STRESS LEVEL AND ACADEMIC PROCRASTINATION OF NURSING

LEARNERS IN A STATE UNIVERSITY

Adrian Dominique Agacid

Ma. Allyssa Andrea T. Agcaoili
Aira Faith P. Anacleto
Nerie Anne Brigado
Julimaricon R. Buenavista
Graziella Beatriz A. Cabuyadao

Submitted to the Faculty of the College of Health Sciences

Mariano Marcos State University
In Partial Fulfillment of the
Requirement of the
Degree

BACHELOR OF SCIENCE IN NURSING

TABLE OF CONTENTS
TITLE PAGE
TABLE OF CONTENTS
CHAPTER 1: THE PROBLEM 1
Rationale
Statement of the Problem 1
Statement of the Objectives 4
Significance of the Study 4
Scope and Delimitation of the study 5
Operational Definition of Terms 6
CHAPTER 2: REVIEW OF RELATED LITERATURE AND STUDIES 7
Related Literature
Stress
Types of Stress
Physical
Interpersonal
Academic
Environmental 7
Related Studies 14
Theoretical Framework 22
Conceptual Framework 24
Research Hypothesis 26
CHAPTER 3: METHODOLOGY 27
Research Design 27
Research Locale 28
Population and Sampling Procedure 28
Data Gathering Instrument 29
Data Gathering Procedure 29
Statistical Treatment 31
Ethical Considerations 33
REFERENCES 42
 CHAPTER I

THE PROBLEM

Rationale

College presents a myriad of new experiences, and many of the experiences are
stressful. Students simultaneously face academic challenges as well as family or social
crises. Many balance irregular or extended workloads, have difficulty with time
management and may have fears over loss of financial scholarship support (Tansy &
Roe, 2009, as cited in Kurland, 2014). The involvement of different factors present in
college or university life imposes stress on students in various ways.
According to Hans Selye (1936, as cited in Samson and Koh, 2020), stress is
defined as the non-specific response of the body to any demand for change. Stress that
can arise from various academic and environmental aspects is very common among
college students. It may lead to many negative things, and one specific effect of stress
on a student is by constantly setting aside or refraining from doing something that is
causing the stress. This is most commonly known as procrastination, in which according
to Nayak (2019), it commonly occurs in academic contexts with a variety of negative
consequences. Further, he defined academic procrastination as the tendency when
learners postpone the completion of activities, projects, and assignments unnecessarily.
It is a less-studied and unique outlet of procrastination that deserves much more
attention because students' academic procrastination is a major problem (McCloskey,
2011).
Jaffe (n.d, as cited in Knaus, 2015) claimed that the level of stress affects what a
person does. When distracted by stress, they more likely to put more things off and
suffer from a procrastination accumulation effect. This is when the person feels
stressed, puts things off and then feels stressed thinking about what has been left
undone. And as a result, more things are left undone and feel overwhelmed. Moreover,
according to Sarafino & Smith (2011, as cited in Muliani et al., 2020), stress has
psychological effects which have some negative feedback such as depletion of memory,
anxiety, sadness, and procrastination. In addition, it has an adverse impact on the
academic progress of students and thus induces stress and anxiety. Expanding these
claims, Khalid et al. (2019) in their study entitled “The relationship between
procrastination, perceived stress, saliva alpha-amylase level and parenting styles in
Chinese first-year medical students”, found that academic procrastination by doctoral
students results from anxiety, stress, and guilt, thus needing attention. Pascoe et al.
(2020) stated that uncontrollable stress lowers academic, social, environmental,
psychological, and physical adjustment. Thus, the researchers in this study believe that
knowing the stress level of the student would create recommendations and actions on
how to help the students to address and cope with stress and avoid academic
procrastination.
Nursing students are prone to stress due to the transitional nature of college life
and different aspects. The nursing profession demands the skills for working in busy
schedules, stressful situations, and unexpected emergencies in the hospitals. According
to Rafati et al. (2017), nursing students experience higher level s of stress than students
in other health sciences. The clinical part of nursing education is more stressful than the
theoretical part. In that condition, there is a need to inculcate good time management
skills and reduction in procrastination and stress to prepare the students to work in the
hospitals (Nayak, 2019).
The study of Mercado-Vinces, et al (2021) entitled “Academic Procrastination
and Stress of University Students of Electronic Engineering from Callao Region”, focuses
only on the aspect of academic stress and academic procrastination. Likewise, the study
of Khalid et al, (2019) was able to explore the linked between academic procrastination
with academic demands. Moreover, there are also studies on other aspects such as
physical, interpersonal relationship, and environment and their relationship to academic
procrastination, but are limited in number. The researchers have also found that the
majority of these studies are from different countries like Indonesia and China. In
addition, the responses of the learners were confined to the face-to-face environment
and not during the new normal. The majority of studies also explored the relationship of
stress into the academic performance of the students which has been found significant
and one reason for low academic performance is procrastination. However, there are
other causes of procrastination that need to be explore, thus according to Abdullah
(2017), it is important to investigate its relationship with mental health levels.
With the above-mentioned reasons, the researchers were motivated to
undertake a study that will bridge the gaps of the previous studies. This study will allow
the researchers to suggest solutions on improving the learning skills, develop motivation
and coping mechanism to avoid procrastination as key to help learners in reducing
further stress.
.

Statement of the Problem

Generally, this study will be conducted to determine the relationship of stress

level and academic procrastination of the Level I nursing learners.

 Specifically, it seeks answer to the following questions:

1. What is the stress level of the respondents as to:

a. physical,

b. interpersonal relationship,

c. academic, and

d. environmental?

2. What is the extent of academic procrastination of the respondents?

3. Is there a significant relationship between the stress level and academic

procrastination of the respondents?

Statement of Objectives

Generally, this study will be conducted to determine the stress level and

academic procrastination in a State University.

Specifically, it seeks to:

1. identify the stress level of the respondents as to:

1.1. physical,

1.2. interpersonal relationship,

1.3. academic, and

1.4. environmental;

2. find out the extent of academic procrastination of the respondents; and

3. determine if a significant relationship exists between the stress level and extent

of academic procrastination of the respondents.

Significance of the Study

Recognizing the present status of the nursing learners in terms of their stress

level and academic procrastination is vital for incrementing mindfulness and advancing
psychological well-being among nursing learners. This study will be beneficial to the

following:

Learners. This study will promote the learners' awareness and take action on

developing study habits, improving interpersonal relationship and communication, ways

on eliminating environmental stressors and improving coping mechanisms on stress to

minimize stress level and avoid academic procrastination.

Family members. The results of the study can help the family gain knowledge

and insights on how they can help their children in coping with stress to avoid academic

procrastination, as well as to help them in promoting their mental, social, environmental

and social health.

Nursing educators. This study can be used by nursing educators in providing

online consultations with the learners to verbalize their feelings and concerns.

CHS administrators. The findings of the study will provide the CHS

administrators with a basis for planning programs as to online learning.

Future researchers. This study will be used as a basis for conducting more

studies about stress level and academic procrastination among nursing learners.

Specifically, it can serve as a pilot study for the nursing learners in Ilocos Norte.

