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Cognitive Behavioral Stress Management Training for Nursing Students | 2019:31 Ulrik Terp | Cognitive Behavioral Stress Management Training for Nursing Students | Training | Cognitive Behavioral Stress Management Ulrik Terp Cognitive Behavioral Stress Management Cognitive Behavioral Stress Training for Nursing Students Management Training for The overall purpose of this thesis is to examine a new stress management intervention developed for nursing students. The thesis includes three studies. The aim in the first study was to investigate the Nursing Students feasibility and acceptability of the stress management intervention. The analysis suggested that the feasibility of conducting a full-scale evaluation was confirmed for recruitment, acceptability, data collection, and adherence to the intervention. However, difficulties were also identified. In the second study the aim was to investigate the participants’ experiences from participating in the intervention. The findings indicate that participants developed new and more adaptive coping Ulrik Terp strategies. Findings emphasize the importance of both theoretical and structural aspects when planning a stress management training intervention. The third study aimed at investigating preliminary psychological effects regarding self-esteem, self-efficacy and stress management competence. Perceived stress management 2019:31 competency was improved and had withstanding effects one year later when compared to a control group. Self-esteem and self-efficacy, both psychological resources, also increased over time after the training program. In summary, this thesis provides insight and knowledge into the challenges and the complexities of developing and implementing a stress management intervention in a nurse education context. ISBN 978-91-7867-056-7 (print) ISBN 978-91-7867-066-6 (pdf) Faculty of Arts and Social Sciences ISSN 1403-8099 Psychology DOCTORAL THESIS | Karlstad University Studies | 2019:31 DOCTORAL THESIS | Karlstad University Studies | 2019:31 Cognitive Behavioral Stress Management Training for Nursing Students Ulrik Terp DOCTORAL THESIS | Karlstad University Studies | 2019:31 Cognitive Behavioral Stress Management Training for Nursing Students Ulrik Terp DOCTORAL THESIS Karlstad University Studies | 2019:31 urn:nbn:se:kau:diva-75458 ISSN 1403-8099 ISBN 978-91-7867-056-7 (print) ISBN 978-91-7867-066-6 (pdf) © The author Distribution: Karlstad University Faculty of Arts and Social Sciences Department of Social and Psychological Studies SE-651 88 Karlstad, Sweden +46 54 700 10 00 Print: Universitetstryckeriet, Karlstad 2019 WWW.KAU.SE Doctoral dissertation in Psychology: CBT-based stress management training for nursing students Ulrik Terp, Department of Psychology, Karlstad University, Sweden Abstract The overall purpose of this thesis is to examine a new stress management intervention developed for nursing students. The thesis comprises three studies (Study I-III) based on empirical data from a sample of nursing students. The specific aim in the first study (Paper I) was to investigate the feasibility and acceptability of the stress management intervention. The results in the first study suggested that the feasibility of conducting a full-scale evaluation was confirmed for recruitment, acceptability, data collection, and adherence to the intervention. However, difficulties relating to homework were also identified. In the second study (Paper II) the specific aim was to investigate the participants’ experiences from participating in the stress management intervention. Findings indicate that participants developed new and more adaptive coping strategies, which were attributed to the intervention. The participants expressed that they had increased their ability to reflect which led to increased insight and self-reflection. Findings further emphasize the importance of both theoretical and structural aspects when planning a stress management training intervention. A group format delivery in combination with a multi-component cognitive behavioral intervention can be interrelated elements for positive stress-related changes. The third study (Paper III) aimed at investigating preliminary psychological effects regarding self-esteem, self-efficacy and stress management competence. In the third study, perceived stress-management competency among nursing students was improved and had withstanding effects one year later when compared to a control group. Self-esteem and self-efficacy, both psychological resources, increases over time after the training program. In summary, this thesis provides an important insight into the challenges and the complexities of developing and implementing a stress management intervention in a nurse education context. 2 Keywords: Stress management, Health promotion, Higher education, Nursing students, Cognitive Behavioral Training, Feasibility, Acceptability 3 Paper I Terp, U., Bisholt, B., & Hjärthag, F. (2019). A feasibility study of a cognitive behavioral based stress management intervention for nursing students: Results, challenges, and implications for research and practice. (Submitted manuscript). Paper II Terp, U., Bisholt, B., & Hjärthag, F. (2019). Not Just Tools to Handle It: A qualitative study of nursing students’ experiences from participating in a cognitive behavioral stress management intervention. Health Education & Behavior, 1-8. https://doi.org/10.1177/1090198119865319 Paper III Terp, U., Hjärthag, F., & Bisholt, B. (2019). Effects of a cognitive behavioral-based stress management program on stress management competency, self-efficacy and self-esteem experienced by nursing students. Nurse Educator, 44(1), E1-E5. https://doi.org/10.1097/nne.0000000000000492 Reprints were made with permission from the different publishers. 4 Preface ................................................................................................................ 7 Introduction ........................................................................................................ 8 Dissertation’s rationale .................................................................................. 11 Stress prevention and health promotion within higher education ............. 12 Interventions aimed specifically at nursing students .................................. 13 Gaps in the literature ..................................................................................... 14 Stress theories ................................................................................................. 17 The transactional model ............................................................................... 18 The job demand-control-support model ...................................................... 19 The effort-reward approach .......................................................................... 22 Kember’s model on perceived workload ..................................................... 23 Modern cognitive research on stress........................................................... 25 Cognitive activation theory of stress (CATS) .............................................. 26 The stress mindset research ........................................................................ 27 The Intervention .............................................................................................. 30 Theory of change – active ingredients of the intervention ......................... 30 Rationale for the length, format and content of the intervention ............... 33 Content and applied exercises ..................................................................... 34 The first session: Introduction .................................................................. 34 The second and third session: Focus on emotions ................................ 34 The fourth and fifth session: Focus on cognitions .................................. 35 The sixth session: Self-compassion ........................................................ 36 The seventh session: Acceptance and Commitment Training (ACT)... 37 The eighth session: The balances of life ................................................. 38 The ninth session: Effective communication ........................................... 38 The last session: Summary ...................................................................... 39 Methods and summary of studies ............................................................... 40 Study I............................................................................................................. 40 Study design and participants .................................................................. 41 Measures and analysis ............................................................................. 41 Results ........................................................................................................ 43 5 Study II ........................................................................................................... 44 Study design and participants .................................................................. 44 Data collection ........................................................................................... 45 Method and analysis ................................................................................. 45 Results ........................................................................................................ 46 Study III .......................................................................................................... 47 Study design and participants .................................................................
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