Introduction
Every student is distinctive and learns things in their unique fashion. Higher education institutions (HEIs), being one of the powerful pillars and stakeholders in the growth of any nation, mainly relies on the success of its students. 1
Nursing undergraduate study programme has a highly competitive academic environment in which students are expected to develop their knowledge and also to master critical skills and abilities for the patient care. Nursing is one of the long, complex, and quite stressful courses of undergraduate study programme, with a demanding field of study requiring knowledge on a wide-range of subjects over a limited time period. 2 While striving to successfully compete in their educational environment, nursing students experience greater pressure from various sources of academic life, which ultimately creates stress among them. 1
The nursing education has long been perceived that nursing students experience higher levels of stress than other college students. 3 Its effects could be reflected in student’s social, mental health and academic performance. 3 The major purpose of nursing education is to prepare nurses to meet the health care needs of the people. 3 Undergraduate degree programme provides the appropriate foundation for nurses to practice following registration, and prepares nurses for on-going continuing professional growth and development of further competencies as appropriate. 3 The nursing education process equip nurses with the skills and competencies for delivering patient care with the help of modern evidence-based healthcare delivery methodologies. 3
There are many factors, which may encourage or detain the nursing students learning style and intellectual performance in classroom and clinical area.4 Students’ performance predominantly is affected by factors such as social media, academic quality, family and social bonding, out of which the two factors, parental pressure and peer-related factors, is found to significantly augment or impede their academic achievement. 4, 5 Students, who feel accepted by their peer group and their parents, are likely to feel good about themselves, whereas, it’s opposite can have a negative effect and can hold them back in their studies. Thus, these two factors have a major influential effect on the academic performance of students. 6
Family is a vital part of one’s social world. 7 Parents have a great impact on the academic performance of their wards. Parental pressure is a term used when the influence exerted by parents make their children to leave their own desires, likings, and decisions, and they are forced to fulfil their parents’ expectations. 7 The pressure in itself is neither positive nor negative. If the pressure is positive, it encourages positive attitude, healthy values, respect, and hard work, and strengthens the potential of students and lead them towards success. If pressure is negative, it develops negative attitude, and ends up in reducing person’s strength leading to failure of academic life. Parental pressure is the emotional stress parents tend to put on their children and is often related to academic success, cultural and social standards, and other factors. 8 The outcome of these actions is, more often than not, unhealthy on a large scale.8 On the other hand, children who are assisted by their parents in terms of academic performance, tend to excel in their studies. Significantly, they have the chance in inspiring their children in terms of academic achievement.6 Parents often urge their children to confirm to their values and can or sometimes pressurize their children in order to attain desirable grades, without thinking about their abilities. 6 A lot of parents consider that transmitting a sense of high expectations to children is one way to inculcate them with self-honor, self-assurance and distinct standard of worth and importance. But, for the most part of the time, these expectations are idealistic and unachievable. 9 High expectations to become successful can be devastating. In some cases, it can be harmful too. 10 Students, by securing lower grades in their subjects, often have the fear of discouraging the parents.
Peer group may be defined as a group of people who share similar characteristics with one another such as age, ethnic background and social status.7 The peer influence is defined as the influence exerted by a peer group in encouraging a person to change his/her attitude, values, behavior in order to confirm the group norms.7 Peer group play a large role in social, emotional, and academic development of students. The peer acceptance and attachment are as important as the parental attachment. The peer relationships may positively or negatively affect the academic performance of students. According to study of Kalpana Borse, 2 ninety percent of students agreed that a friend is one of the influential factors and have a significant positive effect on the academic achievement. 2 Pressure coevals is associated with wrong decisions, rebellion and humor fluctuations, which will lead to a poor academic performance. Positive peer influence on academic performance depends on self-identity, self-esteem and self-reliance. 7
Parent pressure mainly arises from the concern for the welfare of their children, and has significant positive effects on their academic performance. 10 It means that a positive parent can enhance the academic performance of nursing students as they feel forced to attend the classes, to be punctual in their assignments, presentations, and project work and tend to fulfil their expectations. 10 High parental expectations on the other hand can lead to a negative influence that affects student's psychological and physical health and increases the chances of developing disorders such as depression, sleep deprivation, eating disorders and academic misconduct. 11
According to Olalekan, 12 it is generally observed that peer group has a lot of influence on student’s life and learning, in which the students feel more comfortable and relaxed among their peer group. A student who is brilliant and surrounded by dull friends would lose interest in learning, whereas, a peer group with studious members can have a positive effect on the dull member towards learning, and can stimulate his or her interest on learning. 12
Although many research studies have been conducted internationally, there is lack of studies on identifying stressors related to parent pressure and peer-related factors among nursing students. 3 Evidence from the previous research studies suggests that, parental pressure and peer influence has both positive and negative impact on the academics of nursing students. But these two areas have not been explored much in the studies conducted in India, especially Kerala. Thus, the present study is intended to assess the impact of parental pressure and peer-related factors on academic performance nursing students, to explore the relationship of parental pressure and peer-related factors on their academic performance, and to determine the association of sociodemographic variables on parental pressure and peer-related factors.
