English Self-Care Theory

Social Work Student Self-Care and Academic Stress Marissa O’Neill , Greta Yoder Slater , and Deric Batt

ABSTRACT The purpose of the present study was to investigate the relationship between self-care and academic stress in the hope that training social work students to practice self-care will start them on the right path to academic success and career longevity. The study surveyed 90 BASW and MSW students using the Academic Stress Scale. Students who practiced daily self-care had lower academic stress. In addition, with each year of progression through the program, students experienced minimally less academic stress. The type of self-care practiced was not a factor. Social work programs can be encouraged to teach self-care. Self-care theory and domains are also reviewed. More studies are needed to examine other factors that might reduce academic stress.

ARTICLE HISTORY Accepted: September 2017

Social work, by definition, is a profession dedicated to serving others. Although social workers occupy a wide variety of positions, fields of practice, and areas of expertise, they share a common ethical mandate to work compassionately with the most vulnerable people in communities. Often this work comes at a heavy price for social workers and their families. While serving others— especially clients who have experienced complex trauma and those with problems involving multiple systems—social workers can become overworked and fatigued personally and professionally. Job stress can include large caseloads, low pay, lack of advancement opportunities, and unclear job roles (Thomas, Kohli, & Choi, 2014). Emotional stress on the job can include secondary trauma from hearing about a client’s loss, abuse, poverty, family violence, medical burdens, neglect, and addiction. Over time, secondary trauma can lead to burnout causing exhaustion, depersonalization, and inefficacy (Maslach, Schaufeli, & Leiter, 2001). This fatigue sometimes leads social workers to change professions or to find work that is less emotionally demanding (Oser, Biebel, Pullen, & Harp, 2013)

There are ways of decreasing the risk for burnout in the helping professions. Practices such as coworker support, clinical supervision, and attending personal counseling sessions as needed are noted to help decrease the risk of burnout (Oser et al., 2013). Self-care is another practice that has some promising results for reducing the risk of burnout. The purpose of the present study was to investigate the relationship between self-care and academic stress in the hope that training social work students will start them on the right path to career longevity. We wanted to incorporate self- care at the ground level with students who are learning how to practice. Our rationale was simple: Teach students about self-care from the beginning and the likelihood that they will maintain this practice and avoid burnout will increase. In the following sections we discuss the current literature on self-care, social work burnout, and academic stress.

Literature review

Theoretical background

Although many scholars have investigated the impact of trauma on clients, fewer have explored the theoretical relationship of trauma on the helpers who experience trauma through their empathic

CONTACT Marissa O’Neill [email protected] Humboldt State University, 1 Harpst Street, Arcata, CA 95521. © 2019 Council on Social Work Education

JOURNAL OF SOCIAL WORK EDUCATION 2019, VOL. 55, NO. 1, 141–152 https://doi.org/10.1080/10437797.2018.1491359

relationship with traumatized clients (Sansbury, Graves, & Scott, 2015). In the past 2 decades, more attention has been paid to the theoretical relationship between workers and the trauma they experience from their clients. Often the terms vicarious trauma, secondary traumatic stress, compas- sion fatigue, and burnout are used interchangeably, but this is not quite accurate. Secondary traumatic stress (STS) refers to shorter-term symptoms experienced by a helper similar to posttrau- matic stress disorder, but the emotional crisis is because of the interaction with trauma survivors not the trauma itself. It includes physical characteristics such as sleep problems (reexperiencing the trauma), emotional aspects (avoidance and numbing), and behavioral aspects (burnout) (Figley, 1993; Sabin-Farrell & Turpin, 2003). STS was renamed compassion fatigue to reduce some of the negative connotations associated with the STS label (Sansbury et al., 2015).