Nursing Administrators - The findings of the study will provide them a basis

that will support the learners’ well-being by providing a conducive online learning

environment.

Nursing Practice - This study will be used

Nursing Education. The findings of study will provide nursing education an in depth

perception on the academic procrastination and stress level of nursing learners. -Juli

Nursing Research - The study's findings will aid educators and nurses in advancing

their careers, be well informed, and develop more effective solutions by allowing them to

utilise knowledge more efficiently.

Community People -Through this study, it will promote awareness and enhance the

knowledge of the community people regarding the stress and its effects, experienced by

nursing learners thereby bridging the implementation of information dissemination about

stress throughout the community.

Scope and Delimitation of the Study

This study will focus on determining the stress level of the respondents as to the

physical, interpersonal relationship, academic, and environment, as well as the extent of

academic procrastination. In gathering the data, a google form questionnaire will be

used as the primary instrument.

The quantitative, non-experimental, descriptive-correlational method will be used

in this study to describe and determine the relationship between the respondents’ stress

level and extent of academic procrastination. The respondents of the study will be limited

to Level 1 nursing learners, who are currently enrolled in Mariano Marcos State

University. The nursing learner must be officially enrolled in the nursing program of the

College of Health and Sciences, regardless of age and civil status. Excluded from this

study will be the 10 learners who will participate in the pilot testing.

The data that will be gathered will be statistically treated using weighted mean

and Chi-square test of independence.

The study will be undertaken during the month of January to June, 2022.

Operational Definition of Terms

The following terms are defined according to how they are being used in the

study:
 Academic procrastination. This refers to the practice of the respondents of

unnecessarily and intentionally postponing or delaying academic activities such as

assignments, studying for exams and requirements.

Nursing learners. This pertains to the respondents of this study who are

officially enrolled Level 1 of Mariano Marcos State University, A.Y 2021-2022.

Stress. This means the problems encountered by the nursing learners in terms

of physical, academic, interpersonal, and environment.

Academic. This pertains to stressors that describe things that are associated

with work done and demands in the academic environment of the nursing learners.

Environment. This means the stressors present in the conditions and

surroundings in which nursing learners live, and carry out their academic

responsibilities and tasks during online learning.

Interpersonal relationship. This pertains to the stressors associated

with how nursing learners deal and communicate with people in their

environment.

Physical. This refers to stressors that place strain on the nursing

learner’s body.

Stress Level. This pertains to the point or degree of stress caused by

problems encountered by the respondents in terms of physical, academic,

interpersonal and environmental.

Academic. This concerns the body’s response to the problems that have

to do with work and demands in the academic environment.

Environmental. This pertains to the response of the body to the

problems that exist in the environment the respondents live and complete their

academic duties and tasks while enrolled in online classes.

 Interpersonal Relationship. This refers to the body's reaction to

pressures related to how the respondents interact and communicate with others

in their environment.

Physical. This pertains to the body’s response to the demands of

pressure the respondents face in daily life.

 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the review of literature and studies carefully classified to

discuss the different topics that serve as the foundation of this study. The published

literature and studies were consolidated from websites and online journals.

Related Literature

This section provides a discussion of related literature focused on stress and its

different aspects, as well as academic procrastination.

Stress

Stress is viewed as a process whereby an individual perceives and responds to

events that he appraises as overwhelming or threatening to his well-being. A critical

element of this definition is that it emphasizes the importance of how a person appraises

—that is, judge—demanding or threatening events (often referred to as stressors); these

appraisals, in turn, influence the reactions to such events. Stressors have a major

influence on mood, our sense of well-being, behavior, and mental health

Stress occurs due to demands that exceed individual resources, affecting the

adaptive, cognitive, and emotional capacities of the subject. In nursing students, stress

can be produced when the demands are perceived as excessive and uncontrollable, and

its effects are related to health problems (Criollo, 2018).

Stress in students shows in many different aspects such as in physical,

interpersonal relations, academic, and environment.

Types of Stress
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The following discusses the different aspects of stress specifically, physical,

interpersonal relationships, academic, and environment.

Physical stress —------> paragraph heading

According to Lemos et al. (2018, as cited in Mercado-Vinces et. al, 2021), stress

is a process in which an event or stimulus is perceived as threatening and that

generates physiological, emotional, and behavioral responses that can be considered

normal. When such responses are over-given, they produce in the body an overload of

tension that harms the person, thus appearing diseases and psychopathological

abnormalities, which prevent the normal functioning and development of the body such

as mood disturbances, lack of concentration, muscle contractures, headaches, among

other symptoms are difficulty of breathing, back pain, sleep problem, excessive worry,

stomach pain or nausea, fatigue, sweating, frequent cold, flu, fever, and drastic weight

loss.

Interpersonal relationship stress

Kato (2014) defined interpersonal stress as stressful episodes between two or

more people that involve quarrels, arguments, negative attitudes or behavior, an

uncomfortable atmosphere during a conversation or activity, and concern about hurting

others’ feelings. Interpersonal interaction is a vital part of the college students self-

development process. Among adolescents, especially those in highschool and college,

dependence on parents is gradually reduced and transferred to peers, from whom they

seek recognition. Favorable relationships with peers or family members can help

teenagers to develop positive values and attitudes. More positive interpersonal

interactions with peers can affect the emotion of a teenager, which leads to lower levels

of depression and detrimental emotions. By contrast, negative interpersonal interaction

with peers or teachers generates higher levels of depression and more harmful emotions

(Wang et al., 2020).

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Academic stress

As stated by Kumar (2020), adolescents are particularly vulnerable to the

problems related to academic stress, as transitions occur at a personal and social level.

Today, nursing schools are considered as a stressful environment that often exerts a

positive impact on the academic performance and psychological well-being of students.

Academic sources of stress are exams, long study periods, grades, lack of free time,

lack of timely feedback after the performance, special elements of the academic

program such as organization and implementation of workshops. Academic stress is the

highest health impediment among nursing students, followed by sleep issues,

depression, and anxiety.

Furthermore, depression, anxiety, behavioral problems and irritability are just

some of the many problems reported in students with high academic stress. Incidences

of depression were also found among stressful adolescents as it is linked with the

inability to concentrate, fear of failure, negative evaluation of the future, etc. It is

imperative to also understand that low stress does not necessarily ascertain that

students will perform better, but in fact under these circumstances, they might perceive

the task as unchallenging and may also get easily bored (Reddy, 2018).

In addition, according to Zarrin et al. (2020), academic stress has been identified

as the primary cause of suicide cases. This stress is an interaction between

environmental stressors, students’ appraisal, and reactions to the same. It has now

become a grave reality that is termed as a “career stopper”. Academic stress becomes a

pervasive problem among nursing students across the country and it still continues to be

a destructive problem affecting the students’ academic performance, mental health, and

wellbeing.

Environmental stress
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According to Steel et al. (2018, as cited in Svartal et al., 2020), temptations and

diversions in the environment may be detrimental for most students particularly those

who are prone to impulsivity and distractibility. Procrastinators are especially vulnerable

to environments rich in temptations and distractions since they tend to draw attention

and shift intended action into more rewarding activities accessible at the time.

