Nursing students' stress and coping strategies during clinical training in KSA

Stressors and coping styles of nursing students in the middle period of clinical practicum: a qualitative study

BACKGROUND

Nursing students encounter various stressors during their clinical practicum; however, the stressors are not the same during different periods. At present, studies on the stressors and coping styles of nursing students in the middle period of their clinical practicum are rare.

AIMS

The current study aimed to explore the stressors and coping styles of nursing students in the middle period of their clinical practicum.

METHODS

A qualitative study with a descriptive phenomenological method was conducted to collect data from 10 nursing students undergoing the middle period of their clinical practicum from December 2020 to February 2021. The data were collected by semistructured interviews using interview outlines prepared in advance. The data were analyzed by Colaizzi's analysis method.

RESULTS

The stressors experienced by nursing students in the middle period of their clinical practicum mainly included personal reasons, teaching arrangements, interpersonal relationships, occupational particularity and career planning. Additionally, nursing students coped with the stressors that they face in the clinical practicum by eliminating stressors and regulating emotions.

CONCLUSIONS

Nursing students experienced various stressors and used a variety of coping styles in the middle period of their clinical practicum, which was different from what occurred in the early and late periods. Targeted interventions should be formulated and implemented to relieve nursing students' stress and guide them to adopt effective coping styles.

The effect of a stress management program on first-year nursing students' clinical stress: A randomized controlled experimental study

BACKGROUND

Clinical clerkships lie at the core of nursing education and are crucial for developing professional skills. However, nursing students, especially freshmen, often encounter significant stress during their clinical experiences.

OBJECTIVES

This study investigated the effect of a stress management program on first-year nursing students' clinical stress levels.

DESIGN

This randomized controlled experimental study adopted a pretest-posttest-follow-up test research design.

SETTINGS AND PARTICIPANTS

Participants were recruited using simple randomization. The sample consisted of 64 first-year nursing students (intervention = 32; control = 32) from the nursing department of the faculty of health sciences of a university in Türkiye.

METHODS

Participants were randomized into intervention and control groups. The intervention group attended a stress management program, one weekly session for five weeks (intervention). The research was conducted between 21.02.2022 and 20.05.2022. Data were collected using a personal information form, the Perceived Stress Scale, the Physio-Psycho-Social Response Scale, and the Coping Behavior Inventory. The data were collected pretest and posttest the intervention and two months follow-up test. The data were analyzed using the two-way repeated measures analysis of variance (ANOVA).

RESULTS

The changes in the Perceived Stress Scale mean scores, group*time interaction, were statistically significant (p < 0.05). The results showed that the changes in the Coping Behavior Inventory "problem-solving" subscale mean scores, group*time interaction, were statistically significant (p < 0.05). The multiple comparisons showed a statistically significant difference in posttest Physio-Psycho-Social Response Scale "social behavioral symptoms" and "emotional symptoms" subscale scores between the intervention and control groups (p < 0.05). The multiple comparisons showed a statistically significant difference in posttest Coping Behavior Inventory "problem-solving" and "avoidance" subscale scores between the intervention and control groups (p < 0.05).

CONCLUSION

The stress management program helps first-year nursing students experience less stress and develop problem-solving skills before they perform clinical clerkships. It also allows them to suffer from fewer emotional and social behavioral symptoms and exhibit fewer avoidance behaviors.

Coping strategies and social support in nursing students during clinical practice: A scoping review

AIM

To identify the coping strategies and social support received by nursing students during clinical practice.

DESIGN

Scoping review.

METHODS

Primary studies on coping strategies and social support, in full text, in English, French, Spanish or Portuguese and published in 2018 or later were included. Search was carried out in January 2023 on EBSCOhost, PubMed, SciELO, ScienceDirect, OpenAIRE, MedNar Search, WorldWideScience and the references of previously selected articles.

RESULTS

A total of 24 studies were identified. Seven studies mentioned social support as a useful strategy and several instruments were identified that allow measurement.

CONCLUSIONS

Few studies establish a direct relationship between the effectiveness of coping strategies with stressful situations. Positive coping strategies are associated with effective stress management. The relationship between social support and stress reduction is scarcely addressed.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Stressful situations can have an impact on students' health and on the quality of care. Nursing schools and healthcare institutions must work together in programmes to improve students coping abilities.

IMPACT

This review addressed coping strategies used by nursing students during clinical practice. A set of relevant coping strategies were identified that can be used by teachers to improve students' outcomes.

