The Effectiveness of Self-Esteem Enhancement Program Among Adolescence in Selected Nursing College, Wayanad

Introduction

Adolescence marks a transformative phase in human development, characterized by profound physical, emotional, and psychological transitions. Central to this developmental stage is the formation of self-esteem, a fundamental aspect that influences individuals' well being and behavior patterns.¹ However, adolescents often face challenges related to self-esteem, which can manifest in various adverse outcomes, such as academic underperformance, substance abuse, depression, and risky behaviors.² This critical juncture underscores the significance of interventions aimed at bolstering self-esteem, particularly among vulnerable populations such as nursing students.

In the context of undergraduate nursing students whose professional responsibilities demand robust self-confidence and resilience, the exploration of self-esteem becomes particularly pertinent.³ Nursing education serves as a critical phase in the transition to professional practice, where self-esteem can influence students' adaptability, competence, and satisfaction with their chosen career paths. Moreover, as future healthcare providers, nursing students not only need to possess clinical skills, but also interpersonal competencies, such as effective communication and empathy, which are closely intertwined with self-esteem. Therefore, investigating self-esteem levels among undergraduate nursing students and evaluating interventions to enhance their self-esteem have significant implications for both personal development and professional preparedness.

A targeted self-esteem enhancement program tailored to the unique challenges and demands of nursing education could offer invaluable support to students in this critical phase of development.⁴ By fostering resilience, self confidence, and a positive self-concept, such a program has the potential to enhance students' ability to cope with stress, navigate professional challenges, and ultimately thrive in their nursing careers.

This study aimed to assess adolescent self-esteem levels and to examine the effectiveness of a targeted self-esteem enhancement program among undergraduate nursing students. By employing a pre-experimental one-group pre-test, post-test design, the study sought to measure baseline self-esteem levels, implement a structured intervention, and evaluate its impact on participants' self-esteem post-intervention. The findings of this study are anticipated to contribute valuable insights into addressing low self-esteem in adolescent populations, particularly among nursing students, and to inform the design of tailored interventions to promote positive psychosocial development.

Self-esteem is a concept with a fairly long research tradition, especially after Rosenberg published his seminal book in the mid-1960s, which also included a comprehensive scale for measuring the construct.⁵ Psychologists increasingly focused on this construct in their research. This steadily culminated in an annual number of more than 600 publications and over 26,000 citations by 2022 (in Web-of-Science using [“self-esteem” in title] as the search term), which is currently one of the most frequently studied concepts in psychology.

A large number of studies conducted in various cultures and populations support the significance of self-esteem in adolescence. Adolescents with high self-esteem always handle stress and frustration in more appropriate ways. Because late adolescence is a phase where there is pressure to start an independent social life and the number of environmental and social challenges that occur during this period, self-esteem helps individuals cope with these changes and to protect their mental health. In addition to other factors, self-esteem is directly related to personal well-being.⁶

Labrague et al., investigated stress and coping strategies among nursing students, highlighting the impact of self esteem on their ability to manage academic and clinical demands effectively. The authors emphasized the need for interventions targeting self-esteem enhancement to help students navigate the challenges of nursing education.⁷

Upon reviewing relevant journals and articles, the investigators identified low self-esteem as a prevalent issue among adolescents today, often associated with the adoption of negative behaviors and habits. This recognition prompted the investigators to initiate this study, which also contributed to fulfilling the departmental research objectives. Consequently, the investigators selected the study to address this important societal concern.

Objectives

The objectives of this study were to evaluate the self esteem levels among adolescents, assess the effectiveness of a self-esteem enhancement program in improving their self-esteem, and analyze the association between pre-test self-esteem levels and selected demographic variables of the students and their parents.

The hypotheses of the study are as follows:

H1: There is a significant difference between the pre-test and post-test self-esteem scores among adolescents.

H2: There is a significant association between Pretest knowledge scores and the selected demographic variables.

Materials And Methods

Inclusion criteria

Students willing to participate in the study were available at the time of data collection.

Exclusion criteria

First year B.Sc nursing students who are above 19 years.

Study design

The independent variable in this study is the selfesteem enhancement program, while the dependent variable is self-esteem, as measured before and after the intervention.

Participants - The sample comprised first-year undergraduate nursing students from a selected nursing college. Wayanad.

