A TRUE-EXPERIMENTAL STUDY TO ASSESS THE
EFFECTIVENESS OF LAUGHTER THERAPY ON STRESS
REDUCTION AMONG NURSING STUDENTS IN SELECTED
COLLEGES OF DISTRICT MOHALI, PUNJAB.
A Synopsis
Submitted for the partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
PSYCHIATRIC (MENTAL HEALTH) NURSING
of
Baba Farid University of Health Sciences, Faridkot, Punjab
2021
HARDEEP KAUR
Saraswati Professional & Higher Education
College of Nursing, Gharuan,
Mohali,Punjab.
1
A TRUE-EXPERIMENTAL STUDY TO ASSESS THE
EFFECTIVENESS OF LAUGHTER THERAPY ON STRESS
REDUCTION AMONG NURSING STUDENTS IN SELECTED
COLLEGES OF DISTRICT MOHALI, PUNJAB.
A Synopsis
Submitted for the partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
PSYCHIATRIC (MENTAL HEALTH) NURSING
of
Baba Farid University of Health Sciences, Faridkot, Punjab
2021
HARDEEP KAUR
Name & Signature of Supervisor Name & Signature of Co-supervisor
Dr.(Mrs). Anu Sharma Mrs. Gurjot Kaur
Professor Assistant Professor
Psychiatric (Mental health) Nursing Psychiatric (Mental health) Nursing
Saraswati Professional & Higher Education
College of Nursing, Gharuan,
Mohali, Punjab.
2
BABA FARID UNIVERSITY OF HEALTH SCIENCES
FARIDKOT
PERFORMA FOR REGISTRATION OF SYNOPSIS
[Link] TOPIC CONTENT
1. NAME OF THE CANDIDATE Mrs. Hardeep Kaur
AND ADDRESS #99, Village-Mattour, secter 70,
district Mohali, Punjab.
2. NAME OF THE INSTITUTE Saraswati Professional & Higher
Education College of Nursing,
Gharuan, Dist. Mohali, Punjab
3. COURSE OF STUDY AND [Link]. Nursing 1st Year
SUBJECT Psychiatric (Mental Health) Nursing
4. DATE OF ADMIISSION OF 20-02-2021
COURSE
5. TITLE OF THE TOPIC A true-experimental study to
assess the effectiveness of
laughter therapy on stress
reduction among nursing students
in selected colleges of district
Mohali, Punjab.
3
APPROVAL PERFORMA BY
RESEARCH AND ETHICAL COMMITTEE
S.P.H.E COLLEGE OF NURSING, GHARUAN, MOHALI,
PUNJAB.
NAME OF THE CANDIDATE Hardeep Kaur
DEPARTMENT Psychiatric (Mental health) Nursing
TOPIC OF SYNOPSIS A true-experimental study to assess the
effectiveness of laughter therapy on
stress reduction among nursing students
in selected colleges of district Mohali,
Punjab.
DATE OF ENROLLMENT 20-02-2021
SUPERVISOR Dr.(Mrs). Anu Sharma
Professor
Psychiatric (Mental Health) Nursing
SIGNATURE OF MEMBERS OF SIGNATURE OF MEMBERS OF
RESEARCH COMMITTEE ETHICAL COMMITTEE
Approved Yes/No Approved Yes/No
Chairperson Chairperson
Research Committee Ethical Committee
4
ABSTRACT PLAN FOR SYNOPSIS
[Link] TOPIC CONTENT
1. RESEARCH A true-experimental study to assess the
PROBLEM effectiveness of laughter therapy on stress
reduction among nursing students in
selected colleges of district Mohali,
Punjab.
2. FOR THE DEGREE [Link]. Nursing 1st Year
Psychiatric (Mental Health) Nursing
OF
3 NAME OF THE Ms. Hardeep Kaur
[Link]. Nursing (1st Year)
CANDIDATE
S.P.H.E. College of Nursing, Gharuan
Punjab
4. SUPERVISOR Dr. (Mrs.) Anu Sharma
Professor
Psychiatric (Mental Health) Nursing
S.P.H.E. College of Nursing, Gharuan,
Mohali, Punjab.
