Institute
for Christian Teaching
Education
Department of Seventh-day Adventists
CARING
FOR THE CARE-GIVERS
HEALTH
PROMOTION OR NURSING STUDENTS
By
Marjorie
Sczekan
Department
of Nursing
Atlantic
Union College
South
Lancaster, Massachusetts
Prepared
for the
Faith
and Learning Seminar
Held
at
Union
College
Lincoln,
Nebraska
June
1989
045-89
Institution for Christian Teaching
Silver
Spring, MD 20904, USA
INTRODUCTION
The
second half of the 20th century has, to date, been marked by unprecedented
growth in scientific knowledge and technological achievements. Nowhere are
these developments more evident than in the field of human health. During the fast thirty years phenomenal
progress has been made in eliminating or successfully treating conditions
which, in previous years were fatal or permanently disabling. In the western world, epidemics of
poliomyelitis, measles, pertussis, small pox, diphtheria and typhoid fever no
longer threaten human health and well being.
Mechanical devices and new technologies offer relief from kidney
disease, cancer, bone degeneration and cardiovascular disorders. More remarkable are the options for removing
complete body and replacing them with structures taken from human donors.
In
the midst of this progress however, new and devastating health problems are
emerging. The existence of Auto-Immune Disease Syndrome, AIDS-- a terminal
condition-- is spreading at an alarming rate.
Substance abuse, mental illness and suicide are decimating the ranks of
teenagers and young adults.
Complicating the situation are the skyrocketing costs of health care and
the lack of financial resources to meet the demands. Hospitals, that build
their budgets on projected income from private funds plus state and federal
subsidies are experiencing difficulty in meeting operating costs. In Massachusetts, an ambitious plan for the
total population has hit major roadblocks.
Because of a state-level deficit, the staggering sum of $214 million,
promised as a supplement to hospital resources, has been withdrawn, (Eubanks:
1989). As a means of adjusting to the
short-fall, some institutions have initiated extensive cutbacks in services
rendered and in auxiliary staffing. On
a national level, there is a scarcity of institutions, funds, modalities and
personnel needed to meet the challenge of the emerging health care needs. A most critical factor in the situation is
the shortage of nurses, educated and available to provide essential service.
THE NURSING
SHORTAGE
Nurses,
numbering in the neighbourhood of one and one-half million, make up the largest
category of workers in the health care field.
Unfortunately for the American public, the current and potential supply
of nurses is falling markedly behind the expanding demand for their
services. The seriousness of the
nursing shortage is reflected in numerous publications and reports. Magner, writing in The Chronicle of Higher Education states: "The nursing
shortage varies in severity from city to city, but is a nation wide problem...On
average, about 15 percent of the nursing positions budgeted by hospitals are
now vacant,"(1989:35). In a news
article focused on health care careers it was recorded that approximately one
nursing position in eleven is now unfilled, (Saltzman, 1989). As far back as June, 1987, a Newsweek staff
report on nursing presented some sobering information;
Detroit-area hospitals have 1,200 posts empty, Dallas-Ft. Worth has 900
vacancies... The staffing shortages have severely stretched the quality of care
at some hospitals-- further adding to the burnout and high turnover... Quoting
one staff nurse who preferred to remain anonymous, "When I got home after
a night in the heart ICU, I was becoming physically ill. My heart would pound. My social life was nil. I would crawl into bed and not answer the
phone,"(Clark et. al, 1987).
The dimensions
of the problem are staggering. Carolyn
Davis, head of the Health and Human Services Secretary's Commission on Nursing
wrote, "Conservatively, we need about 200,000 nurses to fill the current
vacancies,"(1985).
The
probability that this condition will worsen is evident from statistical data on
enrolment in nursing schools. Donley
and Flaherty state:
Since 1983, students in all RN programs have decreased more than 25
percent--- from 250,000 in 1983 to fewer than 194,000 in 1986. Preliminary data from the NLN indicate
enrolments will be less than 180,000 for 1987, (1989:184).
A recent federal report provided a disturbing
picture when it projected a deficiency of 600,000 professional nurses by the
year 2000, (Davis, 1985). To compound
the problem, increasing numbers of nurses are leaving the profession for jobs
in other fields, (Burger, 1989:10).
This trend is remarkable when viewed in the context of the past six years. As recently as 1983, hospital nation-wide
was unable to employ all the nurses who applied for work. A representative from a major Los Angeles
institution stated they were splitting each vacant full-time position into two
half-time appointments so that work could be offered to two individuals rather
than one. The question arises as to
what is causing this marked change if such a large, long-standing, formerly
rewarding, occupational field.
