A personal reflection: using theoretical frameworks to understand the impact of starting university on health and wellbeing

Defining health

Both lay and theoretical perspectives define health. Lay perspectives of health are definitions formed by non-professional individuals, who use conceptual understandings and perceptions of what health means to them, with information from a wide range of origins (Warwick-Booth et al, 2012). The concepts can have a factual or evidential basis underpinned by broader theories; however, the lay perspective will also incorporate locally developed conclusions regarding health, which may not have a theoretical basis. Giddens (2009) explained how different cultures have opposing views on the definition of health. In the Western world, the body is considered a complex machine, which must be kept tuned to be healthy. Any ailment is considered a flaw in the machine. On the other hand, Tai (2012) highlighted how the Oriental perception of health primarily focuses on a sustained balance between yin and yang, with a holistic approach being central.

Health can also be defined using theories or models, which are conceptual frameworks used to provide representations of health and illness (Bartley, 2016). The most influential framework is the biomedical model of health, with those who accept this ideal placing emphasis on the biological foundations of health. If the human body is a machine, then any ‘malfunction’ is considered to be caused by an engineering problem (Giddens, 2009). ‘Health’ is considered to be the absence of disease. The social model, however, defines health as more than an absence of illness (Nettleton 2013). It incorporates social, economic, environmental and personal factors when determining an individual's health. Potential responsibility for ill health is assigned to a range of causes, along a broader continuum. The social model focuses on treating a human as an organic whole, where the mind and the body are not be separated. The ‘alternative’ model of health can be regarded as an amalgam of the biomedical and social models of health, focusing on individual use of complementary therapies, such as homoeopathy, acupuncture and hypnosis (alongside traditional treatments, or as stand-alone therapies) to enhance health and wellbeing, and manage health problems. For example, stress can be relieved through the use of yoga (Lindquist et al, 2018). In the past, the medical profession viewed the ‘holistic’ concept as antagonistic, without scientific or rational basis; however, opinions are changing. Frass et al (2012) revealed an increase in complementary therapy use from 5% to 74.8% between 1990 and 2006. Among the medical personnel sampled in the review there was an increase in complementary therapy use/consulting a complementary therapy practitioner in 44.7% of nursing students, 18.2% of pharmacy students and 10% of medical students.

Functionalism is a framework that addresses society as a whole in terms of the function of its integral elements, including traditions, norms, customs and institutions, comparable to the networking organs within the human body (White, 2016). The functionalist structure views society as a complex system, with the parts working concurrently to develop stability and solidarity. As a result of this, the perception is societal interdependence, which creates an affirmative social order (White, 2016). In relation to the organs of the human body, if an element of society is flawed or withdrawn, the system will no longer function effectively. In the context of my analysis, functionalism refers to the interdependence between home life, university life and student nurse life, where an imbalance in one area impacts on the others.

Health models have some areas of similarity. The biomedical model places emphasis on biological and physical components of illness and disease only, whereas the social and alternative models of health incorporate a broad range of determinants (Giddens, 2009). Although the biomedical model is exclusive to the practice of doctors and health professionals, the social and alternative models, and the functionalism framework are perspectives that can be practised by a much larger group of people (Nettleton, 2013). The biomedical model dismisses the concept of holism and draws its weight from biological influences (Gross and Kinnison, 2013; White, 2016). Hogg and Vaughan (2017) argued that the biomedical model's focus only on diagnosis, cure and treatment leads to a significant burden on the healthcare system. The social model focuses on broader determinants of health, but also considers prevention, which benefits the population and reduces the burden on the healthcare system. By incorporating prevention, the social model reflects a holistic view of health. The alternative model adopts a holistic view in supporting health and wellbeing through the use of complementary therapies.

My own perspective of health reflects a holistic view. I believe health is an all-encompassing concept determined by both internal and external aspects. These include physical, psychological, cognitive, social, financial, environmental and spiritual factors. If each is not regulated and sharing a positive balance, all will be impacted and health and wellbeing are affected as a result of this.

