Stress has been identified as a 20th century disease and has been viewed as a complex and dynamic transaction between individuals and their environment [1] . The modern stress theory is structured in the evaluation of the meaningfulness of an event(s) to the individuals’ psychological or physical well-being and the internal compensatory mechanisms adapted to cope for the perturbations induced by the external event(s) [2] . An individual’s response to an event thus depends on whether it is appraised as a challenge which would lead to a positive outcome or as a threat which could lead to distress, anxiety, depression, social dysfunction, ill health and even suicidal tendencies [3] [4] .

Stress has become an important topic in academic circle and students have always been perceived as stressed individuals due to the amount of academic workload they bear [5] [6] . Academic stress is conceptualized as interactions between student’s environment stressors, cognitive appraisal and coping with physiological and psychological response to stress and stressors related to academics [7] [8] . In the event of a harsh and extended stress, recorded impact includes reduced or compromised academic performance, hindrance to involvement in campus life (Social withdrawal), dropout, increase probability of substance abuse and other potentially destructive behaviours [9] [10] .

Previous studies have posited that students studying in medical-related fields are particularly liable to experience high levels of academic stress [4] [6] [11] [12] . According to Jacob and Einstein (2016), attributable causes of higher manifestation of academic stress in healthcare students include the expansion of the knowledge base of such profession and the acquisition of clinical skills which demand a significant amount of both theoretical and education practice hours [12] .

Despite the growing interest in academic related stress and advancement in strategies for coping mechanisms and stress management among students in other jurisdictions, there is limited data on stress and its related issues among university undergraduates in general and nursing and midwifery students in particular in the Ghanaian literature. This study, set in the environment of a newly established public university in Ghana, seeks to evaluate the levels and component stress among students offering nursing and midwifery in the top-up module in the University of Health and Allied Science, Ho.

All the presentation made in the results section is from data obtained in this study. In this study, three hundred and fifteens and which students with an average age of 30.83 ± 4.06 years were recruited. The study participants included 252 (80.00%) second year and 63 (20.00%) third year students.

The study was made up of a female population of one hundred and ninety- four 194 (61.60%) and a male population of one hundred and twenty-one 121 (38.40%). Majority of the study participants were married 174 (55.24%). This study included participants pursuing Bachelor of Nursing 155 (49.21%), Bachelor of Midwifery 82 (26.03%) and Bachelor of Public Health Nursing 78 (24.76%). Among the female population, 92 (47.42%) reported to have one or more children under the age of 13 years and in addition, 28 (14.43%) were breastfeeding mothers (see Table 1).

Among the total study population, 109 (34.60%) experienced high stress level, 106 (33.65%) experienced moderate stress level and 100 (31.75%) experienced less stress level. Academic stress 111 (35.24%) and intrapersonal stress 111 (35.24%) were the highest component stress experienced by students. The least component stress experienced was interpersonal stress 106 (33.65%) (see Table 2).

In general, the male students experienced higher percentage stress 44 (36.36%) than their female counterpart 65 (33.51%). The male students experienced more interpersonal 60 (30.93%) and environmental 56 (28.87) component stress than the female students whiles the female students experienced more academic 71 (36.60%) and intrapersonal 72 (37.11) component stress.

Data are presented as figure with percentage in parenthesis, mean ± standard deviation.

Data are presented as figure and percentage in parenthesis.

This study also revealed that students who were single experienced higher percentage of stress than students who were married. Similarly, the third-year students also experienced higher percentage of stress than the second-year students.

Students pursuing Bachelor of Nursing were the most stressful group of students. The exception though was found in the academic component stress where the Bachelor of Public Health Nursing recorded the highest 29 (37.18%) (Table 3).

Data are presented as figure and percentages in parenthesis. B. Mid, B. Nurs, and B. PHN means bachelor of midwifery, bachelor of nursing and bachelor of public health nursing respectively.

As shown in Table 4, among the top 10 stressors, the top 3 stressors were; sense of overload in school work, late closing of classes and financial difficulties. Out of these top 3 stressors, the first two belongs to the academic component stress and the third belongs to the intrapersonal component stress. Academic component stress made up 70.00% of the top 10 stressors. All the top 10 stressors recorded a response percentage rate of more than 69.00% of total respondents.

As shown in Figure 1 and Figure 2, the lead component stressor in academic stress domain was sense of overload in school work, interpersonal was death of a close friend, intrapersonal was financial difficulties and environmental was difficulties in getting accommodation. Higher stressors values were found in the academic component stress whiles the interpersonal component stress recorded the least.

Data are presented as figure and percentages in parenthesis.

The prevalence of the top five academic, interpersonal, intrapersonal and environmental component stressors ranges from (75.80% to 89.74%), (30.16% to 43.17%), (24.59% to 84.39%) and (46.35% to 69.43%) respectively.