REPORTING METHOD

The review was performed according to Preferred Reporting Items for Scoping Reviews (PRISMA-ScR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Associations among stressors, perceived stress, and psychological distress in nursing students: a mixed methods longitudinal study of a Hong Kong sample

Background

Nursing students are at risk for high-stress levels and psychological distress. Limited longitudinal studies have been conducted examining factors associated with stress levels and psychological distress of nursing students in their course of study.

Purpose

The purpose of this study was to examine the levels of stress and corresponding stressors, particularly those predicting psychological distress, among nursing students over their 5 years of study.

Methods

A longitudinal design, using questionnaires and focus group interviews of a single cohort of nursing students in Hong Kong and following them over their 5 years of training. The Stressors in Nursing Students Scale-Chinese version and the Chinese version of General Health Questionnaire-12 were used to assess stress levels and psychological distress, respectively.

Results

Ninety-seven participants completed the questionnaires 5 times. Quantitative findings revealed that the overall stress levels of the nursing students increased over 5 years (from mean = 3.08 to 3.33), with the highest levels in the second wave (mean = 3.33). Nursing students experienced higher stress during years 2 (p = 0.006) and 4 (p = 0.037). Psychological distress was the highest in year 3 (sum score = 18.47) (p = 0.002) but declined from year 4 (p < 0.001). Thematic analysis revealed that academic performance issues, coping challenges, unfavorable learning environments, relationships were identified as the stressors. However, nursing students also used positive coping strategies to pursue success and seek support.

Conclusion

This study suggests that the year of study is a significant predictor of stress levels among nursing students, especially during the first and senior years due to heavy academic workload. Psychological distress was observed among nursing students, and those who worked more part-time jobs tended to report higher levels of distress. The junior year was associated with higher levels of distress related to financial and time-related stress, while academic and personal problems were more prevalent during the senior year.

The relationship between perceived stress and emotional intelligence in Moroccan nursing students

BACKGROUND

Nursing students are subjected to many stressors during their clinical practicums. Emotional intelligence (EI) could act as a real stress regulator. In this perspective, we sought to study the relationship between stress and EI in a sample of Moroccan nursing students.

MATERIALS AND METHODS

This study was conducted using the descriptive correlational method. The statistical population consisted of the nursing students of the Higher Institute of Nursing Professions and Health Techniques of Tetouan in Morocco during the academic year 2021-2022. Among them, 146 participants were selected on the basis of simple random sampling. Participants completed a self-administered questionnaire addressing sociodemographic factors, perceived stress (the Perceived Stress in Clinical Practice Scale), and emotional intelligence (Wong and Law Emotional Intelligence Scale test). Descriptive statistics were used and Pearson's correlation coefficient was applied to assess the correlation between stress and EI, and to compare them according to socio-demographic characteristics. A linear regression analysis was calculated to analyze the effect of independent variables on perceived stress and EI. For the analysis, a level of 0.05 was chosen.

RESULTS

The overall mean age of the students was 20.02 ± 1.12 years. Participants had moderate levels of perceived stress (M = 2.42 ± 0.77) and high levels of EI (M = 3.79 ± 1.09). A significant positive correlation between perceived stress and EI was found (r = 0.741, P < 0,05). The regression model shows that EI, education level, and clinical practice setting can explain changes in perceived stress levels and are effective and significant factors (P < 0,001).

CONCLUSION

EI has been shown to be a protective factor against stress in nursing students. Those with well-developed EI have lower levels of stress. Therefore, it is suggested that a mindfulness-based training program be incorporated into the nursing curriculum to develop emotional skills and combat stress in students.

Strategies used by Iranian nursing students for adjusting to internship: a qualitative study

BACKGROUND

The internship setting is a highly challenging one for nursing students, and working in such an environment requires adjustment. Knowledge of the adjustment strategies used by students enhances the body of nursing knowledge and can help nursing officials adopt appropriate decisions to strengthen the students' effective adjustment skills and increase the benefits reaped from their internship. The present study was conducted to explore the strategies used by nursing students to adjust to internship.

METHODS

A total of 19 senior nursing interns (7 Female, and 12 Male) were selected by purposive sampling with maximum variation from one of the nursing and midwifery schools affiliated to a large metropolitan medical university in northern Iran. Data were collected using audio-taped semi-structured face-to-face interviews over an 18-month period and were carefully transcribed and analyzed using the Graneheim & Lundman qualitative conventional content analysis approach. The researchers analyzed the data in MAXQDA 10 software.

