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RESILIENCE, MINDFULNESS AND PSYCHOLOGICAL WELL-BEING AMONG NURSING STUDENTS
LOCK ROU FEN
MASTER OF SCIENCE (MANAGEMENT) UNIVERSITI UTARA MALAYSIA
AUGUST 2020
RESILIENCE, MINDFULNESS AND PSYCHOLOGICAL WELL-BEING AMONG NURSING STUDENTS
By
LOCK ROU FEN
Thesis Submitted to
Othman Yeop Abdullah Graduate School of Business, Universiti Utara Malaysia,
in Partial Fulfillment of the Requirement for the Master of Science (Management)
iii
PERMISSION TO USE
In presenting this dissertation/project paper in partial fulfillment of the requirements for a Post Graduate degree from the Universiti Utara Malaysia (UUM), I agree that the Library of this university may make it freely available for inspection. I further agree that permission for copying this dissertation/project paper in any manner, in whole or in part, for scholarly purposes may be granted by my supervisor or in her absence, by the Dean of Othman Yeop Abdullah Graduate School of Business where I did my project paper. It is understood that any copying or publication or use of this project paper parts of it for financial gain shall not be allowed without my written permission.
It is also understood that due recognition shall be given to me and to the UUM in any scholarly use which may be made of any material in my dissertation/project paper.
Request for permission to copy or to make other use of materials in this dissertation/project paper in whole or in part should be addressed to:
Dean of Othman Yeop Abdullah Graduate School of Business Universiti Utara Malaysia
06010 UUM Sintok Kedah Darul Aman
iv ABSTRACT
The objectives of the current study are to determine the nursing students’ level of resilience, mindfulness, and PWB, examine correlation between resilience and mindfulness with PWB, and influence of resilience and mindfulness with PWB. This study used simple random sampling technique in data collection. Questionnaire in google form were distributed due to the Covid-19 pandemic for this study. The population for this study is final year nursing students. Three nursing institutions were willing to participate in this research. There is a total of 142 final year nursing students in these nursing institutions. The sample size required for this study is 103. In order to achieve the sample size, a total of 123 google forms were distributed. Only 116 google forms were returned and the response rate was 94.31%. The Brief Resilience Scale, Mindfulness Attention Awareness Scale (MAAS) and PWB Scale were used to measure the variables in this study. According to the findings, mean for resilience (3.52) and mindfulness (3.57) of nursing students are average, and the PWB (3.72) is high. Pearson Correlation is used to analyze correlation between resilience and mindfulness with PWB, and it shows significant, positive, and strong correlation.
Multiple Regression analysis is used to analyze the influence of resilience and mindfulness on PWB. The F value is 75.34 and adjusted R2 value is 0.56. It indicates that resilience (β=0.19) and mindfulness (β=0.62) can significantly influenced PWB and mindfulness with higher standardize beta value showed higher influence on PWB.
The results indicated that nursing students with high resilience and mindfulness would also have high PWB. Resilience and mindfulness play a very crucial role in predicting PWB. Therefore, Malaysia Nursing Board or nursing institutions must bear in mind the importance of resilience, mindfulness and PWB level of the nursing students.
Keyword: Resilience, Mindfulness, Psychological well-being, nursing students.
v ABSTRAK
Objektif kajian ini adalah untuk menentukan tahap ketahanan, kesedaran, dan kesejahteraan psikologi pelajar kejururawatan, meneliti korelasi antara ketahanan dan kesedaran dengan kesejahteraan psikologi, dan pengaruh ketahanan dan kesedaran terhadap kesejahteraan psikologi. Kajian ini menggunakan teknik persampelan rawak mudah dalam pengumpulan data. Soal selidik dalam bentuk borang google diedarkan akibat pandemik Covid-19. Populasi kajian ini adalah pelajar kejururawatan tahun akhir. Tiga institusi kejururawatan sudi mengambil bahagian dalam penyelidikan ini.