Personal reflection

Since starting university, I have learnt much about myself and about my health. My holistic view of health enables analysis of the many factors that have impacted my health. Largely, this has been impacted by stress, which has affected me in numerous ways. I faced stress earlier in the year, when I experienced some difficulties at home. This has resolved and that aspect of my life is positive again, however, during the challenging period everything seemed unbearable. The problems occurred during my first clinical placement, which added significant pressure to an already stressful period of university. I was experiencing a great deal of tiredness due to the long hours of work, shift patterns and the balance of university assignments. Throughout my teenage years, and progressing into my adult life, I have suffered with challenging mental ill health. Whenever my stress levels increase, the disorders I experience can be exacerbated. During my first year of university I became so overwhelmed by everything happening around me, I relapsed mentally, which resulted in physical illness. Consequently, I required time off to recover. This in turn increased my stress further, because I began to worry about making up the sufficient number of placement hours in order to meet the required total and getting back on track with academic deadlines.

In addition, I have faced stress and anxiety regarding the worry of failure. My lifelong dream has been to become a nurse. Now that I am at university and on the final journey to achieving this dream, the pressure has dramatically increased. My fear of failing assignments has intensified because the jump to academic writing has been more challenging than I had anticipated. I also worry about finances. I live at home with my parents, who are very supportive, but their income determines my lower settlement of the student loan. Having been employed since I was 15, I have been used to a regular income. Starting university and no longer having this money to rely on has added further stress. I have struggled to find a balance between my university demands and a social life away from university. Missing out on time spent with my family and friends at times has made me feel alone and anxious. As a result of this stress and anxiety, I have found the past year challenging, and I have found it difficult to relax. Consequently, my physical health has been affected. I become run down very quickly, so have experienced several episodes of physical ill health over the year.

Focused analysis

Fink (2009) defined stress as a negative mental, physical or emotional response to a situation that challenges desired feelings of peace and wellbeing. Stressors can include internal events, such as illness, or external events, such as physiological, social or environmental situations (Gellman and Turner, 2013). There have been numerous events throughout the academic year that have caused me to experience stress and this stress in turn has affected my health. The analysis is framed in the context of Higgins' (1987) self-discrepancy theory, which is still in wide use. The self-discrepancy theory was recently endorsed by Hogg and Vaughan (2017) as a means of developing coping strategies and resilience. The theory links three concepts—the actual self, the ideal self and the ought self—enabling analysis and understanding of the relationship between different types of discrepancies among self-state portrayals and emotional vulnerabilities. The actual self refers to a person at the current moment, the ideal self refers to the person the individual wishes to be, and the ought self refers to our understanding of how others want us to be (Higgins, 1987; Hogg and Vaughan, 2017).

Since nursing is my lifelong dream, I put a lot of pressure on myself to succeed. With this comes a great fear of failure. Since starting university, I have felt the fear of failure increase, causing me significant stress. Singh et al (2012) studied how the stress of examinations and assessments affects students, measuring mood parameters of subjects when relaxed and when stressed. They concluded that during a stressful period, the student's mood was lower, while their cortisol levels were significantly increased. Due to my fear of failure, the time approaching results and feedback of assignments becomes very stressful. This impacts on my health because I find it difficult to clear my mind, and sleep proves difficult. I feel nauseous, which impacts on my diet, both factors that affect my concentration and mood. As a result of the discrepancy between my actual self (who feels stressed) and my ideal self (who would not feel stressed), I am left feeling disappointed and unhappy with myself (Higgins, 1987; Hogg and Vaughan, 2017), creating more stress.

A further challenge was the stress I experienced while on my first clinical placement. Adjusting to the shift patterns and hours was initially quite a challenge, and I was also learning to manage the free time I had to find a balance between study, socialising with family and friends, free time and time to work my paid job. Ferri et al (2016) highlighted how the shift patterns and hours can increase nurses' stress, reduce job satisfaction and increase undesirable health effects. While on placement, my home life difficulties created further stress. With several factors accumulating, I became overwhelmed with stress and began neglecting myself physically. I recognised signs of my mental ill health resurfacing and felt a need to regain control.

Since starting university, I have recognised that, whenever I become stressed and feel out of control in a situation, my attempt at regaining some control is to allow negative behaviours of my illness to take over. The cycle of emotional control, combined with exhaustion, led to me becoming unwell on placement, leading to time off in order to regain health. This exacerbated my stress because I became worried about completing my placement hours. This situation impacted negatively on my physical health and my psychological health. By restricting my diet and not gaining sufficient rest, I was depriving myself of basic needs. Maslow's (2013) hierarchy of needs suggests there are five stages to progress through in order for a person to achieve self-actualisation. Food and water are underlined as basic physiological needs. Without the basic needs being met, a person cannot achieve full potential (Gross and Kinnison, 2013). Reflecting, I am able to recognise Maslow's propositions in the context of my personal health and wellbeing. The dietary restrictions impacted on me severely because I became physically unwell and was not able to reach my full potential because I could not function properly for several days.

