Coping Strategies and Their Influencing Factors Among Nursing Student in Online Learning

Background: the challenge of success for nursing students is getting tougher with the implementation of online learning during the COVID-19 pandemic because it requires adjustments to learning methods that can cause stressors for students. Objective : this study aims to identify a description of the coping strategies used by students of the Faculty of Nursing, Universitas Padjadjaran in carrying out online lectures and the factors that influence them. Methods: this research was a cross sectional design. The population in this study was students of the Faculty of Nursing, Universitas Padjadjaran with a total sample of 271 students who were selected based on the proportional stratified random sampling technique. The instrument used is The Brief COPE questionnaire with 28 statement items,and questionnaire on factors that affect coping strategies with 40 statement items, then analyzed descriptively. Results: the results of the study showed that almost all respondents, namely 208 students (76.75%) had problem focused coping coping strategies. Problem solving skills are the highest factor in the use of coping strategies with a mean value of 0.8413 and physical health being the lowest factor with a mean value of 0.3210. Conclusion: further research is needed with the correlation method to be able to see the factors that influence the use of coping strategies.

For complete information author guidelines please check http://ejournal.poltekkes-smg.ac.id/ojs/index.php/jnj/about/submissions#authorGuidelines BACKGROUND Facing competition and professional needs in the era of revolution 4.0, nursing is faced with the challenge of being able to adapt to technological developments. One learning model with the application of technology is online learning. Online learning is a learning system that is carried out with the help of a platform so that it helps the teaching and learning process even at a distance (Sadikin & Hamidah, 2020). The purpose of online learning is to provide quality online learning that is massive and open to reach learners with unlimited learning space (Sofyana & Rozaq, 2019). In relation to the COVID-19 pandemic, online learning provides its own challenges for nursing students. The reason is, students are still adapting to new learning methods. Facing these conditions, students may experience various challenges and clinical health threats that are very dynamic and complex, one of which is emotional disorders such as stress, anxiety, depression, aggression and personality dysfunction (Majrashi et al., 2021).
The onset of problems experienced by students comes from the source of the problem or stressor they have. During lectures, each student has different stressors including those related to making academic strategy decisions, adapting to life changes, learning methods and the environment, differences in language, beliefs and culture used, social judgment, completion of final assignments or theses, time management, uncomfortable classrooms and environmental influences (Zheng et al., 2022). Online learning creates its own stressors for students, including less than optimal material explanation, the need for devices and a stable internet network, increased needs due to the use of expensive internet quotas, and limited student social interaction. For nursing students, other stressors include concerns about not fulfilling clinical competencies and concerns about failing to build relationships with others due to restrictions on social and practical activities in the laboratory, clinic and community (Ningsih, 2020). E Silva Ribeiro et al (2020) stated that the stress level of nursing students in the global scope reached 3.5% of severe stress, 55.2% of moderate stress, and 41.3% of mild stress. Stress that occurs in nursing students is caused by stressors that increase every semester level. Students in semesters 5 to 8 show higher levels of stress. However, other studies state that higher levels of stress are experienced by 1st semester nursing undergraduate students because of the basic adjustments that must be made (Jiang et al., 2015). Chowdhury et al (2017) said that if the stressors that students have exceed the capacity to solve them, it will cause stress in students. In individuals who are able to handle stress well, they will perceive stressors as a challenge. However, in individuals who perceive stressors as threats or dangers, individuals tend to experience distress (McCarthy et al., 2018). Labrague (2013) stated that nursing students have higher stress than students of other health groups. This happens because nursing students have a fairly heavy learning load, namely students are required to have clinical and academic skills and be able to balance their lives as someone who is heading towards adulthood (Chaabane et al., 2021). To be able to decipher the stress experienced, a person needs to determine the efforts that will be made. However, not all efforts have a good impact on individuals, so choosing the right coping strategy will greatly help individuals in solving problems (Jimenez-Jimenez et al., 2013). Selsa (2021) stated that the stress level of UNPAD Nursing students was For complete information author guidelines please check http://ejournal.poltekkes-smg.ac.id/ojs/index.php/jnj/about/submissions#authorGuidelines at 66% moderate stress, 27.4% severe stress, and 6.6% mild stress. Whereas, Karisa et al (2023) stated that stress and stressors in the learning environment will affect the quality of the learning environment itself. The results of the study found that the academic learning environment of the UNPAD nursing faculty was in the good category, meaning that existing learning stressors could be overcome. However, this cannot be confirmed so further research is needed to identify coping strategies and other factors that influence nursing students when participating in online learning, and can be a strategic step for institutions to develop strategies for developing learning methods.

OBJECTIVE
This study will describe the description of coping strategies used by students and the factors that influence them during online learning.