Seramai 142 pelajar kejururawatan tahun akhir di ketiga-tiga institusi kejururawatan ini. Saiz sampel yang diperlukan untuk kajian ini adalah 103. Untuk mencapai saiz sampel, sebanyak 123 borang google telah diedarkan. Hanya 116 borang google yang dikembalikan dan kadar respon adalah 94.31%. Skala Ketahanan Ringkas, Skala Kesedaran (MAAS) dan Skala Kesejahteraan Psikologi digunakan untuk mengukur pemboleh ubah dalam kajian ini. Berdasarkan dapatan kajian, min untuk ketahanan (3.52) dan kesedaran (3.57) pelajar kejururawatan adalah pada tahap sederhana, dan kesejahteraan psikologi (3.72) adalah tinggi. Korelasi Pearson telah digunakan untuk menganalisis korelasi antara ketahanan dan kesedaran dengan kesejahteraan psikologi, dan ini menunjukkan korelasi yang signifikan, positif, dan kuat. Analisis Regresi Berganda telah digunakan untuk menganalisis pengaruh ketahanan dan kesedaran terhadap kesejahteraan psikologi. Nilai F ialah 75.34 dan nilai R2 terlaras ialah 0.56.
Ini menunjukkan bahawa ketahanan (β = 0.19) dan kesedaran (β = 0.62) dapat mempengaruhi kesejahteraan psikologi secara signifikan dan kesedaran dengan nilai beta terpiawai yang lebih tinggi menunjukkan pengaruh yang lebih tinggi terhadap kesejahteraan psikologi. Hasil kajian menunjukkan bahawa pelajar kejururawatan dengan ketahanan dan kesedaran yang tinggi juga akan mempunyai PWB tinggi.
Ketahanan dan kesedaran memainkan peranan yang sangat penting dalam meramalkan kesejahteraan psikologi. Oleh itu, Lembaga Jururawat Malaysia atau institusi kejururawatan perlulah sedar akan kepentingan ketahanan, kesedaran dan tahap kesejahteraan psikologi pelajar kejururawatan.
Kata kunci: Ketahanan, Kesedaran, Kesejahteraan Psikologi, Pelajar kejururawatan
vi
ACKNOWLEDGEMENT
First and foremost, I would like to express my greatest gratitude to my supervisor, Dr Tang Swee Mei for her valuable guidance, encouragement, and patience. Without her, it would be very tough and difficult for me to finish the research project. I want to thank her for her support and understanding throughout the research.
Secondly, I would like to thank Professor Smith, Madam Nor Aziyan, and Dr Carol Ryff for their approval to use the research instrument for the current study.
Thirdly, I would like to extend my appreciation to all the participants for their cooperation and willingness to participate in this research. Without them, the data collection process would not be successful.
Lastly, I would like to thank my beloved parents and siblings for the endless support and help throughout this research. Their caring and support have helped me to move forward.
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TABLE OF CONTENTS
CERTIFICATION OF THESIS WORK ... ii
PERMISSION TO USE ... iii
ABSTRACT ... iv
ABSTRAK ... v
ACKNOWLEDGEMENT ... vi
TABLE OF CONTENTS ... vii
LIST OF TABLES ... x
LIST OF FIGURES ... xii
LIST OF ABBREVIATIONS ... xiii
LIST OF APPENDICES ... xiv
CHAPTER 1 INTRODUCTION ... 1
1.1 Background to the Study ... 1
1.2 Problem Statement ... 2
1.3 Research Questions ... 5
1.4 Research Objectives ... 5
1.5 Scope of the study ... 5
1.6 Significant of the study ... 6
1.7 Definition of Key Terms ... 6
1.7.1 Resilience ... 6
1.7.2 Mindfulness ... 6
1.7.3 Psychological Well-being ... 6
1.7.4 Nursing student ... 7
1.8 Organization of the Thesis ... 7
CHAPTER 2 LITERATURE REVIEW ... 8
2.1 Introduction ... 8
2.2 Concept and Definition of Psychological Well-being (PWB) ... 8
2.3 Measurement of Psychological Well-being (PWB) ... 9
2.4 Previous Study on Psychological Well-being (PWB) ... 11
2.5 Resilience ... 15
2.5.1 Definition of Resilience ... 15
2.5.2 Previous Study on Resilience ... 16
viii
2.6 Mindfulness ... 19
2.6.1 Definition of Mindfulness... 19
