RESEARCH

A DESCRIPTIVE STUDY TO ASSESS THE LEVEL OF STRESS REGARDING
PREVIOUS ONLINE CLASS AMONG B.SC(N) III YEAR STUDENTS WHO

WERE STUDYING IN C S I JEYARAJ ANNAPACKIAM COLLEGE OF
NURSING AT MADUTAI-2022
A.ANTO KINGSLIN
M.PETCHI
M.UMA MAHESHWARI
A PROJECT SUBMITTED TO
THE TAMIL NADU DR M.G.R. MEDICAL UNIVERSITY,CHENNAI
INPARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF BACHELOR OF SCIENCE IN NURSING
OCTOBER-2022
CERTIFICATE
This is a Bonafide work of A. Anto kingslin, M. Petchi, M. Uma maheshwari,
CSI Jeyaraj Annapackiam college of nursing Madurai ,Tamil Nadu,India
submitted in partial fulfillment for the degree of bachelor of science in
Nursing under the Tamil Nadu DR MGR Medical University Chennai.
Signature of the principal:
Prof Dr.Mrs JOTHI SOPHIA.,MSC(N),Ph.D.
CSI Jeyaraj Annapackiam College of Nursing,
Pasumalai ,Madurai.
Signature of the research guide:
Mrs Jeba Rani,MSC(N),
Reader,
CSI JACON.
College seal
ACKNOWLEDGEMENT
“My grace is sufficient for you”-BIBLE
All the humility .We submit our deepest sense of over lasting gratitude
and heartfelt praise to lord almighty We praise the almighty ,the
providence for this abundant blessing to complete the study successful
with for this wisdom, inspiration and boundless blessing so our sincere
gratitude of this study.
We express our immense gratitude to our principal
Prof .Dr.Mrs.C.JOTHI SOPHIA M.Sc(N).RNRM Ph.D., for her
constant encouragement and concern during the entire of this
dissertation.
We convey our sincere thanks to our Vice Principal Prof.Dr.Mrs.Merlin
Jeyapal M.Sc (N).,RNRM ,.Ph.d., for her excellent and support to this
study.
We express deep sense of gratitude to our guided.
Mrs.JEBARANI,M.Sc(N) READER, of Community health nursing
department for being a source of inspiration in every phase.
It gives us a great pleasure to express our heartfelt gratitude to our class
coordinator Mrs. Priscilla, M.Sc (N).,Ph.D.,Reader and
Mrs.Jebarani., M.Sc(N)., Lecturer of Child Health Nursing Department
for their encouragement, help and the prayer support during the course of
the study.
We wish to thank Mrs .Angelin manova, Librarian and we heartfelt
thanks to Mrs. Mercy of computer Department.
A Word of special thanks to our classmates the “ HEALING
HEBRONS” for the support.
We have no words to express my gratitude seas thanks to beloved parents
V.ANTONY PAUL RAJ-T.ANBUKARASI;P.MUTHU RAJ -
M.RAMALAKASHMI;K.MANIMARAN-M.IRULAYEE. For this
constant support, help, encouragement and prayer during this study
period. We extend my warmest gratitude to my lovable sisters and
brothers are A.ANTO SIBIN; M.SIVA; M.SARAVANA ,
M.MURUGESAN,M.GURU.I submit my deep sense of thanks to the
person who have directly and indirectly involved in finishing this study.
INDEX
CHAPTER NO CONTENTS PAGE NO
I INTRODUCTION
Background of the study
Significance and need for the study
Statement of the problem
Objectives
Operational definitions
Delimitations
II REVIEW OF LITERATURE
1. overview of online class
2.studies related to stress
3.studies related to previous online class stress.
III METHODOLOGY
Research approach
Research design
Setting of the study
Variables
Population
Sample
 Sample size
 Sample technique
Sampling criteria
Description of the tool
Data collection method
Plan for data analysis
Ethical consideration
IV DATA ANALYSIS AND
INTERPRETATION
V DISCUSSION
VI SUMMARY AND RECOMMENDATIONS
Summary
Objectives
Conclusion
Implications
Limitations
Recommendations
REFERENCES
APPENDICES
List of tables
TABLE NO TITLE PAGE NO
To assess the level of stress
regarding previous online class
1 among the 3 year B sc (n)
students.
To find out association between
the level of stress regarding
2 previous online class and
demographical variables
ABSTRACT
A descriptive study to assess the level of stress regarding the previous online class among B.sc
(N) 3rd year students who were studying in CSI Jeyaraj annapackiam college of nursing at
Madurai .
OBJECTIVES
1. To assess the level of stress regarding previous online class among the 3rd year B.Sc nursing
students.
2. To find out the association between the level of stress regarding previous online class and
demographic variables .
CHAPTER 1
INTRODUCTION
BACKGROUND OF THE STUDY
Stress is a common feature in all our lives. It is often seen as a negative emotion but stress plays
an important role in the survival. It helps to face threat sand dangerous situations, makes the
individual to get motivated and can even make the perform once better. Stress is a state of
physical and psychological strain which imposes demands for adjustments upon the stress.
Individual. It has been reported that student nurses are affected with the stressors in academic,
clinical, financial, due to parental expectations, competition for grades, and career choices.
Academic sources of stress are like examinations, long hours of study, assignments, grades, lack
of free time, lack of timely feedback after their performance, special elements of the academic
programme like arrangement and conduction of work shops. Clinical sources of stress are like
taking care of ill patients, interpersonal conflict with peer group, insecurity about personal
clinical competence, fear to complete their clinical requirements, dealing
with uncooperative patients, work overload, prolonged standing, learning psychomotor skills,
e.g.bed making, bed bath, and vital signs monitoring have also been associated with high levels
of stress.
Online learning is a virtual learning system which integrates internet connection with teaching
and learning process [10]. The interaction of teaching and learning activities can be carried out
from the distance with the help of internet and online media [11]. However, this method can be
difficult for those teachers who are specialized in conventional teaching and are uncomfortable
to use electronic gadgets. Also, students may not feel serious in online teaching as teachers have
little control in online teaching [12]. Online learning has become a solution for the continuity of
teaching and learning process in Nepal during Covid-19 pandemic. Although online learning
have various positive impacts, the shift to online education in nursing where student nurses
require practical knowledge creates new challenges for nurse educators [13,14].
Various studies have been conducted across different countries to determine medical student’s
perception on E-learning. A study was done in Pakistani medical and dental students in which
students did not prefer e-teaching over face-to-face teaching during the lock down situation. 77%
students had negative perceptions towards e-learning [15]. Further, a study done in Indonesia
among medical students found some supportive but also inhibitory factors to distance learning.
The most agreed supportive factor was location flexibility (87.9%) and the most common
inhibitory factor was signal dependent (80.2%) [16]. A study was conducted to assess the impact
of E-learning among nursing students and teachers of Kathmandu during COVID-19 [17].
The corona virus disease pandemic, which began in China in December 2019 and spread around
the world, has given rise to new issues and debates. Social, economic, political, and, of course,
spiritual resources, and consequences must be addressed, and it is necessary that we manage the
outbreak through basic principles of public health, and operate the country in a manner that
respects basic human rights.
Although the pandemic began later in Turkey, compared with other countries, Turkey is among
those countries that had implemented early preventive measures. Many countries have
implemented various isolation measures to prevent the spread of the outbreak until a vaccine or
drug is found. These measures include home isolation, social distancing, closing
schools/universities and businesses, canceling or postponing events, canceling or postponing
congresses and seminars, postponing sports events, and travel restrictions
Online study is the most significant aspect of learning. The importance of online learning over
the traditional methods of classroom teaching includes paperless, distant, and instruction-based
learning. During the COVID-19 pandemic, an online study emerged as an excellent solution for
the education of students. Aim: To assess the perception and issues regarding online study during
lockdown among nursing students studying in selected colleges. Methodology: A quantitative
approach and cross-sectional survey research design were used to assess the perception and
issues regarding online study during lockdown among 278 students selected through total
enumeration sampling technique studying in the selected nursing college of block Pachhad,
district Sirmaur, Himachal Pradesh. An online self-structured questionnaire was used as a tool
district Sirmaur, Himachal Pradesh. An online self-structured questionnaire was used as a tool
for data collection. Descriptive data analysis was done with SPSS (version 23). Results &
Conclusion: As per perception, the majority (77.7%) of participants responded that classroom
teaching is the best teaching-learning method. 38.1% of them responded that online learning is
less interactive and difficult to operate. Most (43.9%) of subjects were agreed that online
learning provides the opportunity to create students' own learning environment. More than half
(68.7%) of subjects were partially satisfied with online study lockdown (COVID Pandemic).
Regarding issues of online study, majority subjects were not able to maintain a proper time
schedule, faced network issues, less student & teacher interaction, and inadequate access to
learning material, etc. Hence adequate resources, proper schedule, technical support, etc. are
required to make the online study more effective.
After the first COVID‐19 patients were reported in Turkey, on March 12, 2020, one of the most
significant measures taken by the Ministry of Education and Higher Education Institutions, was
to close school for 3 weeks. Then based on the course of the pandemic, it was decided to keep
the schools closed until the end of that year's Spring term. Training continued through distance
education. Young people worry about the course of COVID‐19, how long the pandemic will last,
and when they will be able to return to normal life, while being away from friends and with
limited to no social life, which causes them to experience stress and tension.
Having limited knowledge with regard to COVID‐19 and being overwhelmed by its coverage in
the media can cause anxiety and fear in the community. In general, the public may experience
distress, frustration, and irritability during the implementation of isolation measures. Quarantine
can lead to loneliness, physical distancing from loved ones, grief, anxiety, and chronic stress,
which can have long‐term psychological effects. It has been demonstrated that the presence of
mass traumas and infectious diseases negatively affects the behavior and psychology of
society. The level of anxiety increases even more because the outbreak and ending process are
unknown.
The interruption of education for nursing students has been unexpected from students. In
addition, the clinical practice of nursing students in hospitals has also been discontinued.
Because much of nursing education consists of clinical practice, students may have been
concerned about being inadequate in clinical skill development. In addition, the application skills
are insufficient, the uncertainty of when, where and how to do the compensatory training for the
elimination of inadequacy could stress nursing students. This research was carried out since it
was thought that especially for nursing students to encounter the pandemic process for the first
time, and not to engage in clinical practices in which they develop skill teaching may have an
impact on their stress levels. So, this study aimed to evaluate nursing students’ views on the
COVID‐19 pandemic and their perceived stress level
:Nursing students are important human resources in the field of health. Detection of potential
anxiety and stress among nursing students is crucial since anxiety and stress can lead to low
productivity, low quality of life, and suicidal ideas. Identifying factors affecting anxiety and
stress in initial period of college among nursing students can help nursing educators to find ways
to decrease anxiety and stress. Objectives: To assess the anxiety and stress among B.Sc. nursing
first year students in their initial college life. Methods: A cross-sectional descriptive research
design was used for this study. Consecutive sampling technique was used to select the subjects.
Total 13 students (100%) were taken as a sample and standardized Beck anxiety scale and
modified scale for academic stress was used to collect data. Results: The study shows that
majority of the students, 8 (61.5%) were in the age of 18 years old, follows Hindu religion, 10
(76.9%) belonged to upper caste, 11 (84.6%) stayed in urban area, 7 (53.8%) had no difficulty in
this college. Out of 13, 2 (15.4%) students had moderate anxiety and 11 (84.60%) had low level
of anxiety with 1.15 ±0.37 whereas 6 (46%) students had mild stress and 7 (54%) had moderate
level of stress with 1.53 ±0.51. There were no significant association of anxiety score and stress
score with age, ethnicity, residence, feeling difficulties in the college with p < 0.05; 6 (46%).