5. CO-SUPERVISOR Mrs. Gurjot Kaur
Assistant Professor
Psychiatric (Mental health) Nursing
S.P.H.E. College of Nursing, Gharuan,
Mohali, Punjab.
6. INSTITUTION Saraswati Professional & Higher
Education College of Nursing, Gharuan,
Mohali, Punjab
ABSTRACT-
The teen years often bring about an increase in perceived stress as young adults learn to cope
with increasing demands and pressures. Studies have shown that excessive stress during the
teen years can have a negative impact upon both physical and mental health later in life.
Laughter is surely the best medicine. With work stress on the rise, laughter therapy sessions
are gaining attention worldwide. The aim of the study is to assess the effectiveness of laughter
therapy on stress reduction among nursing students. Quantitative research approach and true-
experimental :pre-test- post-test control group design will be used. The sample size for the
study will be consist of 60 subjects consist experimental group (30 students) & control group
(30 students) which will be selected by using simple random sampling technique. Perceived
stress scale(PSS) by Cohen. S (1998) will be used to assess the level of stress among nursing
students. Approval will be taken from ethical and research committee of S.P.H.E. College of
Nursing Gharuan, Mohali, Punjab. Written permission from principal of concerned selected
colleges and informed consent will be taken from the subjects. Analysis and interpretation will
be done by using descriptive and inferential statistics.
5
INDEX
Sq. CONENT PAGE
No. No.
I
• Introduction 7-8
9-10
• Need for the study
10
• Problem Statement
10
• Aim
10
• Objectives
11
• Operational Definitions
• Hypothesis 11
• Delimitations 11
II Review of Literature:-
• Review related to Stress 12-13
• Review related to 14
effectiveness of laughter
therapy in reduction of stress
III Methodology
• Research Approach 15
• Research Design 15
• Setting of the study 15
• Population 15
• Sample & Sampling technique 15
• Inclusion criteria 15
• Exclusion criteria 16
• Development of tools 16
• Validity of tool 16
• Reliability of tool 16
• Pilot study
16
• Ethical considerations
16
• Plan of data analysis
16
• Flow chart of methodology
17
IV References 18-19
6
Chapter I
Background of the study
Laughter is the only tranquilizer with no side effects.
Graffiti
Introduction
Stress is defined as an organism's total response to environmental demands or pressures. When stress was fir
st studied in the 1950s, the term was used to denote both the causes and the experienced effects of these pres
sures.[1]
Nowadays stress has become the most common thing among students. Every new day we are noticing many
students whether in college or high school suffering from stress especially the nursing students. These days
the maximum cases of stress are being noticing in the nursing students and even, a study has also been
conducted in this regard to identify the main reasons of stress in nursing students. It is a psychological factor
that not only leaves worst impact on their academic performance but also affect their well-being.
The most observed reasons are fear of being failure, no future planning, lack of confidence and constant
negative issues, anxiety, sadness, some kind of depression or short tempered etc. It can also due to poor
sleep or poor satisfaction towards performance or work or discomfort, nervousness or tiredness or decreased
financial aid. It is affecting their creativity and abilities as well as causing fatigue and sickness among
them.[2]
Stress has become a significant part of the daily lives of health care administrators, yet little attention has
been paid to their experience. To survive in today's health care environment, administrators must address the
effects of stress and develop healthy stress management responses. While many traditional stress
management techniques may be effective.[3]
Stress is unavoidable. It's an unavoidable truth of life. The types of pressures that people face and how they
respond to them, on the other hand, change throughout time. When a person is exposed to a physical or
psychological stressor, two hormonal systems are engaged to help the person cope with the circumstance.
The first is mediated by the sympathetic nervous system's fast responses, which result in the release of
adrenaline and norepinephrine into the bloodstream. It is an instant response to stress that mediates the
temporary "fight-or-flight" response.[4] Physiological Symptoms of stress are insomnia, nightmare, loss of
appetite, palpitation, frequent urination, muscle pain and tiredness and Emotional and psychological
symptoms are anxiety, fear, frustration, depression, restlessness, poor concentration, forgetfulness etc.
Stress and anxiety are simply a fact of nature forces from the outside world affecting the individual.