According to Botros (2020), COVID-19 puts many learners to face challenges,

including distractions when studying or attending online at home. A main source of

distraction is digital technology, as it might divert their attention because phones and

other devices are openly accessible. In addition, background noises are a huge obstacle

when it comes to learning. Television, family members, pets running in the house, or

siblings listening to loud music can all be sources of interruption. It is not limited to those

inside the house, but also outside like kids, neighbors, loud cars, and barking dogs can

draw attention away from school. Even weather and temperature can be a distraction.

Nursing students are adversely affected by high noise levels. Such levels have

been associated with increased stress and annoyance, fatigue, emotional exhaustion,

and burnout. Increased feelings of noise-related stress and burnout can lead to an

increase in dropout intention. Lower noise levels are linked with a number of positive

effects on nursing students, including reduced perceived academic demands, increased

social support, improved concentration, and better speech intelligibility. These positive

outcomes for the nursing students have the potential to decrease nursing students’

intention to drop out (Susan, 2017).

Academic procrastination

Procrastination is prevalent among many people and a variety of conditions

influence it. Among many types of procrastination, academic procrastination is the most

common one. Academic procrastination is a relatively common phenomenon among

adults and students in universities. (Ferrari, 2001, as cited in Moonaghi & Beydokhti,
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2017). Many studies have revealed that indecision, time management, lack of

motivation, fear of failure, poor organizational skills, high stress, poor coping strategies,

and peer influence are causes of academic procrastination.

It was found that cyber-loafing among the students predicts academic

procrastination because overuse of smartphones causes a lack of control, interest,

physical activities, communication, and confidence. Aside from that, excessive usage of

smartphones can result in poor psychological well-being, poor time management,

anxiety, and depression among the students.

Time management problems, self-handicapping to maintain self-esteem, and a

lack of motivation are the factors that contribute to the occurrence of procrastination.

Poor time management or planning in terms of accomplishing activities leads to

procrastination. Self-handicapping can be another factor for a student’s procrastination.

Self-handicapping is the act of creating obstacles so that it is nearly impossible for

success and in this instance success would be with tests, papers, and homework.

Therefore, procrastination is a way for the student to blame their failures instead of

acknowledging their own personal lack of ability and knowledge on the subject (Beck et

al., 2000; Ferrari, 2001; Ferrari & Tice, 2000, as cited in Rosetti, 2011).

Motivation is another reason why a student procrastinates. The intrinsic and

extrinsic motivation was explored in the literature review entitled "Procrastination

behaviors in college students" by Rosetti (2011). Students who are low in extrinsic

motivation are more likely to procrastinate and students with intrinsic motivation can

complete homework and assignments ahead of time even if there is no interest in the

task. Likewise, students with an intrinsic interest in school rather than students who go to

school for external reasons are less likely to postpone studying and completing

homework assignments (Senecal et al., 2001; Conti, 2000, as cited in Rosetti, 2011).
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Self-esteem has also been linked to procrastination. Studies have shown that

students with low self-esteem have a greater tendency to procrastinate than those

students with higher levels of self-esteem (Ferrari, 1991; Beswick, 1988; Steel et al.,

2000; Senecal at al., 2000, as cited in Rosetti, 2011).

Related Studies

This section provides a discussion on the relevant studies on stress and

academic procrastination that have been collected to serve as the foundation for this

research study.

Stress level and Academic procrastination

According to Svartal et al. (2020) in their study entitled, “How study environments

foster academic procrastination", understanding and acknowledging that procrastination

is not merely a problem with producing outstanding academic work is deeply crucial.

There are also other issues that are associated with procrastination such as stress,

reduced well-being, and mental and physical health problems. In addition, for academic

procrastination, the link between academic procrastination and increased stress appears

to be significant. Although the exact role of academic procrastination has yet to be

discovered, academic procrastination is likely to be both a contributing factor and an

outcome. Therefore, the function of environmental factors in encouraging procrastination

is equally crucial to consider from a health standpoint.

Handayani & Abdullah (2016, as cited in Muliani et al., 2020) in their study

entitled “The Relationship between Stress and Procrastination in Students”, states that

stress contributes to procrastination among 14.1% of the students. Further, according to

Ghufron & Risnawita (2014, as cited in Muliani et al., 2020), one of the syndromes that
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arise due to procrastinators is caused due to stress. The common stress experienced by

students is academic stress that is described as a condition in which academic tasks are

beyond their capability accompanied by any physical, emotional, cognitive changes and

some behavioral reactions that lead them to face those conditions (Gadzella & Masten,

2005, as cited in Muliani et al., 2020).

Gomanthi (2018) stated in his study entitled "Impact of Stress on Nursing

Students" that high levels of stress are believed to affect students’ health and academic

functions. Students are subjected to different kinds of stressors such as the pressure of

academics with an obligation to succeed, an uncertain future, and difficulties of

integrating into the system.

Muliani et al. (2020) in their study entitled “Relationship between stress level and

academic procrastination among new nursing students” utilizing the Academic

Procrastination Scale and Student-life Inventory questionnaire showed that there is a

relationship between level of stress and academic procrastination.

Furthermore, according to Scher & Ferrari (2000, as cited in Mahasneh et.al,

2016), academic procrastination can be related to a wide range of contributory cases

including environment, family and individual personal factors. Hussain & Sultan (2010) in

their study entitled “Analysis of procrastination among university student” revealed that

the students appeared to procrastinate and unable to complete their work in time due to

their illness, social and family problems, lack of motivation and interest; overconfidence,

laziness, negative attitude of their teacher, lack of guidance and counselling or

mentoring from teachers, negative comments of teachers on their work: assignments

and presentations, lack of coordination with their class fellows, too much work at the

same time to complete resulting in academic stress, habit of dependency,

communication gap, and enjoying the company of their class fellows.

Physical stress
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In a study by Sirois (2015) entitled “Is procrastination a vulnerability factor for

hypertension and cardiovascular disease: Testing an extension of the procrastination–

health model”, headaches, digestive difficulties, colds and flu, and sleeplessness have

all been linked to procrastination. In addition, procrastination has also been connected to

poor self-related health, which is a good predictor of poor objective health and health-

related outcomes such as cortisol responses to stress, illness, and mortality.

According to Klainin-Yobas et al. (2014) in their study, “The mediating effects of

coping on the stress and health relationships among nursing students”, reported that

nursing students with high-stress levels reported poorer physical health. Stress has also

been found to be one of the main mechanisms linking perfectionism to health indices.

More specifically, socially prescribed perfectionism is associated with poorer physical

health.

Procrastination-induced stress is thought to lead to stress-related physical

symptoms and psychophysiological alterations, as well as activation of the HPA system,

which can have a detrimental influence on health and increase vulnerability to sickness

in a variety of ways. Stress, in particular chronic stress, is linked to the onset and

worsening of illness and disease due to its effects on the immune system and

contributes to the dysregulation of inflammatory processes, which are known precursors

to major chronic diseases. Growing evidence, characteristic procrastination may be

particularly damaging to health-related outcomes and tasks. The procrastination–health

model has theoretically and empirically explained the link between procrastination and

poor health outcomes.

