Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.25-32 Stress Levels And Physio-Psycho-Social Responses On Undergraduate Nursing Students Undertaking Their Thesis At Harapan Bangsa Institute Of Health Sciences, Purwokerto: A Correlation Study Murniati, Noor Yunida Triana, Adita Silvia Fitriana 1 1 Institute of Health Science Harapan Bangsa Purwokerto, Indonesia Corresponding author : murniati@shb.ac.id ABSTRACT Background: Senior nursing students possibly experience stress due to the difficulties encountered in the process of writing a thesis. The difficulties experienced are commonly making research background, looking for the related theory and proper methods, having pressure from supervisor, feeling saturated, and many more. The stress experienced by students can also cause various responses such as physical, psychological, and social. Purpose : The aim of this study is to analyze the correlation among stress levels andphysio-psycho-social responses of nursing students undertaking thesis. Methods : This analitic cross sectional study was conducted at Harapan Bangsa Institute of Health Sciences, Purwokerto on May-July 2018. A total of 117 senior nursing students undertaking a thesis were taken by simple random sampling. Research data were collected utilizing stress questionnaire and physio-psycho-social responses. The data analysis used was univariate analysis with frequencydistribution, and bivariate analysis used was Spearman Correlation. Result : Findings of this research indicated that the senior nursing students undertaking a thesis experienced moderate level of stress (51,3%) and excellent physio-psycho-social responses (73,5%). In addition, this research showed a significant relationship between stress levels with physio-psycho-social responses (p value=0,000; r=0,508). Conclusion : The results indicated that senior students undertaking thesis can experience stress varying from mildto moderate that potentially cause physio-psycho-social responses. Keywords : stress levels, physio-psycho-social responses, nursing students, thesis Received July, 25, 2018; Revised August 24, 2018; Accepted September 5, 2018 How to Cite: Murniati, M., Triana, N., Fitriana, A. (2018). Stress Levels And Physio-Psycho-Social Responses On Undergraduate Nursing Students Undertaking Their Thesis At Harapan Bangsa Institute Of Health Sciences, Purwokerto: A Correlation Study. Journal Of Nursing Practice, 2(1), 25-32. https://doi.org/10.30994/jnp.v2i1.39 The Journal of Nursing Practice, its website, and the articles published there in are licensed under a Creative Commons Attribution- NonCommercial-ShareAlike 4.0 International License. https://doi.org/10.30994/jnp.v2i1.39 Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.25-32 26 BACKGROUND Thesis is a scientific work written by undergraduate students at the end of their studies. It becomes one of the requirements accomplished by undergraduate candidates (Sujono & Altiarika, 2014). This paper is based on the results of research (Saifuddin, Ismail, dan Wekke, 2018). Moreover, thesis must be conducted in the last semester that makes them feel worried about. This becomes a phenomenon in almost all college environments because students are less accustomed to writing, especially writing scientific papers. As the results, students regard the assignments given by their lecturers as a burden including in terms of thesis writing. The common problems experienced by students are the difficulty in finding literatures, the limited budged, unhabitual scientific paper writing, unfamiliar with systematic-organised paper consultation, and fear of facing thesis supervisors (Mage, 2008). The previous issues are in line with the results of a preliminary survey conducted by the researchers on 22 students working on their thesis in March 2018.The data showed that 63.7% of students sometimes felt depressed during doing their thesis, 59.1% of students felttheir heart pounding when having consultation with theirsupervisors, 50% ofstudents were worried that their thesiswould not be completed on time, 45.5% of students sometimes felt burdened in completing their thesis, 63.6% of students wanted to cry when there were a lot of revisions from their supervisors, 31,8% of them sometimes avoidedwhen asked about the progress of their thesis, 68.2% of students sometimes were lazy to have consultation with their supervisors, 63.6% of students sometimes were annoyed and often complained of their thesis, and 54.5% of students sometimes felt being chased when working on their thesis.The results of the survey show that students in working on their thesis experience stressors in their work which inevitably can be an obstacle or obstacle in completing their thesis. Those problems cause students to get stress.Secondary stress occurs when an individual determines their capacity to manage environmental demands.Stress experienced by students working on their thesis can cause various problems. Sukadiyanto (2010) states that individuals who experience stress can cause the emergence of symptoms both physically and psychologically. Physically, individuals may have heart problems, high blood pressure, muscle tension, headaches, indigestion, insomnia, sexual disorders, etc. Whereas, psychologically it can cause feelings of nervousness, anxiety, irritability, reluctance to do activities, working ability and decreased appearance, feelings of fear, self-isolation from the group and pobia. In addition, symptoms of stressexperienced by students include sleep disorders such as difficulty sleeping, frequent anxiety, irritability, and evenretention problem (Januarti, 2009). According to the study conducted by Rizqiea and Hartati (2012), the data showed that students experienced insomnia while doing thesis where the average sleep duration of 4-5 hours, sleep late at night and have an impact on the decrease of their activity, health problems and decreased mood. Based on the description presentedpreviously, it can be seen that stress is a common condition that is often experienced by students who work on their thesis or final assignment and can cause various impacts such as physical, psychological