Pearlman (1995) used the term vicarious trauma (VT) to describe the longer term changes that happen for a helper who engages deeply with a traumatized client. VT includes altered memory, changes in cognition, increased feelings of vulnerability, reduced self-awareness, and sometimes increased defensiveness (Sansbury et al., 2015). The constructivist self-development theory came from the VT research. This approach sees human beings as actively constructing their own personal realities (McCann & Pearlman, 1990). Five aspects of the personality are affected by trauma: frame of reference, self-capacities, go resources, psychological needs and related cognitive schemas, and memory and perception (Jankoski, 2010). Jankoski (2010) explored constructivist self-development theory as it relates to child welfare workers, and she found that the organization, clients, and the worker’s own experiences contributed to VT. Cohen and Collens (2013) expanded the idea of VT to include positive ways helpers grow from vicariously experiencing client trauma. This body of research is called vicarious posttraumatic growth, and it fits well with the strengths perspective used in social work. Cohen and Collens found that coping, organizational support, informal support, self-care, optimism, spirituality, and separation between work and personal life were directly related to decreased stress in their metasynthesis of studies on VT and vicarious posttraumatic growth (Cohen & Collens, 2013).

VT can lead to burnout, another important theoretical construct for self-care. Early research on burnout has focused on the psychological aspects of the person who was experiencing the stress or the organizational elements causing burnout. Burnout has been studied extensively by Freudenberger (1974, 1975) and Maslach (1976, 1982). The multidimensional theory of burnout was developed by Maslach (1982, 1998), and it includes a person-in-environment framework. Although called a variety of other names over the years, burnout includes three primary dimensions: exhaustion, cynicism, and decline in professional efficacy (Maslach & Jackson, 1996). The important personal elements for burnout include health, self-understanding, coping, changing work patterns, and social support. Workload, control, reward, community, fairness, and values are important for understanding the relationship between organizational culture and burnout (Maslach et al., 2001). The organizational culture also includes incivility, unresolved conflict, lack of trust, and relationships between and among workers and supervisors (Maslach, 1993). Ultimately, the point of understand- ing burnout is to work to prevent it from happening. One of the tools for preventing burnout is self- care.

Many researchers stress the importance of self-care practices (Kim, Ji, & Kao, 2011; Shannon, Simmelink-McCleary, Hyojin, Becher, & Crook-Lyon, 2014), but few are focused on the develop- ment of a comprehensive self-care theory. Nursing has been at the forefront of developing a theory of self-care for patients, with nurses helping patients develop these skills. Orem’s (1971, 2001) self- care deficit nursing theory focused on making distinctions between the recovery model, in which patients have hope and are active participants in their own healing, and the traditional medical model, which focuses on evaluation of disease and disease processes and prescription of treatments. Agency is key for self-care theory and self-efficacy theory. Bandura (2000) summarizes the relation- ship between agency and efficacy in the following:

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Among the mechanisms of human agency, none is more focal or pervading than the belief of personal efficacy. This core belief is the foundation of human agency. Unless people believe that they can produce desired effects and forestall undesired ones by their actions, they have little incentive to act. (p. 75)

Self-care happens when people believe they can produce desired results and choose from a variety of options, develop a plan, demonstrate motivation to take care of themselves, and persevere through setbacks. Self-efficacy and personal agency lead to good self-care in multiple areas.

Self-care research

Because in part of the lack of consistency in what constitutes self-care, the body of research on self- care is largely fragmented and often includes one subarea (e.g., spiritual practice or exercise) with a variety of outcomes (reduction in burnout, suicide ideation, or academic stress). Sometimes self-care is an intervention, sometimes improved self-care is desired outcome. Common areas of self-care research include spiritual, physical, emotional, social, and professional domains. In the next section, we review some of the important research in each of these domains.

Spiritual self-care

White, Peters, and Schim (2011) use the following definition of spiritual self-care:

Spirituality is defined as the beliefs a person holds related to their subjective sense of existential connectedness including beliefs that reflect relationships with others, acknowledge a higher power, recognize an individual’s place in the world, and lead to spiritual practices. (p. 48)

There is little empirical research about spiritual self-care and the effects on academic stress. Dombo and Gray (2013) discussed how spirituality might be used as a tool to combat VT but did not include outcomes. Bloomquist, Wood, Freidmeyer-Trainor, and Kim (2016) included physical, psychologi- cal, emotional, spiritual, and professional self-care domains in their study of 787 clinical social workers’ self-care practices. They defined spiritual self-care as involving “nurturing connections and finding meaning in life” (p. 294). Examples of self-care included attending religious or spiritual events, praying, and meditation. Professional, spiritual, and emotional self-care were independent predictors of lower burnout, and professional and emotional self-care were independent predictors of greater compassion satisfaction among clinical social workers.

