INTRODUCTION:

Stress, it is part and parcel of human lifestyle, the rising complexity of modern life has beset us with stress. Students of various professional institutions are increasing beleaguered with this problem.¹_{According to Hans Selye stress is the ‘non-specific response of body}to any demand for change’. It is also defined as a state of strain or tension resulting from adverse or demanding circumstances.²

Modern world which is said to be the world of achievements is also said to be the world of stress. Academic stress is mental distress with respect to some anticipated frustration associated with academic failure or even unawareness to the possibility of such failure. Students have to face many academic demands, for example, university examination, answering questions in the class, showing progress in their subjects, understanding what the teacher is teaching, competing with other class mates, fulfilling teachers and parents academic expectations. These demands may tax or exceed available resources of the students. As a consequence, they can be under stress, since the demand is related to achievement of an academic goal.³_Bisht (1989)⁴has defined academic stress as a demand related to academics that tax or exceed the available resources (internal or external) as cognitively appeared by the students involved. According to her, academic stress reflects perception of individual’s academic frustration, academic conflict, academic pressure and academic anxiety. She has given the definition of four components of academic stress as follows:

Academic Frustration:

Academic frustration is a state caused by harm of some academic goals.

Academic Conflict:

Academic Conflict is the result of two or more incompatible response tendencies to academic goals.

Academic Pressure:

When the student is under heavy demands of time and energy to meet academic goals.

Academic Anxiety:

Apprehension of harm to some academic goals. Academic Stress is an important factor accounting for variation in academic achievement. It also contributes to major mental health hazards, problems both physical and mental stress related diseases.For many young adults, college is the best time of life. These critical years can also be undermined by depression, anxiety and stress. Students are very likely to experience some or many stressors which may test their ability to cope: adapting to a new environment, balancing a heavy work load, making new friends, becoming more independent, and dealing with myriad of other issues.⁵Structure and routine reduce stress because our body goes into automatic pilot. Routine reduces the anxiety of the new. This doesn't mean that we should never make changes or experience new things, but a daily routine requires less mental energy and means fewer unpleasant surprises and thus less unexpected stress.The World Health Organization (WHO) has estimated that stress-related disorders will be one of the leading causes of disability by the year 2020. Nursing colleges are now recognized as a stressful environment that often exerts a negative effect on the academic performance and psychological well-being of the students.⁶Each year, between 30 and 40 people per 100, 000 Indians aged between 15 and 29 kill themselves, stress being one of the strongest reason. 75% of students reported experiencing moderate to high levels of stress in the past month and nearly half reported that their stress has increased in the past year- American Psychological Association.⁷Approximately 1 out of 75 students/people may experience panic disorder- National Institute of Mental Health. Stress is a top health concern for U.S. teens between 9^th and 12^th grade, psychologists say that if they don’t learn healthy ways to manage that stress now, it could have serious long-term health implications-American Psychological Association.⁸Depression is among the leading causes of disability worldwide- World Health Organization (WHO).⁶

India has one of the highest rates of suicides among people aged between 15 and 29. although the reasons are myriad but failure in examination, unemployment, pressure from parents etc. The psychologists suggest these things and pressure lead students to anxiety and traumatic disorders. In a recent survey, two-third (66%) students reported that they feel pressurized by their parents. Also, the pressure from non-graduate parents was more compared to parents those were graduates and post graduates.⁹ The hectic schedules and a number of responsibilities have greatly contributed to this condition and it is important to know the ways that could alleviate stressful conditions. Where meditation could decrease the level of stress, indulging in physical activities is another way to get rid of it. So, maintenance of a proper daily routine helps in living a stress free life to a great extent.

Stress is reported as a growing problem among students, not only in India but all over the globe. In fact India has one of the highest rates of suicide among people aged between 15and 29; and the major reasons were those listed above. In a recent survey, 6.23 students commit suicide due to the peer pressure.⁹ Also some more common stressors for students in college life include, Critical adjustments to college life, Academic requirements, Demands of studies (e.g., assignments deadlines and increasing workload), Pressure on interpersonal relationships, Unsatisfactory housing arrangements, Lack of support system, New hostel life, Ineffective coping skill, Extended commute time and Greater levels of independence. If students are unable to manage and complete their work in the set time, this could cause them greater stress and feelings of being overwhelmed.

