1. Introduction

For the past semester, 30 senior student nurses nearly flanked Competency Appraisal I. I was one of the many students who nearly failed Competency appraisal I (CA I). In my personal experience, I observed and often heard experiences of other student nurses so I can say that competency appraisal is a very hard subject and it is one of the main stressors of a senior student nurse. I am currently taking Competency Appraisal II (CA II), and just like in CA I, it has the same effect to me and to other students.

Because Competency Appraisal tackles everything from first year to fourth year of Bachelor of Science in Nursing, most students are having a hard time coping with this subject. This study aims to determine the coping strategies of senior student nurses in Competency Appraisal and to identify effective strategies on how to cope with Competency appraisal especially to those who are failing and/or troubled by this subject; and to succeeding batches, for them to have an idea on how to deal with the trials of Competency Appraisal.

The objective of this study determined the coping strategies senior student nurses in the Philippines in competency appraisal. Specifically, it sought to answer the question: how do student nurses cope with Competency Appraisal?

2. Overview

Stress is a state produced by a change in the environment that is perceived as challenging, threatening, or damaging to a person’s dynamic balance or equilibrium. The person may feel unable to meet the demands of the new situation. The change or stimulus that evokes this state is the stressor. The nature of the stressor is variable; an event or change that is stressful for one person may not be stressful for another, and an event that produces stress at one time and place may not do so at another time and place. A person appraises and copes with changing situations. The desired goal is adaptation or adjustment to the change so that the person is again in equilibrium and has the energy and ability to meet new demands. This is the process of coping with the stress, a compensatory process that has physiologic and psychological components. (S,Smeltzer et. Al [1] 2010)

Coping occurs in response to psychological stress in an effort to maintain mental health and emotional well-being. Life stressors are often described as negative events; however, positive changes in life can also constitute life stressors, thus requiring the use of coping skills to adapt. Coping strategies are the behaviors, thoughts, and emotions that people use to adjust to the changes that occur in your life (UCLA Dual diagnosis Information and Admissions [2], 2014)

Coping strategies are ways to which external or internal stress is managed, adapted to or acted upon. Susan Folkman and Richard Lazarus define coping as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing". There are many coping styles that people use, and some may prove more effective than others, depending on the nature of the stressful situation and the person who is employing them. Ineffective coping mechanisms, also referred to as maladaptive coping, may also be applied to stressful events or internal conflict, often unconsciously. (S. Sincero [3], 2012)

Competency Appraisal is a process in which an individual is assessed for his or her competence in a particular area of employment. The main objective of competency appraisal is to ascertain whether an employee/student is able to carry out his or her duties in a professional role. There are certain professions in which competency appraisal is of critical importance, such as medical professions in which human safety is an essential priority. If patients are exposed to incompetent medical practitioners, this could be a potential threat to the patient's health and safety. In developed nations, competency appraisal in the medical professional is highly prevalent as it is considered to be absolutely necessary; medical practitioners, particularly in their first years of practice, are monitored closely by senior medical professionals. (L. Prangnell [4], 2007). Competency appraisal in nursing deals with the review of the theories, concepts, principles and processes basic to the practice of nursing learned for the whole four (4) years of Bachelor of Science in Nursing.

Competency Appraisal I deals with the application of the concepts, principles, and processes basic to the practice of nursing with emphasis on health promotion, disease prevention and risk reduction, health maintenance, curative and rehabilitative aspects of care of sick mother, child and family, population group an community. It includes the utilization of the nursing process and the core competencies under the eleven key areas of responsibility. On the other hand, Competency appraisal II deals with the application of the concepts, principles, and processes basic to the practice of nursing with emphasis on health promotion, disease prevention and risk reduction, health maintenance, curative and rehabilitative aspects of care of sick individuals, with alterations in cellular aberrations, adjustment problems, and maladaptive patterns of behavior, acute biologic crisis, disaster and emergency. It includes the utilization of the nursing process and the core competencies under the eleven key areas of responsibility. (L. Caranto [6], CA 2 course syllabus, 2014)

3. Methodology

3.1. Research Design

The study used qualitative research wherein data were gathered from narrative description (subjective) during interaction of the researcher with student nurses in their own language and environment. I utilized the phenomenological approach to determine the coping strategies used by the senior student nurses in Competency Appraisal.

