Chapter able to pay more attention to

Chapter 1
The Problem and Its Background
Introduction – Mangahas, Juan Luis G.Most people experienced stress, but what is it? There are many definitions of stress according to each and anyone of us. One person may say stress is when you have a lot to do, not much time to do it or a couple of emergencies. Another person might say it’s being unemployed, while a third might say it’s because of academics.
In a medical or biological context stress is a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external (from the environment, psychological, or social situations) or internal (illness, or from a medical procedure). Back in 1936, Hans Selye coined the word, “stress”. He defined it as the “non-specific response of the body to any demand for change.” After several experiments on animals, he concluded that they responded to persistent stress over time with the same illnesses as human beings – hypertension, strokes, heart attacks, ulcers etc. This finding was revolutionary because scientists previously believed that illnesses were caused by different pathogens. Stress, as a concept, caught on.

Stress has become part of daily life. Nowadays, the word “stress” has been generally used when everything becomes too much to handle, when there are overloaded things to do and wondering how to manage the pressures placed upon us. Anything that poses a challenge or a threat to our well-being is a stressor. Some stressors are good and serve as motivation for people to progress actively. It affects our thoughts and feelings, as well as behavior. However, overstress causes problems and discomfort, and can have serious effects on people. Particularly when student faces the stress as they enter a completely new world of professional education.
College students have a lot of obstacles to overcome in able to achieve their optimal academic performance. It takes a lot more than just studying to have a successful college career. All kinds of stressors may encounter such as time management, social relationships, finances, daily hassles and etc. that may affect academic performance of students. This highlights the need for research to examine the sources of academic stress faced by dentistry students. With this, educationists will be able to pay more attention to the sources of academic stress of students and the use of counseling measures to assist students.

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Background of the Study – Bonifacio, Lyndelou Abegayle B.The perceived sources of stress among dental students have been the subject of a considerable amount of research undertaken in a variety of countries. In a number of studies, authors found that the most frequently reported factors contributing to stress and anxiety around the examination periods were extensive course loads, lack of physical exercise, and long duration of exams, reported by the students CITATION Dal15 l 1033 (Gabriel, 2015). Among college students, a strong relationship is found between stressful life events and reduced academic performance as well as there is a link between health related quality of life and stress CITATION Mus13 l 1033 (Mussarat Jabeen Khan, 2013). In the final year many studies have addressed this issue and it was found that many psychological problems, such as depression, anxiety, and stress have an impact on the student’s academic achievement.
Students experience stress due to different many factors including issues of time management, financial matters, interaction with lecturers, personal subjective goals, social behavior, adjustment in the academic culture lack of support system CITATION Mus131 l 1033 (Khan, 2013), admission process, high expectation of parents, curriculum comprised of complex concepts, unsuitable school timings, unbalanced student-teacher ratio, physical environment of classroom, unhealthy student teacher interaction, hard and fast rules of discipline, too many or complex assignments, teaching methodology, unconcerned teacher’s attitude and overemphasis on weaknesses rather than acknowledging strengths CITATION Mus131 l 1033 (Khan, 2013).

Academic stress arises when academic related demands exceeds to those available resources to an individual which he/she adapts CITATION Mus131 l 1033 (Khan, 2013). And this stress must not be overlooked as it negatively affects the general adjustment of the students. CITATION Mus131 l 1033 (Khan, 2013)Learning more about the stressful clinics and academic may be able to offer an opportunity to dental educators and to increase their awareness of student stressors for offering better educational and academic programs. The aim of this study is to determine the perceived sources of stress among Clinic III students of Centro Escolar University Manila.

Statement of the Problem
The study aims to determine the perceived sources of stress among Clinic III students of Centro Escolar University Manila.

