CHAPTER ONE

INTRODUCTION

1.0 Background of the study

The word 'Stress' is originally traced to the Latin word 'Stringers' which paints the imagery of

pain, hardship or affliction (Dhanalakshmi & Murthy, 2018).

The most common accepted definition of stress (mainly attributed to Richard lagams) is that, it is

feeling experience when a person perceives that demands exceed the personal and social

resources the individual is able to mobilize.

Selye made a clear distinction between beneficial stress (eustress) and harmful stress

(distress). Many scholars have admitted that mild stress promotes motivation and assists in

achieving successes (Saqib & Rehman, 2018; Yikealo et al., 2018).

Stress is any situation that evokes negative thoughts and feeling in a person. All person do not

experience the same negative thoughts and feelings when stressed. One model that is useful to

understand stress among students is the person environmental model.

On the other hand, excessive stress leads to severe health and mental problems (Azila-

Gbettor et al., 2015; Essel & Owusu, 2017; Jain & Singhai, 2018; Reddy et al., 2017).

When student appraise their education as a challenge, stress can bring them a sense of competent

and increased capacity to learn when education is seen as a threat, however stress can elicit

feeling of helplessness and a free boding sense of loss.

Among the significant factors that affects students ability to adapt the stresses of studying

epoch is academic vitality (Jenning 2011).Academic vitality means an adaptive response to

various challenges and barriers experienced during education (Folkman 2015).Therefore the

academic life has a relationship with the individual's adaptation to the various situation of the
academic period, feeling of self-efficacy and empowerment in the face of challenge,

experiencing less anxiety and depression, a sense of responsibility in dealing with the academic

tasks and better academic success(Folkman 2015).Stress is unpleasant state of arousal that arises

when perceive that demands of a situation threaten our ability to cope effectively, it is the

greatest environmental of hazard of our time

However, stress is not necessarily something bad, but it all depend on its understanding.

According to (Yikealo& Tareke 2018),Stress is inescapable ,it has been associates with any

peripheral occurrence that could be enjoyable or intimidating while oxford Advanced Dictionary

7th edition says stress is a pressure or worried cause by problems in somebody's life

Stress can be negative or positive ,positive stress like exhilarating due to success like

passing of examination, sudden wealth, promotion, employment and marriage doesn't cause an

individual to go wrong on daily activities that demands skills e.g. driving, operation of

computer ,answering questions during lectures or examination of study while the reverse is the

case with negative stressed like inability to cope with academic activities, financial problems and

failure to achieve one's life goals (Steinmayr,R.,Meibner, A., Weidinger, A., & Wirthweni,L.

(2017)

The stress faced by the students of school of nursing and midwifery zamfara state poses them to

some psychological effects which this project is aiming to determine

According to Kwaah and Essilfie (2017) and Soliman (2014) regardless of age, race and

socioeconomic background, stress emanates in several ways & might disturb an individual's state

of healthiness even though there may be incalculable reasons for stress, the degree harps on one's

physical wellbeing, interconnection with other people, requirement of work, the degree of desire

and dependence, as well as different types of obligation (Soliman 2014).

 Another important view of stress in the examination, the subject being a student. As we

can see in the time of examination is a period of great challenges of stress.it is noticeable that

intense of examination, many student develop fear & become anxious, irritable, worrisome,

apprehensive and even excited. This shows the presence of stress and as long as the issue is not

tackle on time, failure is highly portable & psychological problems will be experienced. (Oluch,

J. N., Aloka, PJ, & Odongo, B.C. 2018).

Stress is a common phenomenon that affects people in all works of life, one such

situation is the examination situation which has been observed that stress has been a major cause

of failure among students who otherwise here performed fairly well, if not better the resultant

tension causes interpret & answer questions in order. Time limit further makes the situation

tenser. (Pandey, D.,% Jha, M. 2016).

For many young adults, school is the best time of life these critical, years canal so be

undermined by depression, anxiety and stress. Students are likely to experience some or many

stressors which may test their ability, balancing the heaving workload, making new friends,

becoming more independent and dealing with myriad of other issue (Mohan SA 2015).

Stress can also affect the emotional intelligence. It negatively impact our ability to intuit other

people feelings convey our own feelings and communicate. Stress can also prevent us from being

aware of and controlling our emotions, getting along with others, adapting to change and

maintaining a positive mood. The major source of stress include: - change in sleeping habits,

vacation and break, increased workload and new responsibility, Elevated stress among student

results in a decreased performance in the academic accomplishments and can affect both the

physical and mental health of students. Therefore, studies on coping stress will have a

significance impact in higher education (Pariat L, Rynjah A, Joplin MS, and Kharjana MG 2014)
Studies established that chronic and continue exposure to stressful condition lead to emotional,

physical and mental disturbance of the students (Melaku L, Mossie A, Negasha A 2015).

The researcher sets out to find stress that accompant examination as it affects the student

academic performance

1.1 Statement of problem

This research is undertaking purposely on academic performance among student midwives. The

psychological effect of stress to analyze the level of stress among student midwives and suggest

measures to control the stress.

Stress become a problem where there is excessive study load, as it puts a person under

tremendous pressure, this may be in two forms that is qualitative study overload which implies

academic performance that is beyond the students capacity and quantitative study overload arises

when number of activities performed in the prescribed time are many

Students may be subjected to poor academic performance, it would include lack of time

to study, excessive noise when studying, inadequate time to study during examination, lack of

concentration etc. All these unpleasant situations create physiological and psychological

imbalance in human there by causing stress.

An optimum amount of stress can always act as an energizer or motivator and propel

students to apply the efforts on academic performance but a high level of stress can be serious

threat to the personality traits of the students and causes psychological stress

1.2 Objectives of the study

The general objectives of the study include the following:-

" To ascertain the factors contributing to stress

" To identify strategies of reducing stress among the student midwives

" To analyzed impact of stress on academic success

" To study the stress coping methods practiced by the students

" To determine the level of awareness of student on psychological effects of stress

1.3 Research questions

1. What are the psychological effects of stress?

2. What are the factors contributing to stress?

3. What are the strategies to reduced stress?

4. To what extent are the student aware of psychological effects of stress?

5. Can stress be a contributing factors to student’s failure in exams?

1.4 Significance of the study.

This research will be beneficial to the school, student of Zamfara State of School of nursing and

midwifery and government at large.