Daily Routine Activities are the activities performed by people on daily basis, be it physical, social, academic or extracurricular activities. Our daily routine and habits create our mood, and our mood is a filter through which we experience our life. When we regulate our daily actions, we deactivate our “fight or flight” instincts because we are no longer confronting the unknown. We are able to feel content because routine consistently reaffirms a decision we already made. The American Journal of Psychology defines routine as a more or less fixed way of thinking, willing or feeling acquired through previous repetition of a mental experience. Daily routine can also be defined as a set of personal customs and habits. Doctors Freddy Gonzalez and Margarita Villegas¹⁰ have studied the advantages of routine, noting that it allows for space to understand one’s social environment from an individual perspective. It also allows for development of knowledge, abilities, behaviors and attitudes necessary for life. John C. Maxwell¹⁰ said you will never change your life until you change something you do daily. The secret to your success is found in your daily routine.

Management and daily routine plays an important role in management of stress. Students can plan their life so that stress does not overwhelm them. Effective planning involves setting priorities and working on simple problems first, solving them, and then going on to more complex difficulties. When stress is mismanaged, it's difficult to prioritize. All problems seem to be equal and stress seems to be everywhere. That is why knowing daily routine of students is also needed. Thus, assessment of both these variables i.e. stress and daily routine activities as well as their correlation becomes the need of this study, so that we can plan help the students in management of stress in relation with their daily routine activities and leading a healthy happy life. The rationale behind this study is “To assess daily routine activities and level of stress among students of B.Sc (Hons) Nursing students at AIIMS, Jodhpur”.

METHODS:

“Quantitative research approach” was adopted for the present study. which in emphasizing the measurement of objectives through statistical or numerical analysis with the help of data collected. Since the present study aim was to assess daily routine activities and level of stress among students of B.Sc (Hons.) Nursing students at AIIMS, Jodhpur, research design selected for the present study was “non–experimental descriptive design”. In the present study the variables were: 1. Demographic variables such as age, marital status, religion, educational qualification of parents, occupation of parents, type of family, family size, totally monthly income, duration of stay in hostel and dietary habits 2. Daily routine and time management. 3. Level of stress.

The present study was conducted in urban setting in natural environment at College of nursing, AIIMS, Jodhpur. B.Sc (Hons.) Nursing (1st, 2^nd, 3^rd and 4^th year) students available at college at the time of data collection where included in the study. A total of 100 students of 25 from each batch were selected through quota sampling technique. Data was collected after seeking permission from the institutional ethical committee. The purpose and need of the study were explained to participant and verbal consent was taken from the students. In the present study a self – structured questionnaire was prepared to assess daily routine activities and level of stress. Tool was prepared on an intensive review of research and non-research literature and books, articles, journals, project reports, different online reference. Formal and informal discussions were held with the guide and opinion of the experts was also taken. Data was collected through following questionnaire: -Z1. Demographic data which were developed to collect basic data among B.SC (Hons.) Nursing students. 2. Self-structured questions MCQ i.e. close ended were included to elaborate the daily routine activities among B.SC (Hons.) Nursing students.3. Perception of academic stress scale was used, to elicit more about stress related to academics and stress related to general behavior was assessed by self structured 5 point likert scale among B.SC (Hons.) Nursing students. In this tool total 16 questions were there, and a set 4 questions were divided in following categories: 1. Stress related to academic expectations, 2. Stress related to faculty work and examinations. 3. Stress related to student’s general issues and 4. Stress related to students’ academic self-perceptions. The maximum ranges from 16 to 80.

Table 1: The criterion for measuring of level of stress is based on percentage of scores.