What is the profile of the respondents specifically, it aims to answer the following questions:
Age; and
How do the respondents perceived sources of stress as to the following:
Academic performance;
Individual and Institutional Factors/Educational Environment;
Interpersonal Relationship;
Difficulties and Insecurities About Professional Future; and
Learning Clinical Skills?
How do the perceived sources of stress compare when respondents are grouped according to Age and Sex?
Conceptual Framework – De Gracia, Donel F. and Mundina, Zymmuele Jarraeau R.4076700201295STRESS5715048895Academic performance FinanceSocial relationship Time Management
Figure 1.1 Conceptual framework on Causes of Stress CITATION Ksh16 l 13321 (Kshirsagar & A. Seema, 2016)This conceptual framework shows the most commonly causes or sources of stress among college students. The purpose of this is to make college students understand more how they get stress and how it increases among them and the solutions for coping up with stress. The stressors are namely academic performance, finance, social relationships, time management which are discussed in detail. This will help college students to understand and find out their stressors and will teach them how to deal with it.
One of the most common causes of stress in life of a college student is academic performance. College has a different atmosphere of that in high school especially the course works given to them are much more very challenging and harder.
In college level, the studies become very highly difficult and the competition is also very high especially to dental students since they need to maintain their good grades while simultaneously keeping up with their clinical requirements. In this competitive world, an individual must keep up with the pace to make sure their academic performance, as well as their practical requirements, are on the right tract. Having to live by with all these works everyday – studying academically and physically working on the clinics, cause too much stress.

It has become more familiar with the fact that the education has become so much expensive and not all parents afford these fees. Despite this circumstance, parents still send their children to good college or universities. They sacrifice their other needs after their child’s career and also for their wants and needs. This may also be one of the stress causes in a college student’s life. A student who is aware of their financial status being unstable may always be wary and bothered whether if they can still continue college. They are worried if at some point, their parents might not be able to provide enough for their school needs, especially for Dentistry, being it a very expensive course. This uneasy feeling causes stress.

Students find many relationships in college. The relationships may be of friendship or love. In early stage of college, individual may find difficult to cope up and trust and find true friends. Due to this, few may get stressed and depressed. On the other hand, individual faces many ups and downs in love relationship too. This causes stress. Fights with partner or friend
or any other issue with your close one or with any one in college gives you stress. Also, individual gets introduced to new people, they become friends and relation continues. Maintaining relation with these people can also cause stress.
Time management also pays an effective role as a stressor. Most of the times, the college students tend to slack around instead of prioritizing their studies. While completing the work at the end, an individual feels the stress of doing the entire task together. Here stress is caused due to not managing time in any of the situations faced by a college student in day to day life. In the case of dental students, time for school and clinics do not go hand in hand with time for going out and having fun. Usually, clinicians who stack up their clinical works on the last minute tend to experience load of stress
Significance of the Study – Ringor, Dennize M.The study aims to determine the perceived sources of stress among dentistry students. The findings of this study will contribute greatly to the benefit of the following:
Society. Considering that stress is a circumstance that people encounter every day. The stress level among the dental students is critical it needs for more effective and life changing approaches.
Dental schools. They could be more aware about the stressors that greatly affect the students which could possibly help them to balance their academics and personal life so that they could train students better.
Administrators. They will be guided on what they could contribute to at least lessen the stress rate and motivate them to reach their goals and finish their tasks more efficiently.
Dental students. They will benefit from this study because they will know what is/are the stressors that really affect them, and they will learn where they could get help or advices in times that they feel burnt out.

Researchers. The study will help them reveal the different stressors and how it affects the Filipino dental students that many researchers were not able to explore.
Assumption of the Study – Santiago, Andrea Marie D.C.The researchers assumed that the respondents would be able to answer the questionnaires truthfully.

The study will test the following hypothesis:
There is no difference between age and sex in perceived sources of stress.

Scope and Delimitation – Gloria, Rean Paolo Q.This study aims to determine the perceive sources of stress among Clinic III students of Centro Escolar University Manila. The research will focus on the students of Clinic III to factor out specific causes of stress among them compared to others; this study is not applicable to other year levels because of varying course load. Within the span of two academic semesters, all the gathered information were analyzed for the purpose of the study.
Definition of Terms – Santiago, Andrea Marie D.C.These definitions are conceptually and operationally definitely for the better understanding of the readers.
Acute Stress. Most common form of stress. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future.
Anxiety. It’s a mental distressing concern of interest.
Chronic Stress. Stress that the body subjected to on a regular basis or a single occasion with lasting negative effects.
Clinic III. A third year out of four clinical levels of CEU dentistry, proper curriculum that includes clinical requirements from the different clinical infirmaries such as oral diagnostic pediatric dentistry, restorative dentistry, periodontics, oral surgery, prosthodontics and orthodontics.

