92 JNK JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk Factor Predictors of Prolonged Stress of University Students Taking Online Learning Dian Pitaloka Priasmoro1, Indari2, M. Ridwanul Dwiona3, Indra Susanto4 1,2,3,4Nursing Department, Faculty of Health Technology Science, Institute of Science and Technology of RS dr. Soepraoen Malang, Indonesia Article Information Abstract The Covid-19 pandemic has caused changes all aspects of people's lives today, especially in the world of education which requires all elements of education to adapt and continue the rest of the semester with online learning. This condition caused prolonged stress, a condition where there is physical, emotional, and mental fatigue caused by excessive. This research was conducted on April 2021 with the aim of identifying predictors of prolonged stress of students taking online learning. The method used descriptive approach. The data analysis used factor analysis with KMO and Bartlett's Test methods. The population in this research were all students of nursing study program ITSK RS dr. Soepraoen Malang total 815. The sampling technique used accidental sampling with total sample of 279. The instrument used Maslach Burnout Inventory which distributed online by google forms. The results showed that almost all of the students who experienced mild to moderate prolonged stress were regular students with a total of 252 people (90.3%), low to moderate respondents were unmarried, organizational factors causing prolonged stress were institutional support, more than half of the respondents, 27 people (9,7 %) who felt adequate support from the institution experienced prolonged stress in the mild to moderate category. The dominant factor was student's status as a regular student or assignment or study permit with the significance value was 0.001 <0.05. It is recommended that students actively seek support systems from family and friends as well as educational institutions that are consistent in supporting students History Article: Received, 13/12/2021 Accepted, 25/04/2022 Published, 25/04/2022 Keywords: stress, online, student © 2022 Journal of Ners and Midwifery Correspondence Address: Institute of Science and Technology of RS dr. Soepraoen Malang – East Java, Indonesia P-ISSN : 2355-052X Email: dianpitaloka@itsk-soepraoen.ac.id E-ISSN : 2548-3811 DOI: 10.26699/jnk.v9i1.ART.p092-098 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) http://jnk.phb.ac.id/index.php/jnk mailto:dianpitaloka@itsk-soepraoen.ac.id https://doi.org/10.26699/jnk.v9i1.ART.p092-098 Priasmoro, Indari, Dwiona, Susanto, Factor Predictors of Prolonged Stress of University Students Taking … 93 INTRODUCTION Moore & Kolencik, (2020) stated that prolonged stress is excessive and prolonged emotional stress. This condition can be caused by various factors such as daily stress, workload, and learning activities (Alimah & Swasti, 2016). The Covid-19 pandemic has caused changes in all aspects of people's lives today, especially in the world of education which requires all elements of education to adapt and continue the rest of the semester with online learning (Herliandry, 2020). Based on WHO data, it was obtained that COVID-19 has become a global pandemic with 4,534,0731 confirmed positive cases in 216 countries worldwide (Update: 17-05-2020). The Corona virus has also been endemic in Indonesia from early March to 13 January 2020 there were 1.13 million confirmed positive cases spread across 34 provinces and 415 districts and cities (Task Force for the Acceleration of Handling COVID-19 Indonesia, 2020) The occurrence of the Covid-19 pandemic has a different handling time in each country depending on the policies implemented and the government's response to minimize its spread (Lee, 2020). Various policies have been issued by the Indonesian government to reduce the level of spread of the corona virus by imposing social distancing, physical distancing to implementing PSBB (large-scale social restrictions) in several areas. The policies issued to limit the spread of COVID-19 have an impact on various fields throughout the world, especially education in Indonesia (Herliandry, 2020). The health impacts caused by Covid-19 eventually forced the simultaneous online learning to be held (Goldschmidt & Msn, 2020). Lecturers and students as an important element in teaching are required to make an unprecedented massive migration from traditional face-to-face education to online education or distance education (Bao, Basilaia & Kvavadze, 2020). Students can be at risk of experiencing burnout or prolonged stress due to the many tasks and routines of life that are carried out while undergoing lectures (Alimah & Swasti, 2016). Implementation of online learning during the Covid-19 pandemic which causes stress and anxiety. Prolonged stress that is not treated immediately can lead to induction of glucocorticoid receptors so that plasma glucocorticoid levels are low and cause changes in brain physiology such as hippocampal atrophy. This condition will cause memory and memory disturbances, causing a person to easily forget and not focus (Tanaka, et all. 2018). If this happens to students, it can interfere with achievement in both academic and non-academic fields. In addition to having a negative impact on individuals who experience it, the occurrence of stress will also have a negative impact on institutions. The impact depends on the stage of burnout experienced by the individual. This statement is in line with Gerber, et al (2013) which states that students who experience burnout can result in symptoms of depression, decreased life satisfaction, and reduced sleep quality. So that it is considered important to identify the predictor factors of Prolonged Stress in Students Participating in Online Learning at ITSK RS DR. Soepraoen Malang. METHOD The research design used factors analized which aimed to explore a phenomenon or social reality, by describing a number of variables related to the problem under study. The researcher wanted to know the predictor factors for prolonged stress of students who took online learning. The research was conducted at ITSK RS DR. Soepraoen Malang in April 2021. The population was all students and the sample was some students. The samples were taken using the accidental sampling method, namely students who were willing to fill out questionnaires that were collected using google form. To maintain research ethics, the researcher gives the respondents the freedom to choose whether they agree or not. The instrument used a questionnaire including a prolonged stress questionnaire, the Maslach Burnout Inventory. The data collected was then analyzed using univariate and multivariate analysis, namely KMO and Bartlett's Test methods to determine the dominant factor. RESULT In this research, showed data on sociodemographic characteristics include age, gender and semester. 94 Journal of Ners and Midwifery, Volume 9, Issue 1, April 2022, page 12-17 Table 1: Frequency Distribution of Sociodemographic Gender f % Male 61 21.9 Female 218 78.1 Age f % Young Adult (17-21) years 230 82.4 Adult >22 years 49 17.6 Souce: Primary Data Based on the table above, it is known that more than half of the respondents are female, with a total of 218 people (78.1%), and almost all respondents aged 17-21 years old with a total of 230 people (82.4%). Table 2: Frequency Distribution Based on Semester Min Max Mean Std Dev Semester 1 6 3.5 1.474 Souce: Primary Data Based on the table above, it is known that the minimum respondent is in semester 1 and the maximum is in semester 6 and the average respondent is more than semester 3. Table 3: Respondent Special Data Predictor Factors Prolonged Stress Total Low Moderate High Student Status (Demografic Predictor) Regular 104 (37.2%) 143(51.2%) 5 (1.9%) 252 (90.3%) Assignment / Permits 26 (9.3%) 1 (0.4%) 0 (0%) 27 (9.7%) Total 130 (46.5%) 144(51.6%) 5 (1.9%) 279 (100%) Marital Status (Personal Predictor) Married 24 (8.6%) 0 (0%) 0 (0%0 24 (8.6%) Not Married 106 (37.9%) 144(51.6%) 5 (1.9%) 255 (91.4%) Total 130(46.5%) 144(51.6%) 5(1.9%) 279 (100%) University Support (Organizational Predictor) Low 18 (6.4%) 23 (8.2%) 2 (0.8%) 43 (15.4%) Moderate 70 (25%) 98 (35%) 3 (1.3%) 171 (61.3%) Good 42 (15%) 23 (8.3%) 0 (0%) 65 (23.3%) Total 130 (46.4%) 144(51.5%) 5 (2.1%) 279 (100%) Table 4: KMO dan Bartlett’s Test Kaiser-Meyer-Olkin Measure of Sampling Adequacy .459 Bartlett's Test of Sphericity Approx. Chi-Square 23.635 df 6 Sig. .001 Based on the table above, it is known that the significance value is 0.001 <0.05, so the variables studied can be continued for factor testing. Priasmoro, Indari, Dwiona, Susanto, Factor Predictors of Prolonged Stress of University Students Taking … 95 Table 5: Dominant Factors Initial Extraction Marital status 1.000 .713 Student status 1.000 .807 University Support 1.000 .706 Extraction Method: Principal Component Analysis. DISCUSSION Demographic Factors as Predictors of Prolonged Stress In table 1 above, it can be seen that almost all of the respondents with the status of regular students as many as 252 people (90.3%) and a small portion as assignments/study permits, as many as 27 people (9.7%) experienced low prolonged stress. According to Hirschle & Gondim (2020), stress is one of the important psychological responses to study, because stress can occur in every individual in everyday life and this is a factor that can endanger the psychological and physical well-being of individuals. Stress is a physiological reaction as an individual reaction to a stressor that may occur due to the individual's perception that the individual has demands in the work environment. In other words, individuals will feel that the demands of the environment will make individuals think and see themselves and the resources they have to deal with these stressors can produce negative reactions, namely the welfare of the individual's soul. Based on the facts and theories above, the researcher's opinion is that respondents who experience prolonged stress and are regular students. Where it is possible that regular students will feel that their demands as students are heavier than the task/study permit, they must compete in work after graduation. So that it will be a perception or a burden of thought that will continue to be thought about. In addition, regular students will definitely perceive that from the aspect of their resources they have not been fully met compared to assignments/permits. This condition is different from the perception experienced by students on assignments or study permits. Because they are used to the rules and pressures in the workplace it may be assumed that the burden experienced during learning from is less heavy than it once felt. Personal Factors as Predictors of Prolonged Stress Based on table 3, it is known that the personal factor that causes prolonged stress is marital status, based on the table it is known that almost half of the 150 respondents (53.7%) who experienced prolonged stress in the low to moderate category were unmarried respondents. And a small proportion of respondents who experienced low prolonged stress as many as 24 people (8.6%) were married. Based on this fact, according to the researcher, respondents who are married experience a lower burden, it is possible because someone who is married is possible to share feelings with their partner so that the burden they feel is also lighter. This is different from respondents who are not married, the respondents will feel the burden is borne by themselves, while the characteristics of students may be more inclined to close themselves to tell their parents about problems in online learning for various reasons, such as fear of being scolded and so on. The opinion of this researcher is in line with Suhita & Subandi (2018) which states that marital status can affect individual satisfaction and psychological well-being, both for the individual himself or for a partner in living life such as: communication, conflict resolution, intimacy, affection, and togetherness. This will make it easier for individuals to go through and deal with stressors that occur in everyday life. Organizational Factors as Predictors of Prolonged Stress Based on table 3, it is known that more than half of the 171 respondents (61.3%) who felt adequate support from the institution experienced prolonged stress in the mild to moderate category. And a small proportion of respondents who felt very high support from the institution amounted to 45 people (15%) experienced only mild prolonged. Prolonged stress is a type of stress 96 Journal of Ners and Midwifery, Volume 9, Issue 1, April 2022, page 12-17 response that often occurs as a result of the demands of a modern lifestyle. During this pandemic, it demands that all aspects of life including education change, the shift to the offline learning system makes all kinds of jobs have an impact on high pressure levels, busy physical conditions, and can make the body experience chronic stress. To face high demands every time the implementation of online learning, individuals need resources, besides those individuals need the involvement of other people and institutions to become the main support system (Ratnasari and Prasetyo, 2018). Respondents perceive the involvement of these institutions as a form of support. According to research data, respondents said that institutional support, such as providing interesting learning media, campus areas that have wifi, was felt to be very supportive of learning activities. Based on the facts and theories above, it is in the opinion of the researcher that even though respondents experience high pressure and for a long time, respondents can still tolerate this because respondents can also feel a form of involvement or organizational support in supporting the learning process. Dominant Factors as Predictors of Prolonged Stress Based on table 3 above, it is known that the order of the dominant factors causing prolonged stress seen from the largest extraction value is student status, marital status and institutional support as the last factor. Stress is a negative emotional experience, stress occurs due to a combination of various kinds of stimuli, both physiological, biochemical, cognitive, and behavioral. Stress is a place of human self due to pressure from the environment that has an impact on our psychological and biological aspects. Stress in the long term or prolonged stress needs to be watched out for because the function of body systems that work under pressure to cope with environmental demands can bring psychological and biological changes that can cause disease (Khan & Khan, 2017). Based on the research data in table 3, it is found that demographic factors (student status) are the dominant factors that affect prolonged stress, while based on table 3 it is known that prolonged stress experienced in the mild to moderate category is only 274 people (98.2%). The results of this research may also be influenced by the age of the respondents, based on table 4.2, it is known that almost all of the respondents are young adults (17-21) years old with a total of 230 people (82.4%). In the development of several theories of aging, it is stated that the prediction of the complexity of emotional problems including stress will have a greater chance of being accompanied by increasing age. At a young age, individuals will find it easier to regulate and control various kinds of stressors, including the body's confusion in responding. So it is suggested that in the emotional setting the older age group is expected to blend in with the younger age group (Scott et al., 2014). In accordance with this statement, the researcher's opinion is that the long-term stress response experienced by respondents is mostly in the mild category because most of the respondents are young adults, it is assumed that at that age someone still does not have a big responsibility and role in the family so they can still tolerate pressure. due to online learning. This condition may be different for respondents who are older adults who also have other responsibilities in the family, so they will feel heavier pressure. The next influential characteristic is gender, based on table 3 it is known that almost all respondents who experienced moderate prolonged stress were women with a total of 180 people (65%). According to the researchers, it is possible that women tend to have more sensitive feelings and emotional responses so that when they accept different responsibilities such as with online learning, women will tend to perceive more pressure than usual so they are easier to experience long-term stress. The opinion of this researcher is in line with the results of research by Calvarese (2015) among students at a university which found that male and female students gave different responses when they were under pressure. Overall, women experience higher reactions than men, such as complaining of stress, depression, frustration, and anxiety than men. Women also tend to prefer to express the stress they experience than men, such as feeling irritable, speaking in a high tone, or withdrawing from the environment. From the description above, it is very important that apart from looking at the dominant factors causing prolonged stress, as health professionals, we assess the characteristics of the respondents from various aspects, such as age and gender. Priasmoro, Indari, Dwiona, Susanto, Factor Predictors of Prolonged Stress of University Students Taking … 97 CONCLUSION From the results of the research and analysis of the discussion in the previous chapter, it can be concluded that the demographic factor causing prolonged stress is student status. Almost all of those who experienced mild to moderate prolonged stress were regular students with a total of 252 people (90.3%), personal factor was marital status, it was found that almost Half of the respondents, 150 people (53.7%) who experienced prolonged stress in the low to moderate category, were unmarried respondents. The organizational factor causing prolonged stress was institutional support. More than half of the respondents, 171 people (61.3%) felt adequate support from the institution. experienced prolonged stress in the mild to moderate category. The dominant factor is the status of students as regular students or assignments/study permits. SUGGESTION For universities, it is hoped that they can become the main support for students for example by providing guidance and counseling service facilities so that stress does not occur. ACKNOWLEDGMENT The author would like to thank to the Nursing Department, the Institutr of Science and Technology of RS dr. 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