3.2. Population and Locale of the Study

The target population was selected through purposive sampling. The participants should have taken Competency Appraisal one (1) and two (2) consisting of three (3) units for the past and present semester. The study’s time frame is from December 2014 to January 2015.

3.3. Data Collection Procedure

A structured interview was utilized to gather information needed. It served as the primary tool for data gathering. The questions constructed are related to the objectives of the study.

The structured interview is composed of three (3) parts. The first part is the consent. The second part is the profile of the participants such as their age, section, gender, and educational background. The third part was the interview proper which determined the coping mechanisms of senior student nurses of the Philippines in competency appraisal. Interview was used to certify the responses and gather further information.

First, I looked for the participants through purposive sampling. Second, I had the consents from the participants by letting them sign the respondent’s consent after explaining the objectives and purpose of the study. The participants and I set a specific date and time for the interview. Third, I conducted an in-depth interview about the coping strategies of the participants. Each participant was interviewed separately. Recording data were transcribed verbatim. The last step is I analyzed and interpreted the data gathered.

3.4. Data Collection Instrument

Data were collected through in-depth interviews. Since phenomenological approach was used in this study, I was more interested in the responses of the students and how they cope with a specific phenomenon. Thus, the method of analysis that was used is triangulation.

3.5. Data Analysis

Given that the data was gathered are in descriptive and verbatim form, I used a coding sheet to organize the raw data by assigning codes to each of the respondent’s answer to every question. The responses of the informants in their local dialect were translated in English. Subsequently, I grouped the patterns observed in the data thus producing categories. The themes were then based and procured from the categories formulated. From then, the data was analyzed using literatures to further support the findings of the study.

To establish credibility of the data gathered, multiple sources and investigator triangulation were employed. Member check was used to validate information by summarizing data gathered from participants and this was done in every end of the interviews and discussions.

In addition, the study employed triangulation to enhance the credibility of the qualitative data.

4. Results and Discussion

The following discussions present the analysis and interpretation of the identified domains, themes, and where relevant validation with literature. The themes were examined in view of literature with the intent to describe the coping mechanisms used by senior student nurses in their subject Competency appraisal. The themes that were developed from the data are presented in the concept map below.

4.1. Working It through

This domain “working it through” or simply dealing with the work and/or trials of Competency Appraisal (CA) includes participants’ schemes on how they face the challenges of CA. Furthermore, it discoursed the possible ways on how to pass the subject.

Feeding the Brain. The most popular coping response is “feeding the brain” or simply studying for the subject. Almost all the participants stated that they read before every exam, as stated by Mr. W, “agrevrevreview ak…” (I really study hard). According to Dr. B. Kizlik, a primary means by which you acquire information is through reading. We must learn to read with a purpose. In studying, we may read the same assignment three or four times, each time with a different purpose. We must know before you begin reading what your purpose is, and read accordingly. (2015)

Comfort Zone. Most participants said that they can study best when they’re alone, in a place where there are no distractions. “sa lugar kung saan tahimik aku nagrereview…” (I study in a quiet place) as stated by Ms. M. “…ijay balay ta awan kadwak, makastudy ak nga usto…” (At home because no one is there, I can study hard) as said by Mr. W. According to an article in Advising and Learning Assistance Center, whether the study location is the typical "quiet" of a library or the noise and confusion of the Union it still depends on how well the student can focus. Quiet environments, such as the library or a classroom, can work for the student who is easily distracted and needs the minimum of sound and visual stimulation. The lack of sound in such an environment magnifies any sound that does occur, and this in turn increases the ability of a sound to distract students from their studies. (alac.rpi.edu)

Time to Study. All the participants were asked if what time they usually study. Some said that they study late night until early morning. “Kung talagang magrereview, matutulog aku ng mga 11 tapos gigising ng 4 am…“as aforementioned by Mr. I. Mr. W shared “one (1) AM pinaka late nga agreview ak tapos agriing akun ti six…” (One (1) am is the latest that I review [my notes] and then I wake up at six (6).