Khan, Hamdan, Ahmad, Mustaffa, and Mahalle (2016) examined a variety coping skills (including spiritual practice) on academic stress (as a mediator for suicide ideation). Among Malaysian and Asian college student participants (N=600), they found that coping strategies (including social support and praying and seeking the assistance of a spiritual leader or God) significantly reduced academic stress. Structural models provided further evidence that social support and coping (including spiritual practice) mediated the effect of academic stress on suicidal ideation (Khan et al., 2016). This contradicts the findings of King, Singh, Bernard, Merianos, and Vidourek (2012), who sampled 485 college students to find which self-care techniques were most helpful for stress management. Almost 65% of their sample responded that prayer was not helpful for reducing their stress, and 77.5% of students thought that meditation would not be helpful. They listed deep breathing, listening to music, exercising, and talking to someone as the most helpful (King et al., 2012). Although the literature on spiritual self-care has some conflicting findings, physical self-care has much stronger evidence for its use.

Physical self-care

Regular exercise has well-documented benefits for psychological and physical health outcomes among college students (deVries, van Hooff, Geurts, & Kompler, 2016; Myers & Roth, 1997). Regular exercise can help college students regulate mood (Chase & Hutchinson, 2015; Li, Xu, & Liu, 2014; Mailey et al., 2010), improve self-esteem (Li et al., 2014), combat fatigue (deVries

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et al., 2016), decrease academic stress (Slade & Kies, 2015), improve sleep (deVries et al., 2016), improve academic performance (Slade & Kies, 2015), and improve overall health (Chase & Hutchinson, 2015; Pedisic, Rakovac, Bennie, Jurakic, & Bauman, 2014). Slade and Kies (2015) evaluated the effects of exercise on academic performance using a sample of 408 first-year medical students in Illinois. Students who used the recreational facilities daily had significantly higher exam scores (8.3% higher) than those who used the facilities less than daily. Their statistical models showed that for every additional five visits to the recreation center in a 3- week period, the students could see a full percentage increase in their exam scores. In the competitive environment of medical school, this is not a trivial finding. Chase and Hutchinson (2015) compared aerobic and resistance exercise on mood (including stress level) among a small sample (N=20) of college students in New England. Using analysis of variance, they found that tension (stress) was significantly reduced after both types of exercise, and the effect for each was also significant. Resistance training had a slightly larger effect than aerobic exercise (d=1.10), but both were worthwhile for reducing stress and tension. Although this was a small sample (common for time-intensive exercise science trials), the results are encouraging for the effects of both kinds of physical self-care on stress. Although regular exercise is an inexpensive way to improve many areas of their lives, many college students exercise only sporadically and find there are many barriers to physical activity (Bray et al., 2011; Kwan & Faulkner, 2011; Myers & Roth, 1997; Slade & Kies, 2015). In a qualitative study of the barriers to implementing a daily exercise routine (physical self-care), Kwan and Faulkner (2011) found many different types of barriers among the 45 first-year students who participated. Commuting, motivation, competing demands for time, self-regulation, and social pressures were important barriers to adopting exercise behaviors. Exercise shows considerable promise as an intervention to improve many outcomes for college students psychologically and physically. The challenge may be in health promotion and helping college students see this form of self-care as important and barriers as less difficult.

Emotional self-care

Emotional self-care includes a wide variety of practices aimed at coping with stress and reducing emotional damage from trauma. In social work and other helping professions, it is sometimes difficult to separate one’s personal emotions from the traumatic experiences of clients. For clarity, we separated individual emotional regulation from work-related burnout and from secondary trauma. Emotional self-care often can take the form of creative arts expression. For example, Huss, Sarid, and Cwikel (2010) found that painting and using reflection was effective for reducing the effects of trauma among their sample of 22 female social workers from a war zone in Israel. Using this approach, participants reported connecting with their identity—despite the trauma—by allowing them to see themselves and the situation from a place outside their experience (Huss et al., 2010). These women expressed themselves and looked through the layers of their own creative expressions to find healing through art and creativity. Another study found that artistic pursuits allowed people to put their feelings and experiences into visual art forms, emphasizing the act of creation and expression more than the act of introspection (Newell & Nelson-Gardell, 2014). Focusing on several aspects of emotional regulation among 359 undergraduate social work students, Grant (2014) found significant inverse relationships between self-reflection (r=-0.26, p<0.01) and empathic reflection (r=-0.20, p<0.01). Grant encouraged further study of emotional regulation, emotional literacy, and empathy and the ways the social work curriculum develops these skills systematically in students.