Sampling - selected using a non-probability convenient sampling technique

Sample size - 75 undergraduate nursing students

Data collection tools:

1. Demographic variables profile of students,

2. Demographic variables profiles of parents, and

3. The Rosenberg Self-Esteem Scale is a 10-item scale that measures global self-worth by assessing both positive and negative feelings about the self. The scale is considered unidimensional, with responses provided on a 4-point Likert scale ranging from strongly agree to strongly disagree.⁸ Method of data collection: For data collection, a self-administered method was used, with researchers providing clarification to participants regarding any questions or doubts they had to maintain data quality. The pre-test phase involved the administration of demographic questionnaires and the Rosenberg Self Esteem Scale.

Following this, a five-day self-esteem enhancement program was conducted, incorporating various activities, such as:

1. Day-1: PowerPoint presentations: Participants attended interactive presentations focused on understanding the concept of self-esteem, its importance in personal and professional development, and practical strategies to enhance it. 
2. Day-2: Progressive muscle relaxation. Progressive muscle relaxation sessions were conducted to help participants alleviate stress, anxiety, and tension and promote a sense of calmness and relaxation.
3. Day-3: Role play exercises: Participants engaged in role-playing exercises aimed at improving their perceptions of physical appearance and self-image. These activities encouraged participants to challenge their negative self-beliefs and develop more positive self-perceptions.
4. Day-4: Quizzes and intellectual challenges are incorporated to stimulate cognitive engagement and promote a sense of accomplishment. By challenging participants' negative self-beliefs and showcasing their intellectual abilities, these activities aimed to boost their self-confidence and self-esteem.
5. Day-5: Group Discussions: provided a platform for participants to share their experiences, challenges, and strategies for building self-confidence. This collaborative approach fosters a supportive environment and encourages peer learning and support.
6. Each day: Dance session. A 30-minute dance session each day aimed at enhancing happiness and promoting positive emotions.

The self-esteem enhancement program was designed to address the specific needs of undergraduate nursing students, recognizing the critical role self-esteem plays in their academic success and professional development. This program aimed to provide participants with practical tools and strategies to enhance their self-worth, confidence, and resilience. It incorporates a variety of activities tailored to promote a positive self-concept and psychosocial well-being.

On the fifth day, a post-test assessment was conducted using the Rosenberg Self-Esteem Scale to evaluate the program’s effectiveness. Throughout these activities, the researchers aimed to maintain objectivity and ensure fairness in the treatment of all participants, avoiding potential biases or prejudices in the research process. Additionally, the program was designed and implemented in collaboration with experts in psychology and nursing education to ensure its relevance and effectiveness in addressing self-esteem among nursing students

Ethical clearance was obtained from the Institutional Ethical Committee, Institutional Research Committee, and the Nursing College Authority and informed consent was secured from first-year B.Sc. Nursing students.

Results

Table 1 revealed that the majority of adolescents 34 (45.3%) belong to 19 years of age. Considering the sex majority 56(74.7%) were female, about religion majority 28(37%) were Muslim. Regarding place of living majority 60(80%) belong to a hostel and the medium of study in schooling majority 70(93%) was English medium.

Table 2 shows that only 1(1.3%) of the students are living with single parents and majority of parents were earning above Rs.15001.

Figure 1 The data reveals that 22 participants, comprising 29.3% of the sample, scored below 15 on the scale, indicating low self-esteem. A larger proportion of participants, 36 individuals representing 48% of the sample, fell within the moderate self-esteem range, scoring between 15 and 20 on the scale. Conversely, 17 participants, accounting for 22.6% of the sample, scored 21 and above, indicating high self-esteem levels

Analysis of the data revealed that eight participants, constituting 10.6% of the sample, scored below 15 on the scale, indicating low self-esteem. A large proportion of participants (29 individuals or 38.6% of the sample) fell within the moderate self-esteem range, scoring between 15 and 20 on the scale. Conversely, the majority of participants, comprising 38 individuals (50.6% of the sample), scored 21 and above, signifying high levels of self-esteem.

Table 4 shows that mean and SD of self-esteem in pre test was 17.39 ± 3.67 and in post-test was 20.42 ± 4.40 and calculated “t” value of 4.670,which had statistically significant difference at P<0.001 level which clearly showed that there was a significant improvement in selfesteem after self-esteem enhancement program among adolescents. Hence the research hypothesis H1was accepted.

Table 5 reveals that only education of father had a high significant influence on self-esteem among adolescents, the remaining variables i.e. gender, religion, place of living, medium of study in schooling, type of parenthood, education of father, education of mother, family income has no any significant association with pre-test selfesteem score.