2.6.2 Previous Study on Mindfulness ... 20
2.7 Previous Study on Resilience and Psychological Well-being ... 21
2.8 Previous Study on Mindfulness and Psychological Well-being ... 22
2.9 Underpinning Theory of the Study ... 24
2.10 Conceptual Framework ... 25
2.11 Research Hypotheses ... 26
2.12 Chapter Summary ... 27
CHAPTER 3 RESEARCH METHODOLOGY ... 28
3.1 Introduction ... 28
3.2 Research Design ... 28
3.3 Research Population, Sample and Sampling Techniques ... 28
3.3.1 Population ... 28
3.3.2 Sample Size ... 29
3.3.3 Sampling Techniques... 30
3.4 Research Methodology and Instrument ... 31
3.4.1 Resilience (Independent Variable) ... 31
3.4.2 Mindfulness (Independent Variable) ... 32
3.4.3 Psychological Well-being (Dependent Variable) ... 34
3.4.4 Layout of Questionnaire ... 35
3.5 Data Collection Method ... 36
3.6 Pretesting of the instrument and Pilot Test ... 37
3.7 Data Analysis ... 40
3.8 Chapter Summary ... 42
CHAPTER 4 RESULTS ... 43
4.1 Introduction ... 43
4.2 Response rate ... 43
4.3 Coding ... 44
4.3.1 Coding ... 44
4.3.2 Reverse Coding ... 44
4.4 Normality Test ... 45
4.5 Validity and Reliability Test ... 46
4.6 Socio-demographic Profile of Nursing Students ... 47
ix
4.7 Descriptive Statistics of Variables ... 49
4.7.1 The Resilience Levels of Nursing Students ... 50
4.7.2 The Mindfulness Levels of Nursing Students ... 51
4.7.3 The Psychological Well-being Levels of Nursing Students ... 54
4.8 The Correlation Between Resilience and Mindfulness with Psychological Well-being Among Nursing Students ... 59
4.9 The Influence of Resilience and Mindfulness on Psychological Well- being Among Nursing Students ... 60
4.10 Summary of Hypotheses ... 60
CHAPTER 5 DISCUSSION AND CONCLUSION ... 62
5.1 Introduction ... 62
5.2 Summary of the Study Findings ... 62
5.3 Discussion ... 63
5.3.1 Resilience, Mindfulness and Psychological Well-being Level ... 64
5.3.2 Relationship between Resilience and Mindfulness with Psychological Well-being ... 65
5.3.3 Resilience and Mindfulness influence on Psychological Well-being ... 66
5.4 Contribution of study ... 67
5.4.1 Practical contribution ... 67
5.4.2 Theoretical contribution ... 68
5.5 Practical Implications ... 68
5.6 Limitations ... 68
5.7 Future recommendation ... 69
5.8 Conclusion ... 69
REFERENCES ... 70
APPENDICES ... 80
x LIST OF TABLES
Table 2.1 Dimensions of Well-Being ... 9
Table 3.1 Krejcie and Morgan Table ... 29
Table 3.2 Sample Distribution ... 30
Table 3.3 Items for Resilience ... 32
Table 3.4 Items for Mindfulness ... 33
Table 3.5 Items for Psychological Well-being ... 34
Table 3.6 Layout of Questions in the Questionnaire... 36
Table 3.7 Validity Interpretation ... 38
Table 3.8 Content Validity (116 participants) ... 39
Table 3.9 Cronbach’s Alpha Rule of Thumb ... 40
Table 3.10 Reliability Test (10 participants) ... 40
Table 3.11 Rule of Thumb for Interpretation of Variables ... 41
Table 3.12 Correlation Strength Interpretation ... 41
Table 4.1 Response Rate ... 43
Table 4.2 Variable Coding ... 44
Table 4.3 Variable Reverse Coding ... 45
Table 4.4 Normality Test (n=116) ... 46
Table 4.5 KMO and Barlett’s Test ... 47
Table 4.6 Reliability Test (116 participants) ... 47
Table 4.7 Socio-demographic Profile of Participants (n=116) ... 48
Table 4.8 Mean and Standard Deviation of Resilience, Mindfulness and Psychological Well-being of Nursing Students (n=116)... 49
Table 4.9 Respond to Resilience (n=116) ... 50
Table 4.10 Respond to Mindfulness (n=116) ... 52
Table 4.11 Respond to Psychological Well-being (n=116) ... 56
xi
Table 4.12 Correlation Among Variables (n=116) ... 59 Table 4.13 Multiple Regression of The Variables (n=116) ... 60 Table 4.14 Summary of the Hypotheses ... 61
xii LIST OF FIGURES
Figure 2.1 Conceptual Framework ... 26
xiii