STRESS FACTORS
IN HEALTH-CARE SETTING
Nursing
has always been associated with conditions of life and death, illness and
suffering, recovery or stabilisation; however, the severity of illness and the
complexity of care in hospitals has never been as great as it is today. Traditionally, nurse have had little say in
determining their working
conditions and
relatively no recognition for their knowledge and ability to participate in
planning patient care. Even their
schedules, salaries and job benefits were determined by management without
nursing input. This situation has caused problems over the years but the
intensity and demands of practice in today's hospitals motivates nurses to
leave positions in which they have no opportunity for participating in
decisions affecting their practice.
A
1982 project by a team of occupational sociologists studied various work
settings and found identifiable job types or positions which were seen as
placing above average pressure on the worker.
These strains were related to the work environment and/or the job content. Four problem areas were categorized as:
"quantitative
overload: too much to do, excessive time pressure....
"qualitative
underload: too narrow and one-sided job content, lack of stimulus
variation, no demands on creativity or problem-solving, or low opportunities
for social interaction,
"lack
of control: especially in relation to pace of work and working methods,
"lack
of social support: inadequate social networks at home and with fellow
workers," (Elliot & Eisdorfer,1982:122).
Another
study done specifically with nursing personnel showed similar findings plus
other negative conditions in the job setting.
According to these researchers, stress exists as a major issue in
nursing. Factors which their subjects
identified as imposing job-related pressures were: staff shortages, increased
demands by management, the need for greater knowledge and skills (compared with
requirements when first employed), patients who were more critically ill, and
an unmanageable work load (in terms of maintaining quality of work). Nurses suffered from unrealistic
self-expectations, a high-intensity work environment and an increasing number
and variety of health workers with whom care of patient was coordinated,
(Gallagher,1989).
RELATIONSHIP
BETWEEN STRESS & BURNOUT
Stress
is described as the non-specific response of the human organism to a change in
its environment. As such it can be a
positive factor, providing heightened awareness and energy to deal with the
precipitating stimulus. In contrast,
too much stress or stress continued without remission over an extended period
of time is detrimental to human well-being.
Hans Selye has been a pioneer in the study of this phenomena. He identified two types of stress,
"eustress" a positive condition, functional for meeting life's
challenges and "distress" a negative condition resulting from too
intense or unremitting demands on the person, (1976). Prolonged exposure to
unrelieved, high levels of distress whether from physical, psychological,
social or environmental demands leads to a newly recognized condition titled
"burnout". Quoting from
Arnold, "Burnout, defined as "exhaustion of physical and emotional
strength," is a term used to describe the end result of prolonged stress..
." She further states that sustained,
intense stress decreases productivity and narrows the individual's perceptions.
Too much stress blocks learning and decreases problem-solving ability,
(1989:325). Drs. Sally and Rena
Lawrence have done extensive study in the area of stress and burnout in
nursing. A recent article by these authors reads as follows:
Common stressors for nurses are environmental conditions, emotional
problems of patients and families, demands of patients and supervisors, working
conditions, interpersonal and collegial relationships, and contemporary ethical
and moral dilemmas. The list of
stressors is endless because of the nature of the nursing profession. Unrealistic self-expectations are perhaps
the most critical sources of stress, (1987/88:45).
Scully concurs
with the Lawrence statement; he writes, "Expecting too much of oneself can
lead to burnout faster than any other single stressor,"(1980:912). Smyth
in her book,
Surviving
Nursing elaborates on the "burnout"
phenomena:
the three major causes. . . are (1) a mismatch between efforts and
results leading to disappointment and frustration, (2) a mismatch between nurse
and environment leading to role ambiguity and conflict, and (3) a mismatch,
between people leading to interpersonal conflict,(1984:34).
Storlie adds a
final dimension,". . . disillusionment and burnout follow confrontation
with reality in which the human spirit is pitted against circumstances
intractable to change," (1979:2108).
Based
on the foregoing discussion it would appear that as a career option is in a
bleak situation in terms of negative job conditions and the difficulty of
retaining current practitioners or recruiting new members. Why then do a
significant number of students, 100,791 in 1985-86, (Donley & Flaherty,
1989) continue to enrol in schools of nursing?
