A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE MASTER DEGREE OF NURSING SCIENCE (INTERNATIONAL PROGRAM) FACULTY OF NURSING BURAPHA UNIVERSITY OCTOBER 2015

FACTORS RELATED TO MENTAL HEALTH AMONG VIETNAMESE NURSING STUDENTS BUI THI LOAN A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE MASTER DEGREE OF NURSING SCIENCE (INTERNATIONAL PROGRAM) FACULTY OF NURSING BURAPHA UNIVERSITY OCTOBER 2015 COPYRIGHT OF BURAPHA UNIVERSITY ACKNOWLEDGMENT With heartfelt gratitude and appreciation, I would like to express my deep appreciation to many persons who did not only support me in completing this thesis, but also in my journey to become a Master student of Nursing Science Firstly, I would like to sincerely thank my major advisor, Assistant Professor Dr.Pornpat Hengudomsub, who was always besides me, encourage, and support me a lot throughout my process of writing this thesis She has been a great mentor This thesis would not complete without her enthusiastic guidance My sincere thanks also go to my co-advisor, Associate Professor Dr.Nujjaree Chaimongkol for her excellent comments and suggestions I am grateful to the Dean of Faculty of Nursing, as well as Chairperson of Master of Nursing Science Program (International Program), all of lectures and staffs in Faculty of Nursing, Burapha University who provide the excellent teaching and supporting environment during my study time in Thailand My special thanks go to the Health Human Resource Development project under the Ministry of Health of Vietnam and the director of Hai Duong Medical Technical University who gave me a great opportunity to pursue Master of Nursing Science Program at Faculty of Nursing, Burapha University, Thailand I also would like to thank the baccalaureate nursing students who participated in this study from Faculty of Nursing at Hai Duong Medical Technical University, Vietnam Last but not least, I wish to express my love and gratitude to my awesome family and friends I sincerely thank them for their support and encouragement throughout my study Bui Thi Loan 56910479: MAJOR: NURSING SCIENCE; M.N.S KEYWORDS: MENTAL HEALTH/ NURSING STUDENTS/ VIETNAM/ EMOTIONAL QUOTIENT/ SELF-ESTEEM/ SOCIAL SUPPORT BUI THI LOAN: FACTORS RELATED TO MENTAL HEALTH AMONG VIETNAMESE NURSING STUDENTS ADVISORY COMMITTEE: PORNPAT HENGUDOMSUB, Ph.D., NUJJAREE CHAIMONGKOL, Ph.D 90 P 2015 Mental health is one of the significant components of health and associated with both individual and environmental factors The purposes of this descriptive cross sectional study were to examine mental health and test its relationships with related factors including education achievement indicated by Grade Point Average (GPA), emotional quotient, selfesteem, and social support among nursing students (Year to Year 4) who are studying at one of a university in Vietnam The sample included 110 baccalaureate full time nursing students who registered in academic year 2015 Simple random sampling technique was used to recruit the sample Self-report questionnaires were used to collect data which included questionnaire about nursing students’ characteristics, GPA, the Schutte Emotional Intelligence Scale (SEIS), the Rosenberg Self-esteem Scale (RSES), the Personal Resource Questionnaire 2000 (PRQ2000), and the Mental Health Inventory: 18-item version (MHI18) The scales of SEIS, RSES, PRQ2000, and MHI-18 yielded Cronbach’s alpha of 83, 81, 86, and 80, respectively Data were analyzed using descriptive statistics and Pearson’s product moment correlation coefficient The results showed that the mental health of these nursing students was at a moderate level with a mean score of 64.91 (SD = 7.57) Mental health was positively correlated with GPA (r = 24, p < 01), emotional quotient (r = 26, p < 01), self-esteem (r = 33, p < 01), and social support (r = 37, p < 01) This study results provided baseline information regarding mental health and its related factors among Vietnamese nursing students It could be used to develop for proper strategies or program aimed at enhancing students’ academic achievement, emotional intelligence, self-esteem and social support among these nursing students CONTENTS Page ABSTRACT v CONTENTS vi LIST OF TABLES viii LIST OF FIGURE ix CHAPTER INTRODUCTION Background and significance of the problem Research objectives Research hypotheses Scope of study Research framework Definition of terms LITERATURE REVIEWS 11 Overview of mental health 11 Mental health among nursing students 14 Factors related to mental health in nursing students 18 Conclusion 22 RESEARCH METHODOLOGY 24 Research design 24 Setting of study 24 Population and sample 24 Research