A variety of forces, internal and external, often impact students who are experiencing life on a college campus; these forces can lead to feelings of increased pressure and stress. To combat the negative effects of stress, faculty and administrators at a mid-size, suburban university collaborated to help students decrease their stress and assist them in attaining and maintaining a healthy lifestyle. A Stress Reduction Room (SRR) was designed, implemented, and evaluated with the goal of decreasing stress in this student population. The function of the SRR, benefits, and implications identified from the stress reduction campus initiative, are described in this paper.
The horrific spate of killings at college campuses, including Virginia Tech, Louisiana Technical College, and Northern Illinois University, and increasing violence on campuses, mandate that faculty members, administration, and healthcare providers critically examine the services they provide within the campus community. The need for psychological services on campuses is heightened after these traumatic events. Serious consideration must be given to the psychosocial needs of the students as campus life becomes increasingly complex with rapid changes in education, the workplace, and everyday life in the 21st century.
The development of a campus wellness program was fully described in an earlier work by Ewing, Ryan, and Zarco (2007). The impetus for the program began with interested faculty from the School of Nursing and Health Studies and the director of the Health Services center. In the early stages of the program, a room within the aforementioned center was converted into a Stress Reduction Room (SRR) for meditation and relaxation. This paper elaborates on the function of the SRR and the benefits and implications gleaned from providing this health-related campus venue.
Health promotion is the first consideration among the goals and objectives of the nation's Healthy People 2010 initiative (U.S. Department of Health and Human Services, 2001). In support, helping students to reach or maintain a healthy lifestyle by decreasing their stress was the goal of faculty and administration at a mid-size, suburban university. The creation of an SRR to decrease stress in the student population is described in this paper.
Campus life and student stress
A college campus is a community that contains within it a multitude of forces that have an impact on the student. Simply entering a school environment and functioning in new surroundings can have an enormous influence on a student's sense of well-being. Students arrive on campuses from various educational settings and backgrounds. Some transfer from other universities, and some come from countries outside of the United States. Other students may suffer from economic burdens. Students in higher education often juggle outside jobs, family, emotional and financial role responsibilities, and the challenges of attaining an education. As students try to fit academics into their busy schedules, they can become increasingly pressured and stressed (Segerstrom & Miller, 2004). This added pressure is even greater for students whose standards, behaviors, beliefs, and values are unique and different from those of the educational system they find themselves in. The impact or pressure of these converging forces adds to student s tress. This phenomenon is known as environmental press, which is the pressure exerted by the larger community upon those entering it (Lewin, 1936). Social pressures, learning challenges, new study methods, a change in peer relationships, and, particularly, examinations, cause stress that can lead to an increased student dropout rate from institutions of higher education (American College Health Association [ACHA], 2007).
Stress can be motivational or may present challenges; it can be negative or positive. Coping with stress in any situation may be difficult, however. Even stress that has a positive outcome can create long-term physical as well as psychological problems that affect one's physical and mental well-being. The Spring 2006 National College Health Assessment (ACHA, 2007), developed by the American College Health Association, reported stress as the number one health impediment to the academic performance of students. Stress can lead to overeating, smoking, anxiety disorders, alcohol and/or drug abuse, or depression (Ewing et al., 2007).
Health professionals can provide opportunities and awareness in the college environment; however, it is the student's responsibility to participate in these activities and behaviors. Creating an environment on a college campus that promotes comfort and personal satisfaction and emphasizes the importance of a positive state of well-being will help students to develop, grow, and learn more productively (ACHA, 2005). Environmental factors and the provision of services from sources such as a wellness program can help students in a holistic way and contribute to their perceptions of their own health and well-being. Focusing on positive emotions and concepts such as optimism an d joy helps people feel better, which results in improved decision making and performance (Fredrickson, 2003). Students can be helped to improve their lifestyle by replacing negative choices with positive ones and experiences that promote health and well-being.
Need for a stress reducing environment
The human ecology model focuses on how external influences affect the ability of an individual to function within a system. Forces outside a person have a powerful effect on what goes on internally (Tiedje, 2001). Using this model as a framework, faculty and other healthcare professionals met to find ways to meet the issues related to stress on this campus. The ecological approach consists of transactions of the individual within groups and communities. Health habits and lifestyles are assessed within the context of the environment to determine characteristics that promote, deter, or prevent well-being. Behavioral and environmental modalities are combined to produce effective strategies and health promotion programs (McKenzie, Neiger, & Smeltzer, 2005). Sallis and Owen (2002) state that multilevel approaches can be effective in implementing interventions.
Faculty from the School of Nursing and other health professionals on camp us met with the director of Health Services to discuss issues related to health and preventive services for students on campus. The director of Health Services identified an increase in visits to Health Services during midterms and finals. These visits were related to a myriad of physical complaints and problems. This phenomenon of increased health visits during stressful periods was supported in the literature with data that link the role stress plays in impairing the immune system (Segerstrom & Miller, 2004). A previous survey (Core, 2005), developed by the Core Institute at Southern Illinois University and administered on this campus, revealed that 75% of students were sleeping fewer than 8 hours each school night, and only 13% of students reported sleeping at least 5 hours on school nights. The mean average time of going to bed was past midnight, and 32.71% of students never engaged in relaxation exercises.