Level of stress	Total scores
Mild	16 – 37
Moderate	38 – 59
Severe	60 – 80

Content validity of the tool was established by submitting it to seven experts. All of them are from nursing field. All the experts were in the agreement with some suggestions. Suggestions of the experts were incorporated and tools were modified accordingly. The tool was found to be valid for the study. The tools were administered to 20 students of B.Sc. (Hons.) nursing 4^th year batch 2014 to check the reliability of tool 2 by test -retest method. The reliability of tool 3 was calculated by Karl’s Pearson’s formula and it was found to be 0.72 (acceptability range is 0.70 to 1). The reliability coefficient for the Likert’s scale was found to be 0.8. Finding of the pilot study revealed that study is feasible to conduct. The plan of the statistical analysis too was determined. No major problem was faced during the pilot study. Permission from the Principal, College of Nursing, AIIMS, Jodhpur was taken and class Coordinators of respective classes were contacted to get help in fixing up the time for data collection. Data collection was done during June, 2018. The samples were selected through non probability quota sampling method, where the sample were selected non- randomly from the population in fixed number depending on the ease of accessibility. By this method total 100 samples were selected i.e. 25 students from each batch (1^st, 2^nd, 3rd & 4^th) of B.Sc (Hons.) Nursing 4 yrs.’ program. Self-introduction was given to the subjects, nature and purpose of the study was explained to them. Confidentiality of their responses was assured and their written consent was taken prior to the study. Data were collected by the investigators using self-report technique. For collection of data, it took around approximately 20 minutes by each student. No problem was faced during final data collection.

RESULT:

Table – 1: Frequency and percentage distribution of students in terms of personal/demographic variables (N=100)

Demographic variables	Frequency (f)	Percentage (%)
A. Age
a) Below 18 yrs	1	1%
b) ˃18-20 yrs	39	39%
c) ˃20-22yrs	48	48%
d) ˃22yrs	12	12%
B. Marital status
a) Married	3	3%
b) Unmarried	97	97%
c) Divorced	-	-
C. Religion
a) Hindu	94	94%
b) Muslim	1	1%
c) Sikh	3	3%
d) Christian	2	2%
e) Others	-	-
D. Medium of education
a) Hindi	40	40%
b) English	60	60%
E. Education of father
a) Lower-upper primary school	19	19%
b) Secondary-higher secondary	28	28%
c) Graduate or above	18	18%
d) No formal education	35	35%
F. Education of mother
a) Lower-upper primary school	15	15%
b) Secondary-higher secondary	38	38%
c) Graduate or above	25	25%
d) No formal education	22	22%
G. Occupation of mother
a) Business	0	0%
b) Govt. job	10	10%
c) Private job	3	83%
d) Home maker	83	83%
e) Others	4	4%
H. Occupation of father
a) Business	12	12%
b) Govt. job	38	38%
c) Private job	25	25%
d) Others	21	21%
I. Type of family
a) Nuclear	77	77%
b) Joint	23	23%
c) Extended	0	0%
d) Others	0	0%
J. No. of family members
a) ≤3 members	3	3%
b) 3-6 members	67	67%
c) 6-9 members	16	16%
d) More than 9 members	14	14%
K. Total monthly income
a) Below 15, 000	10	10%
b) 15, 000-25, 000	17	17%
c) 25, 000-35, 000	23	23%
d) More than 35, 000	50	50%
L. Duration of residence in hostel
a) Less than 1 yr	19	19%
b) 1-2 yrs	24	24%
c) 2-4 yrs	42	42%
d) More than 4 yrs	15	15%
M. Type of diet
a) Vegetarian	72	72%
b) Non-vegetarian	28	28%

Table 1 showed that majority of students were in the age 20-22yrs i.e. 48%. Maximum number of subjects were unmarried i.e. 97% while only 3% were married. 94% of subjects were in Hindu community. Medium of education of subjects in English was 60% and 40% were of Hindi medium. Majority of the mothers did not have proper formal education i.e. 35%. Majority of fathers were graduate or above i.e. 38%. Maximum number of the students’ mothers’ occupation was home maker which was 83% whereas occupation of subject’s fathers was government job which was 35%. Maximum number of subjects had nuclear family i.e. 77% and the remaining had joint family. 67% of them had 3-6 family members while only 3% had ≤ 3 members. A significant part of the samples i.e. 50% were had income > 35000 and Most of the subjects resided in hostel for 2-4 years which i.e. 42%. Most of them were i.e. 72 % were vegetarian.

