University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations 1896 - February 2014 1-1-1982 The relationship between knowledge of stress theory and management of stress as reflected in sources and symptoms of stress and in academic performance in associate degree nursing students. Marita Callahan University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_1 Recommended Citation Callahan, Marita, "The relationship between knowledge of stress theory and management of stress as reflected in sources and symptoms of stress and in academic performance in associate degree nursing students." (1982). Doctoral Dissertations 1896 - February 2014. 3793. https://scholarworks.umass.edu/dissertations_1/3793 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations 1896 - February 2014 by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. THE RELATIONSHIP BETWEEN KNOWLEDGE OF STRESS THEORY AND MANAGEMENT OF STRESS AS REFLECTED IN SOURCES AND SYMPTOMS OF STRESS AND IN ACADEMIC PERFORMANCE IN ASSOCIATE DEGREE NURSING STUDENTS A Dissertation Presented By SR. MARITA CALLAHAN, S.P. Submitted to the Graduate School of the University of Massachusetts in partial fulfillment of the requirements for the degree of DOCTOR OF EDUCATION May 1982 Education © Sr. Marita Callahan, S.P. All Rights Reserved 1982 11 THE RELATIONSHIP BETWEEN KNOWLEDGE OF STRESS THEORY AND MANAGEMENT OF STRESS AS REFLECTED IN SOURCES AND SYMPTOMS OF STRESS AND IN ACADEMIC PERFORMANCE IN ASSOCIATE DEGREE NURSING STUDENTS A Dissertation Presented By SR. MARITA CALLAHAN, S.P. Approved as to style and content by: Dr. Charlotte Rahaim, Member iii DEDICATION In loving memory of my parents JOHN J. AND MARY NALLY CALLAHAN and to the hopes and dreams of MARITA JEANNE CALLAHAN and her parents MICHAEL F. AND THERESE KELLY CALLAHAN ACKNOWLEDGEMENTS I wish to express my sincere gratitude to Dr. Grace J . Craig for the clarity and depth of her invaluable guidance and superb assistance directing this dissertation. Special thanks are due to Dr. Mary Kay Cressy for her keen interest, perceptive, prompt considerations and especially for remaining on my Committee after moving out of this area. Many thanks are due to Dr. Charlotte Rahaim for sharing her dynamic approach and perspective on the developing of this study and for her vision in developing and implementing this off-campus Community College graduate program. I especially want to thank Pauline Ashby for her very kind, thoughtful assistance. I am indebted to each nursing student who has enrolled in the Nursing Program at Holyoke Community College. In particular, very special thanks are due to the Class of 1982 for their crucial contributions to this study. Throughout the development of this study, continual thanks are overdue to Janet Vadnais Courtney for her generous, ongoing dialogue, insight and validations. I also wish to express appreciation to Dale Cadran for his encouragement, direction and invaluable help and to Dean Phillip Campbell for his most kind interest, assistance and consideration. v Many thanks are due to Sister Mary Catherine Laboure, S.P. and each Sister of Providence, especially Sister Mary Horgan, S.P. for her sensitivity and understanding, and Sister Marie Thaddeus, S.P. for her sustained help and continued interest. I also want to express my gratitude to Sister Mary Doloretta, S.P. and the Sisters at Bethlehem Convent for many kindnesses and for living through this study with me. Very special appreciation is due to Frank and Teresa Callahan; Jack, Mary Lee, Katie and Meghan Callahan; 1982 and Maura Marge, Bob, Marykate—Class of — , Michelle Ducharme for their sustained interest and encouragement and for monitoring the process of this dissertation. vi . ABSTRACT The Relationship Between Knowledge of Stress Theorv and Management of Stress As Reflected in Sources and Symptoms of Stress and in Academic Performance in Associate Degree Nursing Students (May 1982) Sister Marita Elizabeth Callahan, S.P., B.S. Boston College; MSN, The Catholic uni- versity of America, MS (R) , St. Louis University; Ed.D., University of Massachusetts/Amherst Directed by: Professor Grace J. Craig This study was designed to investigate the relation- ship between knowledge of stress theory and management of stress as reflected in reported sources and symptoms of stress and in academic performance of associate degree nursing students The sample of this study was 41 nursing students currently enrolled in a Nursing Program in a community college in New England. A pretest posttest training design was used. One group received a videotaped module about knowledge of stress, based on Selye's and Lazarus' theories augmented with counseling interviews. The other group did not. Management of stress was measured by 1) sources and measure symptoms of stress and 2) academic performance. The ments used in this study were the Stress Audit, the Life vi i Stress Questionnaire, a teacher made test on Knowledge of Stress and Quality Point Averages. Findings revealed there were significantly fewer symptoms of stress for the experimental group than for the control group (p <-. 