The school will benefit from this research by having a better understanding on

psychological effect of stress to establish a school based intervention program to create

awareness among students counselling the psychological effect if stress on their academic

performance.

The student will benefit from this research by becoming enlightened concerning effects

of stress in academic performance. Government particularly the Zamfara State ministry of health

can utilize this research to initiate & promote the establishment of school based intervention on

program at various institution across the state to focus on best strategy for prevention of stress
1.5 Scope and limitation of the study.

This research project is limited to midwives students in Zamfara State School of nursing and

midwifery Gusau.

It is intended to cover only from May to march 2022.However other factors which

contribute to the limitation of the study include:-

I. Time factor: - the study covered only a period of 10months in which data was collected

from the student

II. The nature of the profession: - midwifery is one of such profession that makes students

always busy and committed for this, i am not opportune to involve other student from nursing

department

1.6 Operational Definition of terms

1. Anxious: - feeling worried or nervous

2. Anxiety:-A chronic state of mind which affect both mind and body

3. Biochemistry:-the chemistry of living matter

4. Crisis: - A time of great danger difficulty or uncertainty when problem must be solved or

important decision must be made

5. Detrimental:-harmful

6. Depression: - A morbid sadness or melancholy distinguished from grief which is realistic

and proportionate to a person

7. Enthusiasm: - A strong feeling of excitement and interest in something and desire the

become involved in it
8. Tension: - A situation in which the fact that there are different needs or interest causes

difficulty or feeling fear

9. Fear:-the bad feeling that you have when something bad might happen or when a

particular thing frighten you

10. Effect: - A condition caused by something or to cause something to happen as a result

11. Student: - A person who is studying or training

12. Psychosomatic:-relating to the mind and body

 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter was discussed under the following guidelines

" Concepts of stress

" Factors that contribute stress among students

" Impact of stress on academic performance

" Strategies of reducing stress among the student midwives

" Theoretical framework

2.1 Concepts of stress

Introduction

Stress is recognized as an important issue in basic and clinical neuroscience research (Mc Ewen

et al., 2015). Although this physiological phenomenon is fundamental to survival, it is also

strongly related to several brain disorders including, depression, anxiety, post-traumatic stress

disorder (Walsh, 2011; Saveanu and Nemeroff, 2012; Nemeroff, 2016).

Accordingly to the International Classification of Diseases, 10th edition (ICD-10).

Research focusing on the complexity of stress is still challenging, but several studies in animals

and humans have made substantial contributions to its progress in recent years, as reviewed by

Hariri and Holmes (2015). However, it is crucial to provide more meaningful advances in the

stress field by means of a translational approach, integrating basic knowledge and clinical

practice.
 In this review article, we briefly describe the history of stress research and highlight

stress basic concepts, explore the complex neuroanatomy, in fact networks, of the stress system

and its keen axes and mediators, as well as the time domains of the stress response. Lastly, we

raise clinical implications from these concepts and discuss future research challenges on the

stress field (Audet, M.-C., McQuaid, R. J., Merali, Z., and Anisman, H. 2014).

Definition

Stress is defined as the physiological or psychological response to internal or external stressors.

Stress involves changes affecting nearly every system of the body, influencing how people feel

and behave. For example, it may be manifested by palpitations, sweating, dry mouth, shortness

of breath, fidgeting, accelerated speech, augmentation of negative emotions (if already being

experienced), and longer duration of stress fatigue (American psychological association

dictionary 2nd edition).

Types of Stress

According to American Psychological Association (APA 2018), there are 3 different types

stress:- acute stress, episodic acute stress, and chronic stress. The 3 types of stress each have

their own characteristics, symptoms, duration, and treatment approaches.

Stress management can be complicated because each of the 3 different types of stress can

present as single, repeated, complicated, or chronic. Therefore, they require different levels of

treatment interventions, management, and psychological treatment modalities due to the nature

of the person's environment, lifestyle, developmental history, coping resources, and personality.

I. Acute stress is usually brief. It is the most common and frequent presentation. Acute

stress is most often caused by reactive thinking. Negative thoughts predominate about situations

or events that have recently occurred or upcoming situations, events, or demands in the near

future. For example, if you have recently been involved in an argument, you may have acute
stress related to negative thoughts that are repetitive about the argument. Or you may have acute

stress that is about an upcoming work deadline, again the stress is thought induced. However,

most often when the thinking induced stress is reduced or removed the stress will subside too.

However, if the stress meets DSM-5 criteria, then individual may be diagnosed with Acute Stress

Disorder.

II. Episodic stress: - People who frequently experience acute stress, or whose lives present

with frequent triggers of stress, have episodic acute stress. The individuals who frequently suffer

acute stress often live a life of chaos and crisis. They are always in a rush or feel pressured. They

take on many responsibilities, and usually cannot stay organized with so many time demands.

These individuals are perpetually in the grips of acute stress overload.

III. Chronic stress is the most harmful type of stress. If chronic stress is left untreated over a

long period of time, it can significantly and often irreversibly damage your physical health and

deteriorate your mental health. For example, long term poverty, repeated abuse in any form,

unemployment, dysfunctional family, poor work environment, substance abuse, or an unhappy

marriage can cause significant chronic stress. Chronic stress can also set in when an individual

feels hopeless, does not see an escape from the cause of stress, and gives up on seeking solutions.

Chronic stress can be caused by a aversive experiences in childhood or traumatic experiences

later in life. (Temma Ehrenfeld 2018).

2.1 Factors that contribute stress among students

1. Academic Stress: - Academic stress has been identified as the primary cause of these

alarming figures. Lee & Larson (2000) explain this stress as an interaction between

environmental stressors, student's appraisal and reactions for the same. It has now become a

grave reality that is termed as a "career stopper" (Kadapatti & Vijayalaxmi, 2012). It therefore,
becomes a significant cause of concern as it is symptomatic of rising mental health concerns

(Nadamuri & Ch, 2011).