Table – 2: Frequency and percentage distribution of students in terms of daily routine activities variables. And association with level of stress(N=100)

Daily routine activities	Frequency	Percentage	X²	‘P’
General routine and personal hygiene
Q.1) What time do you usually wake up?
a) At 5 am	4	4%	9.035	0.171
b) > 5-6 am	16	16%
c) > 6-7 am	52	52%
d) > 7-8 am	28	28%
Q.2) How much time you take in showering?
a) 10 mins	36	36%	4.077	0.666
b) 15 mins	39	39%
c) >15-30 mins	21	21%
d) > 30 mins	4	4%
Q.3) Do you wash your laundry daily?
a) Once in a day	39	39%	3.105	0.7956
b) Twice a day	6	6%
c) More than twice a day	4	4%
d) Not everyday	5	5%
Q.4) Do you clean your room daily?
a) Once in a day	26	26%	5.674	0.4607
b) Twice a day	2	2%
c) More than twice a day	3	3%
d) Not everyday	69	69%
Q.5) When do you sleep at night?
a) ≤ 10 pm	4	4%	10.323	0.1117
b) > 10-11pm	30	30%
c) ≤ 12 am	42	42%
d) After midnight	24	24%
Q.6) How much time do you sleep in 24 hrs or in a day??
a) ≤ 5 hrs	9	9%	8.010	0.2374
b) ˃ 5-7 hrs	33	33%
c) ˃ 7-8 hrs	45	45%
d) ˃ 8 hours	13	13%
1 Dietary Habits Q.1) Have you experience hunger during the day even if you have had your meal?
a) Once in a day	42	42%	7.652	0.2647
b) Twice a day	16	16%
c) More than twice a day	21	21%
d) Never	21	21%
Q.2) What meal would you consider to be your main meal of the day?
a) Breakfast	30	30%	17.981	0.0063
b) Lunch	63	63%
c) Dinner	5	5%
d) None	2	2%
Q.3) How many servings of fruits do you consume in a day?
a) 1 time	64	64%	18.851	0.0044
b) > 3 times	7	7%
c) > 1-3 times	3	3%
d) 0	26	26%
Q.4) How often do you eat fast food or takeout daily?
a) Once	49	49%	4.130	0.6591
b) Twice	5	5%
c) More than twice	3	3%
d) Zero	43	43%
Q.5) Which of the following do you drink the most in a following day?
a) Juice	4	4%	1.418	0.9648
b) Water	83	83%
c) Milk & tea	9	9%
d) Cold drinks & Energy drinks	4	4%
Q.6) Is your bowel and bladder activity normal daily?
a) Yes	77	77%	1.062	0.9002
b) No	7	7%
c) Not everyday	16	16%
Q.7) Do you eat or drink something specific due to health reasons?
a) Once	21	21%	1.881	0.9303
b) Twice	3	3%
c) More than twice	2	2%
d) Zero	74	74%
C. Social and physical activities Q.1) How much time do you spend with your friends in a day?
a) 1 hr	15	15%	11.172	0.0832
b) 1-2 hrs	14	14%
c) > 2-3 hrs	30	30%
d) > 3hrs	41	41%
Q.2) How much time do you spend on social media in a day?
a) 30 mins	22	22%	3.292	0.7714
b) > 30 mins- 1 hr	18	18%
c) > 1-2 hrs	27	27%
d) > 2 hrs	33	33%
Q.3) How much time you spend on phone calls, be it friends or family on a daily basis?
a) Almost 30 mins	38	38%	11.512	0.0738
b) 1 hr	38	38%
c) 2-3 hrs	16	16%
d) 3-4 hrs	8	8%
Q.4) How much time do you spend in playing daily?
a) 1hr	17	17%	21.254	0.0017
b) > 1-3 hrs	3	3%
c) > 3 hrs	1	1%
d) Zero	79	79%
Q.5) How many times do you exercise in a day?
a) Once	34	34%	2.274	0.6854
b) Twice	0	0%
c) More than twice	2	2%
d) Not daily	64	64%
Q.6) Time spend on your mobile apps daily (online shopping, games, YouTube, video apps, TV apps, movie apps etc.)?
a) 1 hour	43	43%	6.207	0.4005
b) > 1-3 hrs	29	29%
c) > 3 hrs	17	17%
d) Zero	11	11%
D. Extra-Curricular Activities Q.1) Have you joined any activity classes and how much time you spend in then?
a) 1 hr	10	10%
b) 1-2 hrs	6	6%	2.909	0.9399
c) > 2-3 hrs	5	5%
d) > 3 hrs	1	1%
e) No	78	78%
Q.2) How much time do you spend in doing extracurricular activities in your room only?
a) Less than 1 hr	78	78%	3.090	0.7975
b) ≥ 1-2 hrs	16	16%
c) 2 hrs	4	4%
d) More than 2 hrs	3	3%