Discussion

Of the 75 participants in the present study, 22 (29.3%) had low self-esteem. This finding aligns with a similar study conducted by Jindal et al., which focused on assessing the effectiveness of a Self-Enhancement Program among undergraduate nursing students, reported that out of 87 nursing students, 30 (34.50%) were identified as having low self-esteem.⁹

This consistency in the findings underscores the prevalence of low self-esteem among nursing students, highlighting the importance of interventions aimed at addressing this issue. The effectiveness of the self-esteem enhancement program implemented in the present study is evident in a significant proportion of participants experiencing post-intervention improvements in their self-esteem levels. By employing a multifaceted approach that included presentations, relaxation techniques, role-plays, quizzes, group discussions, and dance sessions, the program provided participants with tools and strategies to enhance their self-worth and confidence.

Furthermore, the findings of this study contribute to the growing body of evidence supporting the effectiveness of targeted interventions for improving self-esteem among nursing students. By addressing low self-esteem, these interventions have the potential to positively impact various aspects of students' academic performance, professional competence, and overall wellbeing. Continued research and evaluation of such interventions are essential to inform the development of evidencebased practices aimed at promoting positive self-concept and psychosocial development among nursing students and other adolescent populations.

Limitations of the study

The data collection period was constrained by limited time. The sample was exclusively drawn from Dr. Moopen's Nursing College, restricting the generalizability of the findings. Additionally, the study was confined to 75 participants and focused solely on undergraduate nursing students who met the inclusion criteria.

Recommendation for further research

These include conducting similar studies in different settings to explore variations across contexts. Comparative studies can be carried out to examine differences in outcomes between General Nursing and Midwifery (GNM) students and B.Sc. Nursing students. Additionally, comparisons among various nursing colleges could provide valuable insights. Future studies should also consider using larger sample sizes to enhance the generalizability of the findings.

Implications

Psychiatric Nursing

Psychiatric nursing represents a diverse field that extends beyond the theoretical and clinical aspects of nursing students and plays a pivotal role in their overall personality development. This study aimed to support nursing students experiencing low self-esteem by facilitating improvements in their self-esteem, ultimately boosting their confidence in both academic and personal growth.

Psychiatric Nursing Policies

This study underscores the importance of enhancing the self-esteem of undergraduate nursing students. Recognizing the pressing need for self-enhancement programs to foster a sense of self-worth and confidence among nursing students, it advocates the regular implementation of such programs in every nursing college to benefit all students.

Psychiatric Nursing Research

Nurse researchers should focus on identifying and addressing existing healthcare challenges. Emphasizing evidence-based nursing, there is a clear need for further research on various health care issues. This study places a particular emphasis on areas that have been overlooked or not yet identified as significant problems. The self enhancement program was designed to help nursing students develop a sense of self-respect, self-love, and personal value.

Conclusion

The study concluded that there was a significant increase in self-esteem among participants who exhibited high self-esteem after the introduction of the Self-esteem Enhancement Program for Nursing Students. Statistical analysis revealed notable changes in the mean and standard deviation of self-esteem scores, with a pre test mean of 17.39 ± 3.67 and a post-test mean of 20.42 ± 4.40. The calculated "t" value of 4.670 indicated a statistically significant difference at the P < 0.001 level, underscoring the effectiveness of the intervention in enhancing self-esteem among adolescents. These findings align with H1, which posits that the self-esteem enhancement program would lead to improvements in self-esteem levels among nursing students; thus, the hypothesis was accepted. The results highlight the transformative impact of the Self-esteem Enhancement Program, demonstrating its efficacy in fostering a positive self-concept and psychosocial development among nursing students.

In conclusion, the findings of this study underscore the importance of addressing low self-esteem among nursing students and highlight the value of targeted interventions such as the Self-esteem Enhancement Program in promoting positive self-concept and psychosocial well being. By empowering adolescents to cultivate healthy self-esteem, these interventions play a crucial role in facilitating personal growth, academic success, and professional development among nursing students and beyond.

Source of Funding

Nil

Conflict of Interest

None

Acknowledgement

We would like to extend our sincere gratitude to Dr. Moopen's Nursing College for their invaluable support and cooperation throughout this research. Their commitment to fostering excellence in nursing education and their willingness to facilitate this study have been instrumental in their successful completion. We are deeply grateful for the resources, facilities, and expertise provided by Dr. Moopen's Nursing College, which significantly contributed to the quality and rigor of our study. This work would not have been possible without their unwavering dedication to advancing the field of nursing education. We acknowledge Dr. Moopen's Nursing College for their heartfelt appreciation of their ongoing partnership and commitment to excellence.

Conflicts of Interest

Nil