Study begins on the first day of class. Successful students read and review notes before each class to recall information from the previous class and to warm up for learning. Review your notes immediately after each class to reinforce learning or within a 24-hour period for best recall. Repeated exposure to the material will store it in your long-term memory. Studying one hour immediately after a class will do more good in developing an understanding of the material as several hours a few days later. Studies show that as much as 80 % of material learned in class is forgotten within 24 hours if there is no review. The more active you are, the more effective your study time will be. A tired body only makes a tired mind. Study when you are at your peak, when you are more awake and alert and able to absorb new information. If you are a morning person, your best study time is in the morning. If you are an evening person, study at night. If you cannot find time to study at your peak time, try to study when you are feeling relatively awake and alert. (Mayland Community College, 2002)

In contrast, Ms. P said “…never ak nagpuyat para CA” (I never slept late for CA).

4.2. Stressed-out Remedy

These are the experiences of the participants when they are stressed-out because of competency appraisal. This also includes how they deal with the stress when they fail exams.

Time-out. Everyone needs to take a break; may it be from a long tiring day, from an unending work, and/or from demanding school stuffs. According to P. Korkki on his journal in New York Times entitled To Stay on Schedule, Take a Break, “A growing body of evidence show that taking regular breaks from mental tasks improves productivity and creativity; and that skipping breaks can lead to stress and exhaustion.” As Mr. W stated, “Agrererelaxak” (I take time to relax). “Nu maisistress ak ti CA, maturog ken manganak…” (If I get stress-out by CA, I sleep and eat) he continued.

Anxiety and grief have been described as two major, primary psychological response patterns to stress. A variety of thoughts, feelings, and behaviors are associated with each of these response patterns. Low levels of anxiety are adaptive and can provide the motivation required for survival. Mild anxiety is seldom a problem for the individual. It is associated with the tension experienced in response to the events of day-to-day living. Mild anxiety prepares people for action. It sharpens the senses, increases motivation for productivity, increases the perceptual field, and results in a heightened awareness of the environment. At the mild level, individuals use any of a number of coping behaviors that satisfy their needs for comfort. Eating and sleeping are the first two coping mechanisms identified by Menninger in 1963. (Essentials of Psychiatric Mental Health Nursing 5th ed. - M. Townsend (F. A. Davis, 2011)).

Pecoraro says, "Eating seems to ameliorate some of the symptoms of depression, so you won't feel as anxious. This seems to be the body's way of telling the brain, 'It's OK, you can relax, you're refueled with high-energy food." (Psychology Today, 2007). While Sleep restores the body’s energy levels and is an essential aspect of stress management. To ensure adequate sleep, clients may need help to attain comfort (such as pain management) and to learn techniques that promote peace of mind and relaxation (Kozier & Erb's Fundamentals of Nursing, 9^th edition).

Response to a Catastrophe. On the other hand, students who fail in the exams deal with it through prayers and doing their best in the next examinations as stated by Mr. I: "Pag nababagsak, dasal, dasallang din." According to Rev. C. Duncan, prayer elicits the relaxation response, which lowers blood pressure and other factors heightened by stress (2013).