There was low positive correlation between anxiety and academic stress with rp = 0.395. It was
found that the cause of anxiety was due to college environment, seniors ragging, difficult
subjects, delay session and can be reduced by stopping seniors ragging, providing transportation,
starting session on time, counseling, providing lunch in canteen, friendly environment, free hours
for library. Conclusions: Students who are newly taking admission to nursing profession will
have mild form of psychological variation. Students are mainly faced with practical and
academic stressors and anxiety. Hence the study strongly suggests that, starting session on time,
time management, avoid ragging, student counseling are the most important factors to reduce
anxiety and academic stress to the newly admitted students.
Professional job stress has been studied and identified often in occupations with high physical
and psychological demands and low personal autonomy. Nursing is a typical example of a high
stress occupation, as nurses must interact with other professionals frequently to perform required
work (Decker &Shellenbarger, 2012). Although nursing students share many of the same
stressors as qualified nurses, they are at the lowest level of the hierarchical ladder. They share
responsibilities for the patient and family with the bedside nurse, charge nurse and clinical
nursing instructor (Watson, Yanhua, Smith, Wong, &Deary, 2013). The stress response occurs
regardless of the stressor, whether physical, or psychological or both types of stress (Selye,
1974). Individual reactions to stress are not isolated events, but the outcome of previous
experiences. Holistically the dynamic interaction of coping responses, personality, and social
support all affect the stress response as student nurses are exposed to multiple challenging
experiences during their academic career (Jimenez, Navia-Osorio, & Diaz, 2009). Early research
categorized symptoms of stress into three types. Physical response symptoms were primary, with
increased heart rate, high blood pressure, headache, and ulcers as concerns (Selye, 1974).
Psychological symptoms of anxiety, low self-respect and anger were noted (Gibbons, Dempster,
&Moutray (2008, 2009a, & 2009b). Behavioral symptoms of smoking, drinking, weight changes
and drug abuse were demonstrated in students with decreased coping mechanisms. Gibbons et al.
(2008, 2009a & 2009b) defined nursing student stress predominately as psychological stress, as
in dealing with a dying patient and the grieving family. 3 Additional areas of conflict for nurses
noted by Por (2005) were dealing with role conflict, ambiguity and overload. Academically,
exams have been identified as the most common stressor. Additionally, the timing of exams was
a major concern, especially for the female students with children (Pryjmachuk& Richards, 2007).
Conflicts with physicians and inadequate emotional preparation for patients and families were
reported as sources of stress. Difficult peer interactions occur, as do problems with supervisors.
Interactions between multiple physicians and a student nurse is typical for each patient, often
leading to difficult communication and lack of cohesiveness for a plan of care. Studies of first
year student nurses have found high levels of stress occur often, and led to feelings of self-doubt,
lowered self-esteem, inadequacy, irritability and depression (Christensson, Vaez,
Dickman&Runeson, 2011; Gibbons et al.2008, 2009a, & 2009b). The high levels of stress had
depleted effective coping mechanisms. Coping behavior is the continuous effort required to
maintain a balanced state (Lazarus &Folkman, 1984), with stressors identified as positive,
negative, or benign. Effective coping strategies promote the return to a balanced state, or
eustress, therefore decreasing the negative effects of stress. Additionally, the effectiveness of
coping strategies depends upon the situation. A coping strategy may be very effective in one
situation, but totally ineffective in another situation. As students enter new learning situations,
and encounter multiple new stressors, their stress levels often increase. Lazarus and Folkman
(1984) reported an inverse relationship between stress and learning; learning potential declined
as stress increased. Gibbon et al. (2008) and Edwards, Burnard, Bennet, and Hebden (2010)
researched nursing students and suggested moderate amounts of stress or eustress, were
beneficial for a healthy state and positive learning environment. However, excessive stress or
distress created a negative impact on students’
NEED FOR THE STUDY:
According to National League for Nursing, 2012,annual Survey of Schools of Nursing, 29% of
students in 2009, 27% of students in 2010 and 24% of students in 2011 are enrolled in basic RN
programs .Lo (2002) investigated the perception and sources of stress, coping mechanisms, and
self-esteem among101 nursing students in Athens Medical School.
data were collected during class periods through questionnaires. The results of the study revealed
thetop stressor to be the nursing studies with 81(80.1%),financial problems 61 (60%), lack of
time for family/friends 49(48.51%) and health issues 37 (36.63%).
29
*Most students reported problem focused coping as their method of stress relief which included
recreation/sports, problem solving, and social support. 73(72.27%) had support from family and
friends while4 (3.96%) of the students had no support of any kind.
Nursing is a dignified line of work and the students are posted in clinical areas to render services,
it is essential to have healthy mind set to deal with sick patients. It was noticed that during theory
class most of the students showed disinterest and was proved by their academic results. Abhishek
Singh, et al. used a descriptive cross-sectional study to analyze the perceived stress among 282
North Indian undergraduate nursing students in Haryana. The perceived stress scale was used to
measure the stress level and was 28.67 (SD = 5.32), with a median of 26 (IQR = 22-34). The
level of stress was more among female students (31.33) compared to male students (26.01). The
second year students presented with greatest level of stress (29.66) while, third year students
showed least stress score (26.28). This indicated the need for stress relieving measures in the
nursing colleges [4]. Therefore, the researchers want to know the students perception of
academic stress and how they cope with it on daily basis, as they are struggling to reduce the
negative effects on their health, and their academic performance. In our opinion, it is very
important for nursing students to learn how to manage academic stress, if it cannot be eliminated.
FariasMota, conducted a transversal and quantitative study on stress among nursing students
with the aim of the study was to estimate the level of stress and symptomatology reported in
nursing students. Sample size involving 151 nursing students selected from a draw based on the
list of students enrolled. Result of the study was 49.7% of students showed symptoms of the
stress, and most students were attending the 8th and 9th periods. Psychological symptoms were
more present (50.7%). The conclusion of the study was the implementation of lightweight care
technology tools, at low cost and high resolutive power, such as providing information on stress,
prevention and control, relaxation sessions, integrated community therapy, spaces for physical
activity guided by trained professionals [5]. There is strong evidence of an inverse relationship
between stress and lack of professional knowledge among nursing students AkuZaheya et al.[6].
Based on the above findings related to level of academic stress in nursing students, the researcher
felt that academic stress in nursing students have a common problem everywhere and it is most
vital to guide them in proper way. The academic stress in nursing students may be due to many
factors. Nursing students experience multiple stressors as they are expected to apply theoretical
learning and develop critical thinking skills while in the professional environment. Perceived
overwhelming negative stressors can lead to absenteeism, job dissatisfaction and a high
employment turnover rate. At this point, it is essential to find the level of academic stress in
nursing students and rectify the problems. Hence the researchers are motivated to assess the level
of academic stress among nursing students. Research Methodology A non-experimental research
approach and descriptive design was used for the present study. The setting of the study was
nursing colleges in Mandi district, HP. Nursing Students who were studying in selected Nursing
colleges in different nursing courses like ANM, GNM, P.B.B.Sc Nursing and B.Sc. Nursing at
Mandi district were selected as sample and the total sample size of the study was 200 nursing
students. Convenience sampling technique was used to select the sample. Demographic profile
and Self – Structured Academic Stress Scale was developed after detailed literature search and
the scale was administered to participants after taking signature in the written consent form. The
approximate time taken for administering scale was around 25 minutes Need for the study.
The entire health care system is fighting for survival from the pandemic. Nurses front line
fighters in the healthcare system. Nursing students are the future nurses and they may be the
baton holders of healthcare in the near future. pandemic is affected the academics of nursing
students in a negative way. Online academics can be compensatory only to certain extent, where
practical training is least possible .Professional clinical exposure and training is unavoidable for
nursing profession. The current study is focused to find the academic stress level of nursing
students related to the impact of pandemic .This study information is important to deal the
changes in students, as the uncertainty remains as such to start the regular classes and to mold
them to face the unexpected modifications in the Results The data obtained.
Online learning is a virtual learning system which integrates internet connection with teaching
and learning process [10]. The interaction of teaching and learning activities can be carried out
from the distance with the help of internet and online media [11]. However, this method can be
difficult for those teachers who are specialized in conventional teaching and are uncomfortable
to use electronic gadgets. Also, students may not feel serious in online teaching as teachers have
little control in online teaching [12]. Online learning has become a solution for the continuity of
teaching and learning process in Nepal during Covid-19 pandemic. Although online learning
have various positive impacts, the shift to online education in nursing where student nurses
require practical knowledge creates new challenges for nurse educators [13,14].
Various studies have been conducted across different countries to determine medical student’s
perception on E-learning. A study was done in Pakistani medical and dental students in which
students did not prefer e-teaching over face-to-face teaching during the lock down situation. 77%
students had negative perceptions towards e-learning [15]. Further, a study done in Indonesia
among medical students found some supportive but also inhibitory factors to distance learning.
The most agreed supportive factor was location flexibility (87.9%) and the most common
inhibitory factor was signal dependent (80.2%) [16]. A study was conducted to assess the impact
of E-learning among nursing students and teachers of Kathmandu during COVID-19 [17].
The study of effectiveness of online classes has become essential component in the education
system in Nepal. Very little information exists about the experiences of students regarding online
classes in Nepal. Therefore, the researcher assessed the perception of nursing students’ towards
online learning implemented during Covid-19 pandemic in Nepal. This knowledge is necessary
to identify student’s requirement during online learning to make this learning system beneficial
for the students.
The spread of novel corona virus (COVID-19) disrupted all economic and social activities
around the world. Higher education has been one of the worst hit sectors. Being intensively
interactive in nature, this sector saw a comparatively early and complete shutdown across the
globe. In Oman, the government announced the closure of all educational institutions by mid of
March 2020. Responding to the pandemic and the subsequent advisories by regulating bodies to
suspend on-campus academic activities, higher education institutions (HEIs) switched to online
mode to deliver academic programs. Like elsewhere, most of the HEIs in Oman had no prior
experience of delivering programs completely online and therefore, applied varied approaches
depending on their size, governance models, and disciplinary differences [1]. Over more than a
year in pandemic now, HEIs in Oman are continuing their programs online. With many
improvements and innovations in online teaching and learning process over the past 1 year,
students have started adapting to this new normal.
However, weakness of online teaching infrastructure, inexperience of teachers regarding new

