INTRODUCTION:

Background of the study:

Nursing profession is a disciplined profession involved in the delivery of health to the society also it is helping profession, service oriented to maintain health and well being of people, an art and science but the nursing profession comes with the stress both mentally and physically because of its fast paced and emotional nature.¹

According to WHO stress can be defined as a state of worry or mental tension caused by health and threats in our lives. Everyone experience stress to some degree the way we respond to stress, however, makes a big difference to our overall well being.²

Stress in nursing education is one of the most important issue in the modern world. It can be identified as 20^th century disease and has been viewed as a complex and dynamic between individual and their environments. Stress affects both the mind and body A person with little bit of stress can perform daily activities. Too much stress can cause physical and mental problems.³

Academic source of stress among nursing students mostly are examinations, long hours of study assignments, grade, lack of free time, lack of timely feedback after their performance, special elements of academic program like arrangement and conduction of workshop. Clinical source of stress like taking care of ill patients, inter personals conflicts with peer groups, insecurity about personal clinical competence, fear to complete clinical requirements, dealing with uncooperative patients, work load, prolonged standing. The reaction of parents and friends to the results weigh upon the students to create exam stress, lack of interest to study and cause disinterest in attending classes.⁴

Around 500 Japanese students below the age of 20 kill themselves each year. The U.S. ranks first as the country with the most stressed students. College students feel stress as well, with 45% saying they felt that way at a higher-than-average rate.⁵

The diaphragm is the most efficient muscle for breathing. It’s a large, dome-shaped muscle located at the base of your lungs. Your abdominal muscles help move the diaphragm and give you more power to empty your lungs. During diaphragmatic breathing, you consciously use your diaphragm to take deep breaths. When you breathe normally, you don’t use your lungs to their full capacity. Diaphragmatic breathing allows you to use your lungs at 100% capacity to increase lung efficiency.⁶

Diaphragmatic breathing may be defined as deliberate control of breath rhythm and pattern, usually with the aim of increasing focus and relaxation and/or with the aim of influencing emotional, mental and physical health.⁷

Nursing students experience a lot of stress and should warrant stress reduction strategies and techniques. Nursing curriculum should include comprehensive stress management program and stress management techniques like deep breathing exercises, meditation, mindfulness techniques, maintaining good nutrition which will help students to cope with various stressful situations.

Thus this study introduced a simple stress reduction method of diaphragmatic or deep breathing exercise, that will help nursing students to cope with stressor being faced by them during their entire course and too in their day-to-day life.

PROBLEM STATEMENT:

A study to evaluate the effectiveness of diaphragmatic breathing on level of stress among Basic B.Sc. (Nursing) 2^nd semester students of selected nursing colleges of Shimla -HP.

OBJECTIVES OF THE STUDY:

1. To assess the pre test level of stress among Basic B.Sc. (Nursing) 2^nd semester students of selected nursing colleges of Shimla-HP.

2. To evaluate the effectiveness of diaphragmatic breathing on level of stress among Basic B.Sc. (Nursing) 2^nd semester students of selected nursing colleges of Shimla-HP.

3. To find the association between the level of stress among Basic B.Sc. (Nursing) 2^nd semester students of selected nursing colleges of Shimla-HP and selected demographic variables.

HYPOTHESIS:

H₀There will be no significant difference in the level of stress before and after giving diaphragmatic breathing sessions and also no significant association between level of stress with selected demographic variables.

H₁There will be significant difference in the pre-test and post- test scores on level of stress among Basic B.Sc. (Nursing) 2^nd semester students.

H₀₁There will be no significant differences in the pre-test and post-test scores on level of stress among Basic B.Sc. (Nursing) 2^ndsemester students.

H₂ There will be significant association in the level of stress scores among Basic B.Sc. (Nursing) 2^ndsemester students with selected demographic variables.

H₀₂ There will be no significant association in the level of stress scores among Basic B.Sc. (Nursing) 2^nd semester students with selected demographic variables.

REVIEW OF LITERATURE:

Nhi thi vo et al. (2023) conducted a study on prevalence of stress and anxiety among nursing students. The study results showed that most of the nursing students experienced moderate stress (42.1%) and mild to moderate anxiety (19.4%-25.1%). Third- and fourth-year nursing students had severe stress levels compared with those in the first and second years (29.0% vs 15.1%).⁸

Dhawo S.M, Sadu B, Wicalsono U. (2024) conducted a study on the effect of diaphragmatic breathing on reducing stress levels in nurses A total of 33 nurses in the Emergency room (17) and the Intensive Care Unit (16) were recruited by using purposive sampling technique. The control group was given health education on diaphragmatic breathing while the intervention group practiced diaphragmatic breathing for 12 weeks. The data were collected by Perceived Stress Scale-10 and then analysed using a t-test. The study results showed that the average stress level among nurses in the intervention group was 17.53 which reduced to 12.94 and the average stress level among nurses in the control group was 21.06 which reduced to 19.88.⁹

RESEARCH METHODOLOGY:

Research Approach:

Quantitative research approach.

Research Design:

Quasi experimental research design.

Research Setting:

The present study was conducted on selected nursing colleges of Shimla- HP.

