Stress, coping, and psychological health of vocational high school nursing students associated with a competitive entrance exam.

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.