Lakhasly

Chapter One: Introduction
1.1. Introduction:
Nursing is a humanitarian profession that cares for the care of people, families and communities so that they can achieve, maintain or restore health as best as possible. Nurses can be distinguished from each other through their own scientific training (Dunphy, Lynne M, et. al., 2015).
Learning styles vary widely between different groups of medical students, teaching students, teaching and nursing students, rural and metropolitan nursing students, it is of great interest to find out if nursing students differ to the same extent at the end of their education (Hallin, Karin, 2014).
University is a time of heightened distress and that there is need for students to receive the support necessary to manage the transition into and through different phases of university and the workforce (Bewick et. al., 2010).
Level of stress among students of an undergraduate course in nursing, the activities related to time management, especially time for academic activities and social and family life, were identified as permanent stress factors during the graduation course (Soares-de-Souza, Verusca, et al., 2016).
In the context of education, especially in higher education institutions, the teaching and learning process, alone, can be considered a major stressor. This is because the pursuit of the development of skills and the acquisition of knowledge required by the labor market, requires the student/undergraduate to be able to deal with diverse present and future situations, which can generate adaptive crises and consequently high level of stress (Bublitz S, et. al,.2012).
In line with that explained, in the period of training of nurses, at certain stages, stress tends to be present as the nursing teaching is focused on the human being, which can configure intense emotional stimuli due to the characteristics of the profession that, in essence, deals directly with care and not infrequently with pain, completion of life and the suffering of the individual and family members (Corral-Mulato S, 2011).
The importance of investigating stress in the professional training period of nurses is based on studies that have identified serious signs of depression among nursing students, and highlight time management, with regard to the difficulties reconciling academic activities with personal, emotional and social demands, as the main stressor (Souza VS, 2016).
In response to the demand and pressure to which the worker is exposed, there has been an increase in cases of stress-related disorders, which, in our times, is considered a public health problem (Theme Filha MM, et. Al., 2013). This is because stress is characterized as an adaptive reaction of the body to new situations, the evolution of which occurs in three phases: alarm, resistance and exhaustion In contact with a stress agent, in an attempt to return to the equilibrium point, the body tries to adjust to or eliminate the problem, however, if the agent is not eliminated and/or managed, impairments of a physical and/or psychological nature, such as anxiety, depression, insomnia, high blood pressure, extreme changes in appetite and ulcers, may occur (Faro A, and Pereira ME,2013).
Lazarus, (1990) defined the stress as a personal and environmental event that cause stress is known as stressors. Therefore, stress is simply defined as emotional disturbances or changes caused by stressors. Stress which promotes and facilitates learning is called good stress. An optimal level of stress can enhance learning ability. On the other hand, stress which inhibits and suppresses learning is called bad stress. The bad stress must be prevented and avoided. It is noteworthy that the same stressors may be perceived differently by different students, depending on their cultural background, personality traits, experience and coping skills (Ghatol, and Snehlata D, 2017).
Stress is defined as a physical and/or emotional tension that is experienced when a person feels threatened or anxious. While not all stress is negative, chronic stress can lower an individual’s immunity and adversely affect the musculoskeletal, respiratory, cardiovascular, endocrine, gastrointestinal, nervous, and reproductive systems (Petko, Donna J, 2017).
Stress has become an important topic in academic circle as well as in our society. Many scholars in the field of behavioral science have carried out extensive research on stress and its outcomes and concluded that the topic needed more attention. Stress in academic institutions can have both positive and negative consequences if not well managed. Academic institutions have different work settings compared to non-academic and therefore one would expect the difference in symptoms, causes, and consequences of stress in the two set up. It is important to the society that students should learn and acquire the necessary knowledge and skills that will in turn make them contribute positively to the development of the general economy of any nation. However, the intricate academic environment sometimes poses great medical problems to the students’ lives that tend to negate the positive gains that one would expect after completion of University. In other hand stress defined as the perception of discrepancy between environmental demands (stressors) and individual capacities to fulfill these demands. While another researcher defines stress as the adverse reaction people have to excessive pressure or other types of demands placed on them. Stress occurs when an individual is confronted by a situation that they perceive as overwhelming and cannot cope up with (Busari, A. O. 2014).
Students have to face many academic demands, for example, school examination, answering questions in the class, showing progress in school subjects. Understanding what the teacher is teaching, competing with other class mates, fulfilling teachers and parent’s 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. So, academic related to the achievement of an academic goal (Lal, Krishan. 2014).
Academic stress among university students has become a topic of interest for few researchers to day. Academic commitments, financial pressures, and the lack of time management skills have resulted in many university students experiencing intense stress at predictable times during each semester. University students’ health and academic performance can be negatively affected because of higher degree of stress. The level of experienced stress is influenced by the resources available for the person in order to deal with specific stressful events and situations (Busari, A. O. 2014).