LIST OF ABBREVIATIONS
MNB - Malaysia Nursing Board
LJM - Lembaga Jururawat Malaysia
KMO - Kaiser-Meyer-Olkin Measure of Sampling Adequacy SPSS - Statistical Package for Social Sciences
PWB - Psychological Well-being
PS - Perceived Stress
SA - Self-acceptance
SE - Self-efficacy
SFM - Support from family
SFR - Support from friend
SSO - Support from significant others
xiv
LIST OF APPENDICES
Appendix A: Questionnaire... 80
Appendix B: Permission To Use The Instrument (Resilience Scale) ... 85
Appendix C: Permission To Use The Instrument (Mindfulness Scale) ... 86
Appendix D: Permission To Use The Instrument (PWB Scale) ... 87
Appendix E: Permission Letter For Data Collection ... 88
Appendix F: Gantt Chart/ Project Schedule ... 89
1 CHAPTER 1 INTRODUCTION
1.1 Background to the Study
Nursing is a noble profession. Requirement for nurses increased annually. This profession is viewed as a stressful occupation due to lack of workforce and difficulties related to nursing practice (Hart et al., 2014; Chow et al., 2018). Psychological well- being (PWB) is essential to ensure effectiveness among employees in the organization (Shariff & Sulaiman, 2018). It is essential in the pathway of education for future nurses. PWB is crucial to prevent nursing students from having physiological problems and help to increase their life span (Vázquez et al., 2009; Klainin-Yobas et al., 2016).
Nursing students in Spain have faced enormous stress to meet professional demands (Jimenez et al., 2010; Mathad et al., 2017). In addition, according to He et al. (2018), nursing students from Australia regional universities have higher perceived stress (PS) level and lower PWB level. Nursing students may face academic stress that will lead to psychological distress and harmful effects to their well-being (Thomas & Revell, 2016; Chow et al., 2018). According to Shahira et al. (2018), academic stress is the main contributor to the low-level PWB.
When nursing students undergo clinical practice in the hospital, they may face issues dealing and communicating with patients and other healthcare professionals while having academic stress at the same time. The application of theory inside the clinical practice also causes further stress to the nursing students (Thomas & Revell, 2016;
Chow et al., 2018). This is because nursing students need to memorize and apply all
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80 APPENDICES
Appendix A: Questionnaire
RESILIENCE, MINDFULNESS AND PSYCHOLOGICAL WELL-BEING AMONG NURSING STUDENTS
CODE:
PART A: SOCIO-DEMOGRAPHIC PROFILE
Instruction: Please tick (√) in the appropriate box provided.
1. Age:
18 - 22 23 - 27 28 - 32 33 – 37 38 - 42 43 – 47 48 - 52 2. Gender:
Male Female 3. Ethnicity:
Malay Chinese Indian
Others (Please state):_____________________
81 4. Monthly household income:
≤ RM 1000
RM 1001 – RM 4000 RM 4001 – RM 8000 ≥ RM 8001
5. CGPA obtained:
2.00- 2.99 3.00- 3.66 3.67- 4.00
PART B: RESILIENCE SCALE
Instruction: For each item, please indicate the degree of your agreement to each of the statement by circling the rating provided.
Scale:
1 - Strongly Disagree 2 - Disagree 3 - Neutral 4 - Agree 5 - Strongly Agree
No. Items Scale
1 I tend to bounce back quickly after hard times. 1 2 3 4 5 2 I have a hard time making it through stressful
events.
1 2 3 4 5
3 It does not take me long to recover from a stressful event.
1 2 3 4 5
4 It is hard for me to snap back when something bad happens.
1 2 3 4 5
5 I usually come through difficult times with little trouble.
1 2 3 4 5
6 I tend to take a long time to get over set-backs in my life.
1 2 3 4 5
82 PART C: MINDFULNESS SCALE
Instruction: For each item, please indicate the degree of your agreement to each of the statement by circling the rating provided.