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Social self-care

Social self-care involves spending time with friends, family, and significant others in a variety of ways. Social self-care can include lunch with friends, a phone call to a supportive family member, or going out with friends for the evening, among other things. By interacting with a social network, people receive support, encouragement, and opportunities for enjoyment. It has long been accepted that better social integration is associated with better health and mental health outcomes (Seeman, 1996; Turner & Brown, 2010) and has been associated with a reduction in stress (Moore, Bledsoe, Perry, & Robinson, 2011). Maintaining intimate personal relationships has also been found to be a factor in improving well-being for social workers (Graham & Shier, 2014). In addition, Manning- Jones, de Terte, and Stephens (2016) found that social support from friends and family reduced the risk of developing secondary trauma in health care professionals, including social workers. Wilks and Spivey (2010) used hierarchical regression models to investigate BSW students’ (N=145) social support and academic success on resilience. They found that friend support helped moderate the effects of academic support on resilience measures.

Professional self-care

There is no consensus across the helping professions about what constitutes professional self-care (Dorociak, Rupert, Bryant, & Zahniser, 2017). In the absence of consistent terms, research on professional self-care has focused on general categories of well-being (Baker, 2003; Carroll, Gilroy, & Murra, 1999), teaching the practice of professional self-care (Moore et al 2011; Newell & Nelson- Gardell, 2014) or career-sustaining behaviors (Kramen-Kahn & Hansen, 1998; Stevanovic & Rupert, 2004). In social work, Newell and Nelson-Gardell (2014) defined professional self-care as the use of “skills and strategies by social workers to maintain their own personal, familial, emotional, and spiritual needs while attending to the needs and demands of their clients” (p. 431), and Cox and Steiner (2013) identified self-awareness, self-regulation, and self-efficacy as key components of professional self-care. Although the National Association of Social Workers (NASW) has not identified self-care explicitly as an ethical mandate in its Code of Ethics, NASW has implicitly endorsed self-care through the NASW Press book on self-care (Cox & Steiner, 2013) and promotion of the book on the NASW website (NASW, n.d.). There are also some state chapters that endorse self-care through events (NASW Indiana, 2018; NASW New York State, 2014) and resources on their website (NASW of North Carolina, n.d.).

About three fourths of social workers experience burnout at some point in their careers (Kim et al., 2011). The level of trauma social workers feel—students and professionals—depends on the proximity, intensity, and duration of the difficulty (American Psychiatric Association, 2013; Meadors & Lamson, 2007). Many social work students report exposure to trauma during their field experi- ences, ranging from working with survivors of domestic violence, war, and terminal illness (Didham, Dromgole, Csiemik, Karley, & Hurley, 2011). Research has also found that social workers with the most traumatic cases might experience more extreme cases of burnout (Sansbury et al., 2015). With six times the rate of burnout, high-trauma workers may experience increased apathy, emotional fatigue, and vicarious traumatization. A social worker who is starting to experience burnout may develop anxiety, depression, high blood pressure, lower immunity to diseases, heart disease, stroke, and many other health issues (Kim et al., 2011; Moore et al., 2011; Sansbury et al., 2015).

Several studies on traumatic exposure in social workers suggest that various manners of self- reflection and self-expression are effective in helping social workers deal with trauma exposure. The research that does exist generally points to elevated levels of vicarious traumatization (Pearlman & MacIan, 1995), especially with social workers who lack experience (Adams & Riggs, 2008). This increases the urgency for students and newly professional social workers to develop appropriate self- care practices. Several social work researchers have found that self-care was one of the primary ways to prevent burnout (Bloomquist, Wood, Friedmeyer-Trainor, & Kim, 2016; Oser et al., 2013).

