Stress among healthcare students--a cross disciplinary perspective

Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study

BACKGROUND

Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings.

OBJECTIVE

To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies.

DESIGN

Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis.

SETTING

Simulation laboratories in one university nursing school in Australia.

PARTICIPANTS

21 final year nursing students in seven teams.

METHODS

Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies.

RESULTS

Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness.

CONCLUSIONS

Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.

Quality of life and quality of education among physiotherapy students in Europe

Background

The study of physiotherapy is challenging and can affect the students' well-being and quality of life. The aim of this study was to describe and compare factors that could affect well-being among students across Europe.

Methods

In this descriptive cross-sectional study using an online questionnaire survey, students of bachelor's physiotherapy programs from 23 European faculties, from 8 countries, were interviewed on mental health and stress burden, sleep quality, dietary habits, and physical activity.

Results

Although 75% of students rated their quality of life positively and 47% were satisfied with their mental health, 65% showed higher levels of stress and 51% described impaired sleep quality. The minimum physical activity of 150 min weekly was described by 79% of students, within which 67% engaged in strengthening twice a week. Students with a higher stress load/worse psychological health also showed worse sleep quality and lower amount of physical activity, women were significantly worse off. In terms of physical activity and sleep quality, students from Finland and Kosovo achieved the best results, while students from Italy, Greece, and Portugal achieved the worst. Students from Italy indicated the greatest dissatisfaction with the organisation of the study system and communication with teachers, while in Kosovo students rated the communication and study organisation the highest. All students had a problem with adhering to nutritional habits. Students from Italy and Spain, with the lowest body mass indexes and weight averages, were closest to the nutrition recommendations.

Conclusion

We demonstrated that physiotherapy students are burdened with stress, suffer from sleep disorders, and do not follow the recommendations regarding nutrition nor physical activity. There are significant differences between universities and countries in some aspects.

Association between physical activity and sleep quality among healthcare students

Objective

To assess the relationship between physical activity (PA) and sleep quality (SQ) in Mohammed Bin Rashid University (MBRU) students in Dubai, United Arab Emirates. Taking into account this being one of the first studies exploring this aspect among healthcare students in the Gulf Cooperation Council (GCC) countries.

Methods

This is an analytical cross-sectional study that involved disseminating online surveys via email to students of all 5 colleges in MBRU between March-June 2023. The survey encompassed queries on demographics, the Saltin-Grimby Physical Activity Level Scale (SGPALS), the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and the Pittsburgh Sleep Quality Index (PSQI).

Results

The survey was completed by 105 students. Most students were from the medical college (98/105; 93.3%) and were females (84/105; 80.0%). Females engaged the most in low PA (44.0%) while males engaged the most in high PA (42.9%) according to the IPAQ-SF. There was a significant association between SGPALS and gender (p = 0.007, X2 = 12.0). The global PSQI score showed that 70.5% of the students had bad-quality sleep. Sleep efficiency and leisurely PA are significantly negatively correlated (p = 0.026, ρ = -0.217) while sitting minutes and sleep duration are significantly positively correlated (p = 0.030, r = 0.212).

Conclusion

Significant negative correlations between sleep efficiency and leisurely PA demonstrate that while exercise has been implicated in the improvement of SQ, excessive exercise can behave as an additional stressor and induce negative changes in the SQ of healthcare students. Meanwhile, significant positive correlations between sleep duration and sitting indicate that adequate rest should not be undervalued in its effects on sleep. Furthermore, the findings of this study highlight public health implications that warrant attention by educators and policymakers in academic health systems.

Physical therapy student perception of self-reflection activities in a musculoskeletal course: A mixed-method study

BACKGROUND

Deliberate reflection is an effective method to aid in professional development. Most documented self-reflection activities (SRA) occur during clinical experiences. Literature on SRA within the didactic component of entry-level physical therapy education is lacking.

PURPOSE

The purpose of this mixed-method study was to evaluate student perception of in-class SRA.