Materials and Methods
The study was conducted as a part of the research project, a partial fulfillment of the requirement of completion of the academic degree course in the Bachelor of Science in Nursing Program. The study used a quantitative approach, using a descriptive, cross-sectional survey design. The participants were 408 undergraduate nursing students, both males and females, aged between 18-22 years, belonging to first, second, third or fourth year, and studying in various nursing colleges at Ernakulam district, Kerala, India. The participants were recruited using a convenience sampling method, after getting permission from the respective principals of nursing colleges. The participants were included if they were willing to participate in the study, if they were full-time regular students in a college of nursing, and if both parents were alive. The participants were excluded if they were having any psychological or emotional issues affecting academic performance, if the students were on any regular psychotherapy or counseling sessions, if they were under the care of guardians other than their parents, and if they were having only single parent.
The data were collected using a socio-demographic questionnaire, a parent pressure rating scale (PPRS), peer- influence rating scale (PIRS), and an academic performance assessment rating scale. A written consent was taken from all the participants, who agreed to participate in the study. The data collection was carried out from October 2023 to November 2023 in six selected private and self-financing nursing colleges.
Tools for data collection
The following tools were used in data collection:
Socio-demographic questionnaire: This is a semi-structured questionnaire consisting of a set of sixteen questions to assess the demographic characteristics of undergraduate nursing students which includes age, gender, year of study, marital status, religion, residence, type of family, number of siblings in the family, educational and occupational status of parents, family income, friend’s circle, type of study adopted and academic achievement of their friends. The reliability of the rating scale established through a test-retest method was α = 0.91. The content validity of the questionnaire, CVI, was 0.98.
Parent pressure rating scale (PPRS): This is a 30-item questionnaire developed by the researchers and rated on five-point Likert scale to assess parent pressure on academic performance of undergraduate nursing students (1= Never, 2= Rarely, 3= Sometimes, 4= Often, 5= Always). Nine of the questions were reverse scored (5= Never, 4= Rarely, 3= Sometimes, 2= Often, 1= Always). Total scores ranged from 30–150, with higher scores indicating higher parental pressure. The scores have been categorized as low (scores from 30-70); moderate (scores from 71-111); high (scores from 112-150). The content validity of the tool, CVI, was 0.8, which is satisfactory.
Peer-influence rating scale (PIRS): This is a 27-item tool developed by the researchers for assessing the peer-related factors on academic performance of undergraduate nursing students rated on a five-point Likert scale (1= Never, 2= Rarely, 3= Sometimes, 4= Often, 5= Always). Sixteen of the questions were reverse scored (5= Never, 4= Rarely, 3= Sometimes, 2= Often, 1= Always). Total scores ranged from 27–135 with higher scores indicate higher peer influence. The scores have been categorized as low (scores from 27-63), moderate (scores from 64-100) and high (scores from 101-135). The content validity of the tool, CVI, was 1, which is satisfactory.
Academic performance assessment rating scale: This is a 13-item researcher developed tool for assessing the academic performance of undergraduate nursing students. It is categorized into 3 sections as university examinations, theory and practical sessions including the model examinations, sessional exams, unit tests, topic presentations, projects, and assignments. Total scores ranged from 13-52, with higher score indicate excellent performance in academics. The scores have been categorized as excellent (scores from 43-52), good (scores from 33-42), average (scores from 23-32), below average (scores from 13-22). The content validity of the tool established through CVI was 1, which is satisfactory.