Obviously the profession is still seen as an occupation which provides a
recognisable number of benefits to the newcomer.
VALUES RELATED
TO NURSING AS A CAREER CHOICE
The
occupational characteristics which have drawn aspirants to nursing still
characterise the discipline. A study done in 1973 questioned students regarding
their reasons for choosing to study nursing.
Responses included: a chance to help people, variety of job options,
opportunities for advancement, job security, working with people rather than
"things" and, being a member of a respected occupation. The category, "chance to help
people" was rated as most important twice
as often as any
other feature, (Sczekan & Betz, 1973).
Neff in the book, Work and Human
Behaviour lists characteristics that are particularly significant for
career choice. These factors include
provision of self-esteem, respect from others and opportunities for creativity,
(1985:139-153).
What
is the significance of the data and issues presented to this point? Why should Seventh-day Adventist educators
be concerned about declining numbers of nursing practitioners and what, if any
action should be taken?
CHURCH EMPHASIS
ON THE FIELD OF HEALTH
From
its inception as a distinct religious organisation with an established set of
doctrines and purpose, the Adventist church has emphasised the holistic nature
of man and the importance of physical and mental health. A recent publication titled Seventh-day
Adventists believe. . . A Biblical Exposition of Fundamental Doctrines,
Item 21 reads:
. . . involve
ourselves only in those things which will produce Christ like purity, health,(emphasis
added), and joy in our lives. . . It also means because our bodies are the temples of the Holy Spirit, we are to care
for them intelligently, (Ministerial Association, 1988:278).
and again,
As Christians we are concerned with both the spiritual and the physical
aspects of people's lives. Jesus our
pattern, healed "every disease and sickness of the people, (p. 280).
Ellen
White, a leader in the early days of the church wrote, "The first study of
the young should be to know themselves and how to keep their bodies in
health,"(1923:26). Acknowledgement of a basic, health-centred mission, and
acceptance of a divine commission to care for the sick was reflected in a
decision (1866) to establish a church-operated, major health-care
institution. Since that date, the
health-focused branch of the church has shown phenomenal growth. Statistical listed in the church's 1989
yearbook provide an impressive profile of the health care efforts.
HEALTH
MINISTRY*
Hospitals and Sanitariums 147
Dispensaries, clinics and launches 284
Retirement homes and orphanages 95
Physicians, Dentists, Residents
& Interns 1,736
Nurses 13,364
Assets of Health-care Institutions: $2,725,331,102.
*(Office of Archives
& Statistics, 1989:4).
When establishing health care facilities church officers were instructed that the facilities were not to be ordinary institutions, rather they were to have a distinctive character and focus. Ellen White wrote extensively on this topic:
Seventh-day
Adventist institutions are to represent the various features of gospel medical
missionary work and thus to prepare the way for the coming of the Lord,
(1951:406).
Our sanitariums are the right hand of the gospel, opening doors whereby suffering humanity may be reached with the glad tidings of healing through Christ, (1923:212).
Institutions
for the care of the sick are to be established, where men and women may be
placed under the care of God-fearing medical missionaries,. . . they (patients)
are to be cared for by wise physicians and nurses, (1923:12).
The Christian
nurse, while administering treatment for the restoration of health, will
pleasantly and successfully draw the mind of the patient to Christ, the healer
of the soul as well as the body, (1923:406).
It is obvious then that provision of health services and education of nurses and other service personnel was and is high priority of the Seventh-day Adventist church. Unfortunately, administrators in denominational health-care institutions are experiencing the same personnel shortages as their counterparts in public facilities. During a recent meeting of nurse executives from four Adventist institutions, serious concern was expressed regarding the inability to adequately staff hospital units. More critical is the fact that, of the staff currently employed in denominational facilities, less than 15% subscribe to the Adventist doctrines. Gaebelein, discussing a mandate for employing Christian rather than secular teachers in a religious college made the statement, "Compromise of this issue, if persisted in always results in the progressive de-Christianising of an institution," (1968:37). If the central purpose of Adventist-operated hospitals is to advocate and demonstrate denominational health standards and their philosophy of Christian care, then the institutions are prevented from fulfilling their mission when more than 80% of their service is provided by non-believing, non-conforming personnel.
As
a means of preparing workers who are not only qualified with the necessary
occupational abilities but more important, who support the religious values and
perspectives, educational programs in a variety of health care disciplines are
offered in denominational colleges. At the present time, Adventists operate two
medical universities and offer nursing education more than twenty North
American programs.