Research Design
This research design is descriptive research using quantitative data types. The variables in this study are coping strategies and influencing factors in accordance with the theory developed by Lazarus and Folkman in 1984. The sub variables of each variable are as follows: a) coping strategies: problem focused coping, emotion focused coping, and less useful coping, and b) influencing factors: physical health, positive beliefs or views, problem solving skills, social skills, social support, and material support.

Population and Sampel
The population in this study were all active students of the Faculty of Nursing, Padjadjaran University, totaling 791 students. In determining the number of samples, calculations were carried out using the 5% slovin formula so that a sample size of 271 people was obtained. The sampling technique used in the study was proportionate stratified random sampling, which is a sampling technique by taking into account the level in the population. In the study, the proportion of each group of students was calculated, including 77 final year students, 54 third year students, 73 second year students, and 67 first year students. Samples were selected in accordance with the inclusion and exclusion criteria that have been determined, among others, for inclusion criteria: a) active students, b) selected in randomization, c) students who participated in the study until the end, and exclusion criteria: a) students who refused to participate in the study.

Instrument
In this study, the instruments used consisted of two, namely The Brief COPE to measure coping strategies and the influencing factors instrument made by the researcher. The Brief COPE is the latest standardized instrument developed by Charles S. Carver (1997) which is the result of an update of the measuring instruments that have been made before, namely Ways of Coping and COPE Inventory by Lazarus and Folkman in 1984. This instrument consists of 3 sub dimensions (Problem Focused Coping (PFC), Emotion Focused Coping (EFC) and Less Useful Coping (LUC)) with 14 sub scales and 28 statement items. Measured with a Likert scale consisting of four ratings (1: never, 2: sometimes, 3: often, and 4: always). The influencing factors instrument was created by the researcher based on the theory of factors that influence For complete information author guidelines please check http://ejournal.poltekkes-smg.ac.id/ojs/index.php/jnj/about/submissions#authorGuidelines coping strategies adopted from the theory. Lazarus and Folkman (1984). The questionnaire contains questions consisting of 6 factors that influence coping strategies including: physical health, positive beliefs or views, problem-solving skills, social skills, social support, and material support. Each question in the questionnaire contained 2 options, namely Yes or No. The questionnaire was administered to the participants.
Validity and reliability tests have been conducted in this study. For the validity test of The Brief COPE instrument, the r-count significance ≥ r-table with a validity value of 0.3610. For the influencing factors instrument, the validity test was carried out by reviewing the instrument by experts and also calculating the results of the significance of r-count ≥ r-table with a validity value of 0.4821. The reliability test was carried out using the Cronbach Alpha method obtained results for The Brief COPE instrument and influencing factors including 0.888 and 0.778. Based on these results, both instruments were declared valid and reliable for use.

Data Analysis
The data analysis used in the study was univariate analysis. For data analysis of coping strategies, it is done by grouping data according to the sub dimensions, and summing up all the results for each respondent. Then calculated using the calculation of the relative score by Lazarus and Folkman (1984) using the formula: sub-dimensional result score / maximum sub-dimensional score x 100%. The result of calculation is categorized: if the percentage of PFC is bigger than EFC and LUC, then the respondent tends to use PFC, and vice versa. For data analysis of influencing factors, it is done by summing up the score of all items and calculating the average. The highest average means more influencing factors, and the lowest average means less influencing factors.

Ethical Clearance
This study has received approval from the Research Ethics Committee of Padjadjaran University with letter number 327/UN6.KEP/EC/2022.    Based on table 4 of the analysis results, the highest mean value is found in problem solving skills with an average value (mean) of 0.8413 and the lowest mean value is found in physical health factors with an average value (mean) of 0.3210.