technologies, information gap, and complex home environment still exist . Students, through
online education are facing numerous challenges, such as instructional technological, and
technical ,4; social and family atmosphere home confinement ; emotional and psychological .
Furthermore, many students do not find a suitable space in their homes for effective learning and
do not have access to sufficient hardware or internet which constrains their home learning .
Though online education for HEIs is not anything new, as many HEIs have been offering full
courses and/or full programs online, yet students enrolled in full online instruction-based
programs, who were not familiar with such experiences faced a system shock .
All these challenges faced by the students in online education during have a strong ability to
induce mental health issues among the students. One commonly experienced mental health issue
by university students is the academic stress, which is mostly due to the students’ apprehension
of loss of grades and fear of failure . Fear of lower performance and delay in completion of
studies are also the reasons to induce stress among students during . Many studies conducted
during last 1 year focusing on university students’ mental health during , such as concluded that
had a negative impact on the mental health and wellbeing of the university students. Besides
earlier studies such as have also shown that uncertainties due to public health emergencies, such
as H1N1 influenza, Ebola, SARS, and MERS, caused negative psychological effects on
university and college students. Furthermore, the negative psychological impacts are aggravated
if the public emergencies accompany with home confinement which is what happened across the
globe, during.
In the context of Oman, there are very few studies conducted regarding the impact of on the
mental health of people and these are mostly related to the youth in general , general
population and health workers . Regarding the mental health of university students during in the
context of Oman, we did not find any study except for one by Alqassabi et al. published in
Arabic language. The available literature indicates that there is little being published on impact
of induced e-learning on the stress perceptions of university students in Oman. While there is
considerable literature on this subject available in the Western and Eastern contexts, these cannot
necessarily be generalize
cThe spread of novel coronavirus disrupted all economic and social activities around the world. Higher
education has been one of the worst hit sectors. Being intensively interactive in nature, this sector saw a
comparatively early and complete shutdown across the globe. In Oman, the government announced the
closure of all educational institutions by mid of March 2020. Responding to the pandemic and the
subsequent advisories by regulating bodies to suspend on-campus academic activities, higher education
institutions (HEIs) switched to online mode to deliver academic programs. Like elsewhere, most of the
HEIs in Oman had no prior experience of delivering programs completely online and therefore, applied
varied approaches depending on their size, governance models, and disciplinary differences . Over more
than a year in pandemic now, HEIs in Oman are continuing their programs online. With many
improvements and innovations in online teaching and learning process over the past 1 year, students have
started adapting to this new normal.
However, weakness of online teaching infrastructure, inexperience of teachers regarding new