NURSING
EDUCATION
Educational programs leading to a degree in nursing are similar in some respects yet markedly different in others from the majority of academic majors offered in institutions of higher learning. All degree programs include courses in the sciences, communications, social studies, liberal arts, academic major and general education electives. In this respect nursing is comparable with other disciplines. Differences for nursing appear in the significantly greater amount of credit and time allocated for required, clinical laboratory components when compared with other academic majors. The time spent in required class activities by the average chemistry student, (16 credit hours, two lab courses) is 21 clock hours per week. In contrast, the contact hour commitment for a nursing student (15 credit hours, two lab courses) is approximately 30 clock hours per week. A second difference for nursing is also related to the laboratory experience. Instead of being in campus in a regulated, familiar setting, nursing students spend 10 to 15 hours per week in a complex, unpredictable, high-tech hospital setting. And, instead of working with inanimate clinical materials they provide direct and intrusive care to human beings in pain. Not only must students master extensive theoretical content, they must also learn interpersonal and technical skills and utilize these competencies in the service area. Finally, the character and intensity of the clinical experience is different from any on-campus activities. Students care for individuals with a variety of health problems. A patient may be recovering from an elective surgical procedure or they maybe dying from a terminal illness. In every case, students must deal with their own intense emotional feelings while providing nursing care and psychological support to patients and their families. In reporting on a research project studying deviant behaviour in nursing students, Hilbert notes that students reported excessive and unrelenting pressure in the academic program.
Health problems of the students were often stress related. (problems
cited) were: "pressure or good grades," "lack of time,"
"lack of self-confidence," and "afraid of poor clinical
evaluations,"(1987:39).
Earlier
in this paper recognition was given to the stressful nature of the health-care
setting. The predisposition to burnout
and its negative effects on personnel was seen as directly related to the
condition of unrelieved stress. When
educational sequence is reviewed, it appears that academic pressures experienced
by nursing students may be as great as those encountered in the health-care
practice area. Unfortunately, students have little knowledge regarding the
nature of their stress, its potentially damaging effects or of strategies
available for relieving their strain.
It is likely that these conditions are least partly responsible for the
high rate of academic failure and change of major by students in nursing. Gallagher states,
I believe that cumulative stress that leads to burnout has caused tremendous losses of professional nurses. Because nurses tend to place themselves last, they are all too willing to take on additional responsibility.. . .it is critical that nurses begin the ongoing effort of managing stress, (1989:60,61).
Faculty
in nursing schools focus their attention on equipping students with the
theoretical knowledge and the practical abilities necessary for contemporary
health practice. The instructors are responsible for preparing students with
the knowledge and problem-solving ability necessary for successful performance
on the state licensing examination and for subsequent practice. If the graduate does not pass the test, they
will not be allowed to practice nursing regardless of their academic
record. Because of these expectations,
the majority of instructional effort is placed on transmitting didactic
information with little or no emphasis on preparing students to cope with
stress and avoid burnout. Burger notes that failure to deal effectively with
the problem in the employment setting and offers some suggestions for its
relief; it is possible that similar action would be effective in the
educational arena as well.
As nurses we fight tough battles;
we mourn with patients and their families; we compassionately absorb their
burdens; we try to untangle convoluted problems. When we can take no more, we become critical and resentful of
each other rather than supporting each other.
Let's acknowledge our stress and grief: tell our colleagues when we are
overwhelmed; and accept help from others like social workers, chaplains or
counsellors, (1989:12).
Academic institutions operated by the Adventist church are committed to providing education within a Christian frame of reference. This perspective recognizes and promotes the spiritual dimension as a guiding force for a productive life and as a personal resource for meeting life's problems. Faculty are expected to provide students with the best educational experiences possible while at all times they are to demonstrate concern for students' emotional and spiritual well-being. Educational curricula include requirements in general education, science, religion and the academic major. While nursing programs follow a similar sequence, the time frame and setting for learning activities is more intense than for other disciplines. Attention is given to spiritual values and influence as elements which effect the life and health of patients and as factors which must be considered and supported. Students are encouraged to develop and maintain a day-by-day, personal relationship with God. However, they are not introduced to a program of individually assessing their own emotional, spiritual and resources in maintaining inner peace, restoring confidence and reducing stress in academic and clinical settings is not specifically addressed.