Table 2 depicts the daily routine activities of B.sc (hons.) Nursing students AIIMS, Jodhpur. The selected daily routine activities include their general routine and personal hygiene, dietary habits, social and physical activities and extra-curricular activities. It was found that maximum number of students wakes up in between 7-8 am i.e. 28% and minimum wakes up at 5 am. Only a small percentage of students i.e. 4% take more than 30 mins for showering. Most of the subject i.e. 39% washed their laundry daily. Large part of the sample i.e. 69% did not clean their room daily. 45% of the subjects get enough sleep i.e. 7-8 hours which is needed for an adult and 9% of them get less than 5 hours sleep.

In case of dietary habits 43% of subjects experience hunger even when they had their meal. Lunch is considered main meal by 63% of subjects while 30 % considered breakfast. 64% of subjects consume fruits once in a day while 26%t do not even consume even once. Maximum number of subjects eats fast food atleast once in a day i.e. 49%. 83% of the subjects consume more water than any kind of drinks. Most of the subjects’ i.e. 77% have normal bladder and bowel activity. Maximum numbers of subjects i.e. 74% do not take extra health supplements while 21% consume once in a day.

Around 41% of the subjects spends more than 3 hours with their friends in a day. A significant part of the subjects i.e. 33% and 44%t spends more than 2 hours on social media and 1-hour online shopping respectively. Among all the subjects 38% of the subjects spend their time on phone call, be it with friends or family on daily basis for 30 min - 1 hour. 79% of subjects do not play at all while 17% plays at least for 1 hour. 64% do not exercise daily while 34% do once a day.

Extra- curricular wise distribution shows that 78% of subjects have not join any kind of activity classes and only 1% joined and spend more than 3 hours. 78% of the subjects do extra-curricular activities in their room for less than 1 hour and 3% of the subjects spend more than 2 hours.

Chi square test computed between selected daily routine activities and level of stress. Main meal of the day and serving of fruits] and level of stress had significant association at P < 0.05. Time spend in playing and level of stress also found to be statistically significant.

Figure 3 depicted the level of stress among the selected samples. It was found that majority of the students had moderate stress level i.e. 89%.

DISCUSSION:

Around 89% of samples had moderate stress level, 10% sample had mild level of stress and only 1% had severe stress. Main meal of the day and serving of fruits] and level of stress had significant association at P < 0.05. Time spend in playing and level of stress also found to be statistically significant. This finding was supported by study of Samrat bisai & Richa Chaudhary¹. Descriptive study among 339 engineering students in India were taken and as a result stress was found high due to academic factor. Also Anandlakshmi Swaminathan, Sahityan Viswanathan²conducted a cross sectional study on 19^th sept 2015 on 1^st yr medical students. Total 133 samples were taken and stress was found greater in girls 52.88% than boys 47.12% due to academics.

CONCLUSION:

The study finding revealed that, majority of students suffer from moderate level of stress. There was significant association between dietary routine, duration spent in doing physical activity and level of stress. Healthy diet and proper physical activity can do reduce level of stress and proper planning and implementation of awareness program on healthy daily routine will have positive impact on level of stress.

LIMITATIONS:

The study was confined to a small number of (100) samples which limit the generalization of the findings. The study was confined to a particular nursing student of College of Nursing, AIIMS, Jodhpur. Data collection method was limited with the tool prepared by the self- structured questionnaire.

RECOMMENDATIONS:

The study can be replicated on a large sample to validate the findings and generation. A similar study can be conducted with experimental and control group.

CONFLICT OF INTEREST:

No.

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Received on 08.07.2019 Modified on 08.08.2019

Int. J. Nur. Edu. and Research. 2020; 8(1):13-18.

DOI: 10.5958/2454-2660.2020.00003.4