Self-Care Habits of Undergraduate Nursing Students at University of Lahore

Self-care is a dynamic decision to take an interest in the activities that are known to build general physical, emotional, mental, social, spiritual well-being, improving inspiration, struggle for ideal wellbeing with support to change the way of life to move toward a condition of ideal wellbeing. Cross-sectional descriptive research design was used to conduct the study. Sample (n=133) was taken from nursing institutes by using convenient sampling. 5 point Likert scale base self-administered questionnaire was used for the collection of data. Data was analyzed by using SPSS version 21. Ethical clearance was obtained before research. One sample T test was applied. Nursing students have positive self-care habits as P value regarding self-care habits is significance (p=.000). The study of self-care practices is an important component of health promotion and disease prevention . Students have positive self-care habits related to health.It is clear stated that nursing students have adequate knowledge about self-care habits.


Introduction
Self-care is a process through which people accept requirement for their own specific wellbeing perceiving how to advance it and what can harm it (Stenberg et al., 2016).
World Health Organization characterizes "self-care" as the capacity of people, families, and groups to promote health, preventing disease, limiting illness, cope with illness and reestablishing health".The scope of self-care incorporates physical, mental, emotional spiritual and professional wellness (WHO, 2009).
According to Berkowitz self-care enables nurses to live fully, all the more rewarding lives and turn out to be better nurses as well.A healthy nurse is one who effectively focuses on maintaining a balance of physical, intellectual, emotional, social, spiritual, personal and professional wellbeing (Berkowitz, 2017).
According to a study conducted in California by Nevins the baccalaureate nurses suffered through many disturbances just because of having poor self-care practices.Nursing students found to be having disturbed sleep and rest hours, irregular food habits and inability to cope with stress.Nurses highly affected by poor self-care habits (Nevins et al., 2016).
Self-care habits also effect the performance of nursing students.It is a subjective sensation related to physical and emotional pressures.Too much or too little stimulation can cause stress, harm to mind and body, for example, depression, eating disorders (Gomathi et al., 2013).
Nursing students' self-care habits are also related to their perceived level of stress.In nursing students, stress plays a major role to fulfil self-care habits.Students neglect selfcare due to stress perceived at university level.Such stressors lead to poor eating behaviors, low concern for healthy nourishment stress also effects the sleep habits due to depression and anxiety and students are become anxious very easily (El Ansari et al., 2011).
Stress is the cause of poor self-care habits among nursing students.Undergraduate nursing students report high stress as compared to others.Stress applies negative impacts on, physical health like uses of unhealthy food and irregular sleeping patterns of undergraduate university students.Balancing exercise and simultaneously adapting to stress is a problem for many students.Due to stress students not participate in social events or another activities of university (VanKim et al., 2013).
To cope with stress is "to face and deal with responsibilities, problems, or difficulties, especially successfully or in a calm or adequate manner".(Iyi, 2015) Stress arises when students perceive that they are not able to cope with daily activities on academic environment.These stressors effects on student's poor academic learning, relationships with colleagues, organizational, work-life balance, significantly increase fatigue and impair performance.Hirsch, 2015 suggested in his study that cope well with stress helped to reduce the negative effect of stress improve work performance, engage in some other activities, workload management, make time for self-daily, participate in social events without interfering university works (Hirsch et al., 2015).