Data collection process
After obtaining formal permission from college authorities, the data collection was carried out at 6 selected nursing colleges during the month of October to early November 2023. All the participants were recruited after explaining the purpose of the study and the study procedure, and after obtaining the informed consent from them. Assuring the confidentiality of information, the investigators administered the questionnaires and rating scales to the nursing students during the class hours. Majority of the students were available during their class hours. The participants filled the tool and returned to the researchers after 20-30 minutes on the same day.
Data analysis
Data analysis was carried out using both descriptive and inferential statistics. Correlation between parental pressure and peer-related factors on academic performance were found by Karl Pearson coefficient, and the association between sociodemographic variables and parental pressure and peer-related factors were analyzed using Chi-Square test.
Table 1
Socio-demographic characteristics of the participants
Table 2
Selected family and social characteristics of the participants
Results
Demographic characteristics of the participants
The details of the sample characteristics are given in Table 1.
A total of 408 nursing students participated in the survey. A majority of them (n = 133, 32.59%) were 21 years of age, females (n = 403, 98.77%), third years (n = 120, 29.41%), single (n = 406, 99.51%), Christians (n = 292, 71.57%), and hostellers (n= 364, 89.22%). A majority of them belonged to a nuclear family (n = 379, 93%). With regard to the birth order, a majority of them were elder children in their families (n= 185, 45.34%). A majority of the students had ≤ 2 siblings in their families (n = 392, 96.08%), and the remaining students had more than two siblings (n = 16, 3.92%).
The selected family and social characteristics of the participants is shown in Table 2.
The educational status of the participants parents showed that a majority of the participants’ father had a secondary education (n = 160, 39.22%), and mother were graduates (n = 189, 46.32%).
With regard to the parents’ occupation, a majority of the participants’ father were having a private job (n = 379, 92.89), mothers were mostly unemployed (n = 289, 70.83%), and the family income was ≤ Rs. 50,000 per annum. A majority of the participants reported to have a close friend’s circle (n = 245, 60.05%), did individual study rather than combined study (n = 251 vs. n = 157, 61.52% vs. 38.48), and also had friends with moderate academic achievement (n = 312, 76.47%).
Parental pressure on the academic performance of undergraduate nursing students
The parental pressure on participants’ academic performance is as follows: A majority of the nursing students (n = 324, 79.41%) reported a low parental pressure on their academic performance, and 20.59 % (n= 84) reported moderate parental pressure. None of them reported a high parental pressure on their academic performance.
Peer-related factors on academic performance of undergraduate nursing students
The peer-related factors on academic performance of undergraduate nursing students are as follows: A majority of the participants (n= 273, 66.91%) reported that they had a low peer-pressure on their academic performance, whereas 32.59% (n= 133) reported that they experienced moderate peer-pressure on their academic performance, and two of them (0.49%) reported a high parental pressure on their academic performance.
Academic performance of undergraduate nursing students
The academic performance of the participants based on various assessments such as practical examinations, model exams, sessional exams, unit tests, topic presentations and assignments are as follows: a majority of students (n = 241, 59%) had a good academic performance, 31.13% of them (n = 127) had an average performance, 9.08% (n = 37) had shown an excellent performance, and 0.73% (n = 3) had shown a below average performance on their academics.
The relationship between parent pressure and peer-related factors on academic performance
Parental pressure and academic performance: There was a highly significant, weak negative correlation between parental pressure and academic performance of undergraduate nursing students (r = -0.156, p = 0.002), which showed that when the parental pressure increases, the academic performance of the participant decreases.
Peer-related factors and academic performance: There was a highly significant, weak negative correlation between peer-related factors and academic performance of undergraduate nursing students (r = -0.151, p =0.002), which denoted that when the peer-related factors increase, the academic performance decreases.
The association of socio-demographic variables with parental pressure, and peer-related factors among the participants
Parental pressure was significantly associated with birth order of the participants (χ2= 9.440, p = 0.024), and father’s occupation (χ2= 5.743, p = 0.017). The study type of the participants had shown a highly significant association with parental pressure (χ2= 8.120, p = 0.004).
There was a highly significant association of peer-related factors with year of study (χ2= 22.387, p = 0.001), and type of family (χ2= 219.08, p = 0.000), whereas a significant association was obtained with residential status (χ2= 8.734, p = 0.013) of the participants.