RESULTS

Four main categories and eight subcategories emerged from the data analysis. Main categories include efforts to achieve clinical competency, efforts to be sociable or accepted, self-management and reaction to conflicts.

CONCLUSION

All the participants attempted to attain adjustment by adopting strategies such as achieving clinical competence, trying to be sociable or accepted, self-management, and reaction to conflicts depending on the conditions of internship. Officials should help nursing students use effective strategies and achieve adjustment.

Satisfaction and anxiety level during clinical training among nursing students

BACKGROUND

Quality is a primary concern of health care agencies worldwide. A conducive clinical training environment is essential for nursing students to be capable of enhancing their learning experiences and achieving the desired training outcomes.

AIM

This study aimed to examine the satisfaction and anxiety levels during clinical training among nursing students.

TYPE OF STUDY

A descriptive -analytical cross-sectional study design was utilized. The research was conducted at the Faculty of Nursing, Assiut University and Colleges of Applied Medical Sciences in Alnamas and Bisha, University of Bisha. Sampling method: A convenience sampling technique was used.

SAMPLE SIZE

a sample of 1052 undergraduate nursing students. The data was gathered via a structured questionnaire including the socio-demographic characteristics and nursing students' satisfaction with the hospital and laboratory training. Additionally, Self-Rating Anxiety Scale (SAS) was adopted to measure the anxiety level.

RESULTS

The mean age of the studied sample was 21.9 ± 1.83 years, and 56.9% are females. Moreover, 90.1% & 76.4% of the nursing students were satisfied with their hospital and laboratory training. Furthermore, 61.1% & 54.8% of the students had mild levels of anxiety regarding their hospital training and laboratory training, respectively.

CONCLUSION

The undergraduate nursing students had a high level of satisfaction with their clinical training at the hospitals and laboratories. Moreover, they had mild anxiety related to hospital and laboratory clinical training.

RECOMMENDATIONS

Developing clinical orientation and training programs and improvement strategies to enhance the effectiveness of the clinical training environment. The establishment of a modern, tastefully designed, and fully stocked skill lab for the college's student training should receive more attention.

CLINICAL RELEVANCE

Through the provision of ongoing education about different method of practice, nursing was intended to shape future professional nurses who master core competencies of the profession. Organizations may benefit from developing a comprehensive strategy to achieve an effective teaching program.

Factors associated with perceived resilience among unergraduate nursing students: findings of the first cross-sectional study in Palestine

BACKGROUND

Resilience has emerged as a concept that could explain and predict good academic and well-being of students in stressful and traumatic situations. This study was conducted to assess resilience and identify predictors of high or low resilience scores among future nurses in Palestine.

METHODS

This cross-sectional study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology statement. Undergraduate nursing students in all academic years were recruited and asked to complete a questionnaire that contained the Trait Resilience Scale and the State-Resilience Scale. Multiple linear regression models were used to identify predictors of higher resilience scores and to control for potentially confounding factors.

RESULTS

In this study, 290 students completed the questionnaire (response rate = 92.4%). The means of trait, state, and combined resilience scores were 71.4 (SD: 7.5), 62.7 (SD: 6.7), and 134.1 (SD: 12.8), respectively. There was a significant moderate positive correlation between state resilience scores and trait resilience scores (r = 0.63, p < 0.001). Having a study routine on daily basis predicted higher trait (β = -0.20, p < 0.001), state (β = -0.12, p = 0.032), and combined (β = -0.18, p = 0.001) resilience scores. Trait and combined resilience scores were predicted by the absence of chronic diseases (β = 0.12, p < 0.05), experiencing addiction issues (β = -0.11, p < 0.05), living in Israeli seized areas (β = 0.16, p < 0.05), and living in a house with enough number of rooms per siblings (β = 0.13, p < 0.05). On the other hand, state and combined resilience scores were predicted by being in the first academic year (β = -0.18, p < 0.01), and state resilience scores were predicted by living in urban areas (β = -0.12, p < 0.05).

CONCLUSIONS

Undergraduate nursing students in Palestine reported relatively high trait and state resilience scores. Higher trait, state, and combined resilience scores were predicted by having a study routine on daily basis. More studies are still needed to investigate the relationship between resilience scores, perceived well-being, willingness to care, and the future success of nursing students in Palestine.