technologies, information gap, and complex home environment still exist . Students, through
COVID-19-induced online education are facing numerous challenges, such
as instructional [3] technological, and technical ; social and family atmosphere [5]; home
confinement [6, 7]; emotional and psychological [3, 8]. Furthermore, many students do not find a
suitable space in their homes for effective learning and do not have access to sufficient hardware
or internet which constrains their home learning [9].
Though online education for HEIs is not anything new, as many HEIs have been offering full
courses and/or full programs online, yet students enrolled in full online instruction-based
programs, who were not familiar with such experiences faced a system shock [10].
All these challenges faced by the students in online education during have a strong ability to
induce mental health issues among the students. One commonly experienced mental health issue
by university students is the academic stress, which is mostly due to the students’ apprehension
of loss of grades and fear of failure [11]. Fear of lower performance and delay in completion of
studies are also the reasons to induce stress among students during . Many studies conducted
during last 1 year focusing on university students’ mental health during , such as
[12,13,14,15,16] concluded that had a negative impact on the mental health and wellbeing of the
university students. Besides earlier studies such as [17,18,19] have also shown that uncertainties
due to public health emergencies, such as H1N1 influenza, Ebola, SARS, and MERS, caused
negative psychological effects on university and college students. Furthermore, the negative
psychological impacts are aggravated if the public emergencies accompany with home
confinement [6, 7], which is what happened across the globe, during .
In the context of Oman, there are very few studies conducted regarding the impact of on the
mental health of people and these are mostly related to the youth in general [20], general
population [21], and health workers [21]. Regarding the mental health of university students
during COVID-19 in the context of Oman, we did not find any study except for one by Alqassabi
et al. [22], published in Arabic language. The available literature indicates that there is little
being published on impact of onlineclassinduced e-learning on the stress perceptions of
university students in Oman. While there is considerable literature on this subject available in the
Western and Eastern contexts, these cannot necessarily be generalized to Arab world considering
that its culture, social structure, and social norms vary greatly from the Western and Eastern
cultures.
Thus, the present study aimed at examining the impact of online class-induced e-learning on the
university students’ stress perceptions in Oman, thereby filling the gap in the literature that exists
in the Oman context on the topic under study. The results of this study provide insights to the
higher education educators, administrators, and policy makers to enhance e-learning
implementation in a way that ensures mental and psychological wellbeing of the s
Significance to Nursing Although student nurses experience many of the same stressors as other
general students face, they also have stressors unique to their situation. The stress nursing
students experience as clinical students extends into their professional lives. Research by Wu,
Fox, Stokes and Adam (2012) found episodes of significant stress in newly graduated nurses.
New nurses reported stress, especially when applying nursing skills appropriately during nursing
cares, during interactions with hospital staff, and when using unfamiliar hospital equipment.
Nurse educators are ideally placed to assist students with managing their stress. The American
Nurses Association (ANA) lists promotion of nurses’ health, wellness and safety as a priority, as
does the National Student Nurses Association (NSNA) (Trossman, 2013). Nursing students are
coping with many challenges as they balance school and family life, performance anxiety and the
fear of failure. Unfortunately, some nursing students utilize maladaptive coping methods to
manage their stressors. All nurses must build up their own resources so they can handle stress
and maintain psychological well-being. Typically, baccalaureate students with the ability to
manage their stress display greater self-confidence, increased motivation and improved academic
performance (Goff, 2011). However, there is minimal research in this area. Recent studies by
Gibbons et al (2008, 2009 a, 2009 b, and 2010) have demonstrated eustress or balance in
promoting effective learning in nursing students, and noted the coping mechanisms which
increase self-efficacy, control and support were most helpful. Stress may also enhance nursing
performance in a 5 different setting. Research by Rella, Winwood and Lushington (2008)
measured burnout and stress and found a significant portion of nursing students were
dangerously fatigued when they graduated, and then entered the work environment without any
time for recovery. Research of nursing student stress also showed memory, concentration and
problem solving ability were affected, with the potential to progress to decreased learning,
coping, academic performance and retention (Goff, 2011). Purpose of Study Past research has
indicated all college students are vulnerable and experience stress. I
STATEMENT OF PROBLEM
A descriptive study to assess the level of stress regarding previous online class among B.sc
(N) 3rd year students who were studying in CSI Jeyarajannapackiyam college of nursing at
Madurai .
OBJECTIVES
1. To assess the level of stress regarding previous online class among the 3rd year B .S c nursing
students.
2. To find out the association between the level of stress regarding previous online class and
demographic variables .\
OPERATIONAL DEFINITIONS:
1) Assess – to judge or from an opinion about something.
2) Level of stress – stress is the feeling being ovewhelmed or unable to cope with mental or
emotional pressure.
3) Previous online class experience – online classes fit my lifestyle, because I am not a
traditional student. It given a choice .i would take all of my classes through the internet.
Online classes have saved money and time. Also ,online classes allow to work, to e a full
time student.
Assumptions:
3rd year B.sc Nursing students may have the stress.
PROJECTED OUTCOME:
The findings of the study will help to:
1. To know about the level of stress regarding the previous online class among the 3rd year
nursing students.
CHAPTER-2
REVIEW OF LITERATURE
The Review of literature entails the systematic identification, reflection critical analysis and
reporting of existing information in relation to the problem .The purpose of review of literature is
to obtain comprehensive knowledge and in –depth information about effectiveness of resilience
on previous online class stress among BSC nursing 3rt year students
SECTION A; OVERVIEW OF ONLINE CLASS;
Manikanda Kand Nirmala.(2000) study et. Al . the study Stress can be overwhelming and
can lead to a state of sadness in many teens. An NYU study claims that much of high school
students stress emerge during the school years and the baggage of stress is carried to college
years which leads to academic disentanglement and can result to mental health problems. Once
the student finally lands in the college, they have to deal with the stress of new and enhanced
workload, pressure of making friends and being in the socially acceptable circle, handling a
network which is much more challenging, all this without the support of the parents on many
occasions. Hence it is of utmost importance to learn to deal with stress, so that the students can
learn to navigate in the waters and are able to sail through.
There are various ways and means that the students can adopt to relieve stress, like imbibing any
one form of exercise to be done on daily basis, this small change will go a long way and
guarantees an environment of sustainable happiness. Meditation and breathing exercises can also
be incorporated to relieve stress during exams and students avoid panicking. It is also important
to ensure that students receive enough sleep, it would help the students to be more patient and
have better learning graph. Music is therapeutic whether played in stress or otherwise. Listening
to music can reap many benefits and can subside stress certainly. The way one talks with oneself
really makes big difference in the attitude, hence positive self talk is important which will further
lead to harmonious surroundings.
There are various ways and means that the students can adopt to relieve stress, like imbibing any
one form of exercise to be done on daily basis, this small change will go a long way and
guarantees an environment of sustainable happiness. Meditation and breathing exercises can also
be incorporated to relieve stress during exams and students avoid panicking. It is also important
to ensure that students receive enough sleep, it would help the students to be more patient and
have better learning graph. Music is therapeutic whether played in stress or otherwise. Listening
to music can reap many benefits and can subside stress certainly. The way one talks with oneself
really makes big difference in the attitude, hence positive self talk is important which will further
lead to harmonious surroundings.
the study concludes that stream wise difference in stress does exist in students. It is important to
deal with stress at personal, social and institutional level. Remedies such as feedback, yoga, life
skills training, mindfulness, meditation and psychotherapy have been found useful to deal with
stress. To identify the main reason of stress is the key to deal with it. Professionals can develop
tailor made strategies to deal with stress. The integrated well being of the students is important
not only for the individual but for the institute as well. Some study claimed that stress can be
addressed by ensuring that the students give utmost importance to their welfare. Food, exercise,
work, recreation are some of the areas to focus on. He also concluded that the education system
is more to do with the academic qualifications and does not contribute enough to the holistic
development of students.
Students are usually conditioned in a way that makes them fearful to take up upcoming
challenges as the focus is only the academics and not the development of a go getter mentally.
There are not many choices for the medium of education. English being the only option available
can pose as a hindrance for the students from rural background. There are not many courses
available that are employment centric. Fresh graduates need more communication skills
development for better placements.
Subramani and Kadhiravan (2002)a study et al .the study conducted. He endorsed that
academic stress and mental health are correlated and that students are cramped with the academic
structure. Parents and schools pressurize the students way too much for the higher grades that
disheartens the students, further to add on there is not enough support from the parents and
school in terms of guidance. The students are mentally healthy when they perform constructively
in the academic forums. They also propounded that students from private schools are more
pressurized as compared to students from government schools due to the excess of homework
and other academic related assignments. Significant difference in mental health of students from
private and government schools was found. He asserted that students from private schools have a
different nurturing and vast exposure as compared to government school students who belong to
poor socio economic background and lack of exposure. This is one of the reasons for the
escalation of stress.
Sharma et al. (2007) a study et al .the study conducted The study stated the use of various
methods to curb stress. Doing one physical exercise on daily basis can address the concern of
stress. One can also adopt to various time management tools and get involved with leisure
activities which can benefit students. Also, it was suggested that colleges should have a
conducive ambience to curtail the stress. Change in the style of delivery from teachers end and
providing mentors can bring fresh air to the teaching style.
Sharma et al. (2010) a study et al. .the study conducted The study stated the use of various
methods to curb stress. Doing one physical exercise on daily basis can address the concern of
stress. One can also adopt to various time management tools and get involved with leisure
activities which can benefit students. Also, it was suggested that colleges should have a
conducive ambience to curtail the stress. Change in the style of delivery from teachers end and
providing mentors can bring fresh air to the teaching style.
Agolla (2015) study et al the study The stress among students of professional studies and
claimed that curriculum and instructions parameters were most responsible for stress with 86
percent, followed by 63 percent for placement related issues, assessment and team work issues
accounted for 41 percent and 24 percent respectively. The study further identified various micro
issues responsible for stress, and listed twelve sub issues related to curriculum and instruction.
Once the sub issues of each parameter are identified, it provided improved vision to the academic
administrators for initiating efforts to reduce the gravity of academic stress.
SECTION B; STUDIES RELATED TO STRESS;
Academic stress
(Mallinckrodt &Leong ,et al 2017) conducted study on Academic stress is commonly felt by
students all over the world, whether they are studying in their home country or overseas.
However, it seems that international students face more academic challenges than their domestic
student peers due to the differences between the learning styles or teaching methodologies in
their home country and the host country (Chavajay&Skowronek, 2008; Irizarry, & Marlowe,
2010; Sanders &Lushington, 1999). For example, Asian students report a problem in applying
their critical skills and the way they deal with staff or faculty.
International students also experience greater academic stress from frustration due to delays, lack
of resources, failure to achieve goals and feeling like social outcasts, or from the pressure due to
competition, deadlines, work, responsibilities and overload. Stress also occurs when too many
changes, including rapid changes, disrupt a student’s life and goals (Misra, Crist, &Burant,
2003).However, Khawaja and Dempsey (2008) and Rice, Suh, Yang, Choe, and Davis (2016)
found no significant differences in perceived academic stress between international students and
domestic students in the US and Australia. Interestingly, Misra and Castillo (1995) found that US
students reported a higher level of academic stress than international students. They found that
this type of stress is more often self-imposed among US students compared to Asian
international students. However, the international students may have answered questions in a
socially desirable manner to avoid the stigma associated with admitting personal inadequacies.
Six studies focused on international students in one subject area, and most of them considered
professional sciences, such as law, which is culture-based and requires an understanding of a
specific culture in order to understand the legal system. This makes it difficult for international
students that come from countries with a different culture and different values (Svarney, 1989).
Other studies examined subject areas in which international students had to deal with patients or
clients, such as nursing (Arty, Dns, &Rady, 2002), clinical and counseling psychology (Nilsson,
2007), social work (Irizarry et al., 2010), dentistry (Sanders &Lushington, 1999) and music
therapy (Kim, 2011). International students may experience social anxiety, and sometimes
clinical work is described as a stressful activity due to language difficulties and
misunderstandings as well as the lack of familiarity with the culture, values and beliefs of the
host country’s health care system. A systemic review of international health care students found
that a lack of cultural awareness had negative consequences on their performance ies.ccsenet.org
International Education Studies Vol. 11, No. 6; 2018 26 (Mikkonen, Elo, Tuomikoski,
&Kääriäinen, 2016). International students who study abroad usually have a high GPA in their
home country. Consequently, they might believe that they can achieve the same level of
academic excellence in the host country; these mismatched expectations can lead to stress and
depression (Rosenthal, Russell, & Thomson, 2008). Nevertheless, international students who
report high academic competency and self-efficacy tend to experience less academic stress.
clients, such as nursing (Arty, Dns, &Rady, 2002), clinical and counselling psychology (Nilsson,
report high academic competency and self-efficacy tend to experience less academic stress
clients, such as nursing (Arty, Dns, &Rady, 2002), clinical and counselling psychology (Nilsson,
report high academic competency and self-efficacy tend to experience less academic stress
used coping were more likely to be motivated and perform better than students who engaged in
emotion-focused coping. Tung and Chahal (2005) examined the relationship between stress
aReviews of Studies conducted at International level While studying the academic stress and
health changes in female college students, Lesko and Summerfield (1989) found a significant
positive correlation between the incidence of illness and number of exams and assignments,
while Felsten and Wilcox (1992); Struthers et al. (2000) as well as Akgun and Ciarrochi (2003)
found a significant negative correlation between the stress levels of college students and their
academic performance. Lin and Chen (1995) also noted negative impact of academic pressure on
students’ intellectual, psychological, and physical growth. While Schafer (1996) observed that
the most irritating daily hassles were usually school-related stressors such as constant pressure of
studying, too little time, writing term papers, taking tests, plans, and boring instructors. Cheng
(1999) noted that stress from high expectations of teachers, parents, and self is usually an agony
for students studying in schools. Peach (1991) observed that academic class work, relationship
with the opposite sex, concern about grades, feelings about personal appearance, pressures to
succeed and achieve, test-taking, feelings about self-worth and personal respect, peer acceptance,
relationship with friends, and problems at school were major stressors. Sarmany (1994) observed
the higher level of stress in girls than boys and significant negative correlation between GPA and
actual duration of sleep was observed. conducted extensive review of literature study on stress
management in adolescents and tried to present the causes and symptoms of stress as well as
coping mechanism for stress. Huli (2014) noted that disturbed family dynamics, peer pressure,
inability to cope with studies, drug abuse, lack of competence are major reasons for stress during
adolescence. While exploring the academic stress and its management/ coping mechanism,
Mishra and Michelle (2000) found that time management behaviors had a greater buffering
effect on academic stress than leisure satisfaction activities and significant gender differences
existed among all the measures. Females had more effective time management behaviors than
males, but also experienced higher academic stress and anxiety. Males benefited more than
females from leisure activities. Struthers et al. (2000) noted that students who engaged in
problem-focnd adjustment and found no significant causal relationship between stress and the
adjustment. Study results by Mathew and Jayan (2006) revealed that both the boys and girls
experienced same kind of academic stress but there was no significant difference between them
and similar types of copying mechanism was used to deal with academic stress. Leung et al.,
(2010) indicated that academic stress was a risk factor that heightened student anxiety levels and
that parental emotional support was a protective factor that contributed to better mental health
among children. However, paternal informational support delivered to children during times of
high academic stress appeared to heighten student anxiety levels. Busari (2011, 2014) indicated
that stress inoculation technique is an effective method of fostering adjustment to academic
stress. Previous year Mr .MANIKANDAN.K and MrsNIRMALA.S(2015)Conduced a study to
find out the level of stress among Previous online class .learners in various colleges at
Madurai ,Tamilnadu.This study intends to assess the stress in the following four dimensions of
PHYSICAL STRESS,EMOTIONAL STRESS,SOCIAL STRESS and ACADEMIC STRESS.
JAYANTHI.P THIRUNAVUKARASU.M and RAJAMANICKAM RAJKUMAR
(2014)Conduced a cross sectional study at various collegesof nursing Madurai ,TAMILNADU
to examine the relationship between previous online class stress among nursing 1st year students.
BHUTNATH MAHATO SUNIL JANGIR(2012)conduced study on previous online stress