Depression, anxiety, behavioral problems, irritability, etc. are few of the many problems

reported in students with high academic stress(Deb, Strodl & Sun, 2015;Verma, Sharma &

Larson, 2002).Incidences of depression were also found among stressful adolescents as it is

linked with inability to concentrate, fear of failure, negative evaluation of future, etc. (Busari,

2012).

Adolescents were also reported to be indulging in various risky behaviours such as

increased consumption of alcohol and drugs, unprotected sexual activities, physical inactivity,

poor eating and sleeping patterns (American College Health Association, 2010; Bennet &

Holloway, 2014; King, Vidourek & Singh, 2014).

The pressure these students face to perform is so severe resulting in five-fold increase in

suicide attempts. It becomes imperative to also understand that low stress does not necessarily

ascertain that students will perform better, but in fact under these circumstances, they would

perceive the task as unchallenging and may also get easily bored (Uchil, 2017). The educational

system also plays an enabling role subsequently leading to increased stress levels experienced by

students. Some of the sources include overcrowded lecture halls, semester grading system,

inadequate resources and facilities (Awing& Agolla, 2013), vastness of syllabus (Agrawal

&Chahar, 2013; Sreeramareddy et al., 2015), long hours and expectations of rote learning (Deb

et al., 2015). Parents and institutions relentlessly instill the fear of failure which affects their self-

esteem and confidence. Ang & Huan (2012) reported increased expectations as one of the factors

responsible for increased stress levels.

The worry about academic performance can cause stress symptoms such as anxiety,

insomnia or changes in your appetite and overall mood. According to Morehouse State
University (2013), youth have poor study habits and cram last minute studying in the night

before exams. The fear of exams and workload create stress among students. The first cause of

stress among university students is a lot of assignments.

2. Finances: - All young people feel stress about money! Most young people do not have

jobs, or the jobs that they do have don't pay as much as they would like for them to. They want to

maintain the lifestyle and fulfill the demand of articles like mobile, bikes and cars etc. If they fail

to fulfill the requirement then it creates a stress. Relationships - Relationships are another big

aspect of stress (A Singh, S. Singh, Stress and adjustment among professional and non-

professional students, Industrial Psychiatry journal, 2010)

3. Careers:- Job Stress is a chronic disease caused among the current youth that

negatively affect an individual`s performance and/or overall well-being of his body and

mind. The high competition, an inconsiderate work colleague, a lack of job security, there are

many causes of job stress. The students have fear of not getting the job opportunity and

competition in the market (Redhwan AANa, Sami Ara, Karim AJa, Chan Rb and Zaleha MI,

2012)

4. Time management:-A lack of time management also causes stress on youth,

whether secondary or tertiary. Balancing academics, peer activities, and home life can be

difficult. Toss in a part-time job and the challenge increases (Joseph E. Agolla and Henry Ongori

2018)

5. Family Support and financial concerns: - The contextual variables of family support and

responsibilities and concerns about finances can impact students' academic performance.

6. Language difficulties:-Language proficiency may have a profound effect on an

individual's ability to learn and develop, due to its key role in the transmission of information

and regulation of cognitive processes (Binder & Smith 2013). Language is one factor that has so
much influence on the life of a student. Language is the only means to communicate freely, so if

students are having issues understanding the language been used in the academic process it

becomes a big challenge to them and they will eventually start thinking about it. Once this

happens they become frustrated and stressed up when even they have communicated and at the

long run affects their performance.

Flynn et al. (2012) found that family can have a positive and a negative effect on

academic performance among students. Specifically, family support such as encouragement for

degree completion by family members can be a positive motivator for academic performance;

however, family obligations such as helping grandparents or being present for the family while

dealing with a family crisis can negatively affect academic performance.

Other individual specific factors include changes in living atmosphere, Beats stress in

school, Peer pressure, being homesick, academic or personal competition, personal pressure to

do well, social anxieties, and heavy workloads difficulties managing personal and academic life,

sleep disturbance, being expected to speak up in class, being disorganized and having a fear of

change etc. (Chernomas & Shapiro, 2013; Goff, 2011; Jimenez, Navia-Osorio & Diaz, 2010)

2.2 Impact of stress on academic performance

Stress affecting students academically leads them to have bad performance in school work.

Students experience a lack of concentration. Stress in college students can affect the ability to

concentrate, and there have been studies conducted that prove that stress interferes with a

student's ability to concentrate, Stress in students is not something we can take likely. Ironically

stress Improves concentration for a short term because when students are little stressed up they

then to focus to try to get the issue in question which stresses them away but these concentrations
doesn't last for long since they will have more school work or others assignments to do which

demand long-term concentrations rather than the short term. (Centre, K. C. 2010).

Furthermore, stress affects the productivity or the output students make. When students

are stressed up they turn not to give their maximum best when doing school work and as a result,

it manifests in the outputs the bring which are clearly seen in the grades. Stress makes students

spend fewer hours trying to get some school work done and they also do it in a shabby manner

not following the instructions giving the assignments in question. They also don't make adequate

preparation for examinations. In the long term, it can even affect their plans for the future.

(Hiriyappa, B. 2013).

Also, stress affects the initiative skills of students. Most students when stressed up-turn to

lack the ability to bring up new ideas to solve problems or issues, thus when students are faced

with some challenges which might be even so easy to solve because they are stressed up to

refuse or are unable to rack their brains to find solutions to that problem. (Philippe M Binder &

K. Smith 2013).

Lastly, stress cause students to be confused and also suffer from amnesia. All people

when stressed upturn to be sixes and sevens with the little- complicated issues. In the academic

life of students, they easily have misunderstandings with what is been taught in school and don't

know what to do. On the other hand, many of them (Hellhammer D. & Hellhammer, J. 2013.