and social responses.Therefore, researchers are interested in examining the correlation of stress levels with physio-psycho-social responses of Nursing students undertaking their Thesis at STIKES Harapan Bangsa Purwokerto. The result of this study is expected that lecturers / educators especially in Nursing can identify the needs of their Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.25-32 27 students especially in doing the final project, facilitate them in the process of thesis writing, and provide good strategy in preparing the thesis to reduce students’ stress experienced in writing final task / thesis OBJECTIVE The aim of this study is to analyze the correlation among stress levels andphysio- psycho-social responses of nursing students undertaking thesis. METHODS This study is an analytic survey research with cross sectional approach. The study involved 117 respondents who were calculated using the Slovin formula for 170 nursing students undertaking their thesis based on KRS even semester 2017/2018. The samples were collected by using a random sampling technique. The sampling flow is presented in chart 1. The instrument used in this study was a modified stress level questionnaire from Hermawan's study (2016) consisting of 31 questions and 21 questions of physio-psycho- social responses. Data was collected in May-July 2018.Then, it was analyzed by using univariate analysis presented in the form of frequency distribution and bivariate analysis using Spearman correlation with a significance level of 5%. Chart 1. The Flowchart of Research Sampling RESULTS The results of research conducted on 117 respondents are presented in the table below: Tabel 1 The descriptions of stress levels and physio-psycho-social responses of nursing students working on their Thesis at Harapan Bangsa Institute of Health Sciences, Purwokerto. (n=117) Research Variables n (%) Stress Levels Mild Stress Moderate Stress Severe Stress 57 (48.7) 60 (51.3) 0 (0) Physio-psycho-social Response Students Undertaking Thesis N= 170 119 respondents (n=119) The Processed Samples n= 117 Simple random sampling Two(2)Unreturned Questionnaires Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.25-32 28 Excellent health status Good health status Bad health status 86 (73.5) 29 (24.8) 2 (1.7) Table 1 shows that students writing their thesis experienced stress with a similar percentage between mild and moderate stress (48.7% and 51.3%).Meanwhile, there were no respondents who experienced severe stress.More than half of the respondents had a good physio-psycho-social response in order that it was concluded that they had the best health status (73.5%) and the table also shows that there are about 1.7% of respondents who have poor health status when it wasviewed from physio-psycho-social responses Tabel 2. The Relationship Relationship between Stress LevelsandPhysio-psycho- social Responses of Nursing Students Undertking Their Thesis at Harapan Bangsa Institute of Health Sciences, Purwokerto (n=117) Physio-psycho-social Response Stress Levels r = 0.508 p = 0.000 n= 117 *Spearman Correlation Test The analysis resultabove, p = 0.000 (p <α, α = 0.05) shows that the correlation between stress levels and physio-psycho-social response of nursing students undertaking their thesis in Harapan Bangsa Institute of Health Sciences, Purwokerto is meaningful. Spearman correlation value of 0.508 shows a positive correlation with a moderate correlation strength.It means that the lighter the stress level, the better the physio-psycho- social response is. DISCUSSION 1. Stress levels of students undertaking their thesis at Harapan Bangsa Institute of Health Sciences, Purwokerto Based on the results of the study it was found that students undertaking their thesis experienced stress with almost the same percentage of mild stress and moderate stress (48.7% and 51.3%). Meanwhile, there were no respondents experienced severe stress.This provides a description that students working on thesis have varying levels of stress. Thesis is one of the scientific papers that must be done by graduate candidatesof undergraduate programs through a simple research process. Students often assume that a thesis is a frightening thing, and another information that may be obtained from their seniors. Furthermore, the other problems among students are commonly difficulties in finding literature, lack of research methods mastery, unfamiliar with the consultation process that requires students to personally contact with their supervisor (Mage, 2008). According to theresearchers, those things can trigger off stress. According to Santrock (2012), stress is the response of an individual to stressful situations that interfere with and threaten a person's ability to experience problems. In this study, it is found that the source of stress with the biggest score is that students felt there was a conflict with their supervisors and felt that they failedin their live. Moreover, the lack Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.25-32 29 of family support became a stress source of them.In addition, the manifestations that arise due to stress on students such as changingof appetite, having frequent urination and getting cold sweat appearing every time when meeting with their supervisors, avoiding when being asked about their thesis,and feeling guilty fortheir thesis. Stress can be caused by both intrinsic and extrinsic factors. Based on the study of Gunawati, Hartati, and Listiara (2006), internal factors that can trigger the emergence of stress include gender, socioeconomic status, personality characteristics of students, students’ coping strategies, ethnicity and intelligence, while external factors such as academic task demands (related to assignments during college or final assignment) and students’ relations with their social environment. Some of theother effects of stress are biological aspects (loss of appetite, not sleeping well, production of excessive sweating, etc.) and psychological aspects (decreased concentration, irritability, excessive anxiety, blaming others, ignorance to the environment) (Sarafino, 2008). The results of Setyawati and Murniati's research in 2016 also stated that nursing students experienced sufficient levels of stress (71.5%).Research conducted by Hermawan (2016) also further strengthened the results of this study where nursing students who were preparing their thesis at STIKES Jenderal Achmad Yani Yogyakarta experienced stress levels in the medium category (51.2%), low category (17.1%) and high category (31.7%). 