among bsc nursing 1st year students .In that they explained that previous online stress issues is
commonly in bsc nursing students.A study on previous online class stress among regular
residential adolescent students age19-21years.
SECTION C; STUDIES RELATED TO PREVIES ONLINE CLASS STRESS;
COPING STRATEGIES
Tsenc and Newton et al (2020)) Coping strategies are the ways in which people react to
stressful situations. Lazarus (1993) defined coping as the “ongoing cognitive and behavioural
efforts to manage specific external and/or internal demands that are appraised as taxing or
exceeding the resources of the person” (p. 237). There are many different types of coping
strategies, and their effectiveness depends on the type
of stressors and individual encounters. The literature on international students discussed some of
these different stressors and the role and the effectiveness of different strategies. For example,
Tsenc and Newton (2001) interviewed African and Asian international students and reported that
they used eight strategies to attain wellbeing and adjust to their new environment: knowing and
understanding self and others, building friendships with peers and relationships with advisors,
expanding individual worldview, asking for help when needed, English proficiency and letting
problems go. Moreover, Szabo (2015) studied how international students cope with uprooting
stress and found that primary coping predicted more symptoms of anxiety while secondary
coping reduced the number of symptoms experienced over time and buffered the negative impact
of stress. In reaction to academic stress, Misra and Castillo (1995) found international students
reported greater cognitive reactions (e.g. the use of some effective strategies to reduce stress),
whereas US students reported behavioural ies.ccsenet.org International Education Studies Vol.
11, No. 6; 2018 27 reactions (e.g. smoking). Moreover, Misra et al. (2003) found female
international students had more emotional reactions (i.e. fear and physiological symptoms, such
as sweating, trembling, stuttering, body or headaches and weight loss or gain) and behavioural
reactions (crying, self-abuse) to stressors than their male counterparts. The most frequent
reactions to stressors among male students were cognitive; thus, their appraisal of stress was
intellectual instead of emotional (Misra et al., 2003). Khawaja and Dempsey (2008) also
examined how international students and Australian students cope with the challenges of
university life, including academic stress. The findings indicated that international students used
avoidance, repression and other passive coping strategies; however, this might be because the
sample reported a high level of mismatched expectations. Two studies examined religion as a
coping strategy for stressful events. Specifically, Gardner, Krägeloh, and Henning (2014) and
Hsu et al. (2009) found that religion/spirituality might function as a coping mechanism for
international students in response to acculturation stress and perceived stress in general.
However, the use of religious coping strategies among international Muslim students may
decrease over time due to adapting to their new environment. ]’
Well-Being.(2021)
The focus in the research has generally been on stressors and psychological problems faced by
international students, however, this research often neglects uncovering the more positive factors
that facilitate health and well-being within the International students’ experience (Outhred&
Chester, 2013). In the literature pertaining to students in higher education in general and
international students specifically, little is known about wellbeing. Additionally, it i it i positive
effects and negative effects, which are related to emotions and mood. By contrast, psychological
wellbeing (PWB), as Ryff and Singer (2008) defined it, constitutes six aspects: self-acceptance,
purpose in life, environmental mastery, positive relationships, personal growth and autonomy
(Dodge, Daly, Huyton, & Sanders, 2012). Moreover, the model of cross-cultural adjustment by
Ward and Searle (1991) includes psychological and sociocultural dimensions, wherein
psychological adjustment is defined as psychological wellbeing or satisfaction in a new cultural
environment, and sociocultural adjustment refers to an individual’s ability to ‘fit in’ or interact
with members of the host culture. Findings from a longitudinal study on adjustment of
international students by Cemalcilar and Falbo (2008) showed that a positive acculturation was
associated with sociocultural adaptation rather than psychological well-being or academic
adaptation. Furthermore, a comparison between Asian American and Asian international students
revealed that ethnic identity, rather than acculturation, predicted Asian American students’
emotional well-being, and neither ethnic identity nor acculturation predicted Asian international
students’ emotional wellbeing (Yasuda &Duan, 2002). Research has also shown that
participating in a club inside or outside of a university, or building friendships with people on or
off campus, could improve the average student’s level of general wellbeing (Neri& Ville, 2008),
whereas identity loss could decrease wellbeing (Praharso et al., 2017). All the studies that
discussed wellbeing among international students considered that feeling happy or establishing
and maintaining good social networks were just part of a student’s sense of wellbeing; they
emphasised that wellbeing is multi-dimensional. Moreover, studies often used a five-point Likert
scale to rate the level of wellbeing, such as the level of depression or the level of happiness.
However, the studies in this review neglected important aspects of students’ wellbeing,
particularly in terms of a university’s courses and environment and how these aspects affect their
feelings, either positively or negatively. In a further study (Cho & Yu, 2015) investigated the role
the University organisational support systems may play in the well-being of international
students. It was assumed that international students are heavily dependent on the host university
in various ways making the host university the most important source of support. The model put
forward included four dimensions including university identification, university support, school-
life satisfaction, and psychological stress. The findings demonstrated the positive effects of
university support on two dimensions of international students’ psychological well-being:
increased international students’ school-life satisfaction and a reduction in their psychological
stress. It was also found that university identification positively affected international students’
perception of university support and ultimately their school-life satisfaction. In contrast, there
was no significant effect of university identification on psychological stress. Although this study
focused on school life satisfaction it did not provide information on the effect of university
support on well-being. Finally, the Sodexo Quality of Life Services (2014) proposed a model of
wellbeing called wellbeing away. It was originally designed for people working away from their
home and contains five phases. Each phase or stage includes factors that influence the level of an
individual’s wellbeing, either negatively or positively. The model proposes five phases of
transition commencing with Pre-departure planning, which includes developing expectations
about being away, acknowledging that the coming separation is real, setting up a support
network and, more importantly, planning for contacting and communicating with family at
home. The researcher raises the idea that with current technology people tend to think that
technology will mitigate the separation. However, that is not the case when the person is away
and working long hours with little free time. The second phase is called Being away and includes
two main factors: the first includes using technology without over-reliance on it. The second
involves developing the ability to unwind from work or study, as it is known that dwelling on
work- or study-related issues lead to negative effects and other health-related problems. The
model also emphasises changing activities and doing something different from studying. For
example, it is better for a student to exercise in their free time rather than doing something
similar to what they usually do such as surfing the internet.
Literature Review A literature search was performed using key terms of stress, college student
stress, Millennials, mature college student stress, student nurse education, student nurse clinical
education, nurse stress, nursing student anxiety, graduate nurse retention and burnout; with a
focus on research in nursing student stress since 2009. Only articles in English were selected.
Databases searched included CINAHL, Proquest, PubMed, and PsycInfo. Reference lists in all
retrieved journal articles were reviewed. An additional list of search terms included middle range
theory and transition theory. Review of middle range theories indicated Afaf Ibrahim Meleis and
Eun-OkIm were highly regarded worldwide in their research and publications, with other nursing
researchers also using Meleis’ Transition Theory in broad areas of practice. The literature review
demonstrated changes over time in the areas of nursing student stress evaluated by researchers.
Past researchers evaluated student nurses in regard to stress in the clinical setting and the
developmental phase of the students (Beck &Srivastava, 1991). Stress in both novice and
experienced nursing students was explored by Jimenez et al. (2009), revealing stress at similar
levels from three grade levels. Beck and Srivastava (1991) noted lower stress scores in
baccalaureate registered nurses, compared to pre-licensure students and attributed the lower
perceived stress scores to maturity, previous experience, and better problem-solving and time
management skills. Research studies with part-time nursing students noted students must be
educated on the demands of the nursing program they are entering, particularly the workload.
Kenny, Kidd, Nankervis and Connell (2011) conducted a research study on mature age students.
The study focused on steps educators could take to strengthen educational access for 8 mature
students. The study included flexibility of class scheduling, clinical placement during school
hours or on weekends, and financial support as stress reducing strategies. Older students entering
the nursing profession often already have degrees in other fields, such as in psychology or
biology. These students were academically successful and highly competitive. Research by
Montgomery, Tansey and Roe (2009) found mature students entering the nursing field were
highly desirable, especially as many of the students had previous experience working in the
healthcare field. The mature students presented their own set of stressors. The most significant
concern these students identified was financial stress, followed by the financial burden of
childcare, from a financial perspective and time management. Weitzel and McCahon (2008)
researched accelerated baccalaureate nursing students’ stresses and supports, and reported
nursing faculty have the ability to decrease potential stress. As expected, mature students
reported the work load stressful, in addition to family responsibilities. Faculty can contribute to
lower stress levels by decreasing time spent in classroom work groups. Often, mature students do
not care for group class work, especially if they feel a classmate is not doing their share of the
work, providing the potential of bringing down their grade (Weitzel and McCahon, 2008).
Educators were encouraged to evaluate students’ reading and written assignments following core
curriculum learning objectives (Weitzel&McCahon, 2008). Family support, peer and faculty
support, especially from nursing advisors, were reported as valuable by the students. Clinical
experience remains an integral component of nursing education. It provid
Clinical experience remains an integral component of nursing education. It provides nursing