Different physical, emotional and mental problems appear to be associated with

procrastination. It may create embarrassment and inferiority complex among students in

which have found negative relationship between level of ego identity and procrastination;

it lessens confidence among students and their expectancy of completing a task

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resulting in unhealthy sleep, diet and exercise habits, yields to higher rates of smoking,

drinking, digestive ailments, insomnia and cold and flu symptoms; increases a lot of

stress, worry and fear. (Thompson et al., 1995; Steel, 2007; Sirois & Pychyl, 2002;

Adkins & Parker, 1996 as cited in Husain & Sultan, 2010)

Mulian & Imam (2019) said that students will get problems physically and

psychologically when they can't tackle their stress. Physically, they will get headaches

and digestive system problems whereas they will suffer many difficulties such as

cognitive, emotional, and behavioral problems in terms of psychology. This influences

them psychologically and poses negative effect on memory, sadness, and

procrastination (Sarafino & Smith, 2011, as cited in Muliani et al., 2019)

Interpersonal relationship stress

Acuña et al. (2014) said that the cause of stress in students are interpersonal

aspects such as communication with parents and other subjects around them. Similarly,

according to Yikealo et al. (2018) in their study entitled, “The Level of Academic and

Environmental Stress among College Students: A Case in the College of Education”,

academic stressors originate from family expectation, teachers’ expectations,

competition with other students and excessive course work or workload. The study

shows that, of all the academic stressors, family expectations (52.7%) and teacher

expectations (32.4%) contributed the most (i.e. 52.7% and 32.4% respectively) in

inflicting high stress levels among the participants. Therefore, this finding shows that

family expectations and teacher expectations are factors that were largely responsible

for causing academic stress among the respondents.

In a study conducted by Sari & Fakhruddiana (2019) entitled, “Internal locus of

control, social support, and academic procrastination among students in completing a

thesis” they have utilized the Academic Procrastination Scale and Internal Locus of

Control Scale and Social Support Scale, said that external factor such as negative
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evaluation from others and peer influence causes academic procrastination behavior. In

their study, there is a significant negative correlation between social support and

academics. This means that the lower the level of social support, the higher the level of

academic procrastination and vice versa. Aside from a high internal locus of control, the

existence of outsiders who provide facilities, easiness, material and non-material support

will further encourage students to complete tasks.

Moreover, there are other interpersonal relationship conflicts that can contribute

to academic procrastination of student as Visser et al. (2018) found out in their study

entitled, “Differences in learning characteristics between students with high, average,

and low levels of academic procrastination: Students’ views on factors influencing their

learning” that, academic procrastination can also be influenced by situational factors. An

important situational factor is teachers, because if teachers are well-organized, it is

easier for students to organize, structure, and plan for their work (Corkin et al., 2014, as

cited in Visser et al., 2018). Unorganized and lax teachers can be a reason for students’

procrastination.

Litvinova et al. (2020) have studied procrastination as a threat to the

psychological security of the educational environment and it became apparent that

students with high levels of procrastination have significant expressions of proneness to

conflict in interpersonal relations in the educational environment. They explained that

procrastination that arises in the context of learning may lead to damage to the

psychological security of the educational environment. Whereas psychological security

means, the conditions that allow the high level of satisfaction, sense of security, comfort,

and socio-psychological competence that are necessary for the realization of individual

potential in a variety of areas. Baeva (2011, as cited in Litvinova et al., 2020) suggests

that the interpersonal relations of inhabitants of the learning environment give birth to the

psychological security of that environment. A satisfactory level of personally trusting

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social interaction is one criterion for the psychological security of educational institutions.

Constant delaying and postponing of required assignments by students may lower the

level of satisfaction with interpersonal relationships with inhabitants of the education

environment.

Another interpersonal conflict, in the context of family in which Khalid et al.

(2019) conclude that procrastination increases stress in young adults by demonstrating

negative parenting styles such as punishment and rejection. In a different approach but

similar results, according to Mahasneh et al. (2016), academic procrastination can be

related to a wide range of contributory causes including environment, family and

individual personal factors. Scher and Ferrari (2000, as cited in Mahasneh et al., 2016)

suggested that family dynamics play an important or essential role in academic

procrastination. Results from clinical observations and empirical studies have provided

evidence for the role of parental influence in the development of procrastination.

Academic procrastination was associated with university students’ perception of high

levels of parental criticism and parental expectations. The result of the study shows that

there is a positive and statistically significant relation between academic procrastination

and parenting style in which, harsh and unkind parenting style increases the level of

academic procrastination among students, resulting in low commitment, attention, and

concentration on academic tasks all of which negatively affects students’ academic

achievement.

Academic stress

Academic stress is defined as the body’s response to academic-related demands

that exceed adaptive capabilities of students. Most commonly reported stressors in the

academic environment are related to oral presentations, academic overload, lack of time

to meet commitments and taking examinations (Alsulami et al., 2018).

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Elevated stress levels amongst college students can result in a decline in

academic accomplishments and affect both the physical, social and mental health of

students. The issue of stress among college and university students has been a focus of

many researchers for several years. Academic stress booms an individual’s perception

of academic frustration, academic conflict, academic pressure, and academic anxiety

which are the components of academic stress. Likewise, it is a mental and emotional

pressure or tension that occurs due to the painful demands of college life. The

constituents of academic stress originate from being exposed to new educational

concepts, adjusting to new social settings, and taking on the larger workload. Too much

academic stress can contribute to depression and physical illness, which can in turn

negatively affect students’ academic performance. Furthermore, academic stress at the

college level arises from overcrowded lecture halls, semester systems, and inadequate

resources to perform academic work. The pressure to perform well in the examination or

test and time allocated makes the academic environment very stressful (Yikealo et. al,

2018).

Khalid et al. (2019) in their study entitled, “The relationship between

procrastination, perceived stress, saliva alpha-amylase level and parenting styles in

Chinese first-year medical students” asserted that medical school is viewed as a period

of high stress due to the extended duration of the study and activity overload associated

with it, creating significant challenges to students' well-being and happiness around the

world. There are favorable correlations between academic procrastination and stress,

according to the extant evidence. Academic procrastination has a negative impact on

students' academic success, causing stress and anxiety, which can negatively impact

emotional well-being. Students' scholastic achievement is harmed by procrastination and

delay habits, which adds to their stress.

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The study also depicted that higher degrees of procrastination were associated

with higher levels of subjective and objective stress, demonstrating that delaying work

can cause significant stress. In addition, the perceived stress of the medical students

portrayed significant variations from time to time, depending on the time of the semester.

As stress can cause academic procrastination, vice versa, according to Hussain

& Sultan (2010), procrastination has negative impacts on the learning of students

resulting in their low achievements in examinations, causes failures in the examinations,

or creates fear of examinations, resulting in depression and anxiety, lowering their

morale.

Environmental stress

Svartdal et al. (2020) studied “How study environments foster academic

procrastination” and suggested that poor study environments like overly loud or filled

with distraction are external causes of academic procrastination. Perfectionism and fear

of failure are likely to play major roles, other factors can also lead students to manage

their time ineffectively which includes distractions and disruptions in the student’s

learning environment such as noise, clutter, video games, TV shows, social media. The

correlation between distractibility and procrastination is very high. Thus, procrastination

are especially vulnerable to environments with an abundance of temptations and

distractors, as such environments tend to capture attention and divert planned behavior

into more pleasurable activities available now.