In general, among the female participants who have children under 13 years, stress levels increase with increasing number of children under the age of 13 years and breastfeeding mothers recorded a higher stress level than mothers who were not breastfeeding (see Figure 3).

High levels of stress among students could lead to both psychological and physical health-related problems [15] , [16] . In the current study, the prevalence of stress among the respondents was 34.75% high stress and 33.65% moderate level of stress. Varying prevalence of high level of stress among nursing and midwifery students have been reported in other jurisdictions. Among the studies reporting similar levels of stress among students, Kevin et al. (2015) in Piparia India, reported that 30% of nursing students in their first years of their bachelors degree programme experienced severe levels of stress [17] . Samson-Akpan, John, Edet, and Ella (2015) reported 33.80% in University of Calabar, Nigeria and Nancy (2011) reported 33.00% in Punjab in India [18] . Higher levels of stress has also been reported by Amr et al. (2011), 40.2% in Mansoura University, Egypt [19] , Shiferaw et al. (2015), 47.7% in Jimma University Ethiopia [20] and Khater, Akhu-Zaheya, and Shaban (2014), 47.82% in Jordan [21] .

However, according to the trans-cultural model, it is difficult to compare stress levels between different population in different jurisdictions because the individual’s interpretation of a situation to be stressful or not, could be explained by individual’s perceptual and cognitive processes [21] . The varying prevalence of high stress level among nursing and midwifery students may be attributed to the differences in socio demographic characteristics, campus environment, teaching curriculum and type of coping strategies used [22] .

In an attempt to explain the reasons for the high stress levels among nursing students in Egypt, Amr, El-Gilany, El-Moafee, Salama and Jimenez (2011) posited that increasing number of students coupled with the passive learning environments which foster memorization by students at the expense of synthesizing, problem solving and creative thinking abilities that impair the clinical skill training may be the malefactor [19] . This assertion could also be said to account for the levels of stress among students in the current study.

Generally, male students relatively experienced more stress (36.36%) than their female counterparts (33.51%). However, for academic and intrapersonal component stress the females experienced more stress (36.60% and 37.11% respectively) than the males (33.06% and 32.23% respectively). Kumar and Bhukar (2013) reported higher levels of stress in female college students than males [23] . Women face a number of chronic burdens in everyday life because of their social status and roles relative to men and this strain could account for the higher levels of stress [24] .

This study revealed that female participants who had children under 13 years or who were breastfeeding had higher stress levels than other participants (females not breastfeeding or without children under 13 years). This findings could be attributed to the multiple role and increased work load of such participants (child caring and studying at the same time) as corroborated in the study conducted b [25] .

In the present study, the third-year students experienced higher levels of stress than their second-year colleagues. This finding supports that of Elias, Ping and Abdullah (2011) who reported a mean academic stress score among second-year undergraduate students compared to their first-year counterparts [26] . Health science education gets difficult as students progress to higher levels of study [27] . As students move from one level of study to another, there is an increase in academic demands coupled with environmental and personal burden and hence could account for higher percentage stress [26] .

Although the difference in the expression of the individual component stress was not profound, the top 10 stressor items was found to make 70% of the Academic stress domain (Table 3).

This is in agreement with the findings by [15] [20] [21] . In concordance with these research findings, the sense of overload in school work was the leading itemized stressor. This could be explained by the nature of the sandwich programme which leads to crushed courses within a short period of time.

A majority of students in the sandwich top-up bachelor degree programme experience moderate to high stress mostly due to curriculum overload. Therefore, innovative means should be pursued to lessen the level of stress among this category of students. For example, pre-recorded video lectures could be incorporated into the module to lessen the overload in school work.

We want to thank the management of the University of Health and Allied Sciences for allowing us the permission to carry out this study in their facility. Our sincere gratitude goes to Mr. Romeo Asumbasiya Aduko, Miss Judith Emefa Wotortsi and Miss Ethel Onipede Foluke for their various contributions to the success of this project.

Authors have declared that no competing interests exist.

This work was carried out with collaboration between all authors. Authors FWMY, DAD, LAA, AA, EBAP, SF and GAD conceptualized and designed the study. Authors FWMY, DAD and LAA recruited participants and generated the data. Authors FWMY, DAD, LAA, AA, EBAP, SF and GAD analysed the data and drafted the manuscript. All Authors reviewed the manuscript for intellectual content and each author approved the final manuscript.

Yankey, F.W.-M., Dankwah, D.A., Adu-Aboagye, L., Asempah, A., Prempeh, E.B.A., Forkuo, S. and Doe, G.A. (2017) Stress among Nursing and Midwifery Students Offering a Top-Up Module in the University of Health and Allied Health Sciences, Ho. Open Access Library Journal, 4: e3318. http://dx.doi.org/10.4236/oalib.1103318