students with the opportunity to demonstrate physical competency, utilize critical thinking skills
and incorporate didactic nursing theory under supervision of a clinical nursing instructor.
Nursing students’ initial clinical experiences may have significant effects on their basic nursing
education and future studies. 9 Multiple researchers have concluded nursing students have
increased stress or anxiety when they begin clinical work. Melincavage’s (2011) research agreed
with Smedley and Morey (2010) that a positive clinical atmosphere, provided by both staff and
faculty, decreased student anxiety and increased self-esteem. Three main themes emerged from
Nelwati and Plummer’s research (2013) on nursing students’ perceptions of stress in the clinical
setting. Feelings of pressure were described as most stressful, and included preparing for clinical
patients, lack of sleep, overlapping assignments, and timely submission of assignments to
instructors. Challenging relationships was the second theme noted, and included interactions
with patients and families, communication with clinical staff, co-operative peer work, and social
relationships with families and the community. The use of coping strategies was the third theme
of the study. Students described their response to a stressful situation, and what coping strategies
they utilized to relieve the stress. Responses were both physiological and psychological. Sleep
Sleep deprivation, altered appetite, and headaches were reported. Physiological responses to
stress were noted as being upset, panic, anxiety, sadness, withdrawal, sensitivity, and mood
changes. Students may be unaware of their perception to stressors, and may need assistance with
coping strategies (Lazarus and Folkman, 1984). Additional stress may come from a continually
changing clinical environment. Students need some time to develop a working relationship with
a new clinical advisor, settle into a new environment, become familiar with the routines and
norms on the new clinical area, and become acquainted with friendly supportive floor staff to
develop a sense of belonging (Levett-Jones, Lathlean, Higgins, & McMillan, 2007, 2009; Levitt-
Jones &Lathlean, 2007, 2009). Unfortunately, hospital staff nurses are often part of nursing
students’ stress. Researchers (Hichberger, 2009; Thomas & Burk, 2009) found evidence of
horizontal violence or hostility 10 from experienced nurses towards student nurses. Descriptive
terms used by the students included words like sarcastic, patronizing, degrading, overbearing,
and condescending. Hinch berger’s (2009) research demonstrated violence was observed by
student nurses. All of the student nurses who responded to the survey had either personally
experienced violence or observed it. One-half of the violence was directed toward the students
by staff, and verbal abuse was predominant (69%) followed by bullying (21%). Hathorn,
Machtmes and Tillman’s (2009) research agreed with previous studies, and added that poor
treatment received by nursing students reduced the quality of care given to the patient. The word
“anxiety” has also been substituted for “stress” by some researchers. Although of small sample
size, research by Melincavage (2011) reported nursing students’ self-reported anxiety increased
significantly, especially when performing skills in the clinical area, along with a fear of being
demeaned, exposed or abandoned. Students also sensed a competition among their clinical peers
for the instructor’s positive support. The study reported students experienced anxiety due to
inexperienced faculty and staff, and noted demeaning remarks from both inexperienced floor
staff and clinical instructors (Melincavage, 2011). Faculty recognized the need for consistent
support for students, especially in the clinical setting. Collaborative mentoring of medical
students was recognized and encouraged by medical educators (Pololi, Knight, Dennis, &
Frankel, 2002; Mayer, Files, Ko, & Blair, 2005). Li, Wang, Lin, & Lee (2010) and Frankel
(2009) studied the effect of peer mentoring in an effort to help decrease stress and increase
personal self-confidence in future students. Even with the small sample size of the Li et al.
(2010) study, mentees expressed an increased sense of security when working with a peer
mentor. Reeve, Shumaker, Yearwood, Crowell, & Riley (2012) focused their work on
determination of adaptive coping mechanisms student nurses developed in stressful 11 situations.
Positive, or adaptive coping mechanisms identified by students included a period of reflection,
engagement in a physical activity, and the decision to persist and carry on with the program.
Positive emotional focused coping and a social support system were described by students.
Maladaptive coping included ignoring the stress, crying, irritability, isolation, and depression.
Familiar coping strategies were utilized by students as they became new graduate nurses. In the
past the transition time from nursing student to graduate registered nurse was approximately six
months. Due to National Council Licensure Examination-Registered Nurse (NCLEX-RN)
testing, the transition time now between nursing student and graduate nurse is very rapid, often a
matter of days, decreasing the length of time for new nurses to become accustomed to their
profession. Research showed between 18% and 50% of new nurses are leaving their positions in
their first year of nursing practice. Stress and job dissatisfaction lead the list of reasons for their
departure (Brewer, Kovner, Greene, &Tukov-Shuser, 2012; Kowalski & Cross, 2010). As nurse
educators we need to develop an awareness of possible student nurse stress and facilitate
students’ ability to cope effectively with new and challenging stressors. It may be beneficial to
prepare students before a very stressful time in the nursing program. Research by Jimenez et al.
(2009) reported on specific stressors, previously identified by former students and faculty.
Students perceived the stress of the clinical setting more significant than academic stress.
Although students from the three grades in the research reported similar levels of “moderate”
stress, second year students reported the most somatic and psychic anxiety, while experienced
students perceived more academic stress compared to first year clinical students.
Recommendations from the study include support and guidance from clinical instructors, faculty
meetings with students to discuss stressful times in the program, and possible coping
interventions for the students (Jimenez et al. 2009). Research by Cap and Williams (2011)
regarding holistic stress management for nursing students resulted in a holistic stress
management class. College faculty developed the class for students, to help them find lifelong
sustainable stress management techniques. The students were taught how to identify stressors in
their lives, and the effect of the stressors upon both personal and academic life. Effective stress
management skills and a health promotion project were part of the class (Capp & Williams,
2012). Another source of stress for many students is the financial burden of obtaining an
education (Stone &Feeg, 2013). National Student Nurses Association data (2012) revealed
approximately 28% of all nursing students had no financial debt, while over 50% of nursing
students had between $5,000 and $60,000 debt upon graduation. The students financed their
education with financial aid loans, personal savings, parental support, scholarships and working
while in school. Full or part-time employment was undertaken by 47% of the students, adding
the stress of time management to their busy lives. Unfortunately many new graduate nurses have
already felt the stressors of the job market. Healthcare economic policy has created changes in
the need for registered nurses. In 2012, conflicting reports from NSNA and the American
Association of Colleges of Nursing (AACN) resulted in a secondary analysis of the data already
collected. American Association of Colleges of Nursing (2012) reported nursing deans provided
optimistic numbers for new hires, 88% for new bachelor degreed nurses, and 92% for master’s
prepared nurses, with regional variations. Four months post-graduation, the secondary analysis of
NSNA members, also done in 2012, 13 revealed a significantly different view. The analysis
revealed over one-third of the members had not found a nursing position, with up to 45% of the
graduates in the West, and 40% in the Northeast still unemployed (Mancino, 2013). Research by
Benson (2012) showed the increased number of newly educated nurses, along with the slowing
demand for new nurses had changed the nursing shortage. New nurses may also need a realistic
view for gaining employment, as many of the open positions are in long-term care facilities and
ambulatory care. Family financial demands often result in experienced registered nurses
retaining their positions longer than expected, therefore affecting new job openings (Benson,
2012). Hospitals and clinics have been adjusting to the economy as they utilize lower paid
medical assistants and decrease registered nursing hours. New graduates may find it difficult to
obtain employment in the area of their choice, resulting in job dissatisfaction and attrition.
Nursing educators are encouraged to assist students with recognizing their own needs for growth
in coping strategies and stress management, as inability to deal with the stress of the changing
healthcare industry may well cause their departure from the nursing field. A nurse who has
maintained a successful balance of life’s stressors as a nursing student has already started the
practice of self-awareness and self-care, thus decreasing the risk of burnout or other stress-
related symptoms (Clark &Pelicci, 2011). The nursing profession is seeing increasing numbers
of motivated nurses who are interested in increasing their knowledge, at a significant price to
themselves. The price is stress, with nurses struggling to create a balanced state between work,
study and home. National changes in healthcare, combined with the aging population in the
United States should push both medical care facilities and educational institutions to support and
retain healthy nurses. Clarification and identification of sources of 14 stress for student nurses
during stressful transitions will result in personal benefits as well as organizational retention of
registered nurses. Organizational retention of experienced registered nurses will positively
impact patient care. The study of stress in nursing students continues to play an important role in
nursing education. The purpose of this research study is an evaluation of three grades of nursing
students and to consider the implications for nursing education and practice.
Perez,w..espinoza,R..RAMOS.K.CORONADO..HM..CORTES..R(2009)CONDUCED A
DESCRIPTIVE STUDY ON PREVIOUS ONLINE STRESS AMONG BSC NURSING 1 ST
YEAR AT various colleges.
MAGEN MHAKA-MUTEPFA MED ELIAS MPOFU ROBERT CUMMING