The experience of stress on placement made me worried about assignment grades and feedback. Grobecker (2016), highlighted how stress faced by student nurses on clinical placements can negatively impact on learning, motivation and confidence. There is a discrepancy between my actual self (who cannot handle a large amount of stress effectively) and my ideal self (somebody who can use stress positively as motivation, and not be affected by environmental stimuli) (Higgins, 1987; Hogg and Vaughan, 2017). Stress can have serious negative impacts on health and wellbeing in all aspects. When I become stressed about assignments and university deadlines, fear of failure, or demands on placement, I not only adversely neglect my physical and psychological health, but also my social and spiritual health. Black and Lobo (2008) correlated the important activity of spending time with family and loved ones with increased feelings of security, financial management and a positive outlook on life. Encountering stress can cause me to withdraw myself from social situations and from my family and friends, which in turn negatively affects my emotional needs.

In common with many professions, nursing requires the ability to cope effectively with stress. Por et al (2011) suggested that this can be aided by a developed understanding of emotional intelligence and self-awareness. Nursing is considered a highly stressful profession, therefore coping mechanisms are essential. Strategies to manage stress have a clear link with emotional intelligence, and facilitating emotional intelligence can increase subjective wellbeing. Emotional intelligence—described as the power, skill and capacity to establish, consider, and conduct one's emotional self—aids individuals to better cope positively with perceived stress, feelings of control and problem-focused coping, among other aspects (Por et al, 2011). In order to be self-aware, it is necessary to recognise positive and negative aspects of health and how these can be changed for the better. A hugely influential and renowned model for coping with stress is Lazarus and Folkman's (1984) transactional theory of stress and coping. This model acknowledges the stressful event or situation, and then focuses on primary appraisal, considering personal involvement in the encounter. After this, a secondary appraisal would evaluate internal and external coping options, and consider the incorporation of emotional and problem-based coping (Lazarus and Folkman, 1984; Cooper and Campbell-Quick, 2017). Challenging as it has been, I have had to learn and develop coping strategies in order to enhance my health and wellbeing. While using some aspects of transactional theory, I have also developed other coping strategies. Time management has played a significant role in reducing my stress because it allows me to have control over situations. Mirzaei et al (2012) highlighted how effective time management can improve decision-making ability, reduce stress, encourage self-discipline and promote a better work ethic. By effectively planning my deadlines I can give myself the opportunity to put all of my efforts into assignments, which reduces my fear of failure because I know I have tried my best.

In order to reduce my stress, I have learnt several techniques to help myself. I have started practising mindfulness meditation, a technique that allows attention to be focused toward the internal and external present moment. This technique assists me in a holistic way. While helping me mentally and spiritually cleanse any negative or unhelpful thoughts, mindfulness meditation physically enables me to relax my body and calms my mind. Eberth and Sedlmeier's (2012) study concluded that mindfulness has a powerful impact on psychological wellbeing—it greatly reduced stress in all participants. When I feel myself becoming stressed, I employ mindfulness and channel all negative emotion into it, which reduces the symptoms of stress that I experience. The art of mindfulness has also assisted me in becoming more self-aware and emotionally intelligent. Because my stress levels are reduced overall I feel I do not become stressed as easily and I can handle challenging situations more positively, indicating development of resilience. Although this is not always the case, I am now able to recognise that I am becoming overwhelmed and take action to avoid anything serious occurring as a result.

Conclusion

Studying lay and theoretical perspectives of health has reinforced my own belief that health and wellbeing are holistic and multifaceted. The self-discrepancy theory offers a clear basis on which to identify factors that have a negative impact on health and wellbeing, through exploration of discrepancies between the actual, ideal and ought self. Understanding the challenges to health and wellbeing enables me to find solutions to take control, with the aim of enhancing health and wellbeing. In this case, the use of the model has supported me in developing my self-awareness and emotional intelligence. I have learnt more about my own health because this academic year has been stressful and challenging in many ways, but I now try to view this stress in a positive way, and maintain the view that my health is of utmost importance. I have learnt new coping mechanisms, particularly mindfulness meditation, which impacts on my health in a holistic way. This learning is key for my own health and wellbeing, but the understanding that I have developed of myself allows for a deeper understanding of others, which is key in supporting them through my nursing practice.

KEY POINTS

CPD reflective questions