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OJHAS Vol. 10, Issue 2:
(Apr-Jun 2011) |
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| Coping
Ability of Medical and Nursing Students: A Cause of Concern |
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Ramkumar S, Resident, MS Ramaiah Hospital,
Bangalore,
Rakshita C, Resident, MS Ramaiah Hospital,
Bangalore
Elizabeth J, Department of Physiology, MS Ramaiah Medical College, Bangalore
Joji Mathews, Department of Cardiology, MS Ramaiah Memorial Hospital, Bangalore,
Prakash VS, Department of Cardiology, MS Ramaiah Memorial Hospital, Bangalore
Rajeev Sharma, Department of Physiology, MS Ramaiah Medical College, Bangalore |
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Address for Correspondence |
No.1902, 13th Cross,
4th Main, C Block, Sahakarnagar,
Bangalore – 560092, India.
E-mail:
ramkumar.chubby@gmail.com |
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Ramkumar S, Rakshita
C, Elizabeth J, Mathews J, Prakash VS, Sharma R. Coping
Ability of Medical and Nursing Students: A Cause of Concern. Online J Health Allied Scs.
2011;10(2):18 |
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Submitted: June 29,
2011; Accepted: Jul 16, 2011; Published: Jul 30, 2011 |
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| Abstract: |
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Background:
Medical students today are subject to a variety of stress; academic,
social, emotional or stress in the form of affliction of health during
their stay at medical school. The physiological response to these depends
on various factors including their inherent coping abilities. This study
was designed to examine the coping ability of medical and nursing students
at the time of admission to medical school. Materials and Methods:
42 medical and 34 nursing students volunteered for the study. They were
administered the BAI questionnaire and classified as good and poor adjusters
based on their score. Results:
The study revealed an unsatisfactory overall coping ability to be prevalent
among medical and nursing students. Conclusion:
This study showed that there is a need for orientation and counselling
of medical and nursing students at the start of college.
Key Words:
Coping ability; Counselling
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Studies from both the West
and Asia have reported that medical school is highly stressful particularly
for those who are beginning their medical education.1-4 They have
also established links between chronic life stress and cardiovascular
disease.5 Psychological stress is a risk factor
for coronary artery disease (CAD)5 and hypertension.6 Workers in the
field of behavioural science have carried out extensive research on
stress and its outcomes in the academic circle and have inferred that
the topic needed more attention.7-11 According
to Sender et al, the first years at university represent a major
challenge for medical students. They are under pressure to perform according
to the standards of their selected professional career and, at the same
time, initiate the liberation process from parental control. This process
of emotional detachment and change of social roles is a source of psychological
distress, mainly because both the family and academic environment are
underpinned by the model of social competition that predominates in
professional activity. As this process of change evolves, few students
show signs of physical or psychological suffering.12 The available literature on psychological
distress in medical students has largely ignored the influence of personality
traits that might predispose some students to psychological maladjustment
during training.12 According to Srivastava et al,
students with good psychological support have less adjustment problems.13 Warbah
et al
showed psychiatric morbidity to be associated with introversion,
neuroticism, and poor adjustment on all the fours domains on the Bell’s
Adjustment Inventory in nursing students.14 Academic workload, examinations, and
assignments are all sources of stress for student nurses.15-17
An Irish study focusing on measuring various stressors, found examinations,
theory, assignments, and workload and classroom hours to be significant
stressors.18 Ofori showed that academic work provokes
a greater challenge to younger student nurses owing possibly to their
limited coping ability.19 Thus it is evident that medical and
nursing students are subject to stress during their entry into and stay
in medical school. Individuals may vary in response to the same stress
in different ways. The coping ability of an individual may influence
the response to the stress. Hence, this study was done to evaluate the
inherent coping ability of students at the time of their admission into
college.
The study was conducted at
M S Ramaiah Medical College, Bangalore. A total of 76 healthy (42 medical,
34 nursing) students admitted into first year MBBS and nursing courses
during the academic year 2007-2008 participated in the study. They were
included after having obtained a written informed consent to a protocol
approved by the ethical review board of the institution. The study was
conducted a week after the completion of the admission procedure to
the institution. The weight, height and blood pressure were also recorded
simultaneously. Weight was taken on a weighing scale with standard minimum
clothing to the nearest 0.5 kg. Height was measured on a vertical scale
with heels, buttocks, occiput against the wall and head in Frankfurt
plane (A standard position of reference in which the upper border of
the external auditory meatus is on a horizontal plane with the lower
border of the eye), to the nearest 0.5 cm. Body Mass Index (BMI) was
computed as weight (in kg)/height2 (in m). WHO grading of BMI20,21 was
used for determination of relative proportion of underweight and overweight.
Each student was administered the Bell’s Adjustment Inventory (BAI
Questionnaire). The BAI questionnaire is a psychometric analysis tool
designed to assess the coping abilities of an individual in four aspects
– Home, Health, Emotional, and Social. A total score of 44 was used
to classify individuals as having satisfactory or unsatisfactory coping
ability, a higher score indicating poor ability. All the volunteers
were administered the questionnaire simultaneously and were given a
standard 30 minutes to fill the questionnaire. A score of 11 or greater
for coping ability at home, social coping ability and emotional coping
ability indicated an unsatisfactory response. Statistical software namely
SPSS 15.0, Stata 8.0, MedCalc 9.0.1 and Systat 11.0 were used for the
analysis of the data. Descriptive statistical analysis was used to compute
the frequency, percentage, mean, SD etc.