Academic stress among college students has been a topic of interest for many years. Higher stress levels may result in reduction of self-esteem. Self-esteem is an important personality trait for healthcare professionals including nursing. Self-esteem is overall evaluation of one’s worth or value and an important predictor of stress coping. Thus, high self-esteem results in more active and effective coping. The students’ preexisting level of self-esteem strongly contributes to successful or maladaptive adjustment to problem. Student with high self-esteem shows self-confidence and positive expectations in new situations. A new learning environment may be seen as just another challenge and the student will actively participate in learning new behavior. In contrast, a person with low self-esteem consistently demonstrates negative feelings about one self and is pessimistic in new situations (Pandey, R. et. Al. 2017).
The pressure to perform well in the examination or test and time allocated makes academic environment very stressful (Erkutlu and Chafra, 2006). Students are more likely to be in college life because of the relatively high employment rate, but they are more likely to be in clinical practice in extreme academic and unfamiliar environments, fear and anxiety about mistakes in practice, and patient care the difficulty and stress of adaptation due to heavy responsibility, role conflict, lack of knowledge and experience, strict behavior, limitations of applying the theory learned at school to clinics (Anthonisamy, 2018).
Nursing education consider a challenging experience for several of nursing students, which may lead to expose them to high level of stress, the studies demonstrate them are more likely expose to more stress during academic preparations than that expose during a first year of employment (Baldwin ,1999). Nursing education is a process in which nursing students learn all the theoretical knowledge necessary to perform the role of a nurse and how to apply it to actual nursing situations and acquire practical skills through clinical practice (Anthonisamy, 2018).
Nursing students experience a tremendous amount of stress during their professional education. While stress is a common phenomenon experienced by nursing students, it can negatively impact their academic performance and their health. Some researchers found that nursing students have been shown to experience more stress while in school than social work, pharmacy, and even medical students. Additionally, nurse practitioner students experience the highest stress levels of their lives while in school. Unfortunately, the influence of stress not only impacts students’ academic performance, but their overall health and well-being (Petko, Donna J, 2017).
Medical students experience an immense amount of stress during training. Some studies have shown that there is a higher prevalence of psychological distress among medical students than in the general population and age-matched peers. The implications for psychological distress of medical students include lowered academic performance, increased professional misconduct, decreased empathy, increased substance abuse, and suicide (Shiralkar, Malan T, et. Al., 2013).
Rosenberg, (1965), defined self-esteem as a ''positive or negative attitude toward the self''. Self-esteem is a psychological trait related to a person's image of self -value and self-confidence in total aspects of human activity.
Studies all over the world have associated self-esteem with human health and psychological well-being. This effect may be interpreted through the scope of resources increase and active coping against life's problems. Moreover, there seems to be a strong anti-stress impact on self-esteem regardless of the circumstances (Schmidt-Reinwald, A., et, al., 1999).
Branden, (1970), describes self-esteem as "the integrated sum of self-confidence and self-respect", which he describes respectively as "a sense of personal worth and a sense of personal efficacy. Individual's experiences and desires for self-esteem as an urgent, authoritative and rudimentary needs. Positive view of oneself consider intensely need to one's feeling.
Self-esteem is a multidimensional concept exists in a varying degree among individuals, and it is an important element within the Self-concept and which reflects how an individual's sense of his value and efficiency. When positive trends towards persons themselves have significant appreciation is high, and when they have negative attitudes about themselves, their self-esteem is low. In other words, the esteem is the general assessment of an individual's value as perceived by himself (Corsini, 1984).
In today’s highly competitive world, students face various academic problems including exam stress, disinterest in attending classes and inability to understand the subject. Examination stress is the feeling of anxiety or apprehension over one’s performance in the exams. It can lead to students being unable to perform to the best of their abilities in exams. Academic stress is the major source of stress among adolescents and it may lead to low self-esteem. Many psychological problems such as depression and suicide occur as a result of low self-esteem (Nikitha, et. Al., 2014).
Many studies showed the relationship of stress and self-esteem at multiple levels. Self-esteem is included in psychological resources that help people manage stressful events and their responses to them. Self-esteem affects the thinking process, emotions, desires, values and goals in a person developed when the acceptance of others and their personal and group contributions are recognized and applauded, especially in a multi-culturally diverse world, it is a key ingredient that affects the level of proficiency in all fields of endeavor (Redenback, 1991).
High self-esteem is considered a fundamental aspect of personal well-being, happiness and adjustment (Brown, 1993).
Low self-esteem individuals tend to view life in a negative way. These negative views can result in a belief that we are worthless (Crocker, 2006). This may lead us to feel hopeless and not put forth much effort because our experiences are seen as pointless (Burke, 2008). Low self-esteem may lead us to think that other people are better than us. This may lead us to lack assertiveness, confidence, and allow others to take advantage of us (Ogle, 2005).