instruments 26 Psychometric properties of instruments 30 Ethical considerations 31 Data collection procedures 32 Data analyses 32 RESULTS 34 CONTENTS (cont.) CHAPTER Page Description of nursing students’ characteristics 34 Description of mental health among nursing students 35 Description of factors related to mental health among nursing students 36 Description of relationships between mental health and its related factors among nursing students 37 CONCLUSION AND DISCUSSION 39 Summary of the study findings 39 Discussion 40 Study implications 48 Limitations of study 49 Recommendation for future research 49 REFERENCES 50 APPENDICES 63 Appendix 64 Appendix 67 Appendix 70 Appendix 74 Appendix 81 Appendix 88 BIOGRAPHY 90 LIST OF FIGURE Figure Research framework…………………………………………………… Page LIST OF TABLES Tables Page Number of sample in each year of this study 26 Demographic characteristics of nursing students 35 Description of mental health among nursing students 36 Description of education achievement, emotional quotient, self-esteem and social support 37 Correlation coefficients of mental health score with other measures 38 Interpretation for the size of correlation coefficient 89 One-way analysis of variances of mental health score among nursing students 89 CHAPTER INTRODUCTION Background and significance of the problem Nursing occupies an important position in the healthcare system Nursing students are the future professional health care providers who play important roles in providing care as well as supporting patients physically and psychologically Thus, they themselves should also have good mental health, which is one of the significant health components (Ni et al., 2010) Nursing students are not only facing with the challenges like most of other college students including accommodation, interpersonal relationships, financial burden, parental pressure as well as their concerns about the future, but they also have to face with more stressful academic learning and psychological stressors (Dutta, Pyles, & Miederhoff, 2005; Sreeramareddy et al., 2007; Vaez, Ponce de Leon, & Laflamme, 2006) Specifically, with the aims of equipping necessary skills for the students after graduation, nursing students across the nations and Vietnam in particular have to learn both theory-based classes and also practice in the clinical settings In the first year of their studies, heavy academic pressure, concerns about examinations, worrying about grades are cited as a major source of stress for some students (Huong, Hengudomsub, & Suppaseemanont, 2011; Shaban, Khater, & Akhu-Zaheya, 2012) In their subsequent years of study, the students begin specific courses and start practicing in clinical settings such as in the hospitals (Huong et al., 2011) This time period may be the most stressful for some of the nursing students (Moscaritolo, 2009) The students are also required to have continuous interaction with a variety of individuals including patients, their family members, and other health care providers (Reeves, 2005) The students must be concern about their mistakes which can seriously harm the patients, even cause death to the patients Therefore, the students are required high responsibility, circumspection, and discretion Moreover, during practical experience in hospital, they may encounter with conflicts between health staffs, suffering situation of patients, such as pain, cancer disease in young patients, even death sometimes (Augusto-Landa, López-Zafra, Berrios-Martos, & Pulido-Martos, 2012; Gibbons, Dempster, & Moutray, 2009; Pryjmachuk, 2004) All of these cause stressful situations for them, and these may lead them to have to physical and mental health problems (Sreeramareddy et al., 2007) There have been various studies that explored mental health among nursing students worldwide (Liu & Jia, 2008; Wu, 2005) Mental health encompassed of positive mental health or psychological well being and negative mental health which in other words were psychological distress or mental health problems The prevalence of mental health problems or negative mental health among this population was varied According to the data from some epidemiologic studies among nursing students in China, 7.7 % to 28.7 % of the students experienced mental health problems (Liu & Jia, 2008; Wu, 2005) Another study was conducted to examine the mental health of 1,686 first-year medical science students in Iran using the General Health Questionnaire-28 (GHQ-28) The results revealed that 35.7 % of these students had mental health problems Among them, nursing students showed the highest percentage of those who experienced mental health problems (Lotfi, Aminian, Ghomizadea, & Noorani, 2009) Depression and anxiety have been documented as the most common mental health problems among nursing students in several studies (Cook, 2005; Moscaritolo, 2009; Vatanasin, 2005) A high prevalence of depression was found among nursing students in the China, Kenya and India (Chatterjee et al., 2014; Othieno, Okoth, Peltzer, Pengpid, & Malla, 2014; Xu et al., 2014) Other studies also found a high prevalence of anxiety among this population in the United States and Iran (Cook, 2005; Moscaritolo, 2009) Mental health problems not only caused negatively impacts on the students’ lives, but also on their families and society As for the students themselves, there were some studies which demonstrated a relationship between mental illness and academic problems (Breslau, Lane, Sampson, & Kessler, 2008; Hunt, Eisenberg, & Kilbourne, 2010) Specifically, the students who reported depressive symptoms tended to pay less attention in their studies, decreased abilities for study concentration Moreover, elevated anxiety which produced a state of physiological arousal also indicated as a factor leading to the impairment of their abilities to concentration on others (Wood, 2006) All of these can lead to low academic performance among these nursing students In addition, the poor quality of student's life is also reflected as loss of interest in leisure activities, having eating and sleeping disturbances, and even suicidal thoughts (Vatanasin, 2005) According to Hawton, Agerbo, Simkin, Platt, and Mellanby (2011), nursing students were at higher risk for suicide than other college students A statistics from Pennsylvania State University found that more than 30 % of students who seek services for 10 mental health issues reported that they had considered attempting suicide at some point in their lives, up to be about 24 % in the year 2010 (Novotney, 2014) Another study was conducted of 142 nursing students of the Technological Educational Institute of Thessaloniki in Greece (Melissa-Halikiopoulou, Tsiga, Khachatryan, & Papazisis, 2011), and it revealed that 43.9 % of them reported depressive symptoms Also, 10.6 % said that they had suicidal ideation, but they didn’t act on them, while two students (1.4 %) declared that they could have done it if they had the chance to so In terms of profession, students have regular contacts and direct patient care, so quality of care provided for the patients may also be reduced On the other hand, mental health problems among nursing students can also create burden to their family caregivers and society as a whole Families of the students who experienced mental health problems may worry and stress about the illness of their children They also may feel guilty that they might contribute to the development of their children's problems (Dzurec, Allchin, & Engler, 2007) These may lead them to isolate themselves from friends, community, and social support networks that the families used to have due to the fear of stigma or prejudice In relation to financial burden, families of mental illness persons also faced with financial problems and needed more support from society Due to high incidence of mental health problems and its related negative consequences, it should be concerned about mental health among nursing students and the issue of mental health and mental health problems are deserved more attention From literature review, mental health of the individuals related to both individual and environmental factors (Lazarus & Folkman, 1984; Ni et al., 2010; Vatanasin, 2005) These two factors serve as important factors contributing to mental health in both positive and negative aspects For this study, the three most promising individual factors associated with mental health among nursing students include educational achievement (Parvizrad, Charati, Sadeghi, Mohammadi, & Hosseini, 2014), emotional quotient (Tsaousis & Nikolaou, 2005), and self-esteem (Ni et al., 2010) In addition, for the environmental factor which has a significant impact on mental health of this population is social support (Jensen, 2007; Luo & Wang, 2009) Educational achievement is an indicator reflecting learning outcome of students Grade point average (GPA) is considered as one of an indicator reflecting academic achievement The positive correlation between GPA and mental health among nursing student has been found in some studies (Floyd, 2010; Xu et al., 2014) Nursing students 88 The Schutte Emotional Intelligence Scale (SEIS) Each of the following items asks you about your emotions or reactions associated with emotions There is no right or wrong answers Please