Relationship between Self-Esteem and Stress Coping Strategies among Internship Nursing Students

BACKGROUND: Self-esteem is an essential personality trait in nursing professionals and nursing students need to have a high self-esteem and effective coping strategies to be successful in their future career. AIM: This study aimed to assess the relationship between the level of self-esteem and the stress coping strategies, used by internship nursing students (intern-nurses), at the completion of their internship training. METHODS: A descriptive correlational cross-sectional design was used to measure self-esteem and identify the stress coping strategies of intern-nurses at Alexandria University. Data were collected with a self-administered questionnaire, including the Rosenberg self-esteem scale and the Brief Coping Orientation to Problems Experienced (Brief COPE). The questionnaire was distributed to all intern-nurses (273 intern-nurses) during their last rotation in the internship training. In total, 150 completed the survey, resulting in 54.9% response rate. SPSS software was used for the analysis. RESULTS: In total, 150 intern-nurses participated in the study. The majority of the sample had a moderate to high self-esteem, and the mean total self-esteem was 29.21/40 ± 4.44. The most frequently used coping strategy was problem-solving, followed by social support, positive thinking, and lastly an avoidance coping strategy. There was a positive correlation between self-esteem with both the problem-solving and social support coping strategies. However, there was a negative correlation between the self-esteem score and the avoidance coping strategy. CONCLUSION: The majority of the sample had a moderate to high self-esteem and they use problem-solving and social support coping strategies to manage stress. Intern-nurses with a high self-esteem cope positively and effectively with stress. Conversely, intern-nurses with a low self-esteem cope negatively with stress. Counseling and stress intervention programs are essential to promote nursing students self-esteem and assist them to develop positive and active stress coping strategies.

Sources of Stress and Coping Behaviors among Nursing Students Throughout Their First Clinical Training

Introduction

Clinical training allows nursing students to acquire and strengthen their psychomotor abilities, which is an important component of nursing education. The clinical components of nursing training programs were much more demanding than the academic ones.

Purposes

The purpose of this study was to examine sources of stress-related and coping behaviors during first clinical training among nursing students in the Arab American University.

Methods

The study was cross-sectional and conducted with a convenience sample of 266 participants of nursing students. Data collection was performed by "Perceived Stress Scale and the Coping Behavior Inventory." The data were analyzed by using the descriptive, that is, frequency and percentage, mean, and standard deviation.

Results

The results revealed that the perceived stress mean was 41.2 (SD = 19.5). The main stressors were taking care of the patients (M = 11.4 ± 0.85) and teachers and nursing staff (M = 8.32 ± 5.3). Coping behaviors mean was (M = 29.0 ± 15.2). The main coping behavior was problem-solving (M = 9.5 ± 5.6).

Conclusion

The study confirmed that students perceived moderate levels of stress in their first clinical training, and the most common sources of stress were taking care of the patients and teachers and nursing staff. However, the main coping behavior was problem-solving.

Effects of a group poetry therapy program on stress, anxiety, ego-resilience, and psychological well-being of nursing students

This quasi-experimental, nonequivalent control group pretest-posttest study developed a 10-session group poetry therapy program for nursing students and examined effects on clinical training, job-seeking stress, anxiety, ego-resilience, and psychological well-being. Forty-nine nursing students were conveniently recruited (experimental group n = 24, control group n = 25). Program construction used the Analysis, Design, Development, Implementation, and Evaluation model and Mazza's poetry therapy practice model. Compared to the control group, the experimental group showed significant decreases in stress and anxiety and significant improvements in ego-resilience and psychological well-being immediately after intervention, maintained at 5-week follow-up. The program can be a beneficial intervention for individuals experiencing various degrees of stress.

Back to Clinical Training during the COVID-19 Pandemic: Perspective of Nursing Students

INTRODUCTION

The COVID-19 pandemic has affected many areas of life, including the formation of nursing students. After the COVID-19 crisis, learning during clinical training created different challenges. Nursing schools are responsible for ensuring that structures are in place to facilitate coping in the changed clinical setting. This study aimed to analyze nursing students' perceptions during clinical training while caring for COVID-19 patients.

MATERIAL AND METHODS

A qualitative phenomenological study that explored nursing students' perceptions of learning in clinical settings with COVID-19 patients was performed. A total of 15 semi-structured face-to-face interviews were conducted with nursing students who carried out their clinical practices in COVID-19 units during February and April 2022.

RESULTS

Through content analysis, categorization, and the method of comparison constant, four categories emerged: feelings, challenges, coping methods, and clinical practices. The students had to learn to "work" with fear and uncertainty and self-manage the emotional burden using different coping techniques to deal with learning during their practices. Interacting with professors and clinical tutors during the clinical practice were positive experiences.