2.3 Strategies of reducing stress among students

According to American Psychological Association (APA 2018), there are many evidence-based

tools/strategies to help combat or reduce the negative effects of stress in healthy ways. They

recommend that:-

I. Cultivate social support: Strong social support can improve resilience to stress. Reach out

strategically. Some friends or family members may be good at listening and sympathizing.
Others might excel at practical help, like bringing over a home-cooked meal or covering an hour

of child care. Giving support can also increase positive emotions and decrease negative

emotions. Just make sure your relationships stay in balance. A friend who requires support but

never gives it may increase your stress level.(Nelson, S. K...,& Lyubomirsky, S. (2016).

II. Seek good nutrition: When confronted with a stressor, the central nervous system releases

adrenaline and cortisol, which affects the digestive tract among other physiological changes.

Acute stress can kill the appetite, but the release of the hormone cortisol during chronic stress

can cause fat and sugar cravings. Research also suggests that high cortisol combined with high

sugar consumption may prompt the deposition of fat around our internal organs- visceral fat that

is associated with cardiovascular and metabolic diseases. A diet high in a variety of nutrients can

both protect health and provide more physical energy to deal with challenges. No need to go

vegan or swear off cookies -just aim to consume a rainbow of fruits and vegetables as part of

your daily diet. Avoid using substances such as alcohol to dampen the stress response since

substances do not solve the root of the problem and can have serious health effects.

(Gyllenhammer, L. E.,Spruijt-Metz, D...,& Davis, J. N. (2014).

III. Relaxation:-Because stress causes muscles to tense, being stressed out can create tension

headaches, backaches and general fatigue. Combat stress and these symptoms with stretches,

massage or warm baths. Or try progressive muscle relaxation, a method that has been shown to

reduce anxiety and improve overall mental health. To practice progressive muscle relaxation, get

in a comfortable position and choose a muscle group, like your lower leg muscles (most

practitioners recommend starting with the lower body and working your way up). Inhale and

contract the muscles for five to 10 seconds, then exhale and release the muscles suddenly. Relax

for 10 or more seconds and then move on to the next muscle group. Another option is passive

progressive muscle relaxation. This technique is similar to progressive muscle relaxation but
skips the tensing step. Instead, simply picture each muscle group one at a time and focus on

relaxing that portion of the body (Savage, B.M., Thipparthi, R.R & DiCarlo, S.E. (2017)

IV. Meditation:-A strong body of research shows that mindful meditation can reduce

psychological stress and anxiety - even short-term mindfulness meditation programs work. To

get started, set aside five minutes in a quiet place to sit and breathe. Focus on the present

moment; if stray thoughts intrude, acknowledge them and then let them go. Don't judge yourself

for any mental wavering. Gently refocus and bring the attention back to the present moment

(Goyal M, Singh S, Sibinga EMS, et al (2014).

V. Sleep protection: Daytime stress affects night time sleep. Making matters worse, losing

shut eye can affect both cognition and mood. How to sleep better? Try to have a consistent sleep

routine that allows time to wind down before lights out. Meditation and relaxation can help with

insomnia. Also, avoid caffeine and alcohol in the late afternoon and evening. Put down the

screens, as blue light can suppress the sleepy hormone melatonin (and checking social media

may ramp up your emotions.) Finally, move the body during the day: A large body of research

suggests that physical activity can improve sleep, especially for middle-aged and older adults.

(Goyal M, Singh S, Sibinga EMS, et al (2014).

VI. Physical activity: Brisk movement can not only improve sleep, it can directly combat

stress. In one study, working adults who participated in moderate physical activity had half the

perceived stress as working adults who did not participate. Physical activity may also cancel out

some of the negative effects of stress, including the impact of stress on the immune system.

Adding physical activity needn't be expensive or complex: A brisk 30-minute walk or a dance

session in the living room can do the trick. (Black, D. S., O'Reilly, G. A...Breen, E. C., & Irwin,

M. R. (2015).
VII. Take a moment in nature: Studies conducted in multiple countries have found that green

space improves mood. Even nature videos can speed the recovery from stress compared with

videos of urban scenes. Taking a moment to notice nature - even in the form of a bustling city

park - can refocus and calm the mind.(Kondo, M., Fluehr, J., Mckeon, T., & Branas, C. (2018)

2.4 Theoretical framework/Review

Selye's (1956) General Adaptation Syndrome of stress

Selye's General Adaptation Syndrome of Stress is a model that analyses an individual's response

to long term stress which is broken down into three main stages, the initial alarm stage, the

interim resistance stage and finally the exhaustion stage (Nicky Hayes, 1994). If the stressor

persists the individual will progress through each of the stages, and in some cases disease and

even death can result.

During the alarm stage the body reacts to the stressor with a 'fight or flight' response in

which the parasympathetic nervous system is activated and hormones (e.g. adrenalin and

noradrenaline) are released from the adrenal medulla (Richard Gross, 2010). If the stressor

remains, the body then goes into the resistance stage during which it may outwardly appear to be

functioning normally, however levels of blood glucose, cortisol (stimulated by

adrenocorticotrophic hormones known as ACTH) and adrenaline remain higher than normal and

the individual's heart rate, blood pressure and breathing will be higher than normal. The

individual may appear calm but they are physically and mentally at 'action stations'

(currentnursing.com, 2014). During the final, exhaustion stage the further release of ACTH is

inhibited by the hormones it has already stimulated and the levels of ACTH itself circulating in

the blood. At this point the body begins to use up its energy reserves or resources and the body

cannot function adequately. Blood sugar levels drop and the individual becomes vulnerable to
disease and death. As Nicky Hayes (1994, p450) states 'This [final stage] produces an immediate

and strong - sometimes excessive - reaction to even mild sources of additional stress'.

As a model of stress, the General Adaption Syndrome (GAS) is focused primarily on the

bodies' physiological response to stress. It does not take into account other factors influencing an

individual's response to stress such as their thoughts, perceptions or feelings and how these

cognitive and psychological factors impact upon their experience of stress itself (garysturt,

2004). Nonetheless the GAS was a hugely influential model which generated a lot of further

study (currentnursing.com, 2014).