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Bloomquist et al. (2016) investigated the relationship in professional self-care, self-care perceptions, and professional quality of life among 786 clinical social workers from across the United States. Oser et al. (2013) used qualitative methods to investigate the causes, consequences, and prevention of burnout among 28 substance abuse counselors in Kentucky. They found that challenging clients, large caseloads, heavy paperwork, poor client care, coworker support, and clinical supervision were mentioned by urban and rural helpers as sources of burnout. Rural counselors mentioned low job prestige and office culture and politics as being responsible for burnout (these were not themes in urban workers), and urban workers mentioned changing roles and changing jobs as consequences of burnout. Urban and rural workers alike cited self-care as important for prevention. The self-care strategies mentioned included meditation, vacations, and coworker and supervisor support. It is essential for social workers to take the time to practice self-care and connect. Organizational factors, such as supervisor support, are also important and can help promote or discourage self-care.

Academic stress

Academic stress is caused when students are overwhelmed by the knowledge required and the feeling they do not have enough time to master the content. Academic stress tends to be higher during exams, when large assignments are due and when there is competition for rankings (Abouserie, 1994; Archer & Lamnin, 1985; Britton & Tesser, 1991; Kohn & Frazer, 1986; Misra & McKean, 2000). One study of 249 undergraduates from a midwestern university found gender differences in academic stress and time management (Misra & McKean, 2000). Females had more academic stress, despite having better time management practices. Higher anxiety (trait and state) and lower leisure activity satisfaction were found to offset the better time management practices that female partici- pants had over males in study by Misra and McKean (2000). They also found differences between upper-class students when compared to first- and second-year students. Freshman and sophomores had significantly more academic stress than their older colleagues. This was hypothesized to be because of less-developed social supports and coping mechanisms (Misra & McKean, 2000). Overall, the key predictors of academic stress in their model were anxiety, leisure activities, and time management.

International research on academic stress and learning has primarily focused on medical students. In a study of Korean nursing students, Kim (2016) found a small correlation between academic stress and learning. As academic stress increased, self-directed learning decreased. Medical students in Lithuania who were more vulnerable to academic stress had lower grades (Bunevicius, Juska, Buneviciene, & Kupcinskas, 2016). High school students with higher academic stress reported reduced self-concept (Sahu, Jha, & Pandey, 2016). In a study of university students in Mexico, academic stress, specifically class overload and class participation, was correlated with physical symptoms such as headaches, and digestive problems, and psychological symptoms such as anxiety (Pozos-Radillo, de Lourdes Preciado-Serrano, Campos, Acosta-Fernández, & de los Ángeles Aguilera, 2015). Finally, Hystad, Eid, Laberg, Johnsen, and Bartone (2009) also found academic stress was associated with poor health in a study of Scandinavian students.

With social work students, there is very little empirical research on academic stress and any of the activities that can help reduce stress. Papadiki, Katsouli, Tournikis, and Papadiki (2012) conducted a study with 191 undergraduate students in Athens and Crete. They evaluated where the specific demands were coming from in their course work (field placement, essays, course structure, time table to complete the course, and specific instructors) and other academic stress sources (e.g., commuting, family, part-time work, finances). Students identified field placements, being successful in the course, and essays as the top three most demanding academic stressors. Wilks and Spivey (2010) used a convenience sample of 145 BSW students to explore the relationships among social support, academic stress, and resilience. In their study, resilience was the outcome, not academic stress. Using hierarchical models, they found that friends’ support helped reduce academic stress’s moderating impact on resilience. BSW students with lowered academic stress were more resilient.

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Social work students are uniquely positioned to experience multiple stressors not only from academic and family sources but also because of the nature of the work and participation in a field internship. Reducing academic stress may increase social work student success, and investigat- ing ways to target academic stress through self-care is a needed area of research in social work.

Methods

Measures

The measure of self-care created for our study included demographic questions and questions on gender, ethnicity, age, degree program, employment, number of credits enrolled that semester, grade point average, and number of hours per week spent on academic work. Demographic questions included program level: “Which program are you enrolled in?” Answer categories were BASW junior, BASW senior, MSW foundation year, MSW concentration year, and MSW advanced stand- ing. MSW concentration year and MSW advanced standing were combined as they represented the same class. Responses with higher numbers indicated more advanced years in the social work program.