Unhealthy dietary behavior is one of the way to neglect selfcare habit among students.Majority of young university students use extreme amount of sugar-sweetened refreshments and less utilization of recommended amount of whole grains, natural products, vegetables, calcium and drink fresh fruit juice daily.These wrong habits cause obesity, diabetes and other health problems among students (West et al., 2016).
Improper self-care habits of university student related to food consumption are particularly as to low use of fruit, vegetables, milk, dairy items, fish, eggs, and pulses.Mostly students don't take seven to ten servings of fruits and vegetables per day.The excessive utilization of meat, sausages, and sweets cause diabetes and obesity.Students developed these habits as living far from home and perceived to have changed their dietary patterns while going to university.It is a worldwide problem of university students to neglect healthy behavior towards dietary habits (Lupi et al., 2015).
Majority of the students have poor self-care habits regarding intake of healthy food.They do not take their breakfast at time.Few number of students never have their breakfast on a daily basis.Most the students eat fast food and they think that they don't have sufficient time to do breakfast at proper time.Which is major threat to their health and wellbeing.All these ill habits are major cause of self-care deficits (Al-Shehri et al., 2017).
World health organization defined that healthy balanced diet is a fundamental part to keeping up physical and emotional wellness.Eating healthy diet is good for wellbeing it is the one way that students reduce the impact of stressors on their health, allowing them to better care themselves (WHO, 2016).Foods high in vitamins and protein are especially effective in decreasing stress.Eat three balanced meals a day and 3 to 5 serving of fruits and vegetables per day.Fruits, vegetables are high in Vitamin C, drink fresh juices daily, and drink enough water every day (at least 1500ml).Healthy balanced diet beneficial ways for life to reduce fatigue, physical movement, reduce stress, increase energy and especially improves learning performance on their academic area (Reed, 2014).
Rest and sleep are other parameters that nursing students neglect considerably.Among other self-care habits, rest and sleep are highly valued.Rest and sleeping habits are important part of students' development, poor or deficient rest can have a dramatically negative effect on a student's day by day working, especially on performance.Short sleep and rest in undergraduate nursing students may cause weakness, and inadequate academic performance (Khalil, 2017).Furthermore, self-care habits of undergraduate nursing students towards sleep and rest may lead low quality of instability with university life.Certain rest and sleep habits are linked with lower academic performance.Lack of sleep habits in undergraduate students has been recognized as one of the reasons that diminish students' performance.Most relaxation and sleep specialists indicate that people require around 8 hours of rest for each day (Baert et al., 2015).
Neglect of rest and sleep self-care habits among undergraduate nursing may cause poor quality of work performance.Most of the Students not 6-8 hours' sleep in night and perform late night computer work (which can upset the natural rest/wake regulation).These improper habits regarding sleep affect the quality of work .Students who constantly rest 1-2 hour less every day have not enough energy to do work properly, sleep during lecture and seen to be lethargic (ElArab et al., 2014).
Sleep deficiency is defined as a lack of restorative sleep causes physical and psychiatric problems like depression, disturbance of mood, fatigue.Studies indicate that adults require 6 to 8 hours of sleep in a 24-hour period which improve quality of performance, activity, and increase attentiveness (Hanvey, 2012).