Eustress. A psychological condition that refers to the best form of stress that helps individuals to remain healthy.

Perceived. To attain awareness or apprehension of something.
Stress. A state of mental or emotional stress or tension resulting from adverse or demanding circumstances.
Chapter 2
Review of Related Literature and Studies
This chapter presents the related literature and studies after the thorough and in-depth search done by researchers. This will also help the researchers to pursue the study furthermore.

Cause of Stress in Dental Students – Mangahas, Juan Luis
Dental education can be a one source of stress among dental students, and studies have observed higher levels of stress among dental students than in the general population. Stress is a result of certain external physical or mental factors that affect an individual’s physical and psychological actions. Being in so much stress can affect someone’s capacity to do work causing them instead of fulfilling the work properly it will end up messing more of their work increasing them to add more work on their side.

It has been shown that university students are vulnerable to psychological problems due to the various stressors and demands of their education. This is especially true for those students in the health care fields who face additional challenges compared to other students. Having knowledge on other fields or courses on university students know that taking up a course that is in a medical field is not a course for you if you’re not fully committed. Dental students need to obtain training in both theoretical and clinical aspects of dental care. Balancing both laboratory and lecture activity is one of the stressors of dentals students.
Clinical part of the students training requires that students find their patients, be responsible for their care, and perform irreversible dental treatments on those patients, in addition to their clinical requirements and exams. All these factors collectively contribute to significant amounts of stress for dental students that put them at additional risk for psychological problems like anxiety, depression, and burnout.

Impact of Stress Physically – Bonifacio, Lyndelou
Stress affects most people in some way. Acute (sudden or short-term) stress leads to rapid changes throughout the body. Almost all body systems (the heart and blood vessels, immune system, lungs, digestive system, sensory organs, and brain) gear up to meet perceived danger).
These stress responses could prove beneficial in a critical, life-or-death situation. Over time, however, repeated stressful situations put a strain on the body that may contribute to physical and psychological problems. Chronic (long-term) stress can have real health consequences and should be addressed like any other health concern. CITATION Har13 l 1033 (Simon, 2013)Stress also has been linked to suppression of the immune system, increasing your chances of becoming ill or altering the course of an illness if you already have one. In particular, it has been implicated as playing a role in cancer and gastrointestinal, skin, neurologic and emotional disorders, and even the common cold.  CITATION Ste16 l 1033 (Bressert, 2016)Stress cause the increase of alcohol, drugs and tobacco use among students. Some student has the habit of taking alcohol, drugs and smoking tobacco when they feel under pressure to calm them down. Stress worsen this because it increases the intake of whatever thing the student use and at the long run causes health implications for them. Some might even contact severe diseases which may be incurable. CITATION Ess17 l 1033 (Essel, 2017)Furthermore, stress also causes restlessness in a student. Students who happen to be in situations that stress them up are unable to sit at one place but rather will just be walking to and fro to find solutions to their worries. This makes them always busy and tired causing them no to be able to have proper sleep and rest during the night which is not good for the body system. CITATION Ess17 l 1033 (Essel, 2017)Lastly, stress causes fatigue in students. When students are stressed up, they are always tired because the use the energy they have in just thinking about whatever issue that’s making them stressed. When this happens they have no energy left in 32 them for academic purposes or to even do other this for them self. Being fatigue can make students mess up a whole lot of things which are supposed to help them in life. CITATION Ess17 l 1033 (Essel, 2017)Types of stress – De Gracia, Donel
There are different kinds of stress people experience in our society.
Acute stress this is a short-term and the most common form of stress, it is often caused by thinking about an events that occur or upcoming demands and pressure in the future. However, the stress will be reduced once it is resolved. Acute Stress leads to tension headaches, upset stomach and psychological distress.
Episodic Acute Stress occurs to those people who frequently experience acute stress. CITATION Chr171 l 1033 (Nordqvist, 2017) They are usually short-tempered, irritable, and anxious. CITATION Leg16 l 1033 (Legg, 2016) Individual who worry too much on a constant basis are facing this type of stress. It leads to high blood pressure, migraines, persistent tension headaches, chest pain, and heart disorder.
Chronic stress is the most harmful type of stress, if the acute stress isn’t resolved and begins to increase, it becomes chronic stress. Family dysfunction, poverty, bad job, an unhappy marriage can cause this type of stress. This kind of stress can lead to suicide, heart attacks, stroke, violent actions and even cancer. CITATION Chr171 l 1033 (Nordqvist, 2017)
Possible Outcome of Stress – Gloria, Rean Paolo
The immune system compromises the cells, protein, organ and tissue that works organized and delivers protection against diseases. Psychological stress has been linked empirically with the abnormal response of human immune system to stress CITATION Jen15 l 13321 (Morey, Boggero, Scott, & Segerstrom, 2015). Improper response of immune system towards to stress badly affects the functionality of the person which comprises eating. When the body is not receiving enough nutrients, it affects the endocrine system including the well-known fight or flight activation which is important for the survival of a person. Stress also imposes a great risk of serious health problems like heart disease, blood pressure, and depression CITATION Placeholder1 l 13321 (Bressert, The Impact of Stress, 2016).
Stress primarily affects the psychological aspect of a person. Stressful life events are the usual cause of anxiety and depression. These events are usually traumatic experiences like child abuse, sexual assault, marital problems or divorce, death in the family, academic struggles, financial problems, war, and terrorism. These happenings can be the source of loneliness, eating disorders, insomnia, and even suicidal thoughts. Individuals who are experiencing great amount of stress are looking for ways to cope with the problems at hand. Stress can also change personality by altering neural dynamics and cause disorders that shape traits involving negative affectivityCITATION Gra16 l 13321 (Shields, Toussaint, & Slavichc, 2016). Vices like gambling, smoking, drinking alcoholic beverages, impulsive buying, and using illegal drugs are some of the wrong forms of coping strategies. People who are experiencing anxiety that leads to depression are typically pessimistic or negative thinkers.