Theoretical Framework

This study will be under the cognitive-behavioral approach by Albert Ellis, which

argues that a person acts on how they feel and think about themselves and their context.

This supports the influence of environmental factors on feelings and behavior.

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The central claim of Aaron Beck’s Cognitive Theory is that thoughts are the

major determinants of emotions and behavior. Internal mental processes can be

systematically researched, according to the cognitive approach to learning. It focuses on

the learner's mental processes for absorbing, interpreting, storing, and retrieving

information. In essence, the cognitive theory holds that in order to comprehend behavior,

one must first comprehend what occurs in the brain that causes it.

This study will also be correlating to Betty Neuman’s Theory- Neuman Systems

Model, wherein it is based on a general system theory and reflects the nature of living

organisms as open systems in interaction with each other and with the environment. The

individual is viewed as constantly changing in response to the environment and stress

and helps explain an individual’s response to stressors. An individual experiences

multiple stressors, each stressor potentially disturbing the individual’s balance. An

important assumption of the Newman theory is: “each client system is unique, a

composite of factors and characteristics within a given range of responses.”

The study is related to the Cognitive Behavioral Theory and Neuman’s System

Model because variables like physical, interpersonal relationship, academic and

environmental stressors experienced by the learners are being studied as these

variables affect the behavioral and cognitive dimensions which in turn cause the learners

to develop irrational behaviors such as academic procrastination. Therefore, it is right to

address academic procrastination from the center of its causes which is from the stress

levels of learners in terms of physical, interpersonal relationship, academic and

environmental. This makes the Cognitive-Behavioral theory and Neuman’s System

model as accurate propositions to the study.

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Conceptual Framework

Figure 1 shows the paradigm of the study wherein the independent variables

include the stress level as to the physical, interpersonal relationship, academic, and

environmental. While the dependent variable will be the extent of academic

procrastination. The one-way arrow further illustrates that the independent variable

affects the dependent variable. Each aspect of the stress level will be treated separately

and will be correlated with the extent of academic procrastination.

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Stress Level of the

nursing learners

a. physical
Extent of Academic
b. interpersonal relationship Procrastination

c. academic

d. environmental

Figure 1. Research Paradigm

Research Hypothesis

This study seeks to examine the stress level and the extent of academic

procrastination of the Level I nursing learners of Mariano Marcos State University. There

is no significant relationship between the stress level and academic procrastination of

the respondents.
PAGE \* MERGEFORMAT 1
 PAGE \* MERGEFORMAT 41

CHAPTER III

METHODOLOGY

This chapter presents the discussion on the procedures that will be utilized in

conducting the study. Included in this chapter are the research design, the locale of the

study, sources of data, data gathering instrument, data gathering procedure, and

statistical treatment.

Research Design

This study will employ a non-experimental, quantitative, descriptive-correlational

research design. It will be quantitative in nature because it will use numerical values that

will be treated in interpreting the results.

It will be a non-experimental-type because the independent variable will not be

controlled, manipulated nor altered, which is the stress level, instead, it will rely on the

interpretation of the data that will be collected.

Moreover, the study will be descriptive as it will involve analysis and

interpretation of the stress level and academic procrastination of the learners. Moreover,

it will seek a better understanding of the different aspects of stress level and reasons for

academic procrastination, which will serve as a basis for future actions including

formulation of the hypothesis of relationship.

Lastly, it is correlational since it will seek to determine if a significant relationship

exists between different variables, including the stress level of the respondents and

academic procrastination.

Research Locale
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This research study will be conducted at Mariano Marcos State University -

International Organization for Standardization (ISO) certified, in the Province of Ilocos

Norte.

The main campus located in the City of Batac situated in the mid-southeast

portion of Ilocos Norte is about 300 hectares. It consists of six (6) academic units

including College of Agriculture and Forestry (CAFSD); College of Arts and Sciences

(CAS); College of Business, Economics and Accountancy (CBEA); College of

Engineering (COE); College of Law (COE), and the College of Health Sciences (CHS).

The research study will be conducted specifically in the College of Health Sciences

which consists of the Department of Physical Therapy, Department of Pharmacy, and

Department of Nursing - the location center of the study, located at the western part of

the administration building of the said university.

Note: RLE, 8HRS LONG HOURS , ADU NGA RLE , exams hahahahaha hell

week

Nursing programs that are included are different Related learning experiences on

major courses of nursing with different time frames, too many examinations that are

being administered every week such as quizzes, long exams, shifting exams and many

more. (Hectic schedules? Haha)

Nagnegative dating na hahahahhaa . kasla maymayt nga idescribe latta RLE'n

The study is limited in the state university for the reason that the university is

more on using synchronous classes everyday.

Population and Sampling Procedures

All the one hundred seventy-five (165) level 1 nursing learners of Mariano

Marcos State University will be utilized as the respondents for this study. A total

enumeration will be considered by the researchers considering the fact that their number
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will still be manageable. Total enumeration will provide complete statistical coverage

over space and time.

Data Gathering Instruments

Data will be obtained with the use of an online questionnaire which is divided into

two parts, through google forms. The first part will elicit the stress level of the

respondents in the four (4) different categories namely; physical (10 items), interpersonal

relationship (10 items), academic (10 items) and environmental (10 items). A point of

rating scale will be used with the following description: 4 – Always; 3 - Frequent; 2-

Sometimes; 1 – Never. The questionnaire is adapted from the originally developed

Students Stress Inventory (SSI) by Gadzella and Masten (1991), however, some

modifications will be made on the environmental aspect. Modification will be made

because it will be inclined for the online learning environment of the nursing learners.

The second part will determine the academic procrastination of the respondents.

The questionnaire contains 25 items describing habits and routines of a learner, scored

on a 1 to 4 scale where 4 – strongly agree; 3 - agree; 2 – disagree and 1- strongly

disagree. Statements 1, 8, 12, 14, 25 indicate reverse-scored items. All of the items are

adapted from the Academic Procrastination Scale (APS) developed by McCloskey

(2011).

In the pursuit of validity and reliability, the instrument will be validated by a pool

of experts (Sir Lew?) and a pilot testing will be conducted. The pilot testing will include

10 nursing learners from level 1 of the said school. Before the actual conduct of the

study, the researchers will revise the content and structure according to suggestions and

recommendations of the validator for the improvement of the instrument. Then after
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incorporating the suggestions and comments, the improved questionnaire will finally be

submitted to the adviser.

Data Gathering Procedures

Before the conduct of the study, the researchers will present their research

proposal to the research advisory committee for approval and recommendations. After

incorporating their suggestions and their approval, the researchers will seek approval

from the members of the University Ethics Review Board to secure ethical clearance.

The researcher will prepare a letter to the office of the University Registrar to

obtain the total number of first year nursing enrollees in the Department of Nursing. After

getting the number of enrollees, the researchers will request permission to conduct the

study from the Dean of the College of Health Sciences of Mariano Marcos State

University through the Department of Chair of the Department of Nursing. Once the

study will be approved for proposal and ethical clearance will be obtained by the

researchers, they will communicate with the class presidents of the different sections of

BSN Level I to get the list of the Level I learners and to initially inform the respondents in

their participation in the conduct of the study. A letter of request and informed consent

will be given to the respondents through Facebook Messenger prior to the distribution of

the online questionnaire. .