The individual responds to stress in ways that affect the individual as well as their environment. Studies have
7
shown that excessive stress during the teen years can have a negative impact upon both physical and mental
health later in life. For example, teen stress is a risk factor for the development of depression, a serious
condition that carries an increased risk of suicide.
Even though everyone experience stress, research has shown that nursing students, especially have
numerous stressors that affect their daily life. Many factors come into play periodically such as clinical
experience, assignments, preparing for and taking exams, peer events, family and social relationships,
finances and future career plans. Those are just a few of the sources that could possibly cause stress. Hence,
there has been growing awareness about the problems of nursing students which leads to stress among them,
which require adequate coping behavior to deal with the situation. There are many methods and therapies
used to reduce stress e.g. yoga, meditation, music therapy, art therapy and laughter therapy.
The beauty of a child especially when it bursts into uncontrollable peals of laughter is marvelous.
Laughter therapy provides you a great way to get rid of stress, which dissolves all feelings of irritation and
anger. Laughing also helps to motivate person. This in turn, releases all the positive energy. Daily sessions
of laughter help to strengthen the immune system. Moreover, laughter activates about 400 different muscles
of the body, which are located in the head, neck, back, shoulders, abdomen, etc. All these body movements
are accompanied by neurophysiological processes, such as cardiovascular and respiratory changes. Laughter
releases endorphins, which causes a feeling of pleasure that can be compared to that produced during sexual
intercourse and other reactions of the organism.[5]
Laughter therapy has been shown to be a useful strategy in intervening in a long-term stress response and
reducing cortisol levels. Laughter is the human gift for coping and for survival. Laughter ringing, laughter
pealing, laughter roaring, laughter bubbling. Chuckling. Giggling. Snickering. Snorting. These are the
sounds of soul saving laughter which springs from our emotional core and helps us feel better, see things
more clearly, and creatively weigh and use our options. Laughter helps us roll with the punches that
inevitably come our way. The power of laughter is unleashed every time we laugh. In today's stressful world,
we need to laugh much more.[5]
Laughter therapy is a powerful antidote to stress, pain, anxiety and conflict. Nothing works faster or more
dependably to bring mind and body back in to balance than a good laugh. Laughter lightens the burdens,
inspires hopes, connects to others and keeps alert. laughter strengthens the immune system. Most likely, this
is due to the fact that laughter, like other forms of happiness, triggers the nervous system’s relaxation
response. Moreover, a good laugh relieves physical tension, subsequently leaving the muscles relaxed for as
long as 45 minutes. Laughter is linked with the activation of the ventromedial prefrontal cortex which
produces endorphins suppresses stress hormones. Due to these positive changes in physical health also have
a profound impact on mental health. Laughter increases the cells that destroy viruses and tumors. Laughter is
beneficial for one's health. [5]
8
Need of the study
Term "stress", was coined by Hans Selye in 1936, who defined it as "the non-specific response of
the body to any demand for change". In other words, stress is the nonspecific response of the body to any
demand, whether it is caused by or results in, pleasant or unpleasant conditions. Stress from many sources
has been reported for some time by student nurses.[6]
Academic sources of stress include examinations, long hours of study, assignments and grades, lack
of free time, faculty response to student need and lack of timely feedback. Clinical sources of stress include
working with dying patients, interpersonal conflict with other nurses, insecurity about personal clinical
competence, fear of failure, interpersonal problems with patients, work overload and concerns about nursing
care given to patients [7]
According to survey conducted by the American College Health Association National College Health
Assessment (ACHA, 2009, 2010) data revealed over one third of all postsecondary education students
ranked stress as their highest health impediment, followed with sleep issues, depression, and anxiety. Of the
30,000 traditional students surveyed, 38.7% reported “moderate” stress, and 8.7% of the students reported
“tremendous” stress. Additionally, 84% of the students felt overwhelmed, and 28% reported depression
severe enough to limit their ability to function. The students also reported feeling exhausted (78%) and
reported academic requirements were extremely difficult for them (42%). [8]
There are many therapies which are used to reduce the stress e.g. Music therapy, Art therapy, Yoga and laughter
therapy. Stress reduction techniques or relaxation techniques in general involve attention on calmness,
peacefulness, awareness of the mind and the balance between mind and body as well as physical health and
mental health. other relaxation techniques such as deep breathing, massage, hypnosis, Tai Chi, meditation,
biofeedback, music & art therapy and yoga.