Aim of The Study
Aim of this study was to know the self-care habits of undergraduate nursing students of the University of Lahore.

Significance of The Study
This research will be important for me to know that how I neglect self-care habits.This study will be essential to understand that how nursing students ignore their self-care habits.This research study was helpful to improve nursing student's self-care habits through proper nutrition, rest and sleep.Study was useful for students to face daily challenges without taking any stress.
Research study will beneficial for organization to take important steps to improve self-care habits of nursing students to promote health quality and performance.This study will help organization to develop strategies for reducing/removing the identified factors that cause self-care deficit among nursing students.In this way, punctuality and attendance of students was improved.Furthermore, quality of learning was improved in the organization which will enhance organizational prestige.This study will help to improve the nursing practice regarding patient care.Nurses can care for their patients if care for themselves first.So health of nurse is first priority.This research will maintain the standard of nursing profession through improved nursing practice and performance.

Research Question
What are the self-care habits of nursing student?

Literature Review
Nursing students highly ignore their self-care habits.Research reveals that 7.18% poor of nursing students of California.In the developing countries the majority of students 71.7% accounted for that they don't consumed a balanced diet, 22.6% rarely consuming a balanced diet.Same time 66% used fast food at least one more times for every week, Results revealed that 6.68% students don't complete their sleeping hours for every night.Despite 53% of students have an adequate amount of rest (Nevins & Sherman, 2016).
In Pakistan study depict poor habits of self-care among undergraduate nursing students because they have no information about healthy lifestyle behaviors.35% students are found to ignore the breakfast and having meal outside the home, 64.4% take tea at least once per day, and 58.2% eating snacks amongst suppers and there are 65% nursing students don't performed physical activity.90%feel that they have in stress due to workload (Khan & Rasheed, 2016).
Furthermore, according to the study of (Labrague, 2014) the level of stress in undergraduate students of Philippine is very high.About 50% of nursing students perceived stress from studies which develops in psychological disorders.However, the study conduct in Greek about 65% of student are in stress.Stress reported as one of the major sources of depression in nursing students.University students experience poor self-care habits from stress these stressors apply negative consequences on student learning, mental health, and psychological health of students (Labrague, 2014).Fogle et al. (2013) studies in Marion University of USA the nursing students observed which are perceived stress from poor self-care habits.A high group of 43 student's coping stress about 34.32%.Due to stress students neglect their dietary habits.About 44 students perceived stress about 18.60% students experience stress starting example, reduced self-care habits, educational demands, everyday troubles, work performance and developed mental illness and depression (Fogle & Pettijohn, 2013).
South Africa a large number of students have poor eating habits 83.2% didn't consume sufficient amount of bread, cereal, rice.Furthermore 97.5% of students ignore vegetable meals.Moreover 92.6% students did not use dairy, recommended amount of fruits.About 59% of students don't consume three meals per day.Furthermore, the greater part about them 161 shown that skipped the lunch habitually.These nursing students' compulsory overweight and obesity.Furthermore, poor eating habits and insufficient utilization of proper nutrition, which effects negatively to their efficacy as future wellbeing and academic performance (Van den Berg et al., 2012).
Many researchers have also found in developing countries that there is very poor self-care habits of nursing students.In the study of United States and Europe towards eating experience to take unhealthy diet especially fruits, vegetables and meat.Nursing students is characterized by low utilization of cereals, tubers, fruits, vegetables, and high utilization of sweets, snacks, delicate drinks also pastries.Dietary habits of nursing students show about 25% students didn't take breakfast.30% nursing students who skipped breakfast every day have deficient requirements of low carbohydrates and high fat and protein.These wrong habits of students affect their daily work and have negative effects when nursing students omit breakfast (Evagelou et al., 2014).
As studied by (Hogan, 2016) in New York self-care habits of sleep that 50% of college students reported daytime sleepiness and lethargic.These disorder sleeping patterns lead the students many harmful and long-term memory impacts.70.6% of students sleep less than eight hours of every night.Students not sleep at proper time these irregular habits regarding rest executing the students at high hazards of sleeping disorders, daytime sleepiness, problem with learning and daily work routine (Hogan, 2016).
Although the study from Saudia in 2014 and other similar studies in Brazil and Hong Kong self-care habits of nursing students related to rest are very poor.69.7% of the students complained with one or more symptoms of parasomnia, 184 cases of parasomnia side effects are observed in undergraduate nursing students.These symptoms are cause 19.6% headache, 14.6% muscle pain on waking up and 14.6%, nightmares (14%), these symptoms effects on students lifestyle behaviors practices (ElArab et al., 2014).

Theoretical Framework
Orem's theory is about self-care.Theoretical framework depicts self-care and self-care deficit by apply Orem selfcare model.Self-care habits of nursing students could be clearly explaining.According to Orem theory explain that self-care is the basic component for acquiring health.Dorothea Orem focuses that nurses are major part of health care system which are responsible for giving education on self-care practice to patients and they are also responsible for giving proper health care."Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being".
Self-care habits of undergraduate nursing students are in miserable condition as they are not serious in maintaining their basic self-care needs.They don't consider sleeping, eating healthy diet and coping with stress an important part of self-care thus ignoring these factors will lead them toward many health concerns in their future life and also affect their academic activities because when a student don't sleep well, don't eat well he/she can never perform well (Wayne, 2014).

Setting
The setting for this study was Lahore School of Nursing (The University of Lahore) Pakistan.

Research Design
Descriptive cross sectional study was used.

Population
Study population for this research work was the nursing students of Lahore School of Nursing (The University of Lahore).

Sampling
Convenient, non-probability sampling was used for the data collection.
Research Instrument 5 point Likert scale questionnaire adopted from Jackson (2015) was used as a research tool.Questionnaire consist of 2 parts first consists on demographic data of participant and second is Likert scale questionnaire which is further divided into 4 subparts focusing on part 1 level of stress part 2 selfcare habits towards food, part 3 self -care habits related to sleep and rest, Questionnaire comprises of 21 quantitative questions.

Data Analysis
Data analysis was done using SPSS version 21.

Study Timeline
The study was conducted from January 2018 to May 2018 in the area Lahore School of Nursing (The University of Lahore) Pakistan.