METHODS

A convenience sample of 61 students in a DPT program was recruited. Students were enrolled in a musculoskeletal course and participated in six 10-minute SRA. At the end of the course, students completed a survey to assess perception.

RESULTS

Fifty-nine (97%) students completed the anonymous survey. Most reported they would continue SRA in future courses (92%, 55/60) and as a professional (95%, 57/60). Thematic analysis identified SRA promote the professional qualities of self-evaluation, confidence, and clinical excellence. Quiet time, self-evaluation, and sharing with others were identified as benefits of SRA. Curricular threading of SRA in entry-level physical therapy education was strongly suggested.

CONCLUSION

Self-reflection activities can be implemented into the didactic portion of entry-level physical therapy education and be perceived positively by students. Future research can assess the impact of SRA on clinical reasoning development during the didactic portion of entry-level physical therapy education.

Assessing how students value learning communication skills in an undergraduate anatomy and physiology course

Students, particularly those in science, technology, engineering and mathematics (STEM) and healthcare-related programs, should develop proficient interpersonal skills, including communication. To help students develop effective communication skills, instructors need to consider the value students give to learning these skills. The Student Attitudes Toward Communication Skills Survey (SATCSS) was developed to measure how undergraduate students value learning communication skills based on Expectancy-Value Theory across three modes of communication (verbal, written, non-verbal). The survey was given to students interested in healthcare professions and enrolled in an undergraduate anatomy and physiology (A&P) course (n = 233) at a Midwest research active university. The survey showed evidence of validity, measuring two components: (1) "Value to Profession" (attainment and utility value) and (2) "Value to Self" (intrinsic value and cost). There was a significant difference in sub-scores among the four task values such that students thought that learning communication skills was important and relevant (high attainment and utility value) but not interesting (low intrinsic value) and costly. Students with high total scores valued communication skills across all four task values. As total value scores decreased, it was first due to students finding learning communication skills to be time prohibitive and then a lack of interest in learning communication skills. Based on these results, it is recommended that instructors incorporate communication skills training into content that is already part of their A&P course to reduce time concerns. Additional recommendations include using reflective activities and humor to increase student interest.

Mental and physical health-related quality of life and their associated factors among students of a comprehensive allied health institution

BACKGROUND

Healthcare students are subjected to critical levels of mental and physical stress that might hinder their quality of life.

OBJECTIVES

This study comprehensively investigated physical and mental Health-related Quality of Life (HR-QoL) and their associated factors among Allied Health (AH) students of nine academic majors.

METHODS

Participants completed anonymous questionnaire included demographics and life style, HR-QoL measured by the 12-item Short-Form Health Survey (SF-12), Depression Anxiety Stress Scale (DASS21), and Nordic Musculoskeletal Questionnaire. SF-12 Physical (PCS) and Mental (MCS) Components Summary scores were compared between gender and between academic majors. Multiple linear regressions were conducted to examine factor associated with PCS and MCS scores.

RESULTS

A total of 838 students (77.4% females) participated in the study. The overall PCS was 45.64±7.93 and statistically different between majors (P < 0.001). The Overall MCS score was 39.45±10.86 and statistically greater in males (P < 0.001). PCS scores were significantly associated with anxiety score, GPA, diet self-evaluation, and upper back and hip musculoskeletal pain. MCS scores were significantly associated with weekly clinical training hours, stress score, depression score, gender, university year, GPA, sleep self-evaluation, diet self-evaluation, and neck musculoskeletal pain.

CONCLUSIONS

Low levels of mental and physical HR-QoL were observed among AH students and were associated with academic-related, health-related, and lifestyle-related factors. Longitudinal studies are needed to assess effective approaches to improve HR-QoL among AH students.