Participants were asked seven dichotomous (yes or no) questions about self-care planning and participation. Items included, “Have you created a self-care plan for yourself while in school?” and “Do you practice your self-care plan on a daily, weekly, or monthly basis?” Because we were interested in exploring group differences among participants who practiced self-care and those who did not, we asked more specific questions about the types of self-care they practiced including spiritual, physical, and social self-care. The spiritual item was measured with the question, “Does your plan include meditation or prayer?” The physical item was measured with the question, “Does your plan include exercise or physical activity?” and the social item was measured with the question, “Does your plan include socializing with other people?” We decided not to ask about professional self-care in this study, because our participants were students and not yet practicing in the field. The Academic Self-Care Scale is described in more detail in the next section.

The 35-item Academic Stress Scale (Kohn & Frazer, 1986) included questions about stress or worry in academic situations including final grades, classroom conditions, and excessive homework. Responses on a 5-point Likert scale ranged from 1=not at all to 5=extremely. A 5-point scale was chosen to be consistent with other scales that were in the survey but are not included in this article. The Academic Stress scale had high reliability (Cronbach’s alpha=.94). A total stress score was created using the average of participant responses to the all the 35 questions, with higher scores meaning more stress. Subscales were not used. The Academic Stress score was used as the dependent variable.

Participants

All BASW and MSW students at a rural state university were surveyed in 2012. The institutional review board at the university gave the study exempt status. Ninety students completed the survey. Most students were female (n=74, 82%), and half were Caucasian (n=51, 57%). Eighteen percent (n=16) were Latino or Latina, 7% (n=6) were African American or Black, and 4% (n=4) were Native American. About half were in the bachelor’s program (n=48, 53%). The mean age was 29 years, (SD=9.24), with a minimum age of 20 and a maximum of 55.

Procedures

The study was a cross-sectional survey research design using a convenience sampling. One professor for each cohort year was contacted to ask permission to distribute the survey during his or her class. During each class the study was explained, questions were answered, and the instrument was distributed. Those

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who chose not to participate were instructed to turn in an empty survey when surveys were collected so the professor and researcher did not know which students declined to participate. One hundred and two surveys were distributed in class, and the response rate was 88.24%.

Data analysis

Bivariate statistics analysis was performed with IBM SPSS (Version No. 23) software using indepen- dent samples t tests to determine if relationships existed between self-care variables and academic stress. A Spearman’s rho correlation was performed with program level and academic stress to determine if there was a relationship. Linear regressions were then performed with variables that had a statistically significant relationship to determine which factors predict academic stress. Only the academic stress score had missing data. Four people did not complete the scale, and during data analysis, those four cases were removed from analysis by the IBM SPSS software.

Results

Themean score for academic stress was 2.52 (SD=.74) with a range of 3.20, indicating amoderate amount of stress. Eighty-six percent (n=77) of students responded that they did have a self-care plan, and 14% (n=13) did not. Of those who did, only 28% (n=22) practiced self-care daily. Seventy-six percent (n=57) practiced self-care weekly, and 91% (n=71) practiced self-care monthly. Exercise or physical activity was the most common type of self-care (n=72, 91%), followed by socializing (n=65, 82%), and meditation or prayer (n=42, 54%).

When answering the question “What variables have a significant relationship with academic stress?” practicing daily self-care was the only statistically significant self-care variable. Students who practiced daily self-care had lower academic stress (M=2.04, SD=.55) than those who did not (M=2.70, SD=.72), t(47)=4.25, p<.001. Practicing weekly or monthly self-care was not statistically significant. The type of self-care—meditation, physical activity, and socializing—was not statistically significantly related to academic stress. See Table 1 for full t test results. There was also a statistically significant relationship between program level and academic stress, rho=-.284, p=.009; as a student progressed through each year in the social work program, academic stress decreased by .284.