Laughter is surely the best medicine. We probably realize the importance of laughter only when we grow out
of our childhood days. With work stress on the rise, laughter therapy sessions are gaining attention
worldwide. There are so many benefits of laughter therapy. However, one may not really get into the nitty-
gritty of issues at a young age. The importance of laughter therapy is realized only when one loses the reason
to laugh about the simplest of issues.[5]
According to Cindie Leonard, solid scientific research demonstrates that laughter offers the benefits
including, reducing stress hormones there by reducing anxiety, improving circulation, producing a general
sense of well-being, boosting immune function.[9]
Another source of stress for many students is the financial burden of obtaining an education (Stone & Feeg,
2013). National Student Nurses Association data (2012) revealed approximately 28% of all nursing students
had no financial debt, while over 50% of nursing students had between $5,000 and $60,000 debt upon
graduation. The students financed their education with financial aid loans, personal savings, parental
9
support, scholarships and working while in school. Full or part-time employment was undertaken by 47% of
the students, adding the stress of time management to their busy lives.[10]
Labrague LJ, et al(2017)[11]This study was conducted to determine the level of stress, its sources and
coping strategies among 547 nursing students from three countries: Greece, the Philippines and Nigeria.
Using a descriptive, comparative research design participated in the study from August 2015 to April
[Link] standardized instruments were used, the Perceived Stress Scale (PSS) and the Coping Behaviour
Inventory (CBI). Findings revealed that the degree of stress and the type of stressors and coping styles
utilized by nursing students differ according to the country of origin. The result of study predicted overall
stress (β = -0.149, p < 0.001) while advanced age predicted overall coping (β = 0.008, p = 0.037) in the
nursing students.[11]
Lee JS, Lee SK.(2020)[12] conducted a quasi-experimental, non-equivalent, control-group, and pre-
test/post-test was conducted in 4th year student nurses (n = 48) from 2 universities in Korea at a time when
participants' final exams and job searches were simultaneously occurring. Physiological stress (salivary
cortisol), and psychological stress measured using modified Cornell Medical Index questionnaire and the
tool used was Subjective Happiness Scale. The results of the study showed that the Laughter Program was
effective in relieving employment stress and increasing the subjective well-being of student nurses.
Psychological stress (p < 0.001), salivary cortisol levels (p < 0.001), and subjective happiness (p < 0.001)
were statistically significantly improved after the intervention compared with before the Laughter
Program.[12]
Nursing is a profession where nursing students also have the additional pressures and uncertainties shared
with all academic students. Often these students have to maintain balance at home, employment, and
educational responsibilities. With the increase or change in responsibilities, the students face greater risks of
maladaptive coping strategies. Laughter is one of the best ways to release stress and feel good. Studies have
shown that laughter therapy as an adjunct to reduction of stress are very few, especially nursing studies.
Hence the investigator has decided to conduct a study to assess the effectiveness of laughter therapy on
stress reduction among nursing students in selected colleges.[9]
Problem Statement
A true-experimental study to assess the effectiveness of laughter therapy on stress reduction among nursing
students in selected colleges of district Mohali, Punjab.
Aim of the study
To assess the effectiveness of laughter therapy on stress reduction among nursing students in selected
colleges of district Mohali, Punjab.
Objectives of the study
10
• To assess the prevalence of stress among nursing students.
• To assess the pre intervention level of stress among nursing students.
• To assess the post intervention level of stress among nursing students.
• To compare pre and post intervention level of stress among nursing students.
• To find out the association between level of stress among nursing students with their socio
demographic variables.
Operational Definitions
• Effectiveness: Refers to the extent of the stress reduction after giving laughter therapy as evidenced
by the difference in pre-test and post-test stress scores.
• Laughter: Laughter therapy refers to the therapeutic technique that provides mental and emotional
benefits through laughter.
• Stress: Stress is the body's reaction to a change that includes a physical, mental or emotional
adjustment or response.
• Nursing student: An individual who is studying in 1st year of Basic [Link]. (N) and G.N.M Course at
selected colleges.