MED(2006)conduced a study which sound to explore the impact of protective
factors ,health ,and well being ..
CONCEPTUAL FRAMEWORK
Based on The Neuman systems model is a nursing theory based on the
individual's relationship to stress, the reaction to it, and reconstitution factors
that are dynamic in nature. The theory was developed by Betty Neuman, a community
health nurse, professor and counselor.
A conceptual or a model is made up of concepts ,which are the mental images of the
phenomenon. The section deals with the conceptual framework adopted for this study .A
CONCEPTUAL FRAMEWORK OR MODEL provides the investigator the guidelines to
proceed to attain the objectives of the study based on a theory .conceptual framework serves
three important functions in a study.
 It clarifies the concepts on which the study is built.

 It identifies and states the assumptionshypothesis of the study
 It specifies the relationship among the concepts.
The conceptual framework of the present study was developed by the investigator based on
Ludwig von bertanlanffys general system theory of learning 1968.
The general systems theory was initially introduced in 1930 by von bertanlanffy .A system is a
set of interrelated parts that come together to form a whole .Each part isnecessary or integral
component required to make a complete meaningful as a whole. These parts are
1INPUT
2THROUGHOUT
3OUTPUT
4FEEDBACK
1 )INPUT
The first component of a system is input in which information energy or matter enters
a system .for a system to work well ,input should contribute in achieving the purposes of the
system.
In this study ,input refers to the selected demographic variables of previous online class
stress such as age, religion, hobbies, type of sociability ,order of birth, medium of study, level
of dependence ,previous experience of stay in hostel.
2)THROUGHPUT
Throughput is the second component in which it allows the input to be changed so that it
is useful to the system.
In this study , throughput refers to the intervention ,namely ..

CONCEPTUAL FRAMEWORK
Based on BETTY NEUMANS stress model theory(1999).
NURSING DIAGNOSIS NURSING GOALS NURSING OUTCOME

↡⩥⩥⩥⩥⩥⩥➽➽ ➽ ➽
NURSING
DIAGNOSIS
➤ ➤➤ ➤ CENTRAL CARE
STRESSORS NORMAL LINE OF DEFENSE LINES OF RESISTENCE
☮ PHYSIOLOGICAL
│ ☮ PHYSIOLOGICAL
☮ PHYSIOLOGICAL
☮ PSYCHOLOGICAL
☮ PSYCHOLOGICAL │ ☮ PSYCHOLOGICAL
ACADEMIC ☮ SOCIOLOGICAL
☮ SOCIOLOGICAL ☮ SOCIOLOGICAL
PERSONAL
│ ☮ DEVELOPMENTAL
☮ DEVELOPMENTAL ☮ DEVELOPMENTAL
SOCIAL
│ ☮ SPIRITUAL VARIABLES ☮ SPIRITUAVARIABLES
☮ SPIRITUAL
VARIABLES
FIEXIBLE LINE OF NURSING GOALS

DEFENSE PREVENTION
⇐ ⇒
NURSING
INTERVENTION
❥PHYSIOLOGICAL OUTCOME
❥PRIMARY
❥PSYCHOLOGICAL
❥SECONTARY
❥SOCIOLOGICAL
❥DEVELOPMENTAL ❥TERTIARY
❥ SPIRITUAL
CHAPTER-3
METHODOLOGY
Research Design:
Descriptive research design.
Setting of the study:
The study was conducted in CSI JACON , Madurai.
Population:
The population for this study was B.Sc Nursing students.
Target population:
3rdyear B .Sc nursing students.
Accessible population:
3rdyear B.Sc nursing students at CSI JACON
Sample:
Students who are studying 3rd year B. ScNursing in CSI JACON and those who meet the
inclusion criteria are the sample for this study.
.
Sample Technique:
The sampling technique adaptedfor this study was simple random sampling
Sample size
Sample size for this study was 30Students of 3rd year B .Sc Nursing.
DESCRIPTION OF TOOL:
Investigator developed tool with the help of extensive review from various text book, journals
and websites, the tool was developed to assess the level of stress. Tool consists of two parts.
Part-I:
It includes demographic variable such as age, level of dependence ,family income and type of
sociability
Part-II:
Consists of modified student stress scale, it consists 5 items which covers the areas ofpersonal,
social, academic, factors .Minimum score is 0, maximum score is 4.
Inclusion Criteria:
 All B .Sc Nursing students can participate in the survey
Exclusion Criteria:
 Age should be 19-21 years
Method of data collection:
Consent from the participants were obtained and the purpose of the study was explained to them
through survey questionnaire.
The self administered questionnaire consisted of socio demographic data, Perceived Stress Scale
and Brief Coping Strategies Scale.
Participants who were unwilling to complete the questionnaire due to personal reasons were free
to withdraw from the study .
Confidentiality of the collected data was maintained and used only for the research purpose .
ETHICAL CONSIDERATION:
Permission was obtained from the principal of the college of nursing informed consent was
obtained from the study participants.
SUMMARY:
The chapter deal with research Approach, design, setting, sample, and sampling techniques, data
collection and techniques, reliability of tool pilot study and procedure for data collection and
plan for data analysis.
SCHEMATIC REPRESENTATION OF RESEARCH DESIGN
Nursing studentResearch report
ä
Toassess the stress level regarding previous online class
experience among b.sc ((NURSING ) III year
ä
Research approach: Qualitative
approach
Research design: Descriptive design
ä
Study setting:The study was conducted in CSI JACON , Madurai.
ä
Target population:3rdyear B .Sc nursing students.
ä
ä
Sample size : For this study was 30 Students of 3rd year B .Sc Nursing.
ä
Data analysis
Description and inferential
ä
Finding and conclusion
ä
Research report
CHAPTER-4
DATA ANALYSIS AND INTERPRETATION
The analysis of data collected from a sample of 30 students CSI Jeyaraj

Annapakiyam College of Nursing Pasumalai ,Madurai .The findings of the study
are presented in the chapter under the following section.
The data collected were analyzed and presented under the following headings
1. To assess the level of stress regarding previous online class among the 3rd year
B.S c nursing students.
2. To find out the association between the level of stress regarding previous online
class and demographic variables .
S.NO DEMOGRAPHIC VARIABLES FREQUENCY PERCENTAGE
AGE
1 A)13-16years 0 0%
0 0%
B)17-18yers
c)19-20yers 30 100%
2 ORTER OF BIRTH
16 53%
A) First
12 40%
B) Second
2 66%
C) More than second
3 FAMILY INCOME
A) up to Rs 2000-5000 4 13%
B) up to RS 5000 -7500 4 13%
C)up to RS 7500-10000 6 20%
D)more than RS 10000 16 53%
4 LEVEL OF DEPENDENCE
21 70.0%
A)Father
9 30.0%
B)Mother
C)Relative 0 0%
5 TYPES OF SOCIALBILITY
A)Mingles with every one 12 40%
B)Not mingling with anyone 2 66%
C)Sometimes mingles , sometimes not 14 66%

mingle
TABLE-1
The table reveals that among the samples majority 30 (100%)were between the
age group of 21 years .
 Majority of adolescence Students were studying more than second order
of birth.
 Majority of adolescents family income is more than Rs 10000.
 Majority of adolescents level of dependence is their father.
 Majority of sociability was mingling with others.
TABLE-2
To find out the association between the level of stress regarding

previous online class and demographic variables .
LEVEL OF STRESS
MILD MODERATE SEVERE
N % N % N %
4 13.3% 21 66.0% 5 70%
 TABLE-2 shows that among 30 adolescent girls and boys, 4(13.3%) exhibits mild stress.
 In about 30 adolescent girls and boys, 21 (66%) exhibits moderate stress.
 In about 30 adolescent girls and boys, 5 exhibits severe stress.
PIE CHART DIAGRAM
LEVEL OF STRESS
13.3%
MILD
MODERATE
SEVERE
70%
66%
CHAPTER 5
DISCUSSION
This study was conducted to assess the online class behavior among adolescent
girls in selected area class room. After assessing level of study in online class
behavior among adolescent girls students categorized according to standard
scale.
OBJECTIVES ,
1.) To assess the level of stress regarding previous online class among the 3rd year B.S c
nursing students.
FINDINGS;
 Majority of adolescence Students were studying more than second order