Factors Affecting Resilience of Nursing, Optometry, Radiography and Medical Laboratory Science Students

Background: The concern over the high level of stress experienced by students of the caring professions has led to increased attention being paid to the promotion of their resilience. Most earlier studies have focused on the resilience of medical and nursing students. There has been little exploration of the resilience and associated factors of students of other health-care disciplines. The aim of this study was to gather data from students of pre-registration health-care disciplines to identify the factors that influence their resilience. Method: Valid questionnaires were used to assess respondents’ resilience, self-efficacy, mindfulness, coping and trait positive and negative affect. The data were analyzed using descriptive statistics and univariate and general linear regression. Results: A total of 1320 university students from nursing, medical laboratory science, radiography and optometry were recruited. The results showed that the subjects’ resilience scores were lower than those of students in Western countries. We found self-efficacy and denial to be the common predictors for students of all disciplines. Conclusion: The resilience of students in the four disciplines was predicted by a combination of predictors. Faculties of universities and clinical mentors should collaborate in building resilience in their health-care students and support them to grow both personally and professionally during their careers.

Stress, Anxiety and Depression among a Cohort of Health Sciences Undergraduate Students: The Prevalence and Risk Factors

Stress, anxiety, and depression (SAD) have a negative impact on the learning and academic performance of university students. Hence, this study aimed to determine the prevalence, as well as the risk factors associated with SAD among a cohort of students pursuing undergraduate degree courses in health sciences. This is part of the strategy in building a healthy nation. A questionnaire containing socio-demographic factors and the short version of Depression, Anxiety, and Stress Scale-21 (DASS-21) was used to assess the likelihood of psychological distress. Logistic regression analysis was conducted to determine the risk factors of SAD. In total, 449 students completed the questionnaire (93.9% response rate). Of these, 65% had stress, 85.1% had anxiety and 51.4% had depression. Most cases of stress (74.6%) and depression (66.2%) were of normal-to-mild level, while 74.6% of them showed moderate-to-extremely severe anxiety. There was a statistically significant association between stress score and the year of study. In the regression analysis, poor sleep quality and fatigue were risk factors of anxiety and depression, whereas low-grade fever and frequent headaches were risk factors for stress and anxiety. Stress, anxiety, and depression scores were significantly higher among students studying medical imaging. A substantial proportion of health science students are suffering from SAD. This study recommends screening and close monitoring of the above-mentioned predictors and the formulation of comprehensive intervention strategies for students with SAD.

Stress and burnout in chiropractic students of European chiropractic colleges

OBJECTIVE

High levels of stress and burnout are known to negatively impact academic success, quality of life, and well-being of students. The purpose of this study was to investigate the degrees of stress and burnout levels of students from several European chiropractic colleges.

METHODS

Stress and burnout were assessed using the Perceived Stress Scale (PSS-10) and the Maslach Burnout Inventory-Student Survey (MBI-SS). Surveys were delivered electronically in November 2017 to chiropractic students from 4 different chiropractic colleges. Data were analyzed using t test and 1-way ANOVA to determine differences between demographic data. Scores in perceived stress and burnout subscales were compared to the general, chiropractic, and medical student populations.

RESULTS

Both the MBI-SS and PSS had similar response rates (30%-34%) and demonstrated statistically significant differences between institutions, with C-3 demonstrating the highest levels of exhaustion (p < .001) and the highest levels of perceived stress (p = .012). MBI-SS results show that in the general chiropractic student population, 26.4% presented high emotional exhaustion, 18.2% high cynicism, and 43.8% low academic efficacy. Meanwhile, the PSS score indicated "moderate" levels of stress.

CONCLUSIONS

European chiropractic students experience higher levels of perceived stress than the general population and they may suffer levels of burnout similar to those of medical students. These results suggest that colleges should monitor stress and burnout levels in their students. This may help to establish student support systems in order to improve students' quality of life and academic performance, as well as help new graduates transition to their professional lives.

Psychometric evaluation of the Arabic version of the higher education inventory scale for nursing students

BACKGROUND

Studies in the literature have relied on a single instrument to assess stress levels and sources among nursing students in Jordan and in other Arab countries. Thus, there is a need to develop Arabic versions of psychometrically validated instruments for evaluating a wider range of aspects related to stress and stressors. The Higher Education Stress Inventory (HESI) is an instrument used to assess various aspects of stress and stressors related to higher education in different educational settings and among different student populations. To date, no exploratory or confirmatory factor analyses have been conducted to study the factor structure of the Arabic version of the HESI. Therefore, the current study aimed to evaluate the psychometric properties of the Arabic version of the HESI (Arabic-HESI) among nursing students in Jordan.