Scale:
1 - Strongly Disagree 2 - Disagree 3 - Neutral 4 - Agree 5 - Strongly Agree
No. Items Scale
1 I get emotional and do not realize what is happening until it’s over.
1 2 3 4 5
2 I break or drop things because of carelessness, poor attention, or because my mind is on something else.
1 2 3 4 5
3 I find it difficult to pay attention to what is currently going on.
1 2 3 4 5
4 I tend to walk very fast to my destination without paying attention to what is happening on the way.
1 2 3 4 5
5 I tend to ignore physical tension or discomfort until it really bothers me.
1 2 3 4 5
6 I tend to forget people’s names immediately after being introduced from them for the first time.
1 2 3 4 5
7 It’s as if I’m “doing something automatically”
without me realizing it.
1 2 3 4 5
8 I tend to rush through my activities without really paying attention to them.
1 2 3 4 5
9 I’m too focused on the objective that I wish to achieve until I lose direction on what I’m currently doing to achieve it.
1 2 3 4 5
10 I tend to carry out my work or duties automatically without realizing what I’m doing.
1 2 3 4 5
11 I find myself listening to others with only one ear while carrying out other tasks at the same time.
1 2 3 4 5
12 I tend to drive somewhere automatically, and later find myself puzzled why did I go there.
1 2 3 4 5
13 I find myself always thinking about the future and the past.
1 2 3 4 5
83
14 I find myself doing things without paying attention.
1 2 3 4 5
15 I have meals without realizing what I’m eating. 1 2 3 4 5
PART D: PSYCHOLOGICAL WELL-BEING SCALE
Instruction: For each item, please indicate the degree of your agreement to each of the statement by circling the rating provided.
Scale:
1 – Strongly Disagree 2 – Disagree 3 – Neutral 4 – Agree 5 – Strongly Agree
No. Items Scale
Autonomy
1 I tend to be influenced by people with strong opinions.
1 2 3 4 5
2 I have confidence in my own opinions, even if they are contrary to the general consensus.
1 2 3 4 5
3 I judge myself by what I think is important, not by the values of what others think are important.
1 2 3 4 5
Environmental Mastery
4 In general, I feel I am in charge of the situation in which I live.
1 2 3 4 5
5 The demands of everyday life often get me down. 1 2 3 4 5 6 I am quite good at managing many
responsibilities of my daily life.
1 2 3 4 5
Personal Growth
7 I think it is important to have new experiences that challenge how I think about myself and the world.
1 2 3 4 5
8 For me, life has been a continuous process of learning, changing, and growth.
1 2 3 4 5
9 I gave up trying to make big improvements or changes in my life a long time ago.
1 2 3 4 5
84 Positive Relations with Others
10 Maintaining close relationships has been difficult and frustrating for me.
1 2 3 4 5
11 People would describe me as a giving person, willing to share my time with others.
1 2 3 4 5
12 I have not experienced many warm and trusting relationships with others.
1 2 3 4 5
Purpose in Life
13 I live life one day at a time and don't really think about the future.
1 2 3 4 5
14 Some people wander aimlessly through life, but I am not one of them.
1 2 3 4 5
15 I sometimes feel as if I've done all there is to do in life.
1 2 3 4 5
Self-Acceptance
16 When I look at the story of my life, I am pleased with how things have turned out.
1 2 3 4 5
17 I like most aspects of my personality. 1 2 3 4 5
18 In many ways, I feel disappointed about my achievements in life.
1 2 3 4 5
85
Appendix B: Permission To Use The Instrument (Resilience Scale)
86
Appendix C: Permission To Use The Instrument (Mindfulness Scale)
87
Appendix D: Permission To Use The Instrument (PWB Scale)
88
Appendix E: Permission Letter For Data Collection
89
Appendix F: Gantt Chart/ Project Schedule
(Project Starts February 2020 – End August 2020) No. Project
Activities
2020
Jan Feb Mac Apr May Jun July Aug 1. Selection of
research topic, proposal preparation and
presentation, ethical approval 2 Data
collection 3 Data analysis 4 Thesis write
up
5 Thesis draft submission for
evaluation 6 Final
presentation 7 Thesis
correction &
final report writing 8 Submission
of thesis (final draft)
PLANNED RESEARCH MILESTONE
February 2020 : Completion of proposal preparation April 2020 : Completion of proposal
May 2020 : Completion of data collection June 2020 : Completion of data analysis July 2020 : Completion of thesis writing August 2020 : Thesis submission