Folkman & Lazarus' (1984) Cognitive Appraisal Theory of stress

Unlike the GAS model of stress, the Cognitive Appraisal Theory of stress focuses on an

individual's cognition of a stressor which informs their emotional response. It is 'a theory of

emotion which implicates peoples personal interpretation of an event in determining their

emotional reaction' (psych central, 2014). The way in which an individual interprets the stressor

is significant and according to Folkman and Lazarus we respond to a stressful event or situation

by making a primary appraisal, during which we assess whether the event is harmful to us either

physically or in terms of our esteem, core beliefs and our values or goals. During the secondary

appraisal (which can take place before, at the same time or after primary appraisal) we consider

whether we have the resources to manage the stressor; the outcome of which affects our coping

strategy.

Coping strategies can be understood as either: problem based; where the stressor is perceived as

a challenge and we generate strategies to manage it or solutions to remove it, or emotional based;

where the problem is considered to be a threat that cannot be resolved and various coping

strategies such as avoidance, distancing and acceptance are employed (blackswanstress, 2014).
According to the Cognitive Appraisal of Stress model then, in response to a stressor we establish

if there is a threat, employ coping strategies and then reassesses the threat which results in

identification of emotional responses (Nicky Hayes, 1994). Stress is viewed in a more

transactional sense, as a two way process in which individuals respond dynamically to their

environment. Unlike the GAS model then, cognitive approaches are of paramount importance

and it is a more fluid and responsive model, recognizing the importance of the individual in each

and every stress response.

Homles and Rahe.

The Holmes and Rahe questionnaire identifies what it considers to be significant life events in

the causation of stress, and ranks them according to the associated levels of stress that they

would induce. Upon completing a questionnaire, individuals who scored highly (i.e. experienced

a significant number of life events within the last twelve months) are expected to be at a greater

chance of suffering from stress and developing illness than those who did not. The results of

their studies showed a small positive correlation meaning that life events are part of (but not

wholly) the cause of illnesses (simply psychology, 2014). The kinds of physiological effects

stress can have on the body include heart disease, high blood pressure, a repressed immune

system and gastric ulcers (psychology4a, 2014). Other effects include being more prone to

accidents. The underlying assumption being that these life events are negative changes and that

they cause us to experience stress which in turn has an effect on our wellbeing in the long term.

(UKEssays. (November 2018).

Application of theory

This theories was adopted for the study because it serve as a guide student for the student by

helping them to know the concept of stress, its response and also it is effects on academic

performance.
2.5 Empirical Review

A number of studies have been carried out on psychological effects of stress on academic

performance of students by different researchers from different part of Nigeria and outside

Nigeria at different point in time using different method. Among such researchers are

Oduiwaye Rhoda olapeb and Yahya Lasiele (2017) who investigate on psychological effects of

stress on academic performance of student in Kwara University. The researchers use (descriptive

survey research design) to determine the psychological effects of stress. Based on the study out

of 300 respondents 284 (94.7%) experienced high level of stress while 16 (5.3%) experienced

low level of stress. The model age range is 21_30years. 33.0% were married while 77% are

single. This study was concluded that students in Kwara University have moderate academic

performance as a results of high influence of stress personally, in their environment and also in

their achievement which manifest in the achievement of their academic goals.

Azila-Gbettor et al. (2015) examined the stress sources and their effects on academic

performance of Business Students in Ho Polytechnic, Ghana. A cross sectional research design

was employed in conducting the study. Using a sample size of 275 students which were sampled

through the use of multistage sampling procedure. The Burge's (2014) modified five-point Likert

stress scale was used to solicit for the requisite data for the study. While descriptive statistics

were used to determine the most dominant sources of stress, while the Non-parametric inferential

statistics was used to assess the significance differences in stress level by demographic variables.

The study among other things found the most dominant stress for each stressor category

examined. However, the two most dominant stress categories are "TECATS" and "TACS". The

level of stress was found to be significant for all demographic variables evaluated. However, the
causal factors for stress categories have been mixed. Finally, no significant effects were found

between stress and academic performance.

Nandamuri and Gowthami (2013) studied the stress among students of professional

studies and claimed that curriculum and instructions parameters were most responsible for stress

with 86%, followed by 63% for placement related issues, assessment and team work issues

accounted for 41% and 24% respectively. The study further identified various micro issues

responsible for stress, and listed twelve (12) sub issues related to curriculum and instruction.

Once the sub issues of each parameter are identified, it provided improved vision to the academic

administrators for initiating efforts to reduce the gravity of academic stress.

Deb et al. (2014), studied on 400 male students from five private secondary schools in

Kolkata who were studying in grades 10 and 12. 35% students were found to have high academic

stress and 37% were found to have high anxiety levels. Students with marginal grades were said

to have higher level of stress as compared to students with better grades. Also, students involved

with extra-curricular activities were noted to be more stressed as related to those students who

were not involved with it. Kaur (2014) acknowledged that mental health of teenagers get

affected due to the academic stress. Girls with academic stress were found to have poor mental

health as compared to the boys. This was accounted on the study that parents at times put

pressure and strain on students that leads to deteriorated mental health.

Subramani and Kadhiravan (2017) revealed the link between effect of stress and mental

health among students. He endorsed that effect of stress and mental health are correlated and that

students are cramped with the academic structure. Parents and schools pressurize the students

way too much for the higher grades that disheartens the students, further to add on there is not

enough support from the parents and school in terms of guidance. The students are mentally

healthy when they perform constructively in the academic forums. They also propounded that
students from private schools are more pressurized as compared to students from government

schools due to the excess of homework and other academic related assignments. Significant

difference in mental health of students from private and government schools was found. He

asserted that students from private schools have a different nurturing and vast exposure as

compared to government school students who belong to poor socio economic background and

lack of exposure. This is one of the reasons for the escalation of stress.

Sharma et al. (2016) in their study stated the use of various methods to curb stress. Doing

one physical exercise on daily basis can address the concern of stress. One can also adopt to

various time management tools and get involved with leisure activities which can benefit

students. Also, it was suggested that colleges should have a conducive ambience to curtail the

stress. Change in the style of delivery from teachers end and providing mentors can bring fresh

air to the teaching style.