METHODS

The structure of the instrument was tested using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and maximum likelihood estimation among a sample of 355 nursing students at five Jordanian universities.

RESULTS

The Arabic-HESI proved to have excellent content validity index (CVI = 0.92). The instrument showed good internal consistency reliability (Cronbach's α = 0.75), as well as for the two emerged factors "challenges" and "dissatisfaction" (Cronbach's α were 0.75, 0.72 respectively). The results support the two-factor model for the Arabic-HESI, as the instrument was found to have robust structure and acceptable goodness-of-fit indices.

CONCLUSION

The Arabic-HESI is a reliable and valid instrument for assessing stress levels and stressors among nursing students in Jordan. Using the shortened version of the HESI to assess stress among nursing students is recommended. Identifying new features of stress and stressors among nursing students in Jordan will enable universities and nursing faculties to better support their students.

Perception on the mind-nurse program among nursing students: A descriptive qualitative study

BACKGROUND

Nursing undergraduates are susceptible to stress from academic and clinical matters. We developed the MIND-NURSE program for nursing students.

OBJECTIVES

This study aimed to explore students' perceptions towards the program.

METHODS

This was a descriptive qualitative study. A convenience sampling was used to recruit nursing undergraduates from a university in Singapore. Participants attended the eight-week MIND-NURSE program. Each session comprised two components: Education and mindfulness practice. Three focus group interviews were conducted after completion of the program, using a semi-structured interview guide. Thematic analysis was used to identify emerging themes and subthemes.

RESULTS

Twenty students participated in the study. Overall, they reacted positively to the MIND-NURSE program, albeit some concerns raised regarding the mindfulness practice. Six themes were derived from the data including: a) enhanced awareness of the present moment; b) increased serenity through mindfulness practice; c) triad of thoughts, emotion and behaviors; d) working towards interpersonal mindfulness; e) adapting mindfulness into nursing practice; and f) overcoming the challenges for mindfulness practice.

CONCLUSIONS

Mindfulness benefited the students in personal and professional ways. More research should be conducted to implement the program on nursing students in other universities.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Early-onset colorectal cancer: initial clues and current views

Over the past several decades, the incidence of early-onset colorectal cancer (EOCRC; in patients <50 years old) has increased at an alarming rate. Although robust and scientifically rigorous epidemiological studies have sifted out environmental elements linked to EOCRC, our knowledge of the causes and mechanisms of this disease is far from complete. Here, we highlight potential risk factors and putative mechanisms that drive EOCRC and suggest likely areas for fruitful research. In addition, we identify inconsistencies in the evidence implicating a strong effect of increased adiposity and suggest that certain behaviours (such as diet and stress) might place nonobese and otherwise healthy people at risk of this disease. Key risk factors are reviewed, including the global westernization of diets (usually involving a high intake of red and processed meats, high-fructose corn syrup and unhealthy cooking methods), stress, antibiotics, synthetic food dyes, monosodium glutamate, titanium dioxide, and physical inactivity and/or sedentary behaviour. The gut microbiota is probably at the crossroads of these risk factors and EOCRC. The time course of the disease and the fact that relevant exposures probably occur in childhood raise important methodological issues that are also discussed.