Target Population:

Basic B.Sc. (Nursing) students

Accessible Population:

Basic B.Sc. (Nursing) 2^nd semester students of selected nursing colleges of Shimla -HP.

Sample Size:

60 Basic B.Sc. (Nursing) 2^nd semester students of selected nursing colleges of Shimla-HP.

Sampling Technique:

Probability Simple Random Sampling Technique.

Variables Under Study:

Independent Variable: Diaphragmatic breathing

Dependent Variable: Level of stress

Socio Demographic Variable: Age, Family income, Type of family, educational status, Peer group, Previous illness, Previous knowledge regarding the profession, Profession chosen.

Selection and Development of Tools:

· Section 1: In this section sociodemographic profile of the subjects will be collected.

· Section 2: In this section a standardized Perceived Stress Scale (PSS)

Scoring criteria

· Standardized Perceived Stress Scale (PSS) includes the 10 items.

· For each item maximum score was 10 and minimum score was 0.

Sr. No.	Level of stress	Score
1.	Mild stress	0-13
2.	Moderate stress	14-26
3.	Highly severe stress	27 -40

Reliability of the Tool:

The reliability of Perceived stress scale 10 points was found to be higher reliability score (=.78).

Analysis and Interpretation of Data:

Organization of Data for Analysis:

The collected data was organized according to the objectives and presented under the following sections.

Section I: Sample characteristics

Section II: Findings related to the level of stress among Basic B.Sc. Nursing 2^nd semester students of selected Nursing colleges of Shimla -HP.

Section III: Findings related to the effectiveness of Diaphragmatic breathing on the level of stress among Basic B.Sc. Nursing 2^nd semester students.

Section IV: Findings related to the association between the level of stress among B.Sc. Nursing 2^nd semester students and their selected demographic variables.

Section1: Sample Characteristics:

· In case of type of family most of the students 43(71.7%) belongs to nuclear family.

· Majority of student’s 24(40.0%) family income /month is 0-25,000.

· Most of the students 42(70.0%) were having 1^st birth order.

· If we look at the educational status of the father and mother, the majority of students' fathers 26 (43.3%) have studied up to senior secondary education, and in the case of mothers, the highest number 20 (33.3%) have also studied up to senior secondary level.

· In case of occupational status of the father and mother, the majority of student’s fathers 22 (36.7%) are government employees, and in the case of mothers, most student’s mothers 43 (71.7%) are homemakers.

· Most of the students 41(68.3%) don’t have previous experience with hostel stay.

· Majority of students 45(75.0%) show average satisfaction with hostel accommodation.

· A good number 36(60%) had prior knowledge of nursing as a profession, mostly received from family 13(36.1%)

· Most of the students 32(53.3%) chose nursing profession by choice

· With regards to the relationship with teaching faculty a majority 39(65%) reported having a positive relationship with their faculty.

· While assessing the satisfaction with institute interestingly, 36(60%) of students were not satisfied with their educational institute

· In case of participant’s history of any illness most participants 46(76.7%) reported no past illness.

· While assessing the extracurricular activities of the study subjects more than half 35(58.3%) did not participate in any extracurricular activity.

· Majority of student’s main support system for students was their parents 50(83.3%).

· While assessing the sleep duration per night of the students majority of them 34(56.7%) slept for 6–8 hours and in case of average sleeping hours last month majority of participants showed 24(40%) slept 4–6 hours.

· While assessing the previous knowledge about diaphragmatic breathing majority of students 51(85.0%) don’t have any knowledge regarding about nursing profession

· With regard to experience of students with diaphragmatic breathing (DB) Only 51% (85.0%) had practiced diaphragmatic breathing before, mainly through yoga or meditation classes.

Section II- Findings related to the level of stress among Basic B.Sc. Nursing 2^nd semester students of selected Nursing Colleges of Shimla – HP.

N= 60
	Pre- test	Post- test
Level of stress Score	(f) (%)	(f) (%)
High 27-40	6 10	0 0
Moderate 14-26	53 88.3	34 56.7
Low 0-13	1 1.7	26 43.3
Maximum Score=40 Minimum Score=0

Section III- Findings related to the effectiveness of Diaphragmatic Breathing on level of stress among Basic B.Sc. Nursing 2^nd semester students

The mean pre-test stress score was 21.83±3.85 (54.58%), while the mean post-test stress score decreased to 15.30±3.31 (38.25%). The mean difference of -6.53 indicates a decline in scores. However, the paired t-test value of 17.799 with a p-value <0.001 shows a statistically significant difference between pre- and post-test stress scores at the 0.05 level (table value = 2.00). This suggests that the change in stress scores after the intervention is significant, though in this case, it reflects a decrease in level of stress.

Section IV- Findings related to the association between the level of stress among Basic B.Sc. Nursing 2^nd semester students and their selected demographic variables

· The association between the Pre-test stress score with socio demographic variables Based on the objectives, Chi square test was used to associate the level of stress score with socio demographic variables.