of birth.
 Majority of adolescents family income is more than Rs 10000.
 Majority of adolescents level of dependence is their father.
 Majority of sociability was mingling with others.
2.) to find out the association between the level of stress regarding previous
online class and demographic variables .
FINDINGS;
 that among 30 adolescent girls and boys, 4(13.3%) exhibits mild stress.
The study of findings showed association of age family income, level of
dependence social interaction of previous online class stress analyse by using
inferential statistics namely chi square
The obtained value each variables shows that there is significant association
between this variables ant the previous online class stress among B sc(n) III year
student.
Chi square value x2=16.10(p>5.99) shows that there is significant association

between this variables ant the previous online class stress among B sc(n) III year
student.
Chi square value x2=0(p<5.99) shows that there is significant association on

previous online class stress.
Chi square value x2=1.11(p<9.49) ) shows that there is significant association on

being family income.
The obtained each of these variables shows that that is significant association
between this variables
Behavior.
Chi square value x2=5.63(p<5.99) shows that there is significant association on

students.
Chi square value x2= 2.98(p<9.49) shows that there is significant association on
behavior in family income.
CHAPTER :6
SUMMARY,CONCLUSION AND RECOMMENDATION
The focus of the study is to assess the correlation between online class stress
among IIIYEAR B.SC (N) students. The research approach was survey method.
The study was descriptive correlation design which comparative NATURE .The
conceptual framework of study was based upon this instrument are
used for data collection was self – administered questionnaire on online class
stress behavior which was prepared based on review of literature and with the
help of subject expert.
The content validity of the tool was obtained from the expert. The statistical
analysis karl pearson co efficient was found to be ‘r’=0.49 which is positively
correlated ,therefore the instruments were found to be reliable.
A convenient sampling technique was used to identify and to collect data from
the study of participants.
the main study was conducted in CSI JACON in pasumalai.
Descriptive and inferential statistics were used to analyze the data was presented
using tables and graphs.
THE MAIN FINDINGS OF THE STUDY
 Among 30 adolescent girls and boys, 4(13.3%) exhibits mild stress.

 Chi square value shows that there is significant association between this
variables ant the previous online class stress among B sc(n) III year student.
 Chi square value shows that there is significant association on previous
online class stress.
 Chi square value shows that there is significant association on being family
income.
 The obtained each of these variables shows that that is significant
association between this variables
 Behavior.
 Chi square value shows that there is significant association on students.
 Chi square value shows that there is significant association on behavior in
family income.
CONCLUSION
 There is significant association on previous online class stress.

 There is significant association on being family income.
 The obtained each of these variables shows that that is significant
association between this variables Behavior.
 There is significant association on students.

 There is significant association on behavior in family income.
IMPLICATIONS
The study has following implication for nursing practice, nursing services,
administrations nursing research.
NURSING PRACTICE
 Nurses have greatest responsibility for health care of adolescent in the

community the member of healthy team should put more interest in
adolescent psychiatric.
 Primary prevention programme is as effective measures to prevent the onset
of behavioral problems among adolescent.
 The study about previous online class stress.
NURSING EDUCATION
 This study helps the nurses to prevent the suicidal thoughts

 The study to assess the nursing authorities carries out in the community.
 The study is helps to improve knowledge .
NURSING RESEARCH
 This study will be valuable reference in a path way for further research.
 The finding of the study would help to expand professional knowledge

which further researchers can be conducted.
 Further research in this field needed on various aspects which will aid
deeper understanding and new intervention because on improve knowledge
and intervention for the standard of nursing profession.
 Studies can be conducted by using legal scales to assess violence behavior
and consider about contribution variables.
 This study will serve as a valuable material for further investigations in
nursing field especially in mental health nursing.
RECOMMENDATION
 The study can be undertaking with large number of samples with varying
ethnicity.
 A similar study can be compared with attention span also.
 A similar study can be done as experimental research design.
REFERENCE:
1. Yadava,J,S.and Usha V. Readdy (1988),In the midst of diversity of online

stress in urban, India /amities ,In james Lull(cd).
2. Kang,Jong Geum(1989),”Cultural indicators.The Korean cultural outlook

profile”,ph.D Dissertation,University of Massachusetts,Dissertation Abstracts
InterNational.50(12).3783 A.
3.Aggarwal,V.B.(1993),”impact of cable internet on social

life;”communicater.28(3)7-9.
4.Chandra,V.(1997).”online class influence on cultrural and societal values

among Japanese students Journal of Asia Pacific Communication.
5.Midsio,J.(1997),”television viewing habits of children Virginal,”Journal of asia
on Pacific communication.8(1).176-189.
6. Cooper C.L. (1995) Handbook of Stress Medicine and Health, CRC Press.

7. Cooper C., Palmer S. (2000) Conquer Your Stress, Chartered Institute of
Personnel and Development.
8. Cooper K. (1991) Overcoming Hypertension, Bantam Books.
9. Davis M. (2000) The Relaxation and Stress Reduction Work Book, New
Harbinger inc.
10. Edwards M. (2000) Stress Management for Cancer Patients: a Self Help
Manual, Acorn Publishing.
11. Everly G.S. (1989) A Clinical Guide to the Treatment of the Human Stress
Response, Plenum Press.
12. Fried R. (1990) The Breath Connection, Plenum Press.
13. Fried R. (1999) Breath Well Be Well, John Wiley and Sons inc.
14. Hambly K., Muir A. (1997) Stress Management in Primary Care, Butterworth
Heinemann.
15. Handling Stress (1992) The Open University, The Open University Press.
16.Health and Safety Executive Help on Work Related Stress: a short
guide. http://www.hse.gov.uk/pubns/indg281.pdf
17. Hoffman D. (1986) The Holistic Herbal Way to Successful Stress
Control, Thorsons.
18. Hoffman D. (1992) Therapeutic Herbalism,
19. Howell M., Whitehead J. (1989) Survive Stress: A Training Program,
Cambridge Health Promotion.
20. Hubbard J.R., Workman E.A. (1998) Handbook of Stress Medicine, CRC Press.
21. International Stress Management Association, Stress News April 2002 vol. 14
No 2.

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A DESCRIPTIVE STUDY TO ASSESS THE LEVEL OF STRESS REGARDING

PREVIOUS ONLINE CLASS AMONG B.SC(N) III YEAR STUDENTS WHO

THE TAMIL NADU DR M.G.R. MEDICAL UNIVERSITY,CHENNAI

INPARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE DEGREE OF BACHELOR OF SCIENCE IN NURSING

Prof Dr.Mrs JOTHI SOPHIA.,MSC(N),Ph.D.

CSI Jeyaraj Annapackiam College of Nursing,

Signature of the research guide:

Mrs Jeba Rani,MSC(N),

CHAPTER NO CONTENTS PAGE NO

Background of the study

Significance and need for the study

Statement of the problem

1. overview of online class

2.studies related to stress

3.studies related to previous online class stress.

Setting of the study

Description of the tool

Data collection method

Plan for data analysis

IV DATA ANALYSIS AND

VI SUMMARY AND RECOMMENDATIONS

BACKGROUND OF THE STUDY

NEED FOR THE STUDY:

However, weakness of online teaching infrastructure, inexperience of teachers regarding new

However, weakness of online teaching infrastructure, inexperience of teachers regarding new

1) Assess – to judge or from an opinion about something.

3rd year B.sc Nursing students may have the stress.

The findings of the study will help to:

SECTION A; OVERVIEW OF ONLINE CLASS;

SECTION B; STUDIES RELATED TO STRESS;

BHUTNATH MAHATO SUNIL JANGIR(2012)conduced study on previous online stress

SECTION C; STUDIES RELATED TO PREVIES ONLINE CLASS STRESS;

Clinical experience remains an integral component of nursing education. It provides nursing

MAGEN MHAKA-MUTEPFA MED ELIAS MPOFU ROBERT CUMMING

 It clarifies the concepts on which the study is built.

In this study , throughput refers to the intervention ,namely ..

Based on BETTY NEUMANS stress model theory(1999).

NURSING DIAGNOSIS NURSING GOALS NURSING OUTCOME

FIEXIBLE LINE OF NURSING GOALS

Descriptive research design.

Setting of the study:

The study was conducted in CSI JACON , Madurai.

The population for this study was B.Sc Nursing students.

3rdyear B .Sc nursing students.

3rdyear B.Sc nursing students at CSI JACON

 All B .Sc Nursing students can participate in the survey

 Age should be 19-21 years

Method of data collection:

Nursing studentResearch report

Research design: Descriptive design

Description and inferential

DATA ANALYSIS AND INTERPRETATION

The analysis of data collected from a sample of 30 students CSI Jeyaraj

B) up to RS 5000 -7500 4 13%

C)up to RS 7500-10000 6 20%

D)more than RS 10000 16 53%

A)Mingles with every one 12 40%

B)Not mingling with anyone 2 66%

C)Sometimes mingles , sometimes not 14 66%

To find out the association between the level of stress regarding

MILD MODERATE SEVERE

4 13.3% 21 66.0% 5 70%

PIE CHART DIAGRAM