No associations of parental pressure with year of study, religion, residential status, and type of family of the participants was observed (all p ≥ 0.05). Similarly, peer-related factors did not demonstrate any association with birth order of the participants, father’s occupation, and the study type of the participants (p ≥ 0.05). Both parental pressure and peer-related factors did not demonstrate any associations with age, gender, number of siblings, father and mother education, mother’s occupation, family income or friend’s circle of the participants (all p ≥ 0.05).
Discussion
The present study was conducted to assess the impact of parental pressure and peer-related factors affecting the academic performance of undergraduate nursing students in selected colleges of Kerala. Many of the present study results supported other studies carried out in different parts of the country and world, with consistent results indicating an association of parental pressure and peer-related factors with academic performance. The findings of the present study are discussed with reference to the related literature and in relation with other supportive studies carried out by researchers in different settings.
In the current study, 79.41% and 66.91% of the participants had reported a low parent pressure and low peer-related factor, and about 20.59% and 32.59% reported a moderate parental and peer-related factor affecting their academic performance respectively. This was in contrast to the study conducted by Patel et al., 13 among nursing students in which both parental and peer pressure had an average intensity for more than half of the participants, and nearly 39% had reported a high intensity of parental and peer pressure.
The relationship of parental pressure and peer-related factors on academic performance reported in the present study was almost consistent with many other studies carried out across the globe. A highly significant weak negative correlation was observed between parental pressure and peer-related factors with academic performance in the current study. Perceived parental pressure significantly affecting the academic performance of the students is reported in studies carried out by Mandal in West Bengal, 14 Sarma, 15 Okedion in Nigeria, 16 Nagpal, 17 etc. Similarly, a highly significant negative relationship between peer pressure affecting academic performance is reported by Mandal, 14 Okedion, 16 Fadare, 18 Khan, 19 etc. In contrast, a study conducted in South Africa reported that parental involvement is a good predictor for better academic performance. 8 A study carried out in Maharashtra among B.Sc. Nursing students reported a higher impact of parental pressure in comparison with peer influence on their academic performance. 2
In the present study, a significant association of parental pressure with participants’ study type, birth order in the family, and father’s occupation was observed, whereas age, gender, number of siblings, father and mother education, mother’s occupation, family income or friend’s circle did not show any significant association with parental pressure. Few studies have examined the influence of socio-demographic variables of the participants with parental pressure. In a study conducted by Damayanthi in Sri Lanka among nursing students, 3 a high expectation from the parents had been reported as the most stressful factor among third- and fourth-year nursing students. A significant gender difference in parental pressure was reported in another study, in which parental pressure was reportedly higher among female students than among male students. 2 In contrast, in a study carried out in Islamabad, Pakistan, a significant positive relationship between parent pressure in academic achievement among female students is reported.10
Regarding the association of peer-related factors with sociodemographic variables, the present study results demonstrated a significant association of the participants’ year of study, type of family, and the residential status with peer influence, whereas birth order of the participants, number of siblings, parents’ educational status, family income or friend’s circle did not show any association with peer-related factors. In a study carried out in Maharashtra, India, the peer-related factors did not show any difference with factors such as gender, age, socioeconomic status, and number of siblings.2
To conclude, various research studies has demonstrated a striking influence of parent pressure and peer-related factors in academic performance of undergraduate nursing students, whereas the influence of sociodemographic variables with parental pressure and peer-related factors are varied in studies. There is a paucity of studies when it came to reporting the results of parental and peer-related factors with academic performance, as mostly the studies were carried out among school students rather than professional students, and were not much available for comparison.
Strength and limitations of the study
The study addressed an important issue among professional students, especially nursing students, whose parents and peers have a significant influence over their academic performance. The major limitation of the study was that we did not use random sampling to collect data from the participants. There was also an underrepresentation of male nursing students in this study, and also nursing students from Government nursing colleges, whose parents and peers can have a different type of influence on academic performance. However, this study can be viewed as an attempt to explore the significant factors affecting academic performance of undergraduate nursing students.
Conclusion
The study assessed the impact of parental pressure and peer-related factors on nursing students’ academic performance. The results suggested that there is a significant negative influence of both parental and peer-related factors on academic performance of adolescents. This gives an insight to adopt measures to improve the relationship of parents and to support the students in their academics, and also to increase the awareness of peer-related factors in academics to be utilized in a constructive way in order to set limits so that the academic performance is not compromised. Future studies can explore in detail the factors which could positively and negatively influence the nursing students’ academic performance, and also to see the change of these factors over the years, through a longitudinal study.
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