Coping Strategies
Based on the results of the study, almost all UNPAD nursing students, namely 208 students (76, 75%) used problem focused coping strategies or problem-focused coping during online learning. Problem focused coping is coping that is oriented towards efforts made to reduce or overcome the sources of stress that are owned (Lazarus & Folkman, 1984). Kumar & Nancy (2011) stated that problem focused coping is the most adaptive way to deal with workload pressures in adequate resources, role ambiguity, and other sources of stress. This means that during online learning students can take direct action to solve problems related to online learning, such as when experiencing weak internet network constraints, students will immediately look for a place that has stable internet network access when going to online learning (Fitriasari et al., 2020).
Nursing students who use problem focused coping in dealing with academic problems can directly adjust to stressful environments (Mohammed et al., 2020). But in contrast to the research results by Ahmed & Mohammed (2019) who said that a person will use problem focused coping when the person is able to assess the situation to find solutions that they think they can do according to their resources, for example managing stress due to presentations by making small notes and practicing speeches. However, students who do not use problem focused coping in dealing with problems because they consider their academic load to be very heavy so they prefer to focus on preparing assignments and participating in academic activities rather than setting aside time to solve the problems they are facing (Mohammed et al., 2020).
Furthermore, the group of students who use emotion focused coping strategies are students who face problems by only diverting attention without solving the problem completely, so that the impact will only be felt for a moment and not solve the problem until the problem is completely gone (Pragholapati & Ulfitri, 2019). This is natural for nursing students who are in the transitional age range from the late adolescent stage to the adult stage. At this stage, emotions tend to be explosive and difficult to control.
Emotions that arise prioritize feelings over thoughts so that it feels more difficult to solve problems appropriately (Ali & Asrori, 2010). In addition, the use of emotion focused coping is also often associated with more stressors and higher stress levels than the situation in students who use problem focused coping (Abasimi et al., 2015).
In the less useful coping sub-dimension, 3.33% of students were found to use it, this result is less than the other two sub-dimensions. This happens because nursing students avoid coping strategies such as smoking or drinking alcohol to reduce stress because they are related to their religion, law, and culture (Seyedfatemi et al., 2007). This coping strategy needs to be watched out for because nursing students who use it, tend to form students who give up easily so it is feared that in the clinical setting it will lead to an increase in dependency behaviors such as agreement with decisions made by others and surrender (Rafati et al., 2017).
The use of coping strategies is not favored by one of them. Coping strategies can be used simultaneously and in balance depending on the situation and conditions faced by the individual to solve the problem (Fitriasari et al., 2020). Lack of knowledge and confidence in developing coping causes nursing students to experience stress throughout their education which can affect their health and poor academic performance. Particularly in nursing students, it can affect the quality of patient care (Shaban et al., 2012). In addition, nursing students' inability to cope with stressors can affect their performance, health, attitudes, and role satisfaction as nurses (Zhao et al., 2015). Dadgaran et al (2012) stated that the selection of appropriate coping strategy is the development of practical skills that are recognized as professional competencies of nursing students.

Influencing Factors of Coping Strategies
Baluwa et al (2021) stated that the selection of coping strategies is highly dependent on personality and the level of stressors faced by a person. In addition, the selection of coping strategies is also influenced by one's experience, culture, and knowledge (Gunawan, 2018). The same stressor can cause different responses in each individual according to the factors that participate in influencing the selection of coping strategies by the individual (Siswanto, 2007). Based on the results of the study, the factors that influence the use of coping strategies in UNPAD nursing students are problem-solving skills with the highest average value (mean) of 0.8413 and physical health with the lowest average value (mean) of 0.3210.
Hamiyah, N & Jauhar (2010) stated problem-solving skills are assessed based on the ability to understand the problem, plan a solution, solve the problem according to the plan, and ensure all steps taken are correct. Nurses who have problem-solving skills will be better prepared to deal with patients with various situations. Nurses will see problems not as obstacles but opportunities to improve patient health and well-being. According to the Academy of Medical-Surgical Nurses (2019) in solving problems, the first step is to define the problem and formulate questions. The second step is reviewing the evidence, which determines what treatment is most appropriate using the knowledge the nurse has. The third step is implementation, initiating the treatment correctly based on practice expertise and experience. The fourth step is evaluating the plan by reassessing the patient on the predetermined goals. In relation to coping strategies, problem-solving ability is a factor that directly influences a person's use of coping strategies (Sujadi et (2009) stated that the characteristics of someone who has a problem focused coping strategy are someone who tries to solve problems, can assess and control themselves in overcoming problems, so that the two research results correspond to each other.
But in the process, problem-solving skills are skills that require experience, training and guidance (Sujadi et al., 2016). Nurses will constantly encounter patients with complex and varied problems, so nurses must be dynamic when handling multiple responsibilities to identify patient problems and prioritize them. Errors in decisionmaking often lead to problems in the clinical setting that can cause ethical dilemmas (Banunaek et al., 2021). Precise and accurate problem-solving skills are needed by nurses to prove and show the best option in solving a problem that can save the patient (Nibbelink & Brewer, 2018). Not only for themselves, nurses also play an important role in helping patients and their families to make the right treatment decisions. Limited knowledge and skills in making decisions about client care can be fatal. Nurses with good problem-solving skills have been shown to be able to solve patient problems and improve the client's health condition better with much lower mortality and morbidity (Anton et al., 2021). Therefore, problem-solving skills are a very important skill development for nursing students by continuously practicing critical thinking skills (Kourkouta & Papathanasiou, 2014).

CONCLUSION
The selection of appropriate coping strategies needs to be owned by each student in accordance with the problems faced. Students who have been able to use appropriate coping strategies will be able to solve various problems faced, especially those related to online learning stressors. In developing coping strategies, various factors have been identified as factors that influence students' decisions in choosing each coping strategy. Therefore, training and habituation in solving problems constructively are needed by students. In this study, it was only done descriptively to see the distribution of coping strategies and influencing factors, so the results did not assess the relationship between the two. In addition, the instrument made by the researcher only involved a few students. Further research is needed to measure the quality of the instruments used and connect the two in the form of correlational research.