Reddy et al. (2018) in their study concludes that stream wise difference in stress does

exist in students. It is important to deal with stress at personal, social and institutional level.

Remedies such as feedback, yoga, life skills training, mindfulness, meditation and psychotherapy

have been found useful to deal with stress. To identify the main reason of stress is the key to deal

with it. Professionals can develop tailor made strategies to deal with stress. The integrated

wellbeing of the students is important not only for the individual but for the institute as well.

Dimitrov (2017) in his study claimed that stress can be addressed by ensuring that the students

give utmost importance to their welfare. Food, exercise, work, recreation are some of the areas to

focus on. He also concluded that the education system is more to do with the academic

qualifications and does not contribute enough to the holistic development of students. Students

are usually conditioned in a way that makes them fearful to take up upcoming challenges as the

focus is only the academics and not the development of a go getter mentally. There are not many

choices for the medium of education. English being the only option available can pose as a
hindrance for the students from rural background. There are not many courses available that are

employment centric. Fresh graduates need more communication skills development for better

placements.

Researchers such as Woun (2013), Ongori (2017), Erkutlu and Chafra 2016) identified

the following as stressors, too many assignments, competition with other students, academic

failures, lack of 'pocket money', poor relationship with other students or lecturers, family or

problems at home, accommodation and overcrowded lecture halls. When students are faced with

these stressors, they become disorganized, disoriented and find it extremely difficult to cope.

However, majority of students claimed that course load is the source of the stress which in turn

affects their Grade Point Average (Talib and Zai-ur-Rehman, 2012).

Also some students report that the prospect of having to sit for examinations is stressful

because of the pressure to revise all the learned material within a given period of time (Mani,

2014). Baldwin, Wilkinson and Bradley (2012) emphasized that student-workers experience

greater stress during mid-term and final examination periods of the academic year than during

any other time. This arises from absenteeism from class due to the demand to be at work.

Malach-Pines and Keinan (2017), Ongori (2013) Ongori and Agolla (2015) identified stress

symptoms as lack of energy, taking over the counter medication, high blood pressure, feeling

depressed, and increase in appetite, restlessness, tensions and anxieties among others. They

discovered that the major causes of stress among students are academic workload, inadequate

resources, low motivation and poor performance in academic work, over-crowded lecture halls

and uncertainty of getting jobs after graduation from the university

This study finding show that there were factors that contribute stress among students,

these factors that contribute stress among students include: - academic stress, finances, careers,

time management, family support and financial concerns, language difficulties, sleep
disturbance, peer pressure, managing academic or personal life, and heavy workload. These

factors affect their academic performance which lead them to stress.

Secondly majority of students are affected with stress because of inadequate preparation

followed by fear or repeat or dismissal.

Thirdly stress affect the students psychologically which predisposed them to failure in

examination.
 CHAPTER THREE

METHOLOGY

3.0 Introduction

This chapter was discussed under the following sub-headings:-research design, research setting,

target population, sampling technique, instrument for data collection, validity of the instrument,

reliability of the instrument, method of data collection, method of data analysis, ethical

consideration.

3.1 Research Design

A descriptive method of research design is used in this study. This design was used because it

allow people to show their opinion on the particular issue that concern and it helps to describe,

analyze and interpret the condition or variable that exist in the study

3.2 Research Setting

The research was conducted at Zamfara State School of Nursing and Midwifery Gusau.

“Brief history of Zamfara State School of Nursing and Midwifery”

The school was established by edict (Law No.4 of 2006), during the first executive Governor of

the state Alhaji (Dr) Ahmad Rufai Sani (Yariman Bakura) and started admitting students in

NOVEMBER 2007.It was established in order to train the much needed qualified professional

Nurses and Midwives for the state and Nigeria in general. The school has the following

department under the leadership of 'Executive Director'.

1. School of Nursing - headed by the principal school of nursing

2. School of Midwifery - headed by the principal school of midwifery

3. Department of Administration - headed by the director Admin

4. Department of Finance/Bursary - headed by the director finances/bursary

 5. Department of Library - headed by the school librarian

6. Department of Remedial Studies - headed by the director remedial studies

7. Department of Maintenance - headed by the director maintenance.

The school area which is the area under study is located in the northern East part of Zamfara

state in Nigeria, it lies between latitude 12°8'58.3°N and 6°42'51°.5E in the northern -eastern of

the local government area (Gusau). "No 11 Zaria road, Gusau P.M.B 01179" .

The school comprises of administrative, finance, maintenance, hostels well equipped,

modern classroom, block facilities for practical demonstration for both nursing and midwifery

department, science laboratory, school clinic, E- learning center and a library.

The mission of the school is to "actively promote dedication to the professional value of

individual & population centered services, quality care & patient safety"

The motto of the school is Eager to learn, ready to serve.

3.3 Target population

The population of this study was student midwives of Zamfara state School of nursing and

midwifery Gusau, it cut across the various classes of the school i.e. year 1, year 2, year 3 student

where 100 student was selected as a sample to conduct the research.

3.4 Sampling technique

In carrying out his research a simple random sampling was adopted. Therefore all the

respondents have equal chance of being selected, Where 100 students Was randomly select to

represent the whole population.

3.5 instrument for data collection

The instrument for data collected in this study is structured questionnaire, which is for likert

scale format and the questionnaire was drawn from the research question. It comprises of four (4)

Section (A, B, C and D). Section A is demographic data, Section B to obtain on the factors

contributing stress to students. Section C to elicit information on the impacts of stress on

academic performance and Section D to find out ways/strategies of reducing stress among

student Midwives of Zamfara State School of Nursing and Midwifery Gusau.

3.6 Validity of the instrument

Face and content validity was used to validate the instrument, a copy of the structured

questionnaire was given to the project supervisor and four (4)experts from the department of

nursing and midwifery i.e. the initial draft of the questionnaire for editing of all items to ascertain

the validity and all the correction made was considered & proper assessment on the basis

relevance, clarify precision and appropriateness of the respondents, the instrument will later

modified on the basis suggestion by the experts.