The researchers will communicate with the respondents through Facebook

Messenger and Google Meet to explain the purpose of the study and the nature of their

participation. The actual conduct of the study will be done online, in consideration of the

risks of the COVID-19 pandemic.The researchers will send a link of the online

questionnaire-checklist in google forms, together with the informed consent, to the

respondents via Facebook Messenger accounts. The answers will be automatically

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submitted and saved. After which, the data will be arranged, tabulated, and interpreted

with the help of a statistician.

It will be the sole responsibility of the respondent to answer the questionnaires in

the google form. The expected duration of the participation of the respondents in the

study will be 15-30 minutes. But in some cases, if the respondents are busy, the cut-off

of the retrieval of response will be in three to five (3-5) days after the link for the google

form is given. In cases that the prospect respondent will not be able to submit a

response within the given time frame,

The google forms will be closed after the cut-off date and will be deleted after six (6)

months. The data gathered will be transferred and saved in a flash drive, encrypted, and

will permanently be deleted after six (6) months.

Statistical Treatment

The data that will be gathered will be statistically treated using statistical tools

such as weighted mean and Chi-square test of independence.

The stress level of the respondents will be determined using the weighted mean

and will be described using the 4-point Likert scale. Each of the categories contains 10

items, the highest score will be 40, and the lowest will be 10.

The score will be analyzed and interpreted as follows:

MILD MODERATE SEVERE

SCORE (10-18) (19-29) (30-40)

Mild score Having Moderate score Severe score

Physical low vulnerability of Having moderate Having high
sickness Optimum vulnerability of vulnerability of
physical health sickness sickness Bad
Moderate physical physical health
health

Interpersonal Mild score Having Moderate score Severe score

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Relationship good social Having moderate Having low social

connectedness social connectedness
Better in getting connectedness Worse in getting
along with people Good in getting along with people
along with people

Academic Mild score Moderate score Severe score Low

High achiever Average achiever achiever Low self-
High self- Average self- motivation Lack of
motivation motivation time management
Good in time Average of time
management management

Environment Mild score Better Moderate score Severe score

in adjusting social Good in adjusting Lack of adjusting
environment Low social environment social environment
in the level of Medium in level of High in level of
resiliency resiliency resiliency

Total score Level of stress

40-80 Mild stress

81-121 Moderate stress

122-160 Severe stress

The weighted mean will also be used to measure academic procrastination scale.

The following scale will be used in the interpretation of results:

The mean scores will be interpreted as follows:

Range of Mean Description Overall description

3.26 – 4.0 Strongly Agree Very High

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2.51 – 3.25 Agree High

1.76 – 2.50 Disagree Low

1.0 – 1.75 Strongly Disagree Very Low

Finally, the Chi-Square test of independence will be used to test if there is a

relationship between the stress level and extent of academic procrastination of the

respondents.

Ethical Considerations

The conduct of the study will ensure observance and adherence to ethical

standards through abiding on the maintenance of moral, social values, human rights,

and safety among researchers and respondents.

Before the conduct of the study, the research will be presented to the University

Research Ethics Review Board (URERB) chair and panel for formal ethics review and

approval of the research protocol, study tools, as well as informed consent. After ethical

clearance from the URERB will be obtained, a letter will be forwarded to the Dean of the

College of Health Sciences for recommendation to conduct the study. A cover letter will

be attached before the structured questionnaire checklist stating the purpose of the

study, the importance of the respondent's participation, the assurance of confidentiality

of responses, and the cut-off date for responding. Informed consent will also be provided

and sought to state the respondents' willingness to participate in the study and full
 PAGE \* MERGEFORMAT 41

understanding of the explanation letter attached. The contact number of the researcher

whom to contact in case the respondents have concerns related to the study will also be

included.

Anonymity and utmost confidentiality as to the respondents’ identity will be highly

observed. The researchers will also clarify to the respondents regarding confidentiality of

responses and that results will be employed for academic purposes only. Participants

will be informed in a timely manner that they can withdraw anytime if they feel

uncomfortable during the process.

The researchers will also ensure the safety of both respondents and the

researchers, and no inconvenience will arise as online platforms will be utilized in

distributing the questionnaire. The researchers will utilize google forms to administer

questionnaires to limit face-to-face exposure and ensure that health protocols and

guidelines are observed.

The participation of the respondents will be completely voluntary and therefore

will not receive any kind of compensation. However, they will gain knowledge on their

stress level and academic procrastination as they will be informed of the results of this

study. The result of the study will be available at the College of Health Sciences Library

after its completion.

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Title: STRESS LEVEL AND ACADEMIC PROCRASTINATION OF NURSING

LEARNERS IN A STATE UNIVERSITY

Questionnaire-Checklist

Name (Optional): __________________________

Email Address: ____________________________

PART 1: Stress Level

This questionnaire is originally adapted from Gadzella and Masten (1991)

Students Stress Inventory (SSI).

Directions: The following items measure the stress you have experienced in your study and

everyday life during online class. Please put a check mark ( ✓) in the appropriate column

which corresponds to your answer in every statement. The rate on what describes your

experiences is according to the following:

4-Always

3-Frequent

2-Sometimes

1-Never
 PAGE \* MERGEFORMAT 41

Physical 4 3 2 1
(Always (Frequent) (Sometimes) (Never)
)

1. I suffer from
headache.

2. I experience back pain

3. I encounter sleeping
problem

4. I experience difficulty
breathing

5. I suffer from excessive

worrying

6. I encounter stomach
pain/nausea

7. I suffer from constant

tiredness/fatigue

8. I experience
sweating/Sweaty
hands

9. I suffer from Frequent

cold/flu/fever

10. I encounter drastic

weight loss

Interpersonal Relationship 4 3 2 1
(Always (Frequent) (Sometimes) (Never)
)

1. I find it difficult to meet

my parent’s high
expectations.

2. I find it hard to take in

my family’s criticisms

3. I feel guilty if I fail to

fulfil my parent’s high
hopes.

4. I find it difficult to get

along with my group
mates when doing
 PAGE \* MERGEFORMAT 41

academic tasks.

5. I feel pressured
when my
classmates obtain
higher scores or
better remarks than
I do

6. My friends do not care

about me.

7. I feel like I
don’t receive
any kind of
support from
other people

8. Our instructors set

high expectations and
standards with our
outputs, activities and
performances.

9. My instructors are not

supportive.

10. I feel frustrated by the

lack of faculty
management.

Academic 4 3 2 1
(Always (Frequent) (Sometimes) (Never)
)

1. I have a financial
problem because of
the expenses of the
university.

2. I find it difficult when

there is a lack of free
time and lack of
timely feedback after
discussions and
processing of
outputs

3. I feel nervous
delivering the class
 PAGE \* MERGEFORMAT 41

presentation.

4. I feel stressed as the

submission deadline
nears.

5. I feel stressed to take

an examination.

