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Nursing Students Attitude Towards Self-Care Management

Self-care management has become a theoretical discussion among health professional and students. As a result of its importance, the International Council for Nurses has incorporated it in their standard of competence. Self-care encourages health and is a fundamental value of the scope and standards of practice. Nursing students are advised to have proper self-care. This study looked into the self-care management practices of nursing students at the Adventist University of the Philippines and how they align with the institutional outcomes. This quantitative study conveniently samples 47 nursing students as respondents. The study adopted the Circle of Human Potential ' questionnaire by Dossey and Keegan (2009), which assessed self-care management in the areas of physical, relationship, emotional, spiritual, mental, and choice. The application fo SPSS 23 was used for the descriptive and T’Test analysis as demanded by the research questions. The results of the study revealed that there is a positive self-care management attitude among nursing students. The ranked of self-care management from highest to the least in the order of spiritual, mental, emotional, relational, choice, and physical assessments. It further revealed that there was no significant difference in self-care management when considering the gender of the students. The outcomes of the study were in accordance with the AUP institutional outcomes of spirituality, critical thinking, professional expertise, service, health and wellness, and positive attitude. The study recommends that nursing students keep up with their positive self-care management.


INTRODUCTION
Self-care practice should be professional anticipation underlying in the role of nurses (Richards, 2013). This is worth considering. The importance of self-care for nurses is evident in the standards of competence for general registered nurses of the International Council of Nurses (ICN) (Alexander and Runciman, 2003).
However, the standards do not align perfectly with ICN standards in individual countries. For example, in the UK, the importance of self-care for nurses is not evident in the Standards of the Nursing and Midwifery Council for Registered (2010) Nurses framework. The standards for registered nurses in other countries such as New Zealand (Nursing Council of New Zealand, 2007), Canada (College of Nurses Ontario, 2014) and the Philippines are not evident in practice (Philippine Nurses Association, 2012). Korea has also identified the problem of neglecting nurses ' self-care within practice standards (Shin and Eschiti,2005).
The literature on the workforce shows how important self-care is for all nurses, but these discrepancies suggest that it is not consistently acknowledged (Mills, Wand & Fraser, 2015).
This raises implications for the global development of standards for nursing practice or the overhaul of existing standards lacking in self-care content.
Student nurses stress is causing poor performance in academic, suboptimal professional identification of formation and student attrition, (Hensel & Laux, 2014). Learning healthy stress coping strategy is part of self-care development for nurses and student nurses. Self-care encourages health and is a fundamental value of the scope and standards of practice (Mariano, 2013).
The attitude of nursing students is to be favorable or unfavorable (Riley, Collins, & Collins, 2019). Some denote that it should be positive or negative. Attitude is essential for developing nursing education. It is also important to promote nursing strategies which will impact on their self-care, compassion fatigue, clinical performance, and work environment.
Nursing students' self-care management is rarely study studied. As most literature focus on clinical practices, student professional identity (Siappo, Nunez & Cabral, 2016). Also noting the universal problem of regulating and standard health self-care, this study has found a gap in knowledge to know the attitudinal change of the nursing student towards self-care. The crux of this study is to find out the attitudinal level of the nursing students towards their self-care management. The self-care practices will be measured on choices, spirit, and relationship, and physical, emotions, mental and personal. The research questions are: 1. What is the attitudinal level of the nurses' students towards self-care management? 2. Is there a significant difference in gender on self-care management by nursing students?
Self-care is an essential element of nursing practice (Ashcraft & Gatto, 2015), and Dorothea Orem first made its importance in nursing explicit in her theory of self-care. Orem explained that self-care is for human well-being, that is for both nurses and patients nurses . Nurses and nursing students, however, usually focus more on their patients ' nursing care and often pay little or no attention to their personal self-care (Austen, 2015). Personal self-care healthcare workers and nursing students cannot provide their patients with quality care without practice (Mills, Wand & Fraser, 2015).
Students in nursing experience many stressors during their academic life (Pulido-Martos, Augusto-Landa & Lopez-Zafra, 2012;Younas, 2016), affecting their ability to care for their patients and themselves (Clark, 2014). It has also been noticed that patients and their families perceive nurses and nursing students engaged in self-care positively. While nursing students and nurses neglect self-care, young and immature nursing students may lack the much-needed self-care and health promotion practices experience (Nevins & Sherman, 2016).
According to Tachias, and Ferguson (2019) students in nursing understand the importance of self-care for personal physical, emotional well-being, psychological, and realized the importance of keeping their level of sleep, diet, and activity to improve physical and physiological health. Nursing students must avoid tobacco, illegal drug use, alcohol, and pay attention to their safety and concentrate on certain health screening practices in order to overcome their stressors.
Younas (2017) did a literature review of nursing students ' self-care behaviors and practices in general and throughout the study's academic years. A total of 11 studies were scrutinized and critically evaluated to distinguish current trends in the self-care practices and behaviors of nursing students in nursing literature. In order to improve physiological and physical health, nursing students realized the importance of maintaining their level of diet, sleep, and activity.
Nevertheless, they manage to neglect self-care practices that might improve their psychological and emotional health due to academic stress, workload, and inadequate knowledge of self-care strategies in this field. There are confined evidence to draw any conclusions about the use of complementary self-care therapies by students, the difference between nursing and non-nursing student self-care practices, the usefulness of various interventions to improve self-care practices by students, and the differences between student self-care practices and behaviors throughout academic years.
Siappo, Nunez, and Cabrail (2016) did a study to examine living a healthy lifestyle that value of self-care during their undergraduate course as part of the experiences of the nursing students.
To understand and describe the experiences of self-care of nursing students during their professional training. The method of life story was used in 2013 to interview 22 students of nursing at a Peruvian university. Analysis of content generated the following categories of care conceptualization and self-care learning. It resulted that care was something new to examine, a self-care and well-being. Initially, basic human needs change when students are willing to take care of others. The study's conclusion and implication were that health care teaching influences the healthy living. To encourage them to care for themselves, it is necessary to raise awareness of the professional nurses ' humanistic training. Tachias and Ferguson (2019) examined the constant, voluntary, and learned self-care actions carried out to preserve one's well-being by nursing students. Study problems include stress, academic dropout, burnout, secondary trauma, issues of concentration, lack of self-care education, and changes in mood. The study conducted a quantitative survey of 160 nursing students with 52 questions using Health-Promoting Lifestyle Profile II and self-reporting of health-promoting lifestyle habits. The study revealed that self-care is directly related to the nursing students' happiness and work ethic and reduced medical errors and increased patent satisfaction. There is seldom an interest in health care providers ' self-care. The study concluded that nursing students do not related to their health by what they are learning. Some of nursing students ' strong characteristics work towards long-term goals and are aware of what is important in life. Students must know the things that make them happy. These may consist of self-care activities to overcome the stress, which consists of music, prayer, jogging, deep breathing, and friendship fostering (Osei, Antwi, Peprah, & Antwi, 2019). Brown, and Bar (2019) qualitative study aimed at discovering the self-care experience of students in an online science master's course in nursing. Care groups were involved in the course; small groups were organized to provide support. The analysis of 37 students ' reflective summaries revealed two main themes and five sub-themes. Two overarching themes highlighted "Finding Our Inner Self" and "A Lasting Journey and Not a Destination." Students appreciated a focus on self-care, and support from family, setting goals, friends, and caring groups. Many have mentioned that self-care is an ongoing work.
Paul (2019) investigated into nursing, lack of self-care is directly related to increased burnout, decreased job satisfaction, and decreased rates of new graduate retention. Practicing self-care as a nursing student can help new graduate nurses to establish a sound basis and self-care knowledge. How are the perceptions of nursing students about self-care affected by targeted health and wellness booths based on key ANA Healthy Nurse, Healthy Nation Grand Challenge areas? A professional development course for all nursing students in the cohort is included in the curriculum. Research is being conducted on that course. Self-care is one of the topics of research. The collection of data on this topic leads to the application for a Seeds of Wellness Grant from The Diversity in Nursing Association. Of those participants, an estimated 200 participants attended the event, 159 took the pre-quiz and 136 took the post-quiz, while some participants chose to abstain from either quiz. The participants strongly agreed and agreed to "I am likely to engage in self-care activities due to this event".
Goudarzianet al. (2019) study was to determine the effect of self-care training on nursing students ' emotional intelligence. This quasi-experimental study was done in 2016 on Mazandaran Medical Sciences University nursing students. The subjects (60 students) collected using a random sampling method were divided into experimental and control groups, and then the students of the experimental group were taught self-care behaviors in 12 sessions using a checklist. The control group subjects have not been taught. Before and after the intervention, emotional intelligence was measured using the standard questionnaire of Bradberry and Greaves. In the experimental group, emotional intelligence scores of students showed positive and significant changes between before (75.33 ± 7.23) and after (125.70 ± 7.79) training (P < 0.001). A significant change in control (78.73 ± 6.54) and experimental groups (125.70 ± 7.79) after training (P < 0.001) is also shown in the test. It is recommended that special programs be organized to improve students ' emotional intelligence that enhances the likelihood of their lifetime success.