Creating a stress reduction space
From these data, and through discussions and collaboration, the need for an area of quiet relaxation was identified; a place on campus removed from noise and high stress activities. From this, the concept of the SRR evolved. A group of interested faculty members visited a model Wellness Program at Farmingdale State College in Farmingdale, New York, and then embarked on a mission to create the SRR as part of a Wellness Center unique to the needs of their campus (Ewing et al., 2007).
Health Services provided space that was separate from areas where students were treated for illnesses. Art students decorated the walls with murals of underwater scenes to impart a tranquil atmosphere. Administration financed the room and furnished the SRR with two lounge chairs, a television VHS/DVD system with relaxation tapes on a continuous loop, a CD player with a selection of quiet music and soothing sounds, and headphones. Staff placed materials in the room for students to take with them, such as magazines describing relaxation techniques and printed health promotion literature. The room was designed as a preventative support service that would promote health by helping the student to decrease stress and experience a sense of balance in mind, body, and spirit.
The literature on stress and relaxation shows the effectiveness of mindfulness-based stress reduction interventions (Cohen-Katz, Wiley, Capuano, Baker, & Kimmel, 2005; Mackenzie, Poulin, & SeidmanCarlson, 2006). By having access to a service such as the SRR, students may become more mindful of the stressors that impact their health and use the room often to decrease their stress. The SRR became a place where students were free to relax and meditate, especially during examination times or periods of emotional strain. This room allowed students to temporarily remove themselves from outside influences that might contribute to their stress and provided them with a space where they could emotionally regroup. Within a context of caring by Health Services nurses and faculty, students received support and encouragement to enjoy peaceful moments away from libraries, cafeterias, and classrooms. For many students, this time to rest was necessary to help cope with stress.
Creating spaces on campuses where students can feel comfort and peace is essential to health promotion (Pender, Murdaugh, & Parsons, 2006). These spaces may alleviate some of the outside forces affecting these individuals and reduce negative external influences described in the human ecology model. Providing a place to meditate and relax has profound implications for health. With the appropriate guidance, students can replace negative behaviors such as overeating and alcohol use with experiences that will result in a healthier lifestyle (Fredrickson, 2003). Thus, the SRR allows students the opportunity to interface with Health Services staff as well as provides the latter with the ability to assess students who may need additional intervention and referrals to promote health and well-being.
Launching the SRR
Nursing faculty and student volunteers collaborated with the director of Health Services to create a stress reduction educational program to inform students and faculty about the importance of stress reduction. Students prepared PowerPoint presentations, distributed handwritten materials, and developed a series of health promotion activities to empower their peers to understand the importance of taking charge of their health. The use of alternate relaxation therapies, such as music and handheld anxiety reduction devices, provided experiential opportunities for recipients to learn how to experience relaxation and reduced stress. Educational information was distributed and a blood pressure screening event was conducted.
The outcomes established for the program were that students would gain knowledge of stress and its physiological and psychological impacts, become aware of the importance of stress reduction, and gain experiential knowledge of stress reduction techniques, and that the campus community would be introduced to the SRR.
Identifying further efforts
The development of the SRR was successful due to the efforts of the nursing faculty, interdepartmental collaboration, the administration who helped fund and provide the space for the room, the director of Health Services, and the nursing students who embraced the notion and worked toward the success of the project. Following the use of the SRR, students were asked to complete a qualitative survey to indicate what could be done to improve the services in the SRR. Students commented that the room could be darker, have aromatherapy, and "running water on rocks [that] might complete the sense of the room." Another suggestion was for "an individual space for each person;" presently the room accommodates two persons. The director of Health Services observed that students from the university used the room according to their needs and that the registered nursing students utilized it more readily than the undergraduate generic nursing students. Graduate students utilized the room more readily than undergraduates.
This campus stress reduction effort needs to b e fortified b y various strategies for continued success. First, faculty members and administrators need to be educated and made aware of the SRR and other wellness services on campus so they may advise students accordingly. Secondly, ongoing education for all incoming students during freshman and transfer orientations must include information about the existence of the SRR. Also critical is systematic outcomes-related research pertaining to how the space impacts the well-being of students and to determine barriers to the use of the room.
Increased stress threatens one's well-being and potential to reach a healthy state. This effect is particularly true among college students and is due to a variety of factors related to their experiences within an educational environment. The initiation of the SRR was an important step toward alleviating some of the stress among this population of students, thereby helping them to pursue and maintain a healthier lifestyle.
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Marilyn Klainberg, EdD, RN
Bonnie Ewing, PhD, RN
Marybeth Ryan, PhD, RN
Marilyn Klainberg is an associate professor at Adelphi University in Garden City, NY. Bonnie Ewing is an assistant professor at Farmingdale State College in Farmingdale, NY. Marybeth Ryan is a senior adjunct professor at Adelphi University in Garden City, NY.