6. I find it difficult
to juggle time
between study
and society
involvement.

7. I lose interest in the

courses.

8. I feel burdened by the

academic workloads.

9. I feel stressed dealing

with difficult subjects.

10. I feel it is difficult to

handle my academic
problem.

Environment 4 3 2 1
(Always (Frequent) (Sometimes) (Never)
)

1. I feel stressed when I

have an unstable
internet connection.

2. Social media distracts

me.

3. Surrounding noise
distracts me.

4. I feel frustrated
because I spend long
hours sitting inside my
room.

5. I feel stressed when

my parents ask me to
do household chores
while in online class.
 PAGE \* MERGEFORMAT 41

6. Messy living
conditions distract me.

7. The distance of the

loading station is far
from home and I feel
frustrated when I run
out of load.

8. I feel frustrated when

there is an
unannounced power
interruption in our
area.

9. Inappropriate
temperature distracts
me.

10. I feel bothered when

there is insufficient
lighting in my room.

PART II: Academic Procrastination

This questionnaire is adapted from McCloskey (2011) Academic

procrastination scale.

Below are items which consist of various habits and routines as a student. Carefully read

each item, and indicate the degree by placing a check ( ✓) to which you think the items are true to

you in the scale from 1-4. Use the following guide in rating your response:

4 - Strongly Agree - Respondent approves that the situation is extremely true.

3 - Agree - Respondent approves that the situation is slightly true.

2 - Disagree - Respondent approves that the situation is not true.

1 - Strongly Disagree - Respondent highly approves that the situation is not at all true.

Item 4 3 2 1
(Strongly (Agree) (Disagree) (Strongly
agree) Disagree)

1. I allocate time to review

 PAGE \* MERGEFORMAT 41

and proofread my
work.*

2. I put off projects until

the last minute.

3. I have found myself

waiting until the day
before to start a big
school-related activity
or project (i.e. reviewing
for major exams,
memorizing for return
demonstrations)

4. I know I should work on

school work, but I just
don’t do it.

5. When working on
schoolwork, I usually
get distracted by other
things.

6. I waste a lot of time on

unimportant things (i.e.
social media, hanging
out with friends)

7. I get distracted by
other, more fun, things
when I am supposed to
work on schoolwork.

8. I concentrate on school
work instead of other
distractions.*

9. I can’t focus on school

work or projects for
more than an hour until
I get distracted.

10. My attention span for

schoolwork is very
short.

11. Tests are meant to be

studied for just the night
before.
 PAGE \* MERGEFORMAT 41

12. I feel prepared well in

advance for most
tests.*

13. “Cramming” and last

minute studying is the
best way that I study for
a big test.

14. I allocate time so I

don’t have to “cram” at
the end of the
semester. *

15. I only study the night

before exams.

16. If an assignment is due

at midnight, I will work
on it until 11:59.

17. When given an

assignment, I usually
put it away and forget
about it until it is almost
due.

18. Friends usually distract

me from schoolwork.

19. I find myself talking to

friends or family instead
of working on school
work.

20. On the weekends, I

make plans to do
homework and projects,
but I get distracted and
hang out with friends.

21. I tend to put off things

for the next day.

22. I don’t spend much

time studying school
material until the end of
the semester.

23. I frequently find myself

 PAGE \* MERGEFORMAT 41

putting important
deadlines off.

24. If I don’t understand

something, I’ll usually
wait until the night
before a test to figure it
out.

25. I read the textbook and

look over notes before
coming to class and
listening to a lecture or
teacher. *

* Indicates reverse-scored items

 PAGE \* MERGEFORMAT 41

References

Abdullah, M. Q., (2017). Procrastination and its relationship with mental health among

children and adolescents. Psychology and Behavioral Science: International

Journal. DOI:10.190880/PBSIJ.2017.04.555649

Acuña, R.V., Palma, C.d.C.J., Méndez, H.A.M., Arceo, M.d.l.A.C., Castillo, M.M., &

Barra, A.V. (2014). Frequency and intensity of stress in nursing

undergraduate students of the DACS. Health Horizon. 13 (1). 160-172.

https://bit.ly/2OBQ9mX

Alghamdi, S., Aljabri, S., Jafari, G., Alzebali, R., Alkunaidari, N., Kalatan, N

(2019). Sources of stress among undergraduate nursing students. Health

Science Journal. https://www.hsj.gr/medicin e/stress-stressors-andstress-

responses-ofstudent-nurses-in-agovernment-nursingschool.php?aid=2806

Alsulami, S., Al Omar, Z., Binnwejim, M. S., Alhamdan, F., Aldrees, A., Al-Bawardi, A.,

Alsohim, M., & Alhabeeb, M. (2018). Perception of academic stress among

health science preparatory program students in two Saudi universities.

Advances in medical education and practice, 9, 159–164.

https://doi.org/10.2147/AMEP.S143151

Augesti, G., Lisnawati, R., Saputra, O. & Nisa, K. (2015). Differences in stress level

between first year and last year medical students in Medical Faculty of

Lampung University. Journal Majority, 4(4), pp 50-56

Beck, A. (2019). Cognitive Theory. Psychology Mechanics.

https://www.psych.com/cognitive-theory/

Bilge Uzun Özer (2011). A cross sectional study on procrastination: Who

procrastinate more?. https://www.semanticschol ar.org/paper/A-

CrossSectional-Study-onProcrastination%3A-Who-%C3%96zer/

50fc3cbc7 5c77de3e103e1c912014958e97df131
 PAGE \* MERGEFORMAT 41

Botros, S. (2020). Online distractions at home. Rutgers School of Arts and Sciences.

https://writingctr.rutgers.edu/blog/164-online-learning-distractions-at-home

Criollo, F. (2018). Stress in nursing university students and mental health. Health and

Academic Achievement. DOI: 10.5772/intechopen.72993

Ellis, A. (2019). Cognitive Behavioral Approach. Simply Psychology.

https://www.psychology.org/cognitive-behavioral.html

Gomanthi, S. (2018). Impact of stress on nursing students. Researchgate.

https://www.researchgate. net/publication/327013844

Goroshit, M. (2018). Academic procrastination and academic performance. Journal

of Prevention & Intervention in the Community, 46(2), 131–

142. DOI:10.1080/10852352.2016.1198157

Hussain, I. & Sultan, S. (2010). Analysis of procrastination among university

students. Procedia Social and Behavioral Sciences, 5, (1897-1904).

https://doi.org/10.1016/j.sb spro.2010.07.385

Kato, T. (2014). Relationship between Coping with Interpersonal Stressors and

Depressive Symptoms in the United States, Australia, and China: A

Focus on Reassessing Coping. NCBI.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192128/#__ffn_sectitle

Khalid, A., Zhang, Q., Wang, W., Ghaffari, A. S., & Pan, F. (2019). “The relationship

between procrastination, perceived stress, saliva alpha-amylase level and

parenting styles in Chinese first year medical students”.