3.7 Reliability of the instrument

The reliability of the instrument is by test and re test method in order to determine the internal

consistency of the questionnaire, the instrument was administered to 10 student midwives and

after two weeks, the same set of people and instrument was analyzed In order to establish the co

efficiency.

3.8 Method of Data collection

The Instrument was administered to the respondents in their Classes at Zamfara state School of

Nursing and Midwifery Gusau by the researcher face to face on the spot where the respondents

fill and return back to the researcher.

3.9 Method of Data analysis

The data collected was analyzed using statistical mean, as percentage in the tables in the section

A, B, C, D and any item with a mean of 2.5 is expected to be agreed and any item with a mean of

below 2.5 is considered as disagreed.

3.10 Ethical Consideration

The researcher will obtained consent from the respondent assuring them that information from

the respondents would be treated with confidentiality, the research findings are pure and there is

no falsification of data.
 CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

4.1 Introduction

This chapter shows the analysis, presentation and interpretation of information retrieved from the

respondents. The information was presented in frequency distribution table according to research

question that guide the study.

4.2 Section A: (Demographic data)

Table 1: Distribution of the respondent according to age

AGE FREQUENCY PERCENTAGE

16-20 14 14

21-25 40 40

26-30 37 37

31-Above 9 9

Total 100 100%

The above table 1: shows that 14 of the respondents representing 14% are between the ages of

16-20 years, 40 0f the respondents representing 40% are between the ages of 21-25 years, 37 of

the respondent representing 37% are between the ages of 26-30 years while 9 of the respondent

representing 9% are between the ages of 31-Above years.

 Table 2: Distribution of the respondent according to marital status

MARITAL STATUS FREQUENCY PERCENTAGE

Single 77 77

Married 21 21

Divorce 2 2

Total 100 100%

The above table 2: shows that 77 of the respondents representing 77% are single, 21 0f the

respondents representing 21% are married, 2 of the respondent representing 2% are divorce

Table 3: Distribution of the respondent according to occupation

OCCUPATION FREQUENCY PERCENTAGE

Civil servant 4 16

Unemployed 80 80

Business 16 4

Total 100 100%

The above table 3: shows that 4 of the respondents representing 4% are civil servant, 80 0f the

respondents representing 80% are unemployed, and 4 of the respondent representing 16% have

business
Table 4: Distribution of the respondent according to religion

RELIGION FREQUENCY PERCENTAGE

Islam 92 92

Christianity 8 8

Others - -

Total 100 100%

The above table 4: shows that 92 of the respondents representing 92% are Muslim, 8 of the

respondents representing 8% are Christians and 0 of the respondents representing 0% are others,

meaning no any other of respondent with religion other than Islam and Christianity
Table 5: Distribution of the respondent according to tribe

TRIBE FREQUENCY PERCENTAGE

Hausa 75 75

Yoruba 12 10

Igbo 3 5

Total 100 100%

The above table 5: shows that 75 of the respondents representing 75% were Hausa, 12 0f the

respondents representing 12% were Yoruba, 3 of the respondent representing 3% were Igbo

Table 6: Distribution of the respondent according to level of study

LEVEL OF STUDY FREQUENCY PERCENTAGE

Year 3 80 80

Year 2 14 14

Year 1 6 6

Total 100 100%

The above table 6: shows that 80 of the respondents representing 80% were in Year 3, 14 0f the

respondents representing 14 % were in Year 2, While 6 of the respondent representing 6% were

in Year 1

4.3 Section B
 The data analysis of research question 1 represented in table 7

Table 7: Research question 1: What are the factors contributing the stress among students

S/N ITEMS S A S D (X) REMARK

A D S

7 Academic stress have been identified as the 58 38 4 0 3.5 Agreed

primary cause of stress among students

8 Lack of time management can also 20 72 8 0 3.6 Agreed

contribute stress on youth student whether

secondary or tertiary

9 Family Support and financial concern can 44 26 16 14 2.9 Agreed

impact student's academic performance

10 Language proficiency is one of the factors 20 52 12 16 3.1 Agreed

that has so much influence on the life of a

students

N=100

Data in table 7: Shows that respondents agreed with the item 7 with a mean of 3.5, item 8 with a

mean of 3.6, item 9 with a mean of 2.9, item 10 with a mean of 3.1

4.4 Section C
 The data analysis of research question 1 represented in table 8

Table 8: Research question 2: What are the Impacts of stress on academic performance?

S/N ITEMS SA A SD D (X) REMARK

11 Stress affecting students 74 22 0 4 3.7 Agreed

academically leads them to have

bad performance in schools

12 Stress can make students 18 69 6 7 3.5 Agreed

experiencing headache,

restlessness and other mental

health condition

13 Stress can cause students to be 76 22 0 2 3.8 Agreed

confused and also suffer from

amnesia

14 Stress can cause lack of 80 18 0 2 3.8 Agreed

concentration and affect the

initiative skill of students

15 Stress can make student not to 66 24 6 4 3.5 Agreed

make adequate preparation in

exams which can lead to failure in

examination

N=100
Data in table 8: Shows that respondents agreed with the item 11 with a mean of 3.7, item 12 with

a mean of 3.5, item 13 with a mean of 3.8, item 14 with a mean of 3.8, item 15 with a mean of

3.5

4.5 Section D

The data analysis of research question 1 represented in table 9

Table 9: Research question: What are the strategies of reducing stress among students?