Mindfulness in allied health and social care professional education: a scoping review

Background: Investigations into the use of mindfulness with allied health and social care students, many of whom ultimately work in rehabilitation settings, is in the nascent stages and no systematic mapping of the literature has occurred. The purpose of this scoping review was to identify, summarise, and describe the current state of knowledge on mindfulness in allied health and social care professional education.Methods: Arksey and O'Malley's scoping review methodology was adopted. Five data bases were searched; inclusion and exclusion criteria were applied; and 50 papers were identified for inclusion in the study.Results: Quantitative studies depicted mindfulness interventions as contributing to: improved capacities for mindfulness; decreases in stress, anxiety, and depression; improvements in academic skills, quality of life and well-being, and empathy; improved physiological measures and emotional regulation; and mixed effects on burn-out. Qualitative studies highlighted: 1) mindfulness and self-care, 2) mindfulness within professional practice placements, 3) mindfulness in the classroom, and 4) the cultivation of mindful qualities.Conclusions: The study has important implications for the education of future rehabilitation professions and suggests that learning about mindfulness may be useful in assisting students to: manage academic stress, anxiety, and depression; cultivate a physical and mental state of calm; be more present and empathetic with clients; and be more focused and attentive in professional practice settings.Implications for rehabilitationFurther exploration of mindfulness as a promising educational intervention for the professional preparation of future rehabilitation practitioners in allied health and social care fields is recommended.Education and research about mindfulness and its potential opportunities for students in terms of the mediation of stress, anxiety, depression, and the cultivation of empathy, academic skills, quality of life, and resilience are recommended.Education and research about mindfulness and its potential for the cultivation of beneficial qualities of mind such as attention, self-awareness, compassion, non-judgment, and acceptance are recommended.Education and research about mindfulness as a potential means to develop capacities related to self-care, professional practice placements, and classroom performance in students is recommended.

Stressors and coping strategies among physiotherapy students: Towards an integrated support structure

Background

Stress is a major problem among university and, specifically, health care students, as it may influence academic performance and psychological well-being negatively.

Aims

To develop and implement a student support system based on the perceived stress, stressors and coping strategies of physiotherapy students.

Methods

A cross-sectional, descriptive study was undertaken, using a literature-based, self-compiled questionnaire and the 28-item General Health Questionnaire (GHQ-28). Over a period of three years, 207 third- and fourth-year physiotherapy students at a South African university were included.

Results

Psychological distress was experienced by 61.8%-71.2% of participants. During the 3 months prior to the study, 6% of participants received psychological or psychiatric help and 9% of participants used some form of psychiatric medication. The main stressors identified during clinical training were the suffering and death of patients, academic pressure and tension during interaction with personnel. Participants indicated that they mainly coped with these stressors by talking to someone such as a family member or a friend.

Conclusions

Based on the findings of this study, a framework to identify and support students in pre-clinical and clinical training years was developed and implemented over five years. This proposed framework might positively contribute to the psychological well-being of health care students.

Musculoskeletal pain symptoms among allied health professions' students: Prevalence rates and associated factors

BACKGROUND

Very few articles, comprehensively, investigated musculoskeletal pain symptoms (MPS) among wide variety of allied health professions (AHP) students.

OBJECTIVES

This study aimed to investigate the prevalence of MPS and their associated factors among different AHP majors' students.

METHOD

A cross-sectional design was conducted. A sample of AHP students from nine majors (n= 838, Mean age = 21.3 years) completed a validated structured self-administrated questionnaires including Nordic Musculoskeletal Questionnaire, Depression Anxiety Stress Scale (DASS 21), and specific questions regarding demographics and life style. MPS prevalence rate were compared between males and females and between majors. Logistic regression was conducted to identify predictors of MPS.

RESULTS

MPS in neck, lower back, and shoulder 12-month were the most prevalent (67.1%, and 61.4%, 58.8% respectively). MPS prevalence was significantly higher in females and statistically different among majors. MPS were significantly associated with increased clinical training load, mental stress symptoms, and smartphone average use time.

CONCLUSIONS

MPS in AHP students are prevalent and statistically higher among females. Students are advised to adhere to different conservative precautions and follow prevention programs. Future studies are needed to assess actual mechanisms causing MPS among AHP students and designing effective prevention programs specific to AHP students.

Perceived stress and fatigue among students in a doctor of chiropractic training program

OBJECTIVE

High levels of stress and fatigue are associated with decreased academic success, well-being, and quality of life. The objective of this research was to quantify levels of perceived stress and fatigue among chiropractic students to identify sources of and student coping mechanisms for perceived stress and fatigue and to identify the relationship between students' perceived stress and fatigue.

