Increased Stress Levels Among College Students: How Nurse Educators Can Be Effective through Utilization of the ETS Method
- bridge1065
- Mar 26
- 3 min read
Bridgette Bryan, DNP, MS, RN
An increase in stress, anxiety, and depression is clearly identified in research for Generation Z (Gen Z). The 2020 Stress in America report specifically identified education as being a significant source of stress for Gen Z (APA, 2020), and stress continued to increase post pandemic (APA, 2023). A 2023 Gallup survey revealed 47% of Gen Z feels anxious and 22% feel depressed. Generation Alpha will begin college in approximately 6 years and are being diagnosed with anxiety and depression as early as 3 years of age (CDC, 2018-2019). Research has revealed clear and consistent findings leading to an undeniable need for solutions.
The ETS method can be used in real time and begins with understanding two pillars of emotional intelligence (EI). Self-awareness is the first pillar and includes being aware of one’s emotions, feelings, moods, and the impact on others. The second pillar of EI encompasses the ability to manage one’s behavior and reactions to feelings and emotions, also referred to as self-regulation. Emotional intelligence is strengthened through the ETS method by increasing self-awareness and self-regulation and can be utilized when nursing students experience intense negative emotions.
ETS Method:
E – Name the Emotion.
Ask the student to state or describe the negative emotion being experienced to increase self-awareness. I feel _______________ (angry, sad, anxious, frustrated, ashamed, guilty, helpless).
T – Consider a Trigger.
Ask the student to consider an emotional trigger to deepen self-awareness. A trigger is defined as a stimulus that elicits an intense emotional response that can be related to past experiences or trauma. The stimulus can be a memory, event, person, object, or situation.
S – Identify a Solution.
To begin self-regulation, assist the student with identifying a “Ten to Win” solution:
Take ten deep breaths. This provides a pause with improved oxygenation which assists with processing through negative emotion.
Drink ten ounces of water. An additional pause adds time for processing and reflection to further decrease negative emotion.
Take ten minutes to decompress. If negative emotion remains heightened, additional time may be needed to complete self-regulation.
ETS Scenario:
The clinical instructor is approached by a student who is crying after leaving a client room.
E: The clinical instructor asked the student to describe what she was feeling, and the student responded, “I am so angry. My client’s partner just raised his voice and told my client he was done taking care of her and was leaving to see an attorney and file for divorce.”
T: The clinical instructor states, “Your client is experiencing a difficult situation, and I understand this is difficult for you to witness as well. I noticed you were crying as you were walking towards me. Does this situation serve as a trigger in any way?” The student began nodding her head and revealed her dad divorced her mom after she was diagnosed with cancer a year ago.
S: The clinical instructor empathically listened and acknowledged the student’s feelings and then encouraged the student to take ten deep breaths as she stood with her. Then the clinical instructor asked the student to join her while walking to the nursing lounge to get a cup of water. After finishing the water, the student thanked her clinical instructor for listening and understanding and returned to caring for her assigned clients.
ETS can be utilized in real time by nurse educators to effectively assist students with self-awareness and self-regulation ultimately increasing emotional intelligence. If mental health concerns are identified, mental health service options should also be discussed with the student. The mental health hotline is 866-903-3787 and resources by state can be found at https://mentalhealthhotline.org/
For additional information, please visit:
Stress in America (2020). American Psychological Association. https://www.apa.org/news/press/releases/stress/2020/sia-mental-health-crisis.pdf
Data and Statistics on Children’s Mental Health. (2018-2019). CDC.
Stress in America (2023). American Psychological Association.
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March 26, 2025