05 ). Further students in the experimental group reported significantly less internal pressures whereas students in the control group reported significantly greater pressures. Significant correlations between knowledge of stress theory and management of stress as reflected in academic performance were absent. In conclusion, there was evidence to support the prediction that nursing students can be helped to cope more effectively with stress by this mode of instruction. viii TABLE OF CONTENTS ACKNOWLEDGEMENTS iv ABSTRACT vi LIST OF TABLES xii Chapter I. INTRODUCTION 1 4 The Concept of Stress • . 8 Problem Statement- - - - Sub-Problems 9 Hypothesis 9 10 Definition of Terms • Limitations of the Study 12 II. REVIEW OF THE LITERATURE- - 14 14 Overview of the Theory of Hans Selye - • Historical Development 14 Theory Development 17 Overview of the Theory of Richard S. Lazarus 21 Theory Development 22 Application of Stress Theory to Nursing Education 25 Stress and Clinical Practices in Nursing Students and Graduate Nurses 26 Responses of Nursing Students to the Clinical Area 26 Responses of Nursing Students to Role Change to Graduate Nurses 29 Responses of Patients and Nurses to the Stressful Environment 31 Reaponses of Intensive Care Nurses to the Stressful Environment 32 Stress and Educational Preparation Nursing Students and for 35 Graduate Nurses and Associate Degree Stress 35 for Nursing Students* Education 37 Stress Education for Nurses- • • • IX Issues in the Measurement of Psychological Stress 40 The Structured Questionnaire/ Checklist 40 The Unstructured Audit 4 4 The Interview 4 5 The Questionnaire/Interview • . 45 Conclusion 4 7 1 1 1 - METHODOLOGY 4 9 Design 50 Hypotheses Description of Sample 52 Instruments 53 The Stress Audit 5 3 The Life Stress Questionnaire 54 Knowledge of Stress 56 Training Module 57 59 Measurements of Academic Performance- - - The Comparative Guidance and Placement Program (C.G.P.) 50 Pilot Study 61 Data Analysis 67 Protection of Human Rights 67 IV. RESULTS 6 9 Comparability of Samples: Demographic Factors and Academic Ability 69 Stress Levels—Pretest 76 Training Module on Stress Theory and Management 82 Comparability of Samples Stress Levels— Posttest 83 Academic Levels — Posttest 90 • • V. DISCUSSION , SUMMARY AND RECOMMENDATIONS 97 Stress Knowledge and Stress Symptoms Results 98 Stress and Academic Performance Results -102 Interview Results 106 Limitations HI Implications for Nursing Education- • • 112 Recommendations 115 x REFERENCES 116 APPENDICES 125 Appendix A Stress Audit (SA) 126 Appendix B Life Stress Questionnaire (LSQ) . 128 Appendix C Knowledge of Stress Test (KS) . .131 Appendix D Stress Module Learning Guide . .135 Appendix E Permission for Participating in Study 139 xi LIST OF TABLES Table 1. Comparison of Stresses and Satis- factions on the Stress Audit (SA) as Reported in Rank Order by the Nursing Group and the Business Group of Students in the Pilot Study 6 3 2. Comparison of the Means of Numbers of Symptoms on the Pretest and Posttest of the Life Stress Questionnaire (LSQ) as Reported by the Nursing Group and the Business Group of Students in the Pilot Study 64 3. Comparison of Pretest and Posttest Percentage of Number and Symptoms on the Life Stress Questionnaire (LSQ) that Increased, Decreased or Remained the Same as Reported by the Nursing Group and the Business Group of Students in the Pilot Study 6 5 4. Age, Sex and Marital Status of Nursing Students in the Experimental, Control and Baseline Groups 7 0 5. Means, Standard Deviations and t-Values of the Comparative Guidance and Place- ment (CGP) Subtest Upon Admission to the Nursing Program for the Experimental and Control Groups 6. Means, Standard Deviations and t-Values of the Comparative Guidance and Placement (CGP) Subtests Upon Admission to the Nursing Program for the Combined Experi- mental and Control Groups (Class of 1982) and the Baseline Group (Class of 1981) • • 7. Means, Standard Deviations and t-values of the Cumulative Quality Point Averages (QPA) at the Beginning of the Second Semester, First Year for the Experimental and Control Groups xii 8 . Means, Standard Deviations and t-Values of the Cumulative Quality Point