Profile of The Respondents
The questioners were distributed in 133 participants.By using the convenient non-probability sampling technique to collect data, Participants were the undergraduate students of Lahore School of Nursing (The University of Lahore).
Demographic analysis shows that total 133 respondents of nursing students most of the ( 14) were between the age of above 26 years of age which make 10.53% of total population,51.88%from 21-25 years of age group and 37.59% from 16-20 years of age group.15.79%(21) were male nurse respondents and 84.21%(112) were female nursing students.63.16% (84) were BScN respondents and 33.83% (45) of Post RN respondents which were currently studies.
Table 1 shows significant results regarding the self-care habits of nursing students.It showed that nursing students have positive self-care habits as P value regarding self-care habits is significance (p=.000).So findings depict that nursing students have positive self-care habits.Table 2 shows that nursing students use effecting coping strategies as significance value is (p=.000).So findings reveal that self-care habits of the nursing students related to coping strategies are good.
Table 3 show that nursing students have good dietary habits related to health.There is statistically significant result as (p=.000).Findings reveled that self-care habits of the nursing students related to dietary pattern are perfect.
Table 4 shows that there is good self-care habits regarding sleep with the significant value is (p=.000).Nursing students have healthy lifestyle behaviors regarding sleep and rest which lead them to perform good academic performance so the hypothesis accepted that students have good sleeping habits.

Discussion
The results of the study show that there is significant results regarding the self-care habits of nursing students.Findings showed that nursing students have positive self-care habits as P value regarding self-care habits is significance (p=.000).So findings depict that nursing students have positive self-care habits regarding stress and coping, food habits, sleep and rest among the undergraduate nursing students of Lahore School of Nursing (University of Lahore).The purpose of the study was to assess the selfcare habits of undergraduate nursing students of university of Lahore.The findings revealed that nursing students use self-care habits.
Additionally, as comparatively the study of Korn (2013) results also depict that nursing students in Israel also have good self-care habits regarding coping strategies, dietary and sleep habits.Results revealed that there was significance p value is (p=.0.001).nursing students have lifestyle behaviors regarding self-care (Korn et al., 2013).
The present study shows that nursing students use effecting coping strategies as significance value is (p=.000).So findings reveal that self-care habits of students related to coping strategies are good.According to the study of results show that almost 85% of students have good self-care habits related to stress.Statistical significance was (p =.001) nursing students approach good stress-coping habits (Thomas et al., 2016).
As compared to the study of Fogle and Pettijohn that high stress group of 43 students with a mean perceived stress score of 34.32 (SD = 4.30).Students' scores on the A. Javed et al. (2019) Int. J. Soc. Sc. Manage. Vol. 6, Issue-2: 47-53 Full text of this paper can be downloaded online at www.ijssm.org/&http://nepjol.info/index.php/IJSSM/issue/archiveperceived stress scale was high, and a low stress group of 44 students with a mean perceived stress score of 18.60 (SD = 4.52) students not used cope well with stress (Fogle & Pettijohn, 2013).
The results of this study shows that nursing students have good dietary habits related to health.There is statistically significant result as (p=.000).Findings reveled that self-care habits of the nursing students related to dietary pattern are perfect.Furthermore the study of (Van den Berg et al., 2012) that most of the students (80.8%) reported that take two to three servings of meal.(78.3%) significant influence of self-care habits founded as good related dietary habits.56% students which shows positive response of regarding good self-care habits regarding food consumption (Van den Berg et al., 2012).
In the contrast a study conducted by Ansari ( 2011) results depict that students in Hong Kong (23% female and 29% males who indicated that they limit use of fruits and food containing nutrition's skip three serving of meals.Nursing student not utilize good self-care habits and have poor practices related to dietary habits (El Ansari et al., 2011) The results of the present study revealed that almost 51 students have well practices of sleep habits is good with the significant value is (p=.000).Nursing students have healthy lifestyle activities regarding sleep and rest which lead them to complete good academic performance.Results of this study is founded resembling to the study of Paudel ( 2017) which shows that most of the student had significantly higher scores of physical activity as good for healthy life 56% students which shows positive response toward daily exercise and complete hours of sleep (Paudel et al., 2017).

Table 1 :
One Sample T-test for Self-care habits

Table 2 :
One Sample T-test for Stress and coping

Table 3 :
One Sample T-test for Diet habits

Table 4 :
One Sample T-test for Sleep and rest