Delimitation
The Study is limited to
• Nursing students who will be studying in 1st year of Basic [Link]. (N) and G.N.M Course at selected
colleges.
• Sample size will be 60 nursing students.
• Laughter therapy will be given only to those who will have stress.
Hypothesis
H1- There is statistically significant difference in the pre intervention and post intervention mean stress
score of nursing students in the experimental group at 0.05 level of significant.
H1- There is statistically significant difference in the post intervention mean stress score of nursing students
in the experimental and control group at 0.05 level of significant.
11
Chapter II
Review of literature
A review of literature on the research topic makes the researcher familiar with the existing studies and
provides a foundation upon which to base new knowledge. It involves the systematic identification, location,
scrutiny and summary of written materials that contain information on a research problem. A review of
literature related to these aspects has been presented in this chapter under two major dimensions-
• Literature related to level of stress among nursing students.
• Literature related to effectiveness of laughter therapy on stress reduction.
Literature related to Level of Stress among nursing students.
Kataria RK (2016)[13]conducted a descriptive study on Stress and depression in April 2014 among 199
nursing students using simple random sampling technique. The Rosenberg Self Esteem Scale (RSES),
Perceived Stress Scale (PSS-14), and Beck Depression Inventory (BDI) were used and data were analyzed
using descriptive and inferential statistics. Findings revealed that 17.6% of nursing students had high self-
esteem and 81.4% had normal self- esteem. The study found that 43.7% students had severe stress and equal
number of students (28.1%) had mild and moderate stress. Among the subjects, 13.6 % had borderline
depression, 10.6% had moderate depression, and 3.5% had severe depression.
Sarath R, Jeewanthika (2016)[14] conducted a cross-sectional study with 92 undergraduate nursing students
at Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya. A purposive
sampling technique was used. Depression, anxiety and stress were measured by the Sinhala version of
Depression, Anxiety and Stress Scale. The sample consisted of 30.4% male and 69.6% female students. The
mean age was 24.1 years (SD ± 1.6). The majority of the respondents reported mild to extremely severe
symptoms of depression (51.1%), anxiety (59.8%) and stress (82.6%).
Raed M et al (2015)[15] conducted a descriptive cross-sectional study was performed using a convenience
sample of 138 students (females between ages 18 and 22).Data were analyzed using descriptive statistics
The aim of the current study was to determine the most prevalent sources of stress among first-year nursing
students at a military college in Jordan.. The top five sources of stress reported were: increased class
workload (89%), change in living environment (83%), change in social activities (78%), change in eating
habits (77.5 %), and change in sleeping habits (76%), with academic sources of stress being the most
frequently reported.
Prasad CV et al. (2013)[16] conducted a study on level of stress and coping mechanism adopted by I Year
[Link]. nursing students by using non-probability convenient sampling technique. The tools used for data
12
collection were perceived stress scale, structured coping scale, and socio- demographic [Link] studies
revealed that majority of students (95.1%) were in the age group of 17-19 years. The results showed that
only one student (1.7%) has severe stress, 46.7% has moderate stress, and remaining 51.6% has mild stress,
and majority of the students (100) had average coping.
Kumar R(2011)[17]conducted a descriptive study among180 students in a Private Nursing Institute of Punjab
affiliated with Baba Farid University of Health sciences, Faridkot to assess stress level and coping strategies
among nursing students. Perceived Stress Scale -14 (PSS-14) was used to assess stress level and ACOPE
was used to identify the coping strategies. Results of the study revealed that 34% students were having
moderate stress and 33% each were having mild and severe stress.
Sharma N, Kaur A(2011)[18] conducted a study among 37subjects by using standardized scale on factors
associated with stress among nursing students by using validated tool. Study revealed that 97% of the
subjects had moderate level of stress whereas 3% had severe stress. Among the factors contributing to stress,
the environmental factors had maximum contribution (40%) followed by the interpersonal factors (30%).The
academic factors had only 19% contribution whereas the intrapersonal factors contributed minimally.