· No significant association was found between pre-test level of stress with other demographic variables such as type of family , family’s income/ month , birth order , father’s education , mother’s education , father’s education ,mother’s education , previous experience of hostel stay , student’s satisfaction with hostel accommodation, previous knowledge about nursing profession , source of previous knowledge , nursing profession chosen, professional relationship with teaching faculty , student’s satisfaction with educational institute , any history of previous illness , extracurricular activities, support system , number of hours of sleep / night , average sleeping hours during last one month , previous experience with diaphragmatic breathing, source of previous experience with diaphragmatic breathing . Hence, it was concluded that no significant association was found between pre -test stress score with selected demographic variables.

· The association of posttest stress score and socio demographic variables Based on objectives, Chi square test was used to associate the level of stress and socio demographic variables. the Chi square value reveals that there is significant association of level of stress with previous experience of hostel stay (P= 0.018*, df = 1) at p level (< 0.05).

· No significant association was found between scores of stress and the selected demographic variables such as as type of family , family’s income/ month , birth order , father’s education , mother’s education , father’s education, mother’s education, student’s satisfaction with hostel accommodation , previous knowledge about nursing profession , source of previous knowledge , nursing profession chosen , professional relationship with teaching faculty , student’s satisfaction with educational institute , any history of previous illness , extracurricular activities, support system , number of hours of sleep / night , average sleeping hours during last one month , previous experience with diaphragmatic breathing, source of previous experience with diaphragmatic breathing.

· Hence, it was concluded that there was significant association of post test score of stress among Basic B.Sc. Nursing 2^nd semester students with previous experience of hostel stay.

SUMMARY:

The present study was conducted to evaluate the effectiveness of Diaphragmatic breathing on level of stress among Basic B.Sc. Nursing 2^nd semester students of selected nursing colleges of Shimla -HP. Probability simple random sampling technique was used for the selection of samples. Total sample size was 60 (one group – pre test -post test design). The tool comprised of two sections: one was demographic variables which included type of family, family's Income, birth order, father's education, mother's education, father's occupation, mother's occupation, previous experience of hostel stay, student's satisfaction with hostel accommodation, previous knowledge about nursing profession, nursing profession chosen, professional relationship with faculty, student's satisfaction with educational institution, history of any physical illness, support system, number of hours of sleep / night , average sleeping hours last month, extra-curricular activities and previous knowledge about Diaphragmatic breathing , source of previous experience with Diaphragmatic breathing . The other section of the tool included Perceived Stress Scale to assess the level of stress among Basic B.Sc. Nursing 2^nd semester students of selected Nursing Colleges of Shimla -HP. Diaphragmatic breathing session was the intervention which was given to the study subjects. Data was collected in the month of June. The gathered data was then analyzed by using descriptive statistics i.e., calculation of mean, standard deviation and inferential statistics i.e., chi-square test, t-test. Bar diagrams were used to depict the findings of the present study.

CONCLUSION:

On the basis of total mean score findings, it was revealed that in pre-test and post-test the level of stress among Basic B.Sc. Nursing 2^nd semester students was mostly moderate. After the implementation of Diaphragmatic breathing session majority of post-test score of stress in subjects has decreased. There was no significant association of level of stress among Basic B.Sc. Nursing 2^nd semester students with demographic variables were found in pre-test whereas in post-test significant association was found with previous experience of hostel stay.

REFERENCES:

1. Nursing and Healthcare International Journal, Academic Stress Among Nursing Students Volume 4, Published on August 28, 2020.

2. World Health Organization, What is Stress, [Internet], Available from-https://www.who.int/news-room/questions-and-answers/item/stress [ cited on dated 21feb 2023].

3. https://www.who.int//news-room/questions-and- answers/item/stress/?gad_source=1andgclid=Cj0KCQjw-r-vBhC.

4. Cavanagh Kate, Strauss Clara and Fincham W. Guy effect of coherent breathing on mental health and wellbeing: a randomized placebo-controlled trial. Article number :22141. Published :13 December 2023.

5. American Psychiatric Association Journal, [Internet], Available from- https://www.psychiatry.org/news-room/news-releases/october-2023-issues-of-apa-journals

6. Cleveland Clinic, Diaphragmatic Breathing, [Internet] , Available from- https://my.clevelandclinic.org/health/articles/9445-diaphragmatic-breathing

7. Strauss Clara. Effect of coherent breathing on mental health and wellbeing: a randomised placebo -controlled trial , 2023 Available from-https://www.nature.com/articles/s41598-023-49279-8

8. Nhi thi vo et al. Prevalence of stress and anxiety among nursing students: A systematic review and Meta- Analysis [Internet] 2023. Available from- https://pubmed.ncbi.nlm.nih.gov/36538669/

9. Dhawo Silvana Maria, Sadu Bernadus, Wicalsono Utomo. A study on the effect of diaphragmatic breathing on reducing stress levels in nurses in Indonesia. [Internet].2024; Availablefromhttps://babalinursingresearch.com/index.php/BNR/article/view/309

Received on 18.02.2026 Revised on 06.03.2026

Accepted on 20.03.2026 Published on 05.05.2026

Available online from May 09, 2026

A and V Pub Int. J. of Nursing and Med. Res. 2026; 5(2):67-71.

DOI: 10.52711/ijnmr.2026.15

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