Psychological Research and Behavior Management: Dove

Press. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619418/
 PAGE \* MERGEFORMAT 41

Klainin-Yobas, P., Keawkerd, O., Pumpuang, W., Thunyadee, C., Thanoi, W., & He,

H.-G. (2014). The mediating effects of coping on the stress and health

relationships among nursing students. Journal of Advanced Nursing, 70,

1287–1298. doi:10.1111/jan.12283

Knaus, B. (2015). On stress, anxiety, and procrastination.

Psychology Today. https://www.psychologytoday.com/us/blog/science-

and-sensibility/201510/stress-anxiety-andprocrastination?amp

Kumar, P. (2020). Academic stress among nursing students. Nursing & Healthcare

International Journal: Medwin Publishers.

https://doi.org./doi/10.23880/nhij-16000227

Kurland, E. P. (2014). Nursing student stress. North Dakota State University of

Agriculture and Applied Science. Retrieved

from https://library.ndsu.edu/ir/bitstream/handle/10365/27601/Nursing

%20Student%20Stress.pdf?seq uence=1&isAllowed=y

Labrague, L.J. (2013). Stress, stressor, and stress responses of student nurses in a

government school. Health Science Journal.

https://www.hsj.gr/medicine/stress-stressors-and-stress-responses-of-

studentnurses-in-a-government-nursing-school.pdf

Litvinova, A., Kokurin, A., Ekimova, V., Koteneva, A., & Pozdnyakov, V. (2020).

Procrastination as a threat to psychological security of the educational

environment. Behavioral Sciences. https://doi.org/10.3390/bs10010001

Lyon, B. L. (2012). Stress, coping, and health. In V. H. Rice (Ed.), Handbook of

stress, coping, and health: Implications for nursing research, theory,

and practice (2nd ed., pp. 2–20). Thousand Oaks, CA: Sage.
 PAGE \* MERGEFORMAT 41

Mahasneh, A.M., Bataineh, O. T., & Al-Zoubi, Z. H. (2016). The relationship between

academic procrastination and parenting styles among Jordanian

undergraduate university students. The Open Psychological Journal, 9,

(25-34). https://doi.org/10.2174/1874350101609010025

Malla, H. (2021) Academic procrastination among secondary school students:

Exploring the role of smartphone addiction. A mixed method approach.

The Online Journal of Distance Education and eLearning.

http://www.tojdel.net/jour nals/tojdel/articles/v09i03/ v09i03-01.pdf

Mccloskey, J.D. (2011). Finally, my thesis on academic

procrastination. Retrieved from

https://rc.library.uta.edu/uta-ir/bitstream/handle/10106/9538/McCloskey_ut

a_2502M_11260.pdf?sequence=1&isAllowed=y

Mercado-Vinces, S., Aliaga, J.C.C., Castillo, J.A.R., & Ocana-Fernandez, Y. (2021).

Academic procrastination and the stress of university Students of

electronic engineering from the Callao region. Revista Geintec.

https://www.revistageintec. net/index.php/revista/article/view/2110/1432

Moonaghi, H. K. & Beydokhti, T. B. (2017). Academic procrastination and its

characteristics: A narrative review. Future of Medical Education

Journal. https://fmej.mums.ac.ir/article_9049.html

Muliani, R., Imam, H. & Dendiawan, E.(2020). Relationship between stress level and

academic procrastination among new nursing students. The

Malaysia Journal of Nursing.

https://ejournal.lucp.net/index.php/mjn/article/view/relationship/853

Mussi, F.C., Pires, C.G.D.S., Carnerio, L.S., Costa, A.L.S., Ribeiro, F.M.S.S & dos

Santos, A.F. (2019). Comparison of stress in freshman and

 PAGE \* MERGEFORMAT 41

senior nursing student. Journal School of

Nursing. http://dx.doi.org/10.1590/S1980-220X2017023503431

Nayak, S.G. (2019). Impact of procrastination and time-management on academic

stress among undergraduate nursing students: A cross sectional study.

International Journal of Caring Sciences. Retrieved from:

http://www.internationaljournalofcaringsciences.org/docs/18_nayak_origin

al_12_3.pdf

Neuman, B. (1970). Neuman System Model. Nursing Theories and Models.

https://nursing.org/theories-and-models/neuman-systems-model/

Pascoe, M. C., Hetrick, S. E. & Parker, A. G. (2020). The impact of stress on students

in secondary school and higher education. International Journal of

Adolescence and Youth, 25:1, 104-112. DOI:

10.1080/02673843.2019.1596823

Reddy, J. (2018). Academic stress and its sources among university students.

Biomedical & Pharmacology Journal, 11(1), 531-537. DOI: 10.13005/bpj-

1404

Rosetti, L. (2011). Procrastination behaviors in college students. Rowan

Digital Works. https://rdw.rowan.edu/cgi/ viewcontent.cgi?

article=1411&context=etd

Samson, C. & Koh A. (2020). Stress monitoring and recent advancements in

wearable biosensors. Frontiers.

https://doi.org/10.3389/fbioe.2020.01037

Sari, W. L. & Fakhruddiana (2019). Internal locus of control, social support and

academic procrastination among students in completing the thesis.

International Journal of Evaluation and Research in Education, 8(2),

(363-368). https://doi.org/10.1159/ijer e.v8i2.17043

 PAGE \* MERGEFORMAT 41

Shanmugam, G., a Jasmindebora, M. S. V., & Baba, (2017). Impact of stress on

nursing students.

https://www.researchgate.net/publication/327013844_Impact_Of_Stress_

On_Nursing_Students

Sirois, F.M (2015). Is procrastination a vulnerability factor for hypertension and

cardiovascular disease? Testing an extension of the procrastination–health
model. Journal of Behavioral Medicine, 38 (3). pp.
578-589.https://doi.org/10.1007/s10865-015-9629-2
Susan, A. (2017). Impact of environmental stress on nursing students. HHS Public

Access. doi: 10.1027/NNA.0b113e3181e9393b

Svartdal, F., Dahl, T. I., Gamst-Klaussen, T., Koppenborg, M. & Klingsieck, K. B.

(2020). How study environments foster academic procrastination:

Overview and recommendations. Frontiers in Psychology.

https://doi.org/10.3389/fpsyg.2020.540910

Visser, L., Koerthagen, F. A. J. & Schoonenboom, J. (2018). Differences in learning

characteristics between students with high, average, and low levels of

academic procrastination: Students’ views on factors influencing their

learning. Frontiers in Psychology, 9 (808).

https://doi.org/10.3389/fpsyg.2018.00808

Wang, P.-Y., Lin, P.-H., Yang, S.-Y., & Chen, K.-L. (2020). Does

interpersonal interaction really improve emotion, sleep quality, and self-

efficacy among junior college students? International

Journal of Environmental Research and Public Health, 17(12), 4542. DOI:

10.3390/ijerph17124542

Yikealo, D., Yemane, B., & Karvinen, I. (2018). The level of academic and

environmental stress among college students: A case in the college of

 PAGE \* MERGEFORMAT 41

education. Scientific Research Publishing Inc. https://doi.org/10.4236/jss.

2018.611003

Zarrin, S. A., Gracia, E., & Paixão, M. P. (2020). Prediction of academic

procrastination by fear of failure and self-regulation. Educational

Sciences: Theory & Practice, 20(3), 34-43. DOI: 10.12738/jestp.2020.3.

003