Proper guidance and professional medical help is needed in order to assist people manage stress effectively. Social environment and positive social support also plays a significant role in psychological development because having a positive support helps to ease the persons emotion.
How to Manage Stress – Santiago, Andrea Marie
Based on Anxiety and Depression Association of America for the brain acknowledge that you can’t control everything and Put forth a valiant effort, Keep up an inspirational mentality and Realize what triggers your uneasiness and for your body restrict liquor and eat all around adjusted suppers, get enough rest no less than 8hours and practice day by day. Also, for move make a full breath gradually check to 10 , offer back to your group , take a period out, get help on the web and converse with somebody. (Susan Gordy, 2017)
And based on help guide trusted guide to mental and emotional health why is so important to manage stress? In case you’re living with large amounts of pressure, you’re putting your whole prosperity in danger. Stress wreaks destruction on your passionate harmony, and in addition your physical wellbeing. It limits your capacity to think unmistakably, work viably, and appreciate life. Successful pressure administration, then again, encourages you break the hold pressure has on your life, so you can be more joyful, more advantageous, and more gainful. A definitive objective is a healthy lifestyle, with time for work, connections, unwinding, and fun and the versatility to hold up under strain and address difficulties head on. Yet, stretch administration isn’t one-estimate fits-all. That is the reason it’s vital to test and discover what works best for you. It’s very barely noticeable how your own particular considerations, sentiments, and practices add to your ordinary feelings of anxiety. Without a doubt, you may realize that you’re always stressed over work due dates, however perhaps it’s your stalling, as opposed to the real occupation requests, that is causing the pressure. Exercise discharges endorphins that influence you to rest easy, and it can likewise fill in as a profitable diversion from your every day stresses. While you’ll get the most advantage from routinely practicing for 30 minutes or more, it’s alright to develop your wellness level continuously. Indeed, even little exercises can include through the span of a day. Associate with Others There is nothing more quieting than investing quality energy with another individual who influences you to feel protected and caught on. Actually connection triggers a course of hormones that checks the body’s guarded “battle or-flight” reaction. It’s inclination’s characteristic pressure reliever . So make it a point to associate consistently and face to face with family and companions. Remember that the general population you converse with don’t need to have the capacity to settle your pressure. It will just fortify your bond. Set aside a few minutes for the sake of entertainment and unwinding Past an assume responsibility approach and an inspirational disposition, you can lessen worry in your life via cutting out “personal” time. In the event that you frequently set aside a few minutes for entertainment only and unwinding, you’ll be in a superior place to deal with life’s stressors. Put aside recreation time. Incorporate rest and unwinding in your every day plan. Try not to enable different commitments to infringe. This is your opportunity to take a break from all duties and revive your batteries. Accomplish something you appreciate each day. Abstain from booking things consecutive or attempting to fit excessively into one day. Whatever is left of your day will be more lovely subsequently. Break ventures into little advances. In the event that an expansive undertaking appears to be overpowering, make a well ordered arrangement. Concentrate on one sensible advance at any given moment, as opposed to going up against everything on the double. Delegate duty. You don’t need to do everything yourself, regardless of whether at home, school, or at work. Eat a sound eating routine. By diminishing the measure of espresso, sodas, chocolate, and sugar snacks in your eating regimen, you’ll feel more casual and you’ll rest better. Evade liquor, cigarettes, and medications. Feeling tired will expand your pressure since it might make you think nonsensically. (Melinda Smith, 2018)
Based on American Psychological Association Stress happens when you see that requests set on you , for example, work, school or connections surpass your capacity to adapt. Some pressure can be valuable on occasion, creating a lift that gives the drive and vitality to enable individuals to overcome circumstances like exams or work due dates. Be that as it may, an outrageous measure of pressure can have wellbeing outcomes, influencing the resistant, cardiovascular and neuroendocrine and focal sensory systems, and take a serious passionate toll. Untreated endless pressure can bring about genuine wellbeing conditions including nervousness, a sleeping disorder, muscle torment, hypertension and a debilitated invulnerable framework. Research demonstrates that pressure can add to the advancement of real ailments, for example, coronary illness, melancholy and weight. Yet, by discovering positive, sound approaches to oversee worry as it happens, a considerable lot of these negative wellbeing results can be lessened. Everybody is unique, as are the ways they deal with their pressure. Here are five solid methods that mental research has appeared to help diminish worry in the short-and long haul. It might appear to be hard to make tracks in an opposite direction from a major work venture, a crying child or a developing charge card charge. In any case, when you give yourself consent to step far from it, you let yourself have sufficient energy to accomplish something unique, which can enable you to have another point of view or practice systems to feel less overpowered. The exploration continues developing practice benefits your mind similarly and additionally your body. Our brains are interconnected with our feelings and outward appearances. (Cite, 2017)
Stress-related Symptoms – Ringor, Dennize M.In the article Stress and Health: Psychological, Behavioral and Biological Determinant, stressors have a huge impact on mood, sense of well-being, behavior, and health. Occurrence of stressful life events could lead to anxiety that most likely would develop to major depression. However, in young, healthy individuals are more likely to be more adaptive and most of the time do not impose a health burden but in older or unhealthy individuals, the long-term effects of stressors could damage their health.
Exposure to intense and chronic stressors during developmental years has a long-standing neurobiological effects and puts one at increased risk for anxiety, mood disorders, aggressive dyscontrol problems, hypo-immune dysfunction, medical mobility, structural changes in the CNS, and early death. There are also other aftermath effects of stress that could lead to health damage, like incense in smoking, substance use, accidents, sleep problems and eating disorders. It also stated that people that lives in a more stressful environment smoke more heavily and experience higher mortality from lung cancer and chronic obstructive pulmonary disorder. Also people with anxiety disorders were more likely to develop substance abuse or dependence.
According to Rocky Mountain College, disorganized thinking and speech, social isolation or withdrawals inability to focus on a specific topic in a conversation, gain or loss of weight, frequent absence or disappearance over extended periods, signs of excessive alcohol or drug abuse, violent outburst and strong mistrust of others are signs of stress-related symptoms. Having overwhelming problems as a student especially when you have a history of emotional disturbances, traumatic life event, recent loss of an important persons or even self-esteem could lead to different types of stress-related symptoms.
Elizabeth Wolfenden said in her article Physical Symptoms of Stress in College Students, college is fun and full of excitement, but it can also be stressful and when a person is under stress, the physical symptoms can be more difficult to depict. Students can be mor susceptible to infections during stressful times. They can develop ski problems but one of the most common physical symptom is hair loss and menstrual irregularities. Also, digestive symptoms like discomfort, pain, diarrhea, constipation heartburn, nausea or vomiting. It can also cause overweight or weight loss with or without digestive problems. Eating disorders could also develop as an aftermath effect of stress. They could also experience sleeping problems such as trouble of sleeping, insomnia, oversleeping, nightmares and daytime fatigue.
Stress has a huge impact in health, may it be emotional or physical. Getting stressed frequently could lead to depression and other serious health problems. It can suppress immune system, upset digestive system and reproductive system, increase the risk of heart attack and stroke and being more vulnerable to anxiety, depression, and other mental health problems. It can really change the rhythym of dental students and its ability to fulfill their duties in dental school starting from cramming for exams up until finishing clinical requirements. Some of the stressors of the students are the expectation of the parents especially for the students that have a parents or a family of dentist. Stress of perfection is also a stressor for students being good and perfect in the medical field is one of the most important characteristics because students are dealing with a live patient, also when the patient doesn’t appreciate the treatment that students did is also a big stressor for dental students. It greatly affects the body as a whole in terms of physical and psychological aspects. Psychological stress can cause different kinds of disorders leading to weak immune system resulting in physical illness. The environment and the people around also plays an important role in overcoming stress.

Methods and Procedure
This chapter provides the discussion on the methods and procedures that will be used by the researchers in the study. It consists of the research design, the subjects under investigation, research tools, the procedure for collection of data, and the statistical treatment that will be used to process and analyze the information gathered.

Research Methodology – De Gracia, Donel F.The study focused in the Perceived Source Of Stress Of Clinic III Students Of Centro Escolar University, Manila. The researchers will use descriptive method for their study. This method will concentrate on identifying and reporting both the pattern and frequency of health events in a population. It will provide an accurate portrayal of the characteristics of a particular individual of Clinic III students of Centro Escolar University, Manila. It will also describe the occurrence of the stress composed by various methods from all the significant sources.

Setting of the Study
The researchers will be conducting the study at Centro Escolar University Manila School of Dentistry which was established in 1925; the first Dental School in Southeast Asia to be Peer-reviewed by the Southeast Asia Association for Dental Education that is located at 9 Mendiola St., San Miguel, Manila.

Respondents of the Study – Gloria, Rean Paolo Q.The subjects and the respondents of the study will be the Clinic III dentistry students enrolled first semester of school year 2018 – 2019. The researchers will be distributing questionnaires to third year clinicians to gather data. The respondents are chosen using the purposive sampling technique. The researchers used this technique to explain, describe and interpret the selected population. The researchers will pick 209 clinicians as the sample of the study from the total population.
Sampling Technique – Santiago, Andrea Marie D.C
Purposive sampling is a sampling technique in which researcher relies on his or her own judgment when choosing members of population to participate in the study.

Purposive sampling is a non-probability sampling method and it occurs when “element selected for the sample are chosen by the judgment of the researcher. Researchers often believe that they can obtain a representative sample by using a sound judgment, which will result in saving time and money”
The respondents of the study should be enrolled in Clinic III first semester of school year 2018-2019.

Research Instruments – Mundia, Zymmuelea

The researchers will be distributing questionnaires to Clinic III Dentistry students as their main research instrument.

Questionnaire is a set of systematically structured questions used by a researcher to get needed information from respondents. Questionnaires have been termed differently, including surveys, schedules, indexes/indicators, profiles, studies, opinionnaires, batteries, tests, checklists, scales, inventories, forms, inter alia. They are any written instruments that present respondents with a series of questions or statements to which they are to react either by writing out their answers or selecting from among existing answers.
Procedures of Data Gathering – Bonifacio, Lyndelou Abegayle B.The researchers will provide the questionnaire to the respondents from clinic III students and will be distributed it to them according to their sections. The questionnaire will contain 27 questions and will be answered based on their perception about sources of stress by rating each situation from 1 to 4 or from not stressful to very stressful.

Statistical Treatment of Data Gathering – Ringor, Dennize M.Responses to the questionnaire by Clinic III students will be statistically analyzed with the data requirements of the study using the Descriptive Analysis.
The formulas for the statistical tools will be used in the study were as follows:
I. Percentage. This is a method of standardizing for size, which indicates the frequency of occurrence of category per 100 cases.

II. Standard deviation. It is a measure of the variability of the data about the mean (n) which is the number of measurements based on.

III. Weighted mean. It is applied to determine the average for each of the responses where weights were given.

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