George M (2006)[19]A study was conducted on 240 adolescents both males and females, aged between 16
and 17 by using a perceived stress scale (reliability, r=87) and QOL (G=91) in 3 selected English Medium
School of, Tamil Nadu on determine the bio-psychosocial stress and quality of life (QOL) of adolescents and
qualitative analysis of the adolescents perspective to cope with stress and improve QOL. The population for
the present study was comprised of Maximum adolescents (42.9%) experienced moderate stress and 40% of
adolescents experienced severe stress. The spearman rank correlation between overall adolescent stress and
subjective QOL (ρ-0.249) was found to be significant at 0.05 level of significance. Thus it indicated that
there is a significant negative correlation between adolescent stress and [Link] of literature
regarding laughter therapy
Daisy S el al.(2018)[20] conducted An experimental study30,1st year nursing students on effectiveness of
“laughter therapy on stress reduction” in selected college at Tadepalligudem” Random sampling technique
was adopted for the selection of the [Link] result showed that significant reduction in the stress level of
nursing students in the experimental group after the introduction of laughter therapy (t= 1.761, df=14,
p˂0.05). The mean percentage of post-test stress scores of experimental group (33.66) was less than the post-
test stress scores of control group (49.3).
Narula R et al(2011)[21] conducted a randomized control trial study on 90 medical students of 4th Semester
of RMCH, Bareilly to assess the job stress, anxiety and stress reduction in medical education: laughter as an
intervention, by Using simple random sampling lottery method. Result show the comparison of Severe and
Extremely severe Stress: In Group A 40.54% in class -1 increased to 47.54% in class- 4, while in group B
initial 13.15 % was reduced to 0 % (highly significant). Anxiety: In group A, after Class 1 -57.45%
13
increased to 61.11% after class 4, while in group B, after class 1- 23.68% reduced to 2.27% only (highly
significant). Job stress: In group A, after Class 1 - 40.53% & 41.66 % after class 4 (not significant), while in
group B, after class 1- 18.41% reduced to 0% (highly significant)
Lakhwinder K (2008)[22] conducted a experimental study on 42 nursing students of age between 17-21
years by using numerical rutins scale in the National Institute of Nursing Education PGIMER, Chandigarh
with an objective to evaluate the effect of laughter therapy on the stress level of nursing students.
Experiment action involves administering laughter therapy for 15-20 minutes daily for 10 days. After 10
days, laughter therapy has shown positive effect on reducing the stress level of subjects at statistically
significant level (tcal32, df41, P<0.05). Mean stress score was decreased from 112 to 103 after the laughter
therapy.
Kanji N(2006)[23] conducted a randomized controlled study with 93 nursing students aged 19-49 years
study was conducted by using Anxiety inventory and the maslach burnout inventory in Buckinghamshire
chilterns university College, UK to reduce anxiety in nursing students. The treatment group received 8
weekly sessions of autogenic training control group receive no intervention, and the attention control group
received 8 weekly section of laughter therapy. There was a statistically significantly greater reduction of
state (P<0.002) and trait(p<0.002) Anxiety in the autogenic training group and state (p<0.001) and trait
(p<0.001) anxiety in laughter therapy group than the control group.
14
Chapter III
Research Methodology
The Chapter deals with the comparative study of methodology includes the research approach, research
design, research setting, population, sample, criteria for sample selection, sample size, and sampling
procedure, validity, reliability, data collection procedure and plan for data analysis. Research methodology is
a way to systematically solve the research problem. It may be understood as a science of studying how
research is done scientifically.
Research approach
Quantitative Research Approach.
Research Design-
True- experimental- pre-test- post-test control group design.
Variables
Dependents variable- Stress among nursing students.
Independent variable- Laughter therapy.
Setting
The study will be conducted at selected nursing colleges of district Mohali, Punjab.
Population
Nursing students who will be studying in 1st year of Basic [Link]. (N) and G.N.M Course at selected
colleges of district Mohali, Punjab.
Sample and Sampling technique
The sample will consist of 60 subjects who will be selected by simple random sampling technique. 30 in
experimental group and 30 in control group.
Eligibility Criteria
Inclusion
The nursing students who will be
• Willing to participate in the study.
• Present during data collection period.
15
• Studying in 1st year of Basic [Link]. (N) and G.N.M Course at selected colleges of district Mohali,
Punjab.
Exclusion
• Students who are undergoing any psychiatric treatment.