S/N ITEMS SA A SD D X REMARK

16 Adequate provision of the students 74 22 0 4 3.7 Agreed

educational needs, teaching supervision

of the student work at home by parents

can enhance the students’ academic

performance

17 Physical activities such as meditation, 82 10 0 0 3.8 Agreed

guided imagery, deep breathing may

also cancel out some of the negative

effects of stress

18 Diet with high in a variety of nutrient 64 24 4 8 3.4 Agreed

can both protect health & provide more

physical energy to deals with challenges

19 Enhancement of the academic level of 80 20 0 0 3.8 Agreed

the students & positive attitude toward

education can also improve student's

 academic performance

20 Avoidance of reading only when exams 74 22 0 4 3.7 Agreed

come close can reduce stress among the

students

N=100

Data in table 9: Shows that respondents agreed with the item 16 with a mean of 3.7, item 17 with

a mean of 3.8, item 18 with a mean of 3.4, item 19 with a mean of 3.8, item 20 with a mean of

3.7
 CHAPTER FIVE

DISCUSSION OF FINDINGS

This chapter deals with the following subheadings: Discussion of finding, Conclusion of the

study, Summary of the study, Implication of study to the nursing/midwifery, Limitation of the

study, recommendation and suggestion for further studies.

5.1 Discussion of findings

The data collected were discussed in line with the research question that guided the study

Research question 1: What are the Factors contributing stress among students?

The finding shows that majority of the respondents agreed that Academic stress and lack

for time management can also contribute stress among student whether secondary or tertiary.

This is in view of Binder & Smith (2013) Said that language proficiency, Academic stress, lack

of time management may have a profound effect on student ability to learn and develop skills

which if students are having issue on them it become a big challenge to them, and once thus

happens they become frustrated and stressed up and at the long affect their performance

Research question 2: What are the impacts of stress on academic performance?

The finding shows that majority of the respondents agreed that stress affecting students

academically which lead them to have bad performance in schools, experience headache

restlessness and other mental health condition, lack of concentration which may affect the

initiative skills of students, confused and also suffer from amnesia. With the view of that stress

affects the productivity or the outputs students make, when students are stressed up they turn not

to give their maximum best when doing school work and as a result, it manifest in the output

they bring which are clearly seen in the grade, they also don't make adequate preparation for

examination and in the long term can even affect their plans for the future (Hiriyappa, B. 2013)
Research question 3: What are ways of reducing stress among students?

The finding shows that majority of the respondents agreed that physical activities such as

meditation, rest and sleep, guided imagery, deep breathing may also cancel out some of the

negative effects of stress, diet with high in a variety of nutrient can protect health & provide

more physical energy to deals with challenges, avoidance of reading only when exams come

close can reduce stress among students. This is conformity with the views of American

psychological association (APA 2018) they are many evidence-based tools/strategies to help

reduce the negative effects of stress in health ways which include:-"physical activities, seek good

nutrition, rest and sleep, relaxation etc."

5.2 Implication of the finding to nursing/midwifery

The implication of this study cannot be over emphasized. According to analysis which shows

that factors that contribute stress among student midwives are lack of time management, family

support & financial concern, careers, language proficiency/difficulties. Therefore Stress affecting

students academically leads them to have bad performance in schools, it can make students

experiencing headache, restlessness and other mental health, confused and lack of concentration,

amnesia, stress can make student not to make adequate preparation in exams which can lead to

failure in examination and subsequently withdraw from schools

5.3 Limitation of the Study

During the study only female students responded, most of the respondents respond to what they

think is ideal and appropriate on effects of stress on academic performance

5.4 Summary of the Study

This study was conducted at School of Nursing and Midwifery Gusau, Descriptive research

method was used, data was collected from 100 Students in the School whom were withdrawn out

of the target population

The questionnaire was used as an instrument for data collection which has 4 item as

Section A contained demographic data of the respondents where B.C and D were structured

based on the research question that guided the study using 4 likert format scale for the

respondents to tick in appropriate column needed.

The questionnaire was subjected to face and content validity which was given for

validation to four (4) tutors withdrawn from both School of Nursing and Midwifery Gusau.

Necessary corrections was made and the correction was used in the modification of

questionnaire.

A total of 100 questionnaires was administered to the respondents by the researcher 100

questionnaire were retrieved and use for analysis. The data was analyzed using percentage

frequency distribution. On research questions that guided the study was analyzed using mean

statistics, where item with a mean of 2.5 or greater were considered agreed while item with less

than 2.5 considered disagreed.

5.5 Conclusion of the Study

Based on the findings of the study revealed that stress can affect the student academically which

in turn lead them to failure in examination and other mental health condition, there is need for

students to reduce stress which can affect their academic performance, due to lack of
concentration, inadequate preparation before examination, lack of time management, family

support and financial support e.t.c which can affect their academic performance

5.6 Recommendations

The following recommendations were made based on the findings of the study

a) School authorities should ensure good academic environment for the students and ensure

that measures to minimize/reduce stress are put in place, measures such as: appropriate

course load, appropriate lecture hours, proper lecture schedule, non- congested lecture

halls, and reduce load on assignment.

b) Teachers and Lecturers/educators should increase awareness to all nursing students on

stress and it is effects, teaching of quality skills on how to cope with stress in

examination, time management & solving skills and also focus on intrinsic motivation

which will have greater impact on students in achieving high academic performance

amidst academic stress. Finally, competition like football, tennis, quiz and competition

and other social activities like Arena week, talent shows etc. should be organized for

students in order to release them from distress and enhance their academic performance.

c) Guidance programs such as seminars, workshop, public lectures on stress awareness

should be organized periodically for students so that they can be adequately equipped

with the needed skills to handle issues related to stress.

d) Parents and family members should give support, guidance and appropriate counseling to

reduce stress on students

e) Students should be encouraged to make use of the counseling centers provided by the

school to help them build positive perception on academic stress

5.7 Suggestions for further studies

The researcher suggest that the following topics could be carried out for further study

1) similar study should be conducted in the area of present study using academic staff

2) Researchers should research more on inter disciplines in order to find out how different

programs are perceived by students in terms of their stress levels, future research

should use larger sample size from other institutions to validate these findings.

3) More research should be done to examine the effect of academic stress on student’s

performance as a whole in relation to other universities in order to investigate university

activities that induce stress.

4) Also an investigation should be done on the effect of academic stress on students’

health.

5) Finally, more studies can be carried out using longitudinal method to find the role culture

and social class play in academic stress.