was comprised of 15 scales, each with a focus on some meaningful aspect of
coping. It was intended to be a flexible instrument, meaning that researchers may pick and
choose from the relevant scales to use for the purposes of their studies. It is often used in health-
related research to assess coping processes and has often found to be predictive of future
physiological effects. This abbreviated instrument was created in response to criticisms that the
complete version of the COPE scale was too burdensome for respondents in terms of length of
time to take the scale and because of the redundancy of items. The development of the Brief
COPE, which has 28 items instead of the original 60, was guided by factor loadings from
previous analyses and previous cognitive testing that indicated that certain items provided more
clarity to respondents than others (Carver, 1997; Carver, Scheier, & Weintraub, 1989). The Brief
COPE has 14 sub-scales and no “overall” coping index score, thus the author does not
recommend a particular means of generating a dominant coping style for any given person. On
the contrary, Carver encouraged the creation of second-order factors from among the scales and
for researchers to use the factors as predictors using their own unique data. For the purposes of
this dissertation, however, two summated scores were created based on the ten subscales that
dealt with positive coping strategies and for the four subscales that mentioned negative coping
strategies.

This strategy was used because Carver grouped his scales conceptually into “active” and
“avoidant” coping strategies. Instead of using these terms, this study named the scales “positive
coping 60 strategies” and “negative coping strategies.” There are ten ‘positive’ and four
‘negative’ scales that are grouped in the following manner: Positive scales are: Self-Distraction
(items 1 and 19); Active Coping (items 2 and 7); Use of Emotional Support (items 5 and 15);
Use of Instrumental Support (items 10 and 23); Venting (items 9 and 21); Positive Reframing
(items 12 and 17); Planning (items 14 and 25); Humor (items 18 and 28); Acceptance (items 20
and 24); and Religion (items 22 and 27). Negative scales are Denial (items 3 and 8); Substance
Use (items 4 and 11); Behavioral Disengagement (items 6 and 16); and Self-blame (items 13 and
26). Each of the 28 items on the Brief COPE is scored from 1 through 4, with self-report ratings
of the frequency with which a person engages in a particular coping strategy. The value of ‘1’
indicates the person hasn’t been doing it at all, ‘2’ is a little bit, ‘3’ is a medium amount, and ‘4’
is a lot.

The Brief COPE also allows the researcher to tailor instructions in the context of the
particular stressor(s) of interest. Thus, for this dissertation project, there will be two outcome
scores related to this index. One score will be an aggregate of ‘negative coping’, which ranges
from 4-16 possible points. The higher the score, the more often negative coping strategies are
used. It is important to note that a lower score indicates that a person is not engaging in negative
coping, so that must be considered in analysis as well. Since there are 10 ‘positive coping’
strategies, the score range is from 10-40. Scores must be interpreted with caution along this scale
as well, because lower scores indicate that an individual may not be using these coping strategies
with great frequency. Carver (1997) assessed the soundness of the internal structure of the Brief
COPE 61 by completing an exploratory factor analysis on the item set to obtain factor loadings.
The Brief COPE’s factor structure was very similar to that of the original instrument.

Reliability analyses across three administrations of the Brief COPE indicated that each of
the scales (with two items each) met or exceeded Cronbach’s alpha of .50 and all exceeded .60
except for three of the scales: Venting, Denial, and Acceptance. Therefore, Carver believed that
these data support internal reliability of abbreviated scales. In particular, since reliability
measurements are artifacts of the number of items in a particular scale, the Cronbach’s alphas
here are acceptable (Carver, 1997). Data concerning the predictive validity of the Brief COPE is
similar to that for the full instrument. Carver, Pozo, Harris, Noriega, Scheier, Robinson and
others (1993) reported that this instrument assesses many coping responses that are often named
in the coping process and that some are predictive of future physiological effects. For instance,
Antoni, Goodwin, Goldstein, LaPerriere, Ironson, and Fletcher (1991) found that denial and
behavioral disengagement scales were prospective predictors of distress in HIVpositive men,
with acceptance as a coping response as a predictor of lower distress in a subsequent study. In a
1995 study by Antoni, Esterline, Lutgendorf, Fletcher, and Schneiderman, denial and behavioral
disengagement predicted greater HIV progression a year later in subjects.

Data Gathering Procedure

The research study as reviewed by-------. Before the conduct of the administration of the
questionnaire, the respondents themselves were informed on the purpose of the study and its
benefits. Elaboration of explanations were given in case of questions from the questionnaires
needed. For clarification, the researchers set the date on----- at------- at Northern Christian
College. The respondents were asked by the researchers if they are willing to be a participant and
allow them to record their answers. Responses to the questionnaire were tallied, tabulated and
interpreted.

Figure 2 Shows the Data Gathering Flowchart

Forwarded request letter to:

Approval of requested letter

 Validation of the research instrument

Selective of respondents

Obtaining of informed consent from respondents

Implementation of data gathering procedure

Thematic analysis of the data gathered

Tools for Data Analysis

The data gathered on the profile of the respondents will be presented and described using
frequency counts expressed in percentage.

On the other hand, weighted mean will be use to interpret the manifestations of anxiety
experienced by respondents using the following scale.

Weighted mean range Numerical rating Descriptive rating

 4 Very often

3 Fairly often

2 Sometimes

1 Almost Never

1 Never

Likewise, weighted mean will be also used to interpret the coping strategies
employed by respondents in such problems.

Weighted mean range Numerical rating Descriptive rating

4 I’ve been doing this a lot

3 A medium amount

2 A little bit

1 I haven’t been doing this at

all

Moreover, Pearson r will be used to determine the relationship between variables of the
study.