Stress, Coping, and Psychological Health of Vocational High School Nursing Students Associated with a Competitive Entrance Exam

Abstract

加強護理教育以提昇護理專業的起始能力是台灣護理教育體系的重要課題與展望。為 了符合未來技術人力的需求，一般技職教育體系的護生不僅有意願繼續升學，也同樣 面臨升學競爭。本研究以橫斷式調查法，探討高職護生在大專與四技的升學考試準備 階段：(l)壓力感受與壓力源及使用的因應行為；(2)壓力感受對因應行為的影響；(3 )比較不同因應行為在壓力影響心理健康過程中的緩衝效果。研究對象採立意取樣， 包括北台灣兩所三年制的高職護理學校中441位有升學意願的應屆畢業生。研究工具 包括壓力量表，因應行為量表與中國人健康問卷。研究結果顯示五個主要的壓力源依 序為：考試、個人期望、課業、教師期望與父母期望。研究對象普遍以問題導向因應 行為，包括積極行動與社會支持來處理升學壓力，情緒導向因應行為的使用與升學壓 力感受增強有顯著的相關，包括逃避與情緒困擾二項。二因子變異數分析顯示，問題 導向因應行為具有主效果，可以緩衝壓力對心理健康的負向影響，且壓力與問題導向 的因應行為彼此問的交互作用指出這樣的緩衝效果在升學壓力維持輕度至中重度時最 明顯。相反地，情緒導向因應行為產生的主要效果卻會惡化研究對象心理健康，且壓 力與情緒導向因應行為並沒有交互作用產生。 An important issue for the nursing education system in Taiwan is to reinforce nursing education to enhance competence levels for entry to nursing specialties. Consequently, to meet the prospective demands of technical manpower, not only do nursing students in college and vocational schools pursue further studies, but they also take competitive entrance exams. Using a descriptive cross- sectional design, the study examined the following among nursing students in vocational high schools: (1) perception and sources of entrance exam stress and use of coping behaviors; (2) the effect of difference in entrance exam stress levels on coping behaviors used, and (3) measurement of coping function to determine which coping behavior works best for buffering the impact of stress on psychological health during a preparatory stage of a college and university entrance exam. The subjects were 441 third-year nursing students of vocational high schools in northern Taiwan, recruited by convenience sampling. Three measurements were adopted: Stress perceived scale, Coping behavior inventory, and a Chinese health questionnaire. Results showed that the five main stressors of entrance exam stress, in descending order, were taking tests, the student's own aspirations, learning tasks, teacher's aspirations and parent's aspirations. Students generally used problem-focused coping strategies including optimistic action and social support to deal with the entrance exam stress, but use of emotion-focused coping strategies including avoidance and emotional disturbance was significantly increased as perceived level of stress rose. Two-way analyses of variance (2-way ANOVA) revealed that problem-focused coping had a positive main effect of alleviating psychological distress. A significant interaction was observed between stress perceived and problem-focused coping used for psychological health. Further examination of the interaction effect showed that problem-focused coping behaviors were potentially more adaptive in relation to psychological health at the lower and moderate stress levels ( 25-75%T) than that at the extreme stress level (>75%T). Conversely, emotion-focused coping had a negative main effect or impairing psychological health. No interaction effect was found between stress perceived and emotion-focused coping used, suggesting that the relationship between emotion-focused coping and psychological distress was consistent across various stress levels.