Spirituality is defined as connectedness with self, others, a life force, or God that allows people to experience self-transcendence and find meaning in life. Spirituality helps people discover a purpose in life, understand the ever-changing qualities of life, and develop their relationship with God or a higher power. Faith, considered the foundation of spirituality, is a belief in something that a person cannot see. A strong sense of spirituality or religious faith can have a positive impact on health (Hovey & Seligman, 2007; Mc- Manus, 2007). Spirituality is also a component of hope… people often find comfort and emotional strength in their religious traditions or spiritual beliefs. (Brunner and Suddarth's Textbook of Med.-Surg. Nursing 12th edition)

Some dealt with it by just being optimistic about the outcome. “Nu mabagsakak, move on, awan lang. Gamin nu diyay ti panpanunutem, karkaro ka lng nga mastress. Be positive lng…” (When I fail, move on. Because when you keep on thinking about it, the stress will just worsen. Just be positive).

A successful person stays motivated by maintaining balance. The successful person maintains balance in their emotions at every life challenge. When we are in balance, we are happy and well-rounded. We react sensibly to all that is going on around us. This balance brings us happiness and happiness motivates us to wake up the next day.

When things don’t seem to be going in the direction you want, re-assess the positives. This means, find those things you did during the day that were positive, no matter how insignificant you think those things might be. It doesn’t matter how small the positive thing is; what is important is the fact you did something that moved you forward in life and closer to your goals. Focus on the good parts of your day, especially when experiencing the feelings of failure. A large part of staying motivated is focusing on the accomplishments you had. If you focus on failure you will lose motivational energy.

We all fail at one thing or another. Not one of us is perfect, so inevitably we all do experience failure at some points in our lives. However, successful people don’t dwell on the failures they inevitably have; they don’t imagine themselves as failures. When you see yourself personally as a failure and you internalize this, you will most certainly lose motivation. If you want to stay motivated despite failure, do not take failure personally.

A key factor to staying motivated is to see failure as an opportunity. It could be an opportunity to learn a new skill or an opportunity to try something which you had not expected before. Most of the time when failure knocks on our door it is to teach us something about ourselves, the situation, and those around us. An apparent failure which forces us to take a path we did not intend can actually lead to great happiness. Failure is actually there to help us, if we use it right. By thinking of failure in this way, you will find motivation. (getmotivatedstaymotivated.com).

Ms. B also shared, “nu mabagsak, agkape lattan, sempre inya pa ngy maaramidam?” (When I fail, I drink coffee, what else can I do?)

5. Conclusions and Recommendations

The findings of my study and the literatures that support it shows that having a good coping strategy in Competency Appraisal plays an important role in order to pass the subject. The themes that were formulated present the coping strategies used by student nurses. The responses of the participants suggested themes under two domains: Working It Through: Feeding the Brain, Comfort Zone, Time to Study; and Stressed-out Remedy: Time-out, Response to a Catastrophe.

Senior student nurses of the Philippines use different coping strategies to cope with Competency Appraisal. Not all of the coping strategies are created equal. Some were used more often than others and some strategies effective to some do not apply to all. My study concludes that facing or dealing with the challenges of competency appraisal and taking a break are the main strategies used by student nurses in the Philippines. After recognizing a stressor, a person consciously or unconsciously reacts to manage the situation. This is termed as the mediation process (S,Smeltzer et. Al, 2010). This is why the participants eat and sleep to cope with the stress.

I recommend the use of “working it through” as a coping strategy to Competency Appraisal. Aside from it is a healthy way of coping, it also suggests ways on how to pass the subject.

It is also recommended to conduct further interview of the participants to determine more coping strategies and to cluster them to negative and positive ones for the students to know the coping skills that they should adopt and those that they should avoid.

For future researchers, I recommend to conduct a broader study on the coping strategies used by student nurses of each year level in the academic or clinical aspect.

ACKNOWLEDGEMENTS

With sincere appreciation and deepest gratitude, for the people who guided, helped, supported and sacrificed their time for the betterment of this research from the conceptualization to the final output.

To the participants of my research for cooperating and for their honest responses.

To Sir Lawrence Caranto and Sir Juan Jose David for their professional guidance, suggestions, insightful comments and critical analysis to further polish this study.

To my family, friends and classmates for their, warm support and imparting their ideas.