mark “√” in the box that best describes you = strongly disagree = somewhat agree = somewhat disagree = strongly agree = neither agree nor disagree Items Level of agreement 1 You know when to speak about your personal problems to others When you’re faced with obstacles, you remember times you faced similar obstacles and overcame them 3………………………………………… Other people find it easy to confide in you 5………………………………………… 6………………………………………… 7………………………………………… 8………………………………………… 9………………………………………… 10 You expect good things to happen 11 You like to share your emotions with others 12 …………………………………… 13……………………………………… 14……………………………………… 15……………………………………… 16……………………………………… 17……………………………………… 89 Items Level of agreement 18……………………………………… 19 You know why your emotions change 20 When you’re in a positive mood, you’re able to come up with new ideas 21 You have control over your emotions 22……………………………………… 23……………………………………… 24……………………………………… 25……………………………………… 26……………………………………… 27……………………………………… 28……………………………………… 29 You know what other people are feeling just by looking at them 30 You help other people feel better when they are down 31 You use good moods to help yourself keep trying in the face of obstacles 32……………………………………… 33……………………………………… 90 The Rosenberg Self-Esteem Scale Below is a list of statements dealing with your general feelings about yourself Please read each statement and mark “√” in the box the response most appropriate for you = Strongly disagree = Disagree = Agree = Strongly agree Items Level of agreement 1 On the whole, you’re satisfied with yourself At times, you think you’re no good at all You feel that you have a number of good at all 4……………………………………… 5……………………………………… 6……………………………………… 7……………………………………… You wish you could have more respect for yourself All in all, you’re inclined to feel that you’re a failure 10 You take a positive attitude toward yourself 91 Personal Resource Questionnaire (PRQ2000) Below are some statements with which some people agree and others disagree Please read each statement and mark “√” the response most appropriate for you = Strongly disagree = Somewhat agree = Disagree = Agree = Somewhat disagree = Strongly agree = Neutral Items Level of agreement 1 There is someone you feel close to who makes you feel secure You belong to a group in which you feel important 3………………………………………… 4………………………………………… 5………………………………………… 6………………………………………… 7………………………………………… 8………………………………………… You have the opportunity to encourage others to develop their interests and skills 10………………………………………… 11……………………………………… 12……………………………………… 13……………………………………… 14 You have people to share social events and fun activities with 15 You have a sense of being needed by another person 92 The Mental Health Inventory: 18-item version (MHI-18) Below is a list of how you feel, and how things have been for you during the past weeks Mark your choices on the answer sheet by marking “√” the number that comes closest to describing you = All of the time = Some of the time = Most of the time = A little of the time = A good bit of the time = None of the time Items Level of agreement 1 Has your daily life been full of things that were interesting to you? ® Did you feel depressed? 3…………………………………… 4…………………………………… 5…………………………………… Have you felt tense or high-strung? 7………………………………… Have you felt emotionally stable? ® Have you felt downhearted and blue? 10………………………………… 11………………………………… 12………………………………… 13………………………………… 14 Have you been in low or very low spirits? 15 Were you a happy person? ® 16………………………………… 17………………………………… 18 Have you been anxious or worried? 93 APPENDIX Questionnaire (Vietnamese version) 94 Mã số………… Ngày………… Đăc điểm sinh viên điều dưỡng Xin vui lòng điền vào mục theo yêu cầu đánh chữ ―√‖ vào lựa chọn thích hợp với bạn □1 Nam Tuổi: …………… Giới tính: □2 Nữ Hiện bạn học năm thứ □1 □2 □3 □4 Năm thứ Năm thứ hai Năm thứ ba Năm thứ tư Sinh viên năm thứ nhất, vui lòng viết điểm trung bình cộng (GPA) học kỳ I, GPA…………… Sinh viên năm thứ 2, 3, năm thứ 4, vui lòng viết điểm GPA học kỳ gần mà bạn có, GPA: ……………… Bạn lựa chọn học chương trình điều dưỡng: □1 Tự bạn lựa chọn □2 Lời khuyên người khác (hãy ghi rõ, ………………… ) Bạn cảm thấy mối quan hệ với bạn bè nào? □1 □2 □3 □4 Hài lòng Một chút hài lòng Một chút không hài lòng Không hài lòng Bạn cảm thấy mối quan hệ với giáo viên nào? □1 Không hài lòng □2 Một chút không hài lòng 95 □3 Một chút hài lòng □4 Hài lòng Thang đo trí tuệ cảm xúc Schutte (SEIS) Mỗi câu hỏi cảm xúc phản ứng liên quan tới cảm xúc bạn Xin vui lòng khoanh tròn vào lựa chọn thích hợp với bạn = Rất không đồng ý = Không đồng ý chút = Nửa đồng ý nửa không đồng ý = Đồng ý chút 5= Rất đồng ý Các mục Mức độ đồng ý 