CONCLUSIONS

This study constituted an opportunity to build new and adapted educational approaches for teachers to train nursing students to deal with their emotions and thoughts in future pandemic situations.

Nursing students' perceived stress: Interaction with emotional intelligence and self-leadership

PURPOSE

The aim of the current study was to determine how emotional intelligence and self-leadership levels could be related to perceived stress.

DESIGN AND METHODS

A total of 341 nursing students were enrolled in this descriptive correlational study. Study measures included a sociodemographic form, Emotional Intelligence Evaluation Scale, Revised Self-Leadership Questionnaire, and Perceived Stress Scale for Nursing Students.

FINDINGS

Results showed that ''assignments and workload'' as well as "taking care of patients" were the highest sources of stress in clinical training. The emotional intelligence and self-leadership levels had a significant negative correlation with the perceived stress.

PRACTICE IMPLICATIONS

Perceived stress affects students' academic and social success negatively. Therefore, it is important to develop students' emotional intelligence levels, self-leadership perceptions.

Validity and reliability of the Turkish version of Stressors in Nursing Students Scale

PURPOSE

This study aimed to access the reliability and validity of the Stressors in Nursing Students Scale in the Turkish language (SINS-T).

DESIGN AND METHODS

Data were collected after the linguistic and content validity of the instrument. The study included 436 nursing students.

FINDINGS

The exploratory factor analysis was acceptable, and four factors were determined. These factors were named confidence, education, relationships, and uncertainties.

PRACTICE IMPLICATIONS

The SINS-T is a valid and reliable tool to determine the stress experienced by nursing students. Conducting different studies with a large sample size using this instrument will help expose nursing students' stress and its' outcomes.

Perceptions of undergraduate nursing students toward providing care to COVID-19 patients

Background

Undergraduate nursing students were inevitably recruited to provide care in response to overloaded hospitals with COVID-19 patients. The placement was potentially a stressful event and we aimed to understand the students' perception of direct nursing care during the pandemic.

Methods

This qualitative content analysis study carried out in 2020 (May-June) in Tehran, I.R. Iran. Using explanatory questions, we interviewed 15 undergraduate nursing students who provided direct care for at least 2 months to patients hospitalized with COVID-19 in the beginning of the pandemic to obtain their deep experiences. We applied the MAXQDA 10 to extract codes, used the qualitative content analysis method for investigation, and then applied the Lincoln and Guba criteria for rigor and trustworthiness. The study was approved by the National Committee for Ethics in Biomedical Research (IR.BMSU.REC.1399.070. available at: https://ethics.research.ac.ir).

Results

Four hundred and 54 codes were identified, which were then sorted into 12 categories underlying four main themes of "hard and unpredictable," "posttraumatic growth," "on the path to self-determination," and "commitment."

Conclusion

Even though the undergraduate nursing students experienced some stress in the beginning, with close support, their caregiving skills improved and they were able to meet the national healthcare needs. More studies are needed to confirm our findings regarding the experiences of the nursing students in combating COVID-19.

Construct validity and reliability of the perceived stress scale for nursing students in South Africa

Background

Increased levels of stress in nursing students are negatively related to caring behaviours and also result in poorer job proficiency and nurses who are more inclined to leave the profession. The Perceived Stress Scale (PSS), developed by Sheu and colleagues, is one of the most cited instruments for measuring stress and sources of stress amongst nursing students in international studies. However, it has not been widely validated for this purpose.

Objectives

This research aimed to test the construct validity and reliability of the PSS for South African nursing students.

Method

A cross-sectional survey was conducted at a Central South African University, and 471 of the 685 registered nursing students (68.8% response rate) participated in the study. Questionnaires were distributed and collected during classes. Confirmatory factor analysis was performed to test the hypothesised six-factor latent structure and determine the construct validity of the PSS. The internal consistency of the PSS was measured using Cronbach’s alpha.

Results

The model fit was a good fit and supported the six-factor latent structure as stress from (1) taking care of patients, (2) teachers and nursing staff, (3) assignments and workload, (4) peers and daily life, (5) lack of professional knowledge and skills and (6) clinical environment. Overall the PSS had a Cronbach’s alpha of 0.93.

Conclusion

The results confirm the construct validity and the internal consistency of the PSS for South African nursing students.

Nursing students experience during the COVID-19 pandemic: a qualitative research

OBJECTIVES

To describe the professional practice experiences of fifth year nursing students during the COVID-19 pandemic.