METHODS
This study is a descriptive research design. The study conveniently sampled 47 nursing students from Adventist University of the Philippines (AUP) as the respondents in measuring their attitude toward self-care. The descriptive analysis is done by using SPSS 23 to find the mean and standard deviation. Question two, which looks at the significant difference of gender on self-care of the nursing students is analysis by using T'Test.
The null hypothesis of the study: H0: There is no significant difference in gender in self-care management by nursing students.
All these Likert-scales are based on Vagias (2006)  The study fully adopted the research questionnaire developed by Circle of Human Potential ' questionnaire (Dossey & Keegan, 2009). The potential areas in the survey will be reported in the same order: physical, mental, emotional, relationships, choices, spirit.

RESULTS AND DISCUSSIONS
Descriptive statistics were used to analyze the first research question which sought to know the attitudinal level of the nurses' students towards self-care management. The study resulted the nursing students in AUP have a positive attitude towards self-care management (M = 3.1515, SD = .23384) as shown in Table 2. In ranking the self-care management, the study revealed  Finally, the study investigated the significant difference of gender on self-care management.
The outcome of this scrutiny was that there was no significant difference of gender on self-care management, as shown in tables 4 and 5. Based on the equal variance assumed the p-value = .460 is not statistically significant as the means between the nursing students males (3.1142, SD= .27573) not different from the female (M=3.1688, SD = .20977). The implication is that both the males and females are aware and focus on their self-care while studying at AUP. Therefore, this study failed to reject the null hypothesis that there is no significant difference in gender of self-care management for nursing students at AUP.

Recommendation
The study recommends that nursing students keep up with their positive self-care management practices which are in line with the institutional outcomes of AUP.