The final regression model included the only two variables that had a significant relationship with academic stress: daily self-care practice and social work program level. The linear model accounted for 19% of the variance in academic stress, R2=.212, adjustedR2=.190. Themodel estimated from a sample of 75 was statistically significant, F(2,72)=9.69, p<.01. A power analysis using G* Power (Faul, Erdfelder, Bucher, & Lang, 2009), determined a sample of 75 to be ample for a model with two predictors.

Holding social work programs constant, predicted academic stress was reduced by .62 for those who practice daily self-care, b=-.62, t=-3.61, p<.01, 95% CI [-.960, -.276]. Holding daily self-care constant, predicted academic stress was reduced by .17 for each additional year in the social work program, b=-.17, t=-2.44, p=.02, 95% CI [-.313, 1.032].

Table 1. Comparison of mean academic stress scores, t tests.

M (SD)

Yes n No n 95% CI for Mean

Difference t p df Hedges’

g

Do you practice daily self-care? 2.04 (.55) 21 2.67 (.72) 67 [.291, .971] 3.695 <.001 86 .913 Do you practice weekly self-care? 2.43 (.68) 58 2.70 (.80) 30 [.056, .592] 1.64 .10 86 .370 Do you practice monthly self-care? 2.46 (.68) 70 2.74 (.90) 18 [-.102, .663] 1.46 .15 86 .381 Does your self-care include meditation or prayer?

2.48 (.79) 42 2.56 (.69) 46 [-.228, .396] .53 .60 86 .107

Does your self-care include exercise or physical activity?

2.48 (.70) 71 2.70 (.85) 17 [-.176, .609] 1.10 .28 86 .299

Does your self-care include socializing? 2.57 (.77) 63 2.46 (.63) 25 [-.432, .259] -.51 .62 86 -.149

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Discussion

Practicing self-care daily reduced academic stress in our sample. These findings are similar to those of others who have found self-care to reduce work-related stress (Newell & Nelson-Gardell, 2014; Oser et al., 2013; Shannon et al., 2014). Practicing self-care weekly or monthly did not have a relationship with academic stress. Neither had a bivariate relationship or ended up in the final model. The type of self-care practice was also not a factor and did not end up in the final model. In addition, as students’ progress through the program, they experience minimally less academic stress. More studies are needed to examine other factors that may also reduce academic stress for social work students.

There are gaps in self-care practices that can be addressed with future study. Much of the research on self-care focuses on creative, spiritual, or relational activities. Physical activities, such as exercise and improving nutrition are less common. Several studies have found recreational sports participa- tion to be highly effective in reducing stress and promoting physical and relational skills (Newell & Nelson-Gardell, 2014; Shannon et al., 2014). These services promote relationships and get people active, increasing their ability to express themselves and relate with others as well as improving their body’s physical ability to handle stress.

Limitations

The small sample size was a limitation of the study. Because only 90 students completed the study, regression statistics were limited to only two predictive variables to maintain statistical power. Future research should examine a larger sample so that more factors that might have an impact on academic stress can be examined. Using a random sample instead of a convenience sample and more than one university is suggested to increase generalizability. In addition, the study used a cross-sectional research design. Experimental design would increase internal validity.

Implications for social work

The findings suggest that social work faculty could encourage students to practice self-care to reduce academic stress. Self-care takes many shapes and forms. From using basic principles to deal with the routine stresses of social work practice to engaging in specialized practices to work through particularly traumatic experiences, self-care depends very much on where one is at the time. Ultimately, it is up to each person to develop his or her own evidence for what works, although asking for and finding help during especially difficult and traumatic times is wise and human. Effective self-care starts from within, and expressing and relieving the stresses that weigh one down are vital to being able to best serve the clients who most need our help. Social workers’ best tool to treating their clients is to effectively treat themselves first.

Notes on contributors

Dr. Marissa O’Neill, PhD, is Associate Professor and Chair at Humbolt State University, Arcata, California. Greta Yoder Slater, PhD, is Associate Professor and MSW Director at Ball State University, Muncie, Indiana. Deric Batt, BSW, is Supportive Care Specialist at Aspire Indiana, Muncie, Indiana.

ORCID

Marissa O’Neill http://orcid.org/0000-0003-1477-566X Greta Yoder Slater http://orcid.org/0000-0001-6851-468X

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