1 Bạn biết bạn nói bạn nói vấn đề cá nhân bạn với người khác Khi bạn đối mặt với khó khăn, bạn nhớ lại thời gian mà bạn đối mặt với khó khăn tương tự mà bạn vượt qua 3………………………………………… 4………………………………………… 5………………………………………… 6………………………………………… 7………………………………………… 8………………………………………… 9………………………………………… 10 Bạn mong muốn điều tốt đẹp xảy với bạn 11 Bạn muốn chia sẻ cảm xúc thân với người khác 12 …………………………………… 13……………………………………… 14……………………………………… 15……………………………………… 96 Các mục Mức độ đồng ý 16……………………………………… 17……………………………………… 18……………………………………… 19 Bạn biết cảm xúc bạn thay đổi 20 Khi bạn tâm trạng tốt, bạn nảy sinh ý tưởng 21 Bạn thường kiểm soát cảm xúc thân 22……………………………………… 23……………………………………… 24……………………………………… 25……………………………………… 26……………………………………… 27……………………………………… 28……………………………………… 29 Chỉ cách nhìn vào người khác, bạn biết họ cảm thấy 30 Khi người khác buồn, bạn giúp họ cảm thấy tốt 31 Bạn sử dụng tâm trạng tốt để giúp thân trì cố gắng đối mặt với khó khăn 32……………………………………… 33……………………………………… 97 Câu hỏi đánh giá tự trọng Dưới liệt kê tuyên bố liên quan tới cảm giác chung bạn thân Xin vui lòng khoanh tròn vào lựa chọn thích hợp bạn = Rất không đồng ý = Không đồng ý = Đồng ý = Rất đồng ý Các mục Mức độ đồng ý 1 Xét tổng quát mặt, bạn cảm thấy hài lòng thân Đôi lúc bạn nghĩ bạn không tốt chút Bạn cảm thấy bạn có số điểm tốt 4……………………………………… 5……………………………………… 6……………………………………… 7……………………………………… Bạn ước bạn tôn trọng Nhìn chung bạn cho bạn người không thành đạt sống 10 Đối với bạn, bạn cho bạn người có thái độ tích cực 98 Câu hỏi hỗ trợ xã hội (PRQ2000) Bên số ý tưởng có người đồng ý có người không đồng ý Xin vui lòng khoanh tròn cho câu trả lời mà bạn cho với = Hoàn toàn không đồng ý = Đồng ý chút = Không đồng ý = Đồng ý = Không đồng ý chút = Hoàn toàn đồng ý = Không có ý kiến Các mục Mức độ đồng ý Bạn có cảm giác gần gũi người người khiến bạn thấy an tâm Bạn có nhóm người thân quen bạn cảm thấy thật quan trọng với họ 3………………………………………… 4………………………………………… 5………………………………………… 6………………………………………… 7………………………………………… 8………………………………………… Bạn có hội để động viên người khác đẩy mạnh mối quan tâm phát huy kỹ họ tâm phát huy kỹ củ 10………………………………………… 11……………………………………… 12……………………………………… 13……………………………………… 14 Có người bạn chia sẻ hoạt động xã hội hoạt động vui chơi 15 Bạn có cảm giác có cần bạn hoạt động vui chơi 99 Câu hỏi đánh giá sức khỏe tâm thần (MHI-18) Dưới liệt kê cách mà bạn cảm thấy, cách mà thứ diễn bạn vòng tuần qua Hãy khoanh tròn cho lựa chọn thích hợp để mô tả bạn 1= Tất thời gian 4= Một số thời gian 2= Hầu hết thời gian 5= Một chút thời gian 3= Một lượng trung bình thời gian 6= Không chút thời gian Các mục Mức độ đồng ý 1 Cuộc sống hàng ngày bạn có tràn ngập điểu thú vị? Bạn cảm thấy chán nản? 3…………………………………… 4…………………………………… 5…………………………………… Bạn có cảm thấy căng thẳng? 7………………………………… Bạn có cảm thấy cảm xúc bạn ổn định? Bạn có cảm thấy buồn chán nản? 10………………………………… 11………………………………… 12………………………………… 13………………………………… 14 Bạn có trạng thái tinh thần thấp thấp? 15 Bạn người vui vẻ? 16………………………………… 17………………………………… 18 Bạn lo lắng? 100 APPENDIX More results 101 Table Interpretation for the size of correlation coefficient R Strength of relationship 00 to < 30 Weak relationship 30 to 50 Moderate relationship > 50 Strong relationship Table One-way analysis of variances of mental health score among nursing students Mental health df SS 6243.09 109 Between groups 241.18 Within group 6001.91 Total MS F p 80.39 1.42 24 106 56.62 Years of study 102 BIOGRAPHY Name Miss Bui Thi Loan Date of birth November 23, 1987 Place of birth Ninh Giang, Hai Duong, Vietnam Present address Hai Duong city, Vietnam Position held 2011-present Instructor Faculty of Nursing, Hai Duong Medical Technical University, Vietnam Education 2006-2010 Bachelor Science of Nursing (B.S.N), Hai Phong University of Medicine and Pharmacy, Vietnam 2013-2015 Master of Nursing Science (International program) Faculty of Nursing, Burapha University, Chonburi, Thailand Awards or Grant 2015 The master and doctoral thesis support grant from Burapha University, Chonburi, Thailand ... pursue Master of Nursing Science Program at Faculty of Nursing, Burapha University, Thailand I also would like to thank the baccalaureate nursing students who participated in this study from Faculty. .. state of physiological arousal also indicated as a factor leading to the impairment of their abilities to concentration on others (Wood, 2006) All of these can lead to low academic performance among... level of negative mental health or mental health problems depends on the individual's appraisal of the degree of the threat in the transaction, and the relative power of the environmental demands