NURSING
STUDENTS' PERCEPTIONS O STRESS
As
a means of determining whether students actually perceived their academic
program as stressful and, if so what actions they took as a result, a six item,
self-rating survey was done at a small, liberal arts college. The survey instrument consisted of a
two-page, self-administered questionnaire asking students to rank a series of
factors according to the amount of stress they felt from these items. Following response to the stress-focused
questions, subjects were then asked to rank order a list of activities which
they would use to relieve their tension, (see Appendix for questionnaire). The only instructions given to students
participating in the project was that they should consider their over-all
college experience when responding to the items. Twenty-one nursing students
completed the survey. Because of the
small sample size and the brevity of the survey instrument, no generalizations
or conclusions can be drawn. However, trends were apparent even in this
"mini"-pilot study. Students
clearly rated the clinical practicum as most stressful of all academic
factors. In the non-academic area,
getting adequate rest and exercise and meeting financial obligations were rated
highest. The highest ranked factor producing social/personal stress was finding
adequate time to be alone. This item
was rated by students as more stressful than other factors in both first and
second level rankings. When asked to
sequentially order the actions they would take to reduce pressure in the
academic area, meeting with an instructor was marked fifth (relatively last)
choice by the majority of the students. In responding to a question asking how
helpful the campus religious activities/emphasis were in reducing pressures of
being a student, one student said never, five said seldom, and seven said
sometimes. Only six students reported
that the spiritual emphasis was usually or always helpful.
The
study reported here is obviously too small and imprecise to be taken at face
value however, the responses indicate that students do not see faculty as
first-level resource persons when they are having difficulty with their course
work. (The survey was conducted during
the closing weeks of the semester, rating of items might have been different if
done early in an academic term).
Finally, the fact that many students do not view that religious features
of the college as helping them with the problems they are experiencing points
out a need for careful attention by the faculty. These indications are especially significant for instructors in
nursing. Arnold writes:
Since nursing practice is a relational, mutually interactive process in
which the nurse and client are engaged as whole persons, the spiritual life and
well-being of the nurse are pivotal considerations in helping assigned clients
achieve optimal physical, spiritual, and psychological well-being and self-care
capacity. Without a consideration of
the spiritual nature of the nurse and its relational impact on the client, the
subject of spirituality in nursing practice is one-sided and incomplete,
(1989:321).
CONCLUSIONS AND
FUTURE DIRECTIONS
The
seriousness of the problems in the field of nursing as described in this paper
are major concern to nurse educators. Schools of nursing are continually
reviewing and revising their academic programs in an effort to make the
educational experience as meaningful and effective for students as possible.
Within the context of Christian education and values, nursing faculty in
Adventist institutions have a special obligation to prepare students not only
with the necessary intellectual and practice abilities but also to assist
students in developing inner strengths or coping with the demands of a
challenging profession. The findings in
this report will be shared with faculty at the author's home institution. Time will be spent in curriculum meetings
for addressing the problem of stress as it effects students. Consideration will be given to developing an
assessment guide by which students can evaluate their own health state:
physical, intellectual and emotional and spiritual. Incorporated with the guide will be suggested strategies and
checklists for use students in monitoring and promoting their own well
being. Faculty will examine ways in
which students can be encourage to see faculty as primary resource people,
individuals who are committed to helping students achieve personally rewarding
and productive lives. Careful review of
the curriculum will be conducted to assure that the unique, spiritual values
and health principles of the church are clearly and effectively presented.
Conferences will be held with the campus chaplain to explore ways of
strengthening the spiritual dimension in course materials.
The
shortage of professional nurses in America is a national problem, one which
will become progressively worse without immediate and concerted action. Faulty
in nursing schools have an important responsibility to prepare students for the
demanding but rewarding nature of their career choice. The activities listed above reflect one
approach to fulfilling the responsibilities of Christian educators to the
students, the college, the instructors themselves, to the church and to their
God.
Arnold
E. Burnout as a spiritual issue: rediscovering meaning in nursing practice in
Carson, V (Ed), (1989). Spiritual
Dimensions of Nursing Practice.
Philadelphia: W.B. Saunders Co.
Burger
J. (1989). Shaping nursing's future. Journal of Christian Nursing, 6(1),
10-13.
Carson,.
(Ed), (1989). Spiritual Dimensions
of Nursing Practice. Philadelphia:
W.B. Saunders Co.
Catlett,
R. (1989). Identifying and coping with
your stress. Imprint 36(2),
77-81.