1.2. Importance of the study:
Self-esteem is one of the most important concepts relating to the personality of man, and has been widely used in the books of psychology (Anthonisamy, 2018). Also, self-esteem is one of the most important topics of several points of view. First of all, natural psychological development is very important. Where one should believe in himself in terms of the ability to achieve what he needs and wants to do. As a result, one can deal well with the challenges of development and the challenges of everyday life. A person who lacks self-belief may be productive in one form or another, but may be less effective and creative than if he has great respect for himself. Much has been written about the importance of assessing the concept of self-esteem (Peggy, Patten.,1999).
Self-esteem which has shown to be a most important individual character variable which is influential on human behavior. To understand a human psychologically, should be understand the nature and amount of self-esteem, and how one judges oneself depending on standard criteria. The importance of the study that the self-esteem represent a great importance for all of the parents of students, because that the work to make the students see themselves in positive view, consider as a stimulant to help them to raising their abilities and willingness at the all domains high self-esteem became clearer subject which consider as a guide to increase competence and effectiveness in the deal with a lot of life stresses (Abel, 1996).

1.3. Problem statement:
The study is to provide better understand to the concept of nursing colleges student's self-esteem and the relationship with academic stress and is a self-esteem can play an important role in avoiding academic stress and taking into account how students respond to the pressures facing the completion of academic tasks in a manner that results in negative effects on their mental health and student's academic performance. In the Arab World there are a little of research about self-esteem and it is effects on academic stress, so importance of this study back to the few of studies focusing on this topic. Therefore, we should focus on the study of this subjects. It is important to assess self-esteem during this study.

1.4. Objectives:
The Objectives of this study was:
1. To evaluate the level of self-esteem in the study sample
2. To evaluate of academic stress in the study sample
3. To find the relationship between self-esteem and academic stress among nursing students
4. To find the relationship between self-esteem and academic stress with some demographic variables for students,
5. To find the difference between males and females in their response to academic stress

1.5. Research questions:
a) What are the levels of self-esteem for students of nursing colleges?
b) Does the level of self-esteem among students of nursing colleges at middle Euphrates's differ in different roles? Gender, age, and academic level?
c) Is there a relationship between level of self-esteem and level of academic stress for students of nursing colleges at the middle Euphrates’s?



1.6. Research Hypotheses:
a) There is a relationship between self-esteem and academic stress among students of nursing colleges.
a) There is a relationship between academic stress and some demographic variables students of nursing colleges.
b) There is a relationship between self-esteem and some demographic variables for students of nursing colleges.
c) Students who have low self-esteem have academic stress more than those with high self-esteem.
d) There is a difference between males and females in their response to academic stress

1.7. Definition of terms: self-esteem, academic stress, nursing colleges students

Self-Esteem
Theoretical definition:
Self-Esteem is a favorable or unfavorable attitude toward the self (Rosenberg 1965).
Operational definition:
Self-esteem is the vision of each individual towards himself and his judgments about potential, aptitudes, abilities, and it is varying from one individual to another.

Academic stress:
Theoretical definition:
Academic stress is stress that is generated from academic sources, and research has indicated that it affects many college students and can be caused by many different stressors (Agolla & Ongori, 2009).

Operational definition:
Academic stress is an uncomfortable feeling and a state of lack of control over the situations and conditions that occur during the course of study such as the abundance of subject matter and competition with students and the lack of time and difficulty of transportation and diversity of teaching methods

Nursing student:
Theoretical definition:
An individual enrolled in a nursing program (Medical Dictionary, 2009).
Operational definition:
They are a group of people who have chosen nursing as a profession and career for the future.