METHODS

A survey comprised of the Perceived Stress Scale, the Undergraduate Sources of Stress Survey, and the Piper Fatigue Scale was administered to chiropractic students in their 2nd, 5th, and 8th trimesters of doctoral study. Data were analyzed by descriptive statistics, 1-way analysis of variance, and linear correlation tests.

RESULTS

Students reported having moderate to high levels of stress and fatigue, with higher levels of stress and fatigue seen in women than in men. A nonsignificant difference among stress scores and a significant difference among fatigue scores were observed based on program term. Levels of stress predicted levels of fatigue, and stress was strongly correlated with psychological health, relationships with family members, mood, and need for learning accommodations. Fatigue was strongly correlated with psychological health, academic demands, and conflicts between studies and other activities.

CONCLUSION

There are differences in the reporting of perceived stress and fatigue levels in this chiropractic student population based on gender. The correlation between fatigue and stress also suggests that measures that may alleviate one may likely affect the other.

Replacing stressful challenges with positive coping strategies: a resilience program for clinical placement learning

Clinical education is foundational to health professional training. However, it is also a time of increased stress for students. A student's perception of stressors and their capacity to effectively manage them is a legitimate concern for educators, because anxiety and decreased coping strategies can interfere with effective learning, clinical performance and capacity to care for patients. Resilience is emerging as a valuable construct to underpin positive coping strategies for learning and professional practice. We report the development and evaluation of a psycho-education resilience program designed to build practical skills-based resilience capacities in health science (physiotherapy) students. Six final year undergraduate physiotherapy students attended four action research sessions led by a clinical health psychologist. Resilience strategies drawn from cognitive behavioural therapy, and positive and performance psychology were introduced. Students identified personal learning stressors and their beliefs and responses. They chose specific resilience-based strategies to address them, and then reported their impact on learning performance and experiences. Thematic analysis of the audio-recorded and transcribed action research sessions, and students' de identified notes was conducted. Students' initial descriptions of stressors as 'problems' outside their control resulting in poor thinking and communication, low confidence and frustration, changed to a focus on how they managed and recognized learning challenges as normal or at least expected elements of the clinical learning environment. The research suggests that replacing stressful challenges with positive coping strategies offers a potentially powerful tool to build self-efficacy and cognitive control as well as greater self-awareness as a learner and future health practitioner.

Physical activity and quality of life among university students: exploring self-efficacy, self-esteem, and affect as potential mediators

PURPOSE

Physical activity (PA) has been shown to enhance quality of life (QOL) in older adults. Findings from these studies indicate that the relationship between PA and QOL is indirect and likely mediated by variables such as physical self-esteem, exercise self-efficacy, and affect. As PA varies greatly by age, the purpose of the current study is to extend this area of research to young adults and explore the complex relationship between PA and QOL in this target population.

METHODS

Data were collected via anonymous questionnaire from N = 590 undergraduate students. PA was assessed with the Godin Leisure Time Exercise Questionnaire, and QOL was assessed by the Satisfaction with Life Scale. Path analysis was used to test the relationship between PA and QOL, with mediators of exercise self-efficacy, physical self-esteem, and affect.

RESULTS

The PA model (RMSEA = .03, CFI = .99) accounted for 25 % of the variance in QOL. PA had positive direct effects on exercise self-efficacy (β = .28, P < .001), physical self-esteem (β = .10, P < .001), positive affect (β = .10, P < .05), and negative affect (β = .08, P < .05). Physical self-esteem was found to be the most powerful mediating variable on QOL (β = .30, P < .001), followed by positive affect (β = .27, P < .001) and negative affect (β = .14, P < .001).

CONCLUSION

Physical self-esteem and, to a lesser extent, positive affect emerged as integral components in the link between PA and QOL. Findings suggest that health education programs designed to promote regular PA and increase physical self-esteem may be effective in improving QOL in young adults.