Clark,
M., et al. Nurses: few and fatigued. Newsweek,
109(5), 59,61.
Davis,
C. (1985). Secretary's Report to the
Congress, U.S. Department of Health and Human Services.
Donley,
Sr. R., Flaherty, Sr. M. (1989). Analysis of the market driven nursing
shortage. Nursing & Health Care,
10(4), 183-187.
Elliot,
G. & Eisdorfer, L (Eds.). (1982). Stress and Human Health: Analysis and
Implications of Research. New York:
Springer Publishing Company.
Eubanks,
P. (1989). Early turmoil or Massachusetts universal health-care law. Hospitals, 63 (20), 54.
Gaebelein,
F. (1968). The Pattern of God's
Truth: The Integration of Faith and Learning. Chicago: Moody Press.
Gallagher,
D. (1989). Is stress ripping nurses
apart? Imprint, 36(2), 59-63.
Hilbert,
G. (1987). Academic fraud: prevalence, practices and reasons. Journal of Professional Nursing,
3(1), 39-45.
Jones,
L. (1988). How to assess stress: a significant step for the nursing
student. Journal of Nursing
Education, 27(5), 227-229.
Lawrence,
R. & Lawrence, S. (1987). The nurse
and job-related stress: responses Rx, and self-dependency. Nursing Forum, 23(2), 45-51.
Magner,
D. (1989). Nursing schools are urged to
recruit new types of students and offer more financial aid to ease nationwide
shortage. The Chronicle of Higher
Education, 35(36), A35, 37.
Ministerial
Association. (1988). Seventh-day Adventists Believe. . . A
Biblical Exposition of 27 Fundamental Doctrines. Hagerstown, MD: Review
& Herald Publishing Association.
Neff,
W. (1985). Work and Human Behaviour. New York: Aldine Publishing Co.
Saltzman,
A. (1989). One physical therapist, 10
job offers. U.S. News & World
Report, 106(23), 67.
Scully,
R. (1980). Stress in the nurse. American
Journal of Nursing, 80(6), 912-914.
Sczekan,
M. & Betz, M. (1973). Effect of
values, social support, and academic performance in stabilizing occupational
choice. Nursing Research,22(4), 339-343.
Selye,
H. (1976). The Stress of Life.,
Rev. New York: McGraw-Hill.
Smythe,
E. (1984). Surviving Nursing. Menlow Park, CA: Addison-Wesley Publishing
Company.
Storlie,
F. (1979). Burnout: the elaboration of
a concept. American Journal of
Nursing, 79(12), 2108-2111.
White,
E. G. (1951). Counsels on Health.
Mountain View, CA: Pacific Press Publishing Association.
White,
E. G. (1923). Fundamentals of
Christian Education. Mountain View,
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Will,
George. (1988). The dignity of
nursing. Newsweek, 111(21), 80.
APPENDIX
A
In reducing pressures in the various situations what activities or resources do you sue? Please rank order from 1 to 6,1 being the thing you would do first.
Academic
factors
_____
a. spend extra time studying
_____
b. ask classmates for answers or suggestions
_____
c. ask to meet with the instructor
_____
d. pray about the problem
_____
e. try to get extra rest or relaxation
_____
f. other, please describe_________________________________________
___________________________________________________________
___________________________________________________________
Non-academic
_____
a. cut back on study time to get more rest and/or exercise
_____
b. look for a different job
_____
c. increase work hours to get more income
_____
d. discuss family problems with spouse/children
_____
e. get advice from an outside person, (counsellor/pastor/friend)
_____
f. other, please describe ________________________________________
___________________________________________________________
___________________________________________________________
Social or
personal
_____
a. go off campus, (take a walk or drive, go to a park)
_____
b. avoid on and off campus social activities
_____
c. join a club or social group
_____
d. do some religious activity, (pray, read, attend service)
_____
e. discuss with counsellor (pastor, faculty or other person)
_____
f. other, please describe ________________________________________
___________________________________________________________
___________________________________________________________
Two final questions:
1. Do
you find the spiritual emphasis and /or the religious activities on this campus
helpful to you personally in reducing pressures of being a student?
_____
never _____ seldom _____ sometimes _____ usually _____
always
2. In
your opinion, are the religious beliefs and values of the faculty demonstrated
in a caring/helpful attitude with students?
_____ always _____ sometimes _____ infrequently _____
never
Please write in any comment or
suggestions. Thank you for your
assistance.(Signed by the author)