Literature review

The process of education is a very stressful experience and university students encounter a great deal of
academic, personal and social stress during their academic activities. Nursing students face stressful
events in their study period that lead to negative consequences in their academic, professional and
personal life. In addition to class room learning, they have to acquire skills in clinical settings, and
undergo extensive evaluation process consisting of theory and practical examinations that lead to a
complex learning environment.
It is well known that stress is associated with the development of anxiety and depression as well as a
positive relationship between stress, anxiety and depression is well established. According to the
Psychology Foundation of Australia (PFA), these three problems indicate a composite state of negative
emotional symptoms.
According to the study, DASS-21 was used to assess the depression, anxiety and stress level among
participants. The level of Depression, Anxiety, Stress were reported as 51.1%, 59.8%, 82.6% under mild
to extremely severe level. Participants’ response rate was 86.4%.

According to a study which was done among Health care undergraduates of University of Ruhunu, Sri
Lanka in 2021 to identify the coping strategies in management of stress, Most of the students used
positive coping strategies while some students used maladaptive coping strategies. Also, the findings
revealed on usage of coping strategies as given below.
Counseling from student counsellors of the university – 79.9%
Counseling from psychologists – 70%
Career guidance services of the university – 69.4%
Mentoring program – 75.8%
Meditation – 75.8%
Taking a walk – 84%
Eating – 86.3%
Sleeping – 93.6%
Aesthetic activities – 81.6%
Talking to a friend/ meeting loved one – 89.8%
Surfing in social media – 81.6%
Watching TV, films – 84.3%
Methodology
This study was carried out to assess the level of negative emotional problems among final year nursing
students, University of Jaffna.
Study Design
This was a institutional based cross sectional study
Study area
This study was conducted in university of Jaffna.
Study population
Randomly selected …… final year nursing students were recruited.
Study period
Four months from November 2023.
Ethical issues
Anonymity was ensured during data collection
All the data will be maintained confidentially on personal computer with password.
The personal data of the participants will not be exposed to anyone other than researchers. At the end
of the research all data obtained will be submitted to centre for holistic healing, Jaffna Diocese of the
church of South India.
Instruments for Data Collection
Depression Anxiety Stress Scale-21 (DASS-21).
This is a validated questionnaire which was designed to assess the level of negative emotion
states. It consists of 21 items which explores the symptoms of depression, anxiety, stress. Seven
items are allocated for each one. However, they are not in order. Scores will be given for each
item as following,
Did not apply to me at all - 0
Applied to me to some degree, or some of the time - 1
Applied to me to a considerable degree or a good part of time - 2
Applied to me very much or most of the time - 3

Finally the total score will be multiplied by two and classification was done as given below,
Depression Anxiety Stress

Normal 0-9 0-7 0-14

Mild 10-13 8-9 15-18

Moderate 14-20 10-14 19-25

Severe 21-27 15-19 26-33

Extremely Severe 28+ 20+ 34+

Data analysis
Data analysis was done with the help of MS-Excel-2016.