METHODS

Qualitative research design with content analysis. Participant sampling was purposive. 13 fifth-year nursing students participated. All of them completed their professional clinical practice in public hospitals and private clinics who cared for COVID-19 patients in Chile. The data were obtained through guided online written self-reflections.

RESULTS

Three main themes were inductively identified: (1) Facing with a very difficult and stressful situation, due to the permanent use of personal protection elements, multiple emotions, and physical fatigue, as well as facing ethical-clinical dilemmas in daily tasks; (2) Recognising different coping styles in difficult moments, highlighting contact with significant people and combination form of support and harmful ways of coping with stress; and (3) Experiences disciplinary learning and personal growth, such as: nursing care management, interpersonal skills in times of crisis and having contributed to the country in this adverse context.

CONCLUSIONS

The clinical experience of the students in times of COVID-19, was an opportunity to learn how to perform nursing care in times of crisis, humanize care and support health teams in some of the country's hospitals.

Effect of group psychoeducation on depression, anxiety, stress and coping with stress of nursing students: A randomized controlled study

PURPOSE

This study was performed with the aim of determining the effect of group psychoeducation in Turkish nursing students.

DESIGN AND METHODS

This study was planned with experimental design (randomized, controlled, and pretest-posttest control group observational study).

FINDINGS

There were significant differences identified for points in the experimental group before and after psychoeducation and 1 month later and between the posttest and 1-month observation measures (p < 0.05). While there was a significant difference (p < 0.05) in the styles of coping with stress and stress, there was no significant difference (p > 0.05) in anxiety and depression, though anxiety and depression scores decreased.

PRACTICE IMPLICATIONS

The use of group psychoeducation in which stress coping styles are taught is recommended to reduce symptoms of stress and manage the symptoms of anxiety, and depression levels.

The effect of fear of COVID-19 on perceived clinical stress levels in senior nursing students: A cross-sectional study

Aim: This study aimed to examine the effect of fear of COVID-19 on the perceived stress levels in senior nursing students performing their clinical practice. Methods: A cross-sectional study was conducted with senior nursing students in a nursing facility in March 2021. The data were collected using an APP Application sent to the smartphones of students (n = 148) receiving clinical education. Results: With a mean score of 17.2 ± 7.0 on the Fear of COVID-19 Scale, it was determined that the senior nursing students’ COVID-19 fears were at a moderate level. Students’ mean score from the Perceived Stress Scale was 71.0 ± 25.7, which indicated a moderate level. A positive, weak, and significant correlation was found between the total scores of fear of COVID-19 and perceived stress level (r = 0.291, p < 0.001). Conclusions: In this study, the perceived stress of students in their clinical practice was at a moderate level, as it was before the pandemic. It appears that a moderate level of fear of COVID-19 during the pandemic does not affect perceived stress levels in the clinical education setting. Accordingly, we recommend that clinical education should be maintained by taking necessary measures and implementing good management during the pandemic.

Stress management strategies and quality of life in undergraduate nursing and midwifery students in Poland: A pilot study

AIM

To establish the level of the quality of life (QOL) and its determinants in nursing and midwifery students, evaluate stress management strategies and find the correlation between the frequency of specific strategies and the QOL.

DESIGN

Diagnostic survey.

METHODS

The study was conducted in June 2019. Two hundred thirty-four undergraduate students were examined with the use of Mini-Cope Inventory of Stress Management Measurement (Mini-Cope) and World Health Organization Quality of Life Instrument Brief Form.

RESULTS

The average QOL of the respondents was found as good (4.06 ± 0.73). The students graded their QOL in the social relationship domain the highest (15.98 ± 2.97) and the lowest in the physical health domain (14.38 ± 2.75). The QOL was influenced by material status and the source of income. In stressful situations, the respondents most commonly used Active Coping (2.09 ± 0.57) and Seeking Emotional Support (2.09 ± 0.77) strategies. The latter correlated most positively with the QOL in social relationship (r = .514, p < .001) and environmental (r = .387, p < .001) domains.

"You Need to Get Over the Difficulties and Stand Up Again"-A Qualitative Inquiry into Young Nurses' Coping with Lateral Violence from the Feminist Perspective

Previous studies have reported lateral violence (LV) styles among nurses and the adverse impacts of LV on nurses and nursing. Young nurses, including nursing students and novice nurses, are often victims of LV. A large qualitative research study that contained three sub-studies exploring professional identity development in different professional stages was conducted by a research team in Macau, Special Administrative Region of China. Semi-structured interviews with nursing students and clinical nurses were carried out; among the 58 participants in the three sub-studies, 20 described some forms of LV and their ