Perceived stressors among allied health sciences students of NORSU during COVID-19

pandemic
Introduction
Stress is the body’s natural reaction to any situation that needs attention or action. Stress can
positively or negatively affect health, such that it can help you avoid danger or too much stress
can bring harmful effects to the body. There are a lot of external and internal/self-generated
factors that can stimulate stress which is known to be stressors. Stressors are known to be any
events or conditions in the surroundings that trigger stress. External causes of stress include
work, school, life challenges, relationship problems, financial difficulties, or family, while
internal stressors include the inability to accept uncertainty, rigid thinking, negative self-talk, or
unrealistic expectations. Even though these stressors are unavoidable, it can still be managed and
reduced (Scott, 2020).
The worldwide pandemic has been a danger to us for decades, but the coming of COVID-19 was
a bolt from the blue and shocked the world. The sudden occurrence of the COVID-19 pandemic
is one of the most alarming public health threats and the biggest challenge experienced by the
modern world today. WHO defined COVID-19 as an infectious disease caused by a newly
discovered coronavirus and people who are infected with this coronavirus often experience
respiratory illness. According to WHO, this coronavirus affects people of all ages but older
people and those who have underlying diseases are at a higher risk for being infected. The
presence of this coronavirus poses a serious threat to the health of the people and preventive
measures were immediately imposed to control the rapid spread of the virus (Aslan, 2020).
However, despite the measures being implemented by the authorities for the safety of everybody,
living in isolation, changes in our activities of daily living, job loss, financial crisis, and grief
over the death of loved ones has a serious effect on the mental health and well-being of the
people.
In light of rising concern about the current COVID-19 pandemic, schools, colleges and
universities were forced to closed or either postponed their classes to ensure the safety of all the
students and staff members to protect them against the highly infectious virus. The sudden
occurrence of this virus has caused a highly noticeable impact on health and education. Since the
start of the pandemic, many students have been challenged emotionally and psychologically that
has caused undesirable effects on their academic performance. News about students committing
suicide, taking the semester off, facing anxiety and stress, and having financial problems due to
loss of job or businesses, brought remarkable concern to the people. Due to the unpredicted shift
in education, from the physical classroom to virtual space, students were greatly overwhelmed
and have faced numerous challenges such as lack of gadget to be used in participating classes,
slow internet connection, lack of internet connection, piled up activities, lack of educational
resources, family and financial problems. The online dissemination of learning which would
require an internet connection and access to gadgets such as laptops/computers has caused a
struggle for students who belong to low-income groups. The lack of certain gadgets and internet
connection has become one of the main stressors for students which eventually affected their
academic performance. Allied health sciences students were also challenged with their ongoing
online classes most especially that their requirements such as lab tests, practicals, return
demonstrations, and performance tests are not possible to conduct online. The discontinuation of
clinical practices has caused fear, anxiety, and stress to these students, knowing that the
development of their clinical skills that is essential in their future career will be affected. The
tremendous level of stress experienced by allied health sciences students from the stressors
brought about by the pandemic may lead to undesirable effects on learning and psychological
health which would eventually affect their grade point averages (GPAs).
Clinical observations suggest that university students express stress-related responses to fear of
being infected and to personal and relational life limitations during COVID-19 pandemic
lockdown (Zurlo et al., 2020). Despite the fact of the ongoing pandemic, students still carry on
with their education and these stress-related responses have a potential effect on their learning.
Medical students are more vulnerable to physical and mental health issues due to the stress they
acquired from their academic life (Abdulqhani et al 2020). The nature of education for medical
students is more complex than other courses knowing that they will be dealing with the health
and life of people. Any stressors could adversely affect their learning abilities and cognitive
function. In the study of Abdulqhani et al (2020), one-fourth of their participating medical
students felt saddened during the quarantine period, increasing their level of stress. Furthermore,
22.3% of their participating medical students had a severe level of stress for the reason that they
do not prefer online learning. The lack of social interaction and the struggles in the new way of
learning are some of the stressors medical and allied health sciences students are facing during
the pandemic.
In another study conducted by Abbas et al (2020), during the pandemic, medical clerks are more
anxious about their eventual return to clinical rotations and how would the pandemic affect their
learning and future careers than worrying about being contracted with the virus. Medical students
were forced to adapt to this unusual situation to continue to achieve their goals and plans in life.
During the taped televised meeting with President Rodrigo Duterte, Briones said in Filipino that,
they believe that the children and teachers’ general mental health issues are the biggest challenge
for the people in the government during the present psychosocial conditions. (INQUIRER.net,
2020). The alarming increase in suicides have also pushed Justice Secretary Menardo Guevarra
to seek help from the religious sector. Various studies have also reported an increase of 1% to
145% of suicide rates during the COVID-19 pandemic. It has also been highlighted that the
mental health of older adults has been affected during the pandemic as well as an increase in
suicidal thoughts and self-harm (BMJ, 2020).
Furthermore, the development and validation of a questionnaire on evaluating students’ stressors
during the COVID-19 pandemic by Zurlo et al., (2020) have identified three meaningful factors
which include relationships and academic life, isolation, and fear of contagion. It is believed that
these factors are one of the major sources of stress among students that could harm their
psychosocial health conditions.
It is quite distressing to hear various reports regarding students committing suicide or taking off
the semester during the COVID-19 pandemic. The struggles and various stressors encountered
by allied health sciences students are undeniably stressful and thus affect their education. As
future healthcare professionals, we are not prepared emotionally and physically with the
occurrence of this coronavirus. The difficulties we’ve encountered with regards to online
learning and the fear of the existing virus have caused a mental breakdown.
Many studies have looked at the perceived (level of) stress among students during the COVID-
19 pandemic. However, the stressors encountered by the students, specifically the allied health
sciences students, during the COVID-19 pandemic has not yet been elucidated. Therefore, in this
study, the researchers aimed to identify the stressors contributing to the academic performance of
undergraduate allied health sciences during the COVID-19 pandemic.
After identifying the stressors, the researchers intend to determine which among these factors
have greatly affect the students’ academic performance. The results of this study would allow an
extensive research that promote strategies of coping for the faculty and the students.

Statement of the Problem

This study aims to identify the stressors experienced by the allied health sciences students of
NORSU amid of  COVID-19 pandemic and also to determine the major source of stress that
greatly affects their academic performance.

More specifically, this study seeks to find answers to the following questions:

1. What is the profile of the respondents in terms of:

1.1 Age

1.2 Gender 

1.3 Year level

1.4 Course

1.5 Marital status

1.6 Income

1.7 Residence

2. What are the perceived stressors of the respondents in terms of:

1.1 Relationship with others

1.2 Personal Factor

1.3 Economic Factor

1.4 Academic Factor

 1.5 Environmental factors

3. What is the major source of the stressor experienced by the respondents?

Significance of the Study

Scope and Limitation

The study will be conducted to the randomly selected 150 students of Negros Oriental State
University. This study will be limited only to the students from College of Nursing, Pharmacy,
and Allied Health Sciences, who will be the respondents. The study will be focused on the
respondents' perception on the stressors they have encountered during the pandemic that have
influenced their academic performance. The results of the study is applicable and limited only
during the course of COVID-19 pandemic. The study will not focus anymore to the association
of these stressors to the students' mental health and will not cover the stressors experienced by
the students in the absence of the pandemic.

Theoretical Framework

The Neuman's Systems Model is a holistic conceptualization of health and illness as they relate
to their environmental influences. She articulates persons as being client or client-systems, a
composite of multi-dimensional variables  whose goal is to maintain or re-establish equilibrium
as a response to stress (McEwen and Willis, 2011). Neuman described her notion of the client's
structure as concentric rings, or lines of defense, which represent survival factors. When the lines
of defense work to protect the client, balance is maintained or reestablished. When they do not,
however, the end result can be death. According to Alligood and Toomey (2006), the normal line
of defense is the outer circle, which represents stability; its expansion signifies an enhanced state
of wellness, and contraction, a diminished state. In the past year from January 2020 until this
year of 2021, the world has been enduring a pandemic and up until now, we’re still recovering
from it. Since March of 2020, the Philippines has undergone a lockdown to avoid the spread of
the covid-19 virus. The lockdown has affected a lot, including the education sector, meaning that
all students have been halted from going to school. The allied-health science students were not
excused from this type of setup including specifically the College of Nursing, Pharmacy and
Allied Health Sciences from Negros Oriental State University. One of the disadvantages of this
setup is that online mode of the teaching-learning process is often discriminatory to poor and
marginalized students and because of this, learning has been extra hard for most of the students
from CNPHAS which is leading to anxiety regarding their grades and how they can cope with
other factors hindering their learning and their ability to achieve success with their course.
Students from the College of Nursing, Pharmacy and Allied Health Sciences has been
emotionally, mentally, physically, and financially challenged which gives adverse effects to their
academic performance. In this study, the researchers sought to construe and identify the other
factors that result to the emotional instability of the undergraduate students of CNPHAS.
Identifying the other factors can lead to the betterment of controlling emotions for the benefit of
the students’ emotional intelligence which can help them to reduce their anxiety and stress,
communicate better, improve relationships, defuse conflicts, empathize with others, and
effectively overcome life's challenges including this pandemic.
This study acknowledges the nursing theory namely Neuman’s System Model. This theory is
used as a backbone to formulate this study’s framework. Neuman’s theory focuses on the patient
system's response to current or possible environmental stressors and the preservation of the
integrity of the client system to mitigate stressors through primary, secondary, and tertiary
nursing prevention intervention. It is based on the relationship of the individual to stress, the
reaction to it, and progressive factors of reconstitution in nature. A broad, comprehensive and
system-based approach to nursing is provided by the Neuman Systems Model that retains a
versatility factor. The major concepts of Neuman’s theory are content, which is the variables of
the person in interaction with the environment; basic structure or central core; degree to reaction;
entropy, which is a process of energy depletion and disorganization moving the client toward
illness; flexible line of defense; normal line of defense; line of resistance; input-output;
negentropy, which is a process of energy conservation that increases organization and
complexity, moving the system toward stability or a higher degree of wellness; open system;
prevention as intervention; reconstitution; stability; stressors; wellness/illness; and prevention.
 Conceptual Model

Input Process Output

 Possible  Identified
 Assessment of
stressors of stressors that
perceived
CNPHAS contribute to
stressors that
students the majority of
contribute to
 CNPHAS CNPHAS
the majority of
students students
CNPHAS
 Survey
students
Questionnaires

Intervening Variables

 Student’s profile
- Gender
- Course
- Year level
- Address
 Experience during online class
 Review of Related Literatures

Demographic Profile Factors

Anxiety disorders happens when a certain individual feels an immense level of worry, fear, or
distress caused by an emotional trigger. One out of many reasons of anxiety is “demographic
profile.” It is a bit vague but finding out the specific demographic factor that triggered the
student’s anxiety can be the key to a successful intervention. It is quite difficult to mix and match
what certain symptom come from which demographic factor since there are numbers of possible
factors such as age, race, ethnicity, gender, marital status, income, education, employment or a
combination of the ones mentioned. Those are only a few of the possible demographic factors.
One research was conducted in Malaysia to find out what kind of population were susceptible to
suffer from depression and general anxiety disorder. The study was able to recognize that
females, younger adults, Indians, unmarried individuals, less educated people and individuals
with poor self-rated health have a higher chance to develop GAD and depression. These results
may be used as a tool to establish some benefits for people to control their anxiety. It is essential
for us to be knowledgeable that anxiety is just a normal reaction to some circumstances. Every
one of us will respond and react differently at times since we have different demographic factors
and sometimes along with it comes with social, psychological or environmental triggers. Anxiety
is a complex and complicated condition meaning protective factors are needed to be construed as
part of the process of intervening it. The causes of anxiety aren’t fully understood and there’s no
way to determine and predict specifically what causes someone to develop anxiety but just
overseeing through the tip of the iceberg and taking steps to reduce the impact can help already.
Relationship Factor
According to Danielle , C. (2020) During this current COVID-19 pandemic, each of the students are
struggling with their learning most especially that their situation at home in this trying time is a great
factor in their academic performance. Students who have been consistently successful with their academic
performance before the pandemic might be challenged with the online teaching environments as well as
the lack of social interaction with their classmates and friends. Relationships with others contribute an
important part in a student’s life since they usually thrive to collaborate and communicate with their peers
when given opportunities for interactional activities.
According to Skylar ,C (2018) College student’s situation may be affected by their experiences that have
caused them harm such as negative social interactions, perceived threat such as having difficulty or
inability to develop a strong and healthy social connection with others. These relationship factors can
eventually be stressful for a student and can result in negative emotions further affecting their academic
performance. Being surrounded with people that understands and interacts with you increases the self-
esteem and brings a positive outlook in a student’s life.
Motivation have played an essential role in identifying the academic achievements of students. Students
are more encouraged to learn passionately and accomplish any tasks when they have an inspiration. With
regards to this, being in a romantic relationship makes a teenager feels affection, care and love, which
eventually makes them feel motivated. Hence, students who are involved in romantic relationships
performs better in their studies resulting to a better academic performance. However, despite the
advantages romantic relationships can bring to a students’ academic performance, there are also students
who tend to pay less attention and be distracted with their academic work when they are in a relationship.
(Bernales and Colonia, 2011). Relationships is something that needs to be kept in balance in order to
prevent such factor from causing a negative effect on a students’ performance. Moreover, students should
also be more responsible with their own relationships, whether a romantic relationship or a friendly
relationship with others.
According to Essel et. al. (2017) relationship factors are one of the primary sources of stress in students.
The results of their research show that parental conflict took the least percentage with 25%, followed by a
conflict and misunderstanding with roommates with 35%, problems with girlfriend and boyfriends with
40%, and working with other people had the most significant percentage with 82%.

Personal Factors

Stress can be defined as physiological arousal in response to environmental threats and

challenges that are subjectively perceived as overwhelming an individual’s resources (Folkman
and Lazarus 1991). It is a natural bodily reaction to challenge or demand; nonetheless, prolonged
stress can diminish academic performance and provoke maladaptive behaviours (Vermunt and
Steensma 2005). Studying in a university is a stressful stage of a students’ life where they need
to adapt to since they are confronting requests or demands like living away from their families,
and intensely stacked educational plan but the coming of COVID-19 turns the students’ life more
stressful and exhausting. Their need to adapt to the new normal was way beyond they could
imagine and new set of demands are increasing that they are in doubt if they could adhere to it.
The COVID-19 pandemic didn’t just bring out fear of contagion from the virus and social
detachment but it also influences to hinder relationship with support system. Stress experienced
by the students intensifies with personal factors which lead to poor academic performance.
Different studies exploring factors associated to COVID-19 outbreak among university students
highlighted high levels of anxiety and worries about academic delays and influence of the
epidemic on daily life, due to the disruption in students’ daily routine, in terms of activities,
objectives and social relationships (Cao et al., 2020; Chen et al., 2020; Lee, 2020b; Sahu, 2020).
Indeed, the quarantine hindered the possibility to experience the university life, impacting on
academic studying (i.e., uncertainties related to annulment/delays of activities, difficulties in
employment of online platforms for the distance learning), but also impairing the possibility to
benefit from the relationships that may represent anchor in students’ life, such as those with
peers, colleagues, and professors (Lee, 2020b; Sahu, 2020). In addition, also considering the
increasingly key role played by romantic relationships in the young population (Anniko et al.,
2019), research also outlined the potential changes in couple’ relationship, intimacy, and sexual
life due to the COVID-19 pandemic (Li et al., 2020; Rosenberg et al., 2020).

Personal factors such fear of contagion, isolation, poor support system, peer pressure,
health-related problems could be a factor to stress experienced by the students. These factors can
be potentially frustrating to students, having these factors associated with stress being
experienced by them could possibly lead the students to make insensitive decisions. With this
study, it seeks to identify if the factors being modified are a major source of stressors to the
students of College of Nursing, Pharmacy, and Allied Health Sciences.
Academic Factors
In a study conducted by Gbollie and Keamu (2017), one of the most captivating findings is about
students’ concern about poverty and their access to school, specifically the distance to and from their
school). Moreover, other factors affecting students’ academic performance including their motivation,
academic competence, students’ attitudes, behavior, time management, and engagement in class
activities. Academic competency is a variable that is directly proportional to students’ ability to do well in
their study in order to reap a better outcome as well as their attendance in class that plays also plays a big
role on the amount of learnings they gain during discussions when they are consistently present and active
in participating class activities (Smith, 2019).
According to Murphy and Archer (1996) Going to college is the positive encounter for numerous people ,
however numerous people also have seen and experience, college as a chronically stressful due to
academic requirements.
According to Deb et al. (2004) , a study on 400 male understudies from five private auxiliary schools in
Kolkata who were considering in grades 10 and 12. 35 percent understudies were found to have tall
academic stress and 37 percent of them have high anxiety. Students having marginal grades are said to
have higher levels of stress compared to students having way better grades. Moreover, students involved
with extra-curricular exercises were found to be more stressed as related to those students who were not
included with it.
In the study of Agolla, J. E. & Ongon, H. (2009) with 310 respondents about the academic stress of
undergraduate students, they concluded that academic workloads (81%), insufficient resources such as
gadgets and books (66%), lack motivation (68%), poor performance in school (66%), overcrowded
environment (55%) and uncertainty of the future (56%) is the primary cause of stress to students. Every
individual response to pressure in academics may be the same or identical. However, sources of stress can
vary from one person to another
 Research Methodology
Research Design
This study belongs to a descriptive type of quantitative research that tends to focused on the
respondents’ perception about the stressors they have encountered during the pandemic. For data
gathering, the researchers used the simple random sampling. The respondents for data gathering
came from the students in College of Nursing, Pharmacy, and Allied Health Sciences of Negros
Oriental State University.
Research Environment
The respondents of this study were from Luzon, Visayas, and Mindanao who were all studying in Negros
Oriental State University situated in Dumaguete City, Negros Oriental. The questionnaires will be given
to the respondents online through google docs which will only be accessible and exclusive for them.
Research Instrument
This research will use questionnaire which is adapted and modified and it is divided into 6 factors. The
parts include the demographic profile , relationship factor, personal factor , economic factor , academic
factor , and environmental factor. The demographic profile asks questions such as the name , age , sex ,
type of house , to whom they were living with , and the rest of the factors asks them to rate their level of
stressors depending on the given questions. A pilot or preliminary study will be conducted prior to the
actual survey in order to test the effectiveness and accuracy of the questionnaire which will be used in
gathering data.

Data-Gathering Procedure

Before the start of the survey, each respondent was informed about what type of study the researchers
will conduct to gain acceptance of their participation. More specifically, each respondent shall be given
with a consent sent through their respective messengers and the researchers will make sure to respect and
maintain confidentiality.

Statistical Treatment of Data

Ethical Consideration
This study is conducted with the proper guidance of ethical principles. Respondents will be given enough
and accurate information regarding the purpose of the study before giving the consent. The researchers
are also willing and open to cater any questions from the respondents regarding their concerns that they
want to be clarified before participating in the study. Rest assured that the respondents' responses will be
well secured and kept in private to ensure confidentiality and protection of their rights. Respondents will
not be subjected to harm in any ways and are allowed to withdraw from participating in conducting the
study any time they want. The procedure involving human participation strictly follows the standards of
ethical principle to prevent misunderstandings and complications in the future.
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