The results of the study are shown in the tables below:
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Table 1: Distribution of BAI
– Total Score |
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BAI-total score |
Medical students |
Nursing students |
Combined |
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No |
% |
No |
% |
No |
% |
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Good-Excellent |
1 |
2.4 |
0 |
0.0 |
1 |
1.3 |
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Average |
16 |
38.1 |
13 |
38.2 |
29 |
38.2 |
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Unsatisfactory-Very
unsatisfactory |
25 |
59.5 |
21 |
61.8 |
46 |
60.5 |
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Total |
42 |
100.0 |
34 |
100.0 |
76 |
100.0 |
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Table 2: Distribution of BAI
– Social Component Score |
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BAI-Social |
Medical students |
Nursing students |
Combined |
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No |
% |
No |
% |
No |
% |
| Aggressive |
10 |
23.8 |
3 |
8.8 |
13 |
17.1 |
| Average |
18 |
42.9 |
22 |
64.7 |
40 |
52.6 |
| Retiring |
14 |
33.3 |
9 |
26.5 |
23 |
30.3 |
| Total |
42 |
100.0 |
34 |
100.0 |
76 |
100.0 |
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Table 3: Distribution of BAI
– Emotional Component Score
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BAI-Emotional |
Medical students |
Nursing students |
Combined |
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No |
% |
No |
% |
No |
% |
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Good-Excellent |
4 |
9.5 |
0 |
0.0 |
4 |
5.3 |
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Average |
12 |
28.6 |
8 |
23.5 |
20 |
26.3 |
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Unsatisfactory-Very
unsatisfactory |
26 |
61.9 |
26 |
76.5 |
52 |
68.4 |
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Total |
42 |
100.0 |
34 |
100.0 |
76 |
100.0 |
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Table 4: Distribution of BAI
– Health Component Score |
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BAI-Health |
Medical students |
Nursing students |
Combined |
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No |
% |
No |
% |
No |
% |
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Good-Excellent |
3 |
7.1 |
4 |
11.8 |
7 |
9.2 |
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Average |
13 |
30.9 |
16 |
47.1 |
29 |
38.2 |
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Unsatisfactory-Very
unsatisfactory |
26 |
61.9 |
14 |
41.2 |
40 |
52.6 |
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Total |
42 |
100.0 |
34 |
100.0 |
76 |
100.0 |
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Table 5: Distribution of BAI – Home Component Score |
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BAI Home Score |
Medical students |
Nursing students |
Combined |
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No |
% |
No |
% |
No |
% |
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Good-Excellent |
11 |
26.2 |
9 |
26.5 |
20 |
26.3 |
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Average |
17 |
40.5 |
15 |
44.2 |
32 |
42.1 |
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Unsatisfactory-Very
unsatisfactory |
14 |
33.3 |
10 |
29.4 |
24 |
31.6 |
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Total |
42 |
100.0 |
34 |
100.0 |
76 |
100.0 |
The study aimed to analyze
the inherent coping ability of an individual. Analysis of the individual
BAI questionnaire components showed that majority of both the medical
students (40.5%) and the nursing students
(44.2%) have an average home environment. While 61.9% of medical students
showed unsatisfactory health coping abilities, 47.2% of nursing students
showed similar results. Emotional coping ability was found to be unsatisfactory
in 61.9% of medical students, while nursing students showed a similar
pattern, with higher number (76.5%). 42.9% of medical students and 64.7%
of nursing students showed average social coping ability. Overall, 59.5%
of medical students and 61.8% of nursing students had an unsatisfactory
overall BAI score.
The coping ability of an individual
being an inherent quality may influence an individual’s response to
stress. In the case of medical students who have just been admitted
to medical school, dissection of human bodies in the department of anatomy
and physiology practical could be stressors. The sudden requirement
to read voluminous study material with entire range of newer terminologies
and new pattern of study, being very different from their pattern at
the pre-university college level may also be stressful. The nurses in
addition to similar problems have a further larger problem with multiple
subjects in the first year and the stress of maintaining extreme discipline
in both hostel and classes. In addition to these, there is evidence
that finance is a major stressor among nursing students.18,22
Therefore, the individual’s coping ability at home may play a role
to combat the same. When admitted to medical or nursing school for the
first time, all students are exposed new colleagues and faculty. Their
social and emotional coping abilities may govern the time they take
to adjust to the new atmosphere. In addition to the above factors, the
effect of parental and peer pressure to perform cannot be ignored. Our
study also showed that females tend to have a poorer coping ability
to perceived stress. Compounded by the higher level of perceived stress,22
females may be more prone for morbidities as a result of stress.
Thus, coping ability of an
individual becomes very important in how they respond to the stress.
Studies have also shown psychological distress, poor adjustment and
coping to result in poor academic performance among students. In a minority
of students this can result in significant psychiatric morbidity and
even withdrawal from the course.14 Thus, our study showed that a majority
of both nursing and medical students have an unsatisfactory coping ability.
These need to be looked into at the time of their admission into medical
school and the issues be addressed to improve academic performance,
to prevent and minimize psychiatric and other morbidities further ahead
in their career.
The study revealed an unsatisfactory
overall coping ability to be prevalent among medical and nursing students.
The sample size of the study
was too small since only students who volunteered were sampled for the
study. Therefore, the authors recommend that future research should
use larger sample size from other institutions to validate these findings.
The findings will help the individual students, lecturers, career and
counselling centres, and the University administration to put in place
mechanisms that may moderate the effects of stress on students.
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