Mental health promotion among nursing students.

Author:Deeromram, Choochart


Background and significance of the study: In a globalization trend, the world changes every single day, especially in regards to the environment, social functions and cultural aspects. These changes could impact the stress level of people and stimulate their adaptation. Stress is an adaptive phenomenon of human beings which, to the higher degree, contributes to their survival, to an adequate output in their activities and to an effective performance in many phases of life (Pades Jimenez and Homar Amengual, 2006). According to psychoanalytic theory, individual adaptation is the emotional adaptive process and ego defense mechanisms of human beings for dealing with stress (Freud, 1993). Stress, defined by the interaction between the environment and an individual, is experienced when demands from the environment exceed available resources. Overwhelming with stress and anxiety, persons could respond in several manners according to cognitive appraisals and coping competencies (Lazarus and Folkman, 1984).

Situations in the university especially during the academic lives of nursing students, is considered as one of several areas for stress exposure. It exists for students in both the clinical and the academic fields of the studying program (Lazarus and Folkman, 1984). Preparing to become a nurse was found to be significantly emotionally stressful and a possible risk to the well-being of students (Tully, 2004). It involves meeting conflicting demands, feeling over worked, feeling unprepared and seeking respect and support from one's faculty (Magnussen and Amundson, 2003). In a study, financial constraints and academic-related concerns emerged as the most stressful areas for the students (Timmins and Kaliszer, 2002). Nursing student who fulfill their clinical practices are exposed to symptoms specific to nursing in the field of stress (Pades Jimenez and Homar Amengual, 2006). Initial clinical experience for new nursing students can be stressful and intimidating, particularly for young students having no prior healthcare experience (Sprengel and Job, 2004). Additionally, characteristics of nursing profession are significantly and directly related to human health. Therefore, nursing students need to be aware and to be able to utilize the nursing theoretical aspects for high quality clinical practicing. Moreover, nursing shifts and ward rotations, in order to fulfill the patient's needs 24 hours a day also expose nursing students to stress that directly effect their adaptation (Lambert et al., 2007a; 2007b; Xianyu and Lambert, 2006). Therefore if nursing students have an inefficient ability to deal with stress and anxiety in everyday life, they will develop health problems, especially psychological distress quite easily.

In 2006, a participatory action research on the perspectives of defense mechanisms styles and sense of coherence was conducted in order to study mental health in the first year bachelor of nursing science students at the Faculty of Nursing, Mahasarakham University. The findings suggested that nursing students defined mental health as the emotional status, self awareness, concentration and individual adaptive abilities which vary according to situations concerning physical, psychological and environmental. Moreover, they stated that mental health was deeply reciprocal associated with physical health with no other ways of separating each other. They mentioned internal and external factors effected mental health of individuals. Lack of participation in class activities and malpractice of communication were identified as the crucial factors that affected their mental health. Manipulation with personal stress and promoting class participation for solving difficult situations were mentioned as an action plan for promoting mental health which involved self understanding, positive thinking, care and concern, team building, stronger teacher-student relationship and participating of class activity report intervention (Deeromram et al., 2007; 2008). The expected outcomes that focus on health and high competency of nursing professional in the future, therefore, this quasi-experimental study was designed to utilize the action plan from previous study for mental health promotion among nursing students.

Purposes of the study: The quasi-experimental research aimed to study the effect of mental health promotion intervention among nursing students in the Faculty of Nursing, Mahasarakham University.

Literature review: The research was conducted by using the concepts concerning defense mechanisms style and sense of coherence as a conceptual framework. According to the defense mechanisms, Sigmund Freud (1993), the first psychologist who proposed psychoanalytic theory, points out that the theory consists of 3 principle dimensions: Level of mind; structure of mind; and psychosexual development. This theory concerns mental and behavioral disorders of individuals associated with inappropriate ego defense and mental conflict. Or in other words, people who attempt to use coping behaviors when they face difficult situations. Coping behaviors vary with each individual, but all of us use defense mechanisms as one method of coping. Defense mechanisms are automatic psychological processes that mediate individuals' reactions to emotional conflicts and stressors, which often operate without individual awareness. They are not a specific attempt to solve a problem but the use of a mental mechanism to resolve a mental conflict, reduce uncomfortable feelings of anxiety or fear and protect one's self-esteem and sense of security. They protect individuals by allowing them to deny, distort, or restrict full awareness of unpleasant thoughts, feelings and feared impulses (Fortinash and Holoday Worret, 2004; Shives and Isaacs, 2005). The defense mechanisms were evaluated by the Defense Style Questionnaire (DSQ). This questionnaire evaluates twenty defense styles, which are divided into three groups of factors: mature, neurotic and immature. The mature style consists of four defenses (sublimation, humor, anticipation and suppression), as does the neurotic style (undoing, pseudo-altruism, idealization and reaction formation). The remaining, immature style consists of twelve defenses (projection, passive-aggression, acting-out, isolation, devaluation, autistic fantasy, denial, displacement, dissociation, splitting, rationalization and somatization) (Kipper et al., 2007). Individuals with mental and behavioral disorders tend to use maladaptive mechanisms (neurotic and immature defense factor) as coping behaviors (Fortinash and Holoday Worret, 2004; Shives and Isaacs, 2005). Several studies performed in different countries which examined the ego defense mechanisms style found that the results correspond to one another. The endorsement immature defense styles decreases with age (Andrews et al., 1993). Maladaptive defenses were significant positively correlated perceived stress and the...

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