2. Physio-psycho-social response of students undertaking their thesis at Harapan Bangsa Institute of Health Sciences, Purwokerto In this study it was found that physio-psycho-social response of stress in excellent health status category (73.5%), followed by good health status (24.8%) and only about 1.7% who have bad health status.This shows that students were able to overcome various stressors experienced when writing their thesis. This finding further reinforces the theory of Lazarus & Folkman (2004) that stress can affect the physical, psychological, and social health of the community if the result of the adaptation is not achieved. The results of this study are in accordance with Labrague's (2013) study, which states that stress is a common thing in nursing education and can have an impact on the physical-psychological-social health of students. Furthermore, The results of this study are also in line with the results of Setyawati & Murniati's research in 2016 that nursing students experienced physio-psycho-social responses in the sufficient category (54.7%). 3. The correlation between stress levels and physio-psycho-social response of students undertaking their thesis at Harapan Bangsa Institute of Health Sciences, Purwokerto In this study, the results show a significant relationship between stress levels and physio-psycho-social response of students undertaking their thesis with the strength of moderate relations and the direction of a positive relationship. The better the student's stress level, the better the physio-psycho-social response will be. Therefore, the health status of a student will be good condition. The results of the study contributes an idea that the stress experienced by a person can have an impact both negative and positive depending on the level of stress experienced.This statement is supported by the study of Dickinson (2007) who states that stress can increase the risk of various mental and physical disorders on students including anxiety, depression, Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.25-32 30 decreased immune, headaches, heart diseases, blood pressure disorders, energy loss, allergies and strokes (Sari, D., & Mahardyka, M, 2017). The results show that three subscales in the physio-psycho-social response gain the highest points on emotional symptom aspect, physical symptoms, and finally the symptoms of social behavior. In emotional symptoms, students mostly complain of feeling anxious, easily nervous and stressed lately. Based on the physical symptoms often experienced by respondents, they often feel headache, vertigo, frequent colds and fever, abdominal pain, and diarrhea. In conclusion, stress experienced by students undertaking their thesis can indeed affect the body's response in terms of physical, psychological and social.This is in accordance with the theory stated by Hawari (2011) that stress can have an impact on two things: physiological impact (retention, tensed-face, shortness of breath, beating heart, nausea and pain, frequent urination) and impact psychologically (anxiety, anger and aggression, depression). The appearance of physio-psycho-social responses due to stress might also be influenced by the level of stress experienced by respondents. From the results of this study obtained the levels of stress experienced by respondents were mild and moderatelevel, and there was no stress on the level of severe. According to the theory of Hartono (2016), there are several levels of stress that occur in humans: if a person is at the stage of mild stress, s/he may have a desire to work, while the second stage of stress is usually accompanied by various complaints such as feeling of fatigue after waking up in the morning, getting tired quickly during the afternoon, experiencing beating heart, feeling uncomfortable with stomach, getting on tense on neck and back. If the individual has reached the third to sixth stage, the complaints following stress will beworse. For example, starting from sleep disturbances, disrupting routine activities, feeling anxious and fearful, inability to complete work, physical and mental fatigue, severe digestive disorders, and even shortness of breath, cold sweat and trembling body. The above gives an explanation that the higher the level of stress experienced by a person, the more severe complaints will be physically, psychologically and socially CONCLUSION To sum up, more than half of the respondents had moderate stress levels (51.3%) and excellence physio-psycho-social response (73.5%). The result of Spearman correlation test shows a significant relationship among stress levelsand physio-psycho-social responses, positive relationship direction, moderate relationship strength (p-value = 0,000; r = 0,508). SUGGESTION This research is expected to provide information about symptoms, stress levels and the negative effects caused by stress namely the appearance of physio-psycho-social responses to students undertaking their thesis on.Students undertaking their thesis are expected to identify the positive and negative impacts of stress experienced so that they can perform good stress management and minimize stress.For researchers, further analysis can be carried out on the correlation of stress levels with subscales both from physio-psycho- social responses and sleep quality subscales Journal Of Nursing Practice http://jurnal.strada.ac.id/jnp ISSN: 2614-3488 (print); 2614-3496 (online) Vol.2 No.1. October 2018. Page.25-32 31 REFERENCES Candra, I.W., I.G.A Harini, dan I.N Sumirta.2017. Psikologi:Landasan Keilmuan Praktik Keperawatan Jiwa. Yogyakarta: CV.Andi Offset Dickinson, Wendy Lynn. 2007. Incresing Coping Resource: an Experimental Intervention Approach. 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