Development of tool
• Section A: Socio-Demographic variables.
• Section B: Perceived stress scale (PSS) by Cohen S. is a standardized tool to assess the level of
stress.
Content Validity
It will be determined by expert’s opinion.
Reliability of tool
Perceived stress scale (PSS) by Cohen.S is a standardized scale so the reliability is already established.
Ethical considerations
• Approval will be taken from ethical and research committee of S.P.H.E. College of Nursing Gharuan,
dist. Mohali, Punjab.
• Written Permission from principals of selected colleges will be taken to conduct the study.
• Written informed consent will be taken from an individual subject.
• Confidentiality of information will be maintained.
Pilot study
Pilot study will be conducted on 10 % of subjects to assess the feasibility in conducting the main study and
to obtain information for improving the project.
Plan for data analysis
Analysis and interpretation of data will be done according to the objectives by using descriptive and
inferential statistics.
16
Research Approach
Quantitative
Research Design
True experimental:Pre-test,Post-test control group
design
Target Population
Nursing students of selected colleges
Sample Size – 60
Tool
Sampling Technique
Simple random sampling technique • Socio-demographic variables
• Perceived Stress Scale
Experimental Control Group (30
Student) Data Analysis &Interpretation
Group(30 Student)
Descriptive and interential statistics
Pre-test Pre-test
Intervention
Laughter
Therapy
Post Test Post Test
17
Research Methodology
LIST OF REFERENCES
1 Stress definition.[Link]
2 Mark tim, Causes and effects of stress on nursing students know the causes and effects of stress on nursing
students which is very essential for nursing students. published on june 3, 2019
[Link] k, mccarthy vl. Stress and anxiety among nursing students: a review of intervention strategies in
literature between 2009 and 2015. [Online]. Available from: [Accessed 26 June 2021].pmid: 27889624.
4. Brun, [Link]-related stress stress : scientific scientific evidence-base of of risk factors, factors,
prevention and costs in who workshop on work related stress. [Online].2006 Available from: [Accessed 26
June 2021] pp. 1–10.
[Link]. Laughter surely is the best medicine. available from: URL:www. [Link]
6. Stress [Link]/what-is-stress 2020
[Link] P, schoenfield,How to manage stress. 2009. [online]. available from:
url:[Link] (accessed on 01.12.2009)
8. American college health association, national college health assessment. demographical characteristics of
the 51 us postsecondary institutions included in the fall 2012
[Link] L, Laughter therapy. [online] available from url:[Link] 01.12.2009
10. Stone, A. M. & Feeg, v. d. In debt and misled: new graduate voices on the “nursing shortage”. dean’s
note. (2013).
[Link] Lj, Mcenroe- petitte dm, Papathanasiou iv, Edet ob, Tsaras k, Leocadio mc, Colet p, Kleisiaris
cf, Fradelos ec, Rosales ra, Vera santos-lucas k, Velacaria pit. Stress and coping strategies among nursing
students:an international study of mental health. 2018
[Link] Js, Lee S. The effects of laughter therapy for the relief of employment-stress in korean student nurses
by assessing psychological stress salivary cortisol and subjective happiness. 2020 feb.
[Link] rk. self esteem, Stress and depression in nursing students. indian j cont nsg edn 2016;17:30-7
[Link] Rathnayake, Jeewanthika Ekanayaka, depression, anxiety and stress among undergraduate nursing
students in a public university in sri lanka: (2016) volume 9 | issue 3| page 1020
[Link] and raya yousef, Perceived sources of stress among first-year nursing students, journal of
psychosocial nursing and mental health services,vol. 53, no. 6 published online:may 22, 2015
[Link] C V,Suresh a, Thomas dk, Pritty m k,Beebi s, Multazim v. The level of stress and coping
mechanism adopted by i year [Link]. nursing students. arch med health sci 2013
[Link] Kumar, Stress and coping strategies among nursing [Link] 7- nursing & midwifery
research journal,2011
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[Link] N., and Kaur A. Factors associated with stress among nursing students. Nursing and Midwifery
Research Journal, Vol-7, No. 1. January 2011,
[Link] m. “A study to determine the bio psychosocial stress and quality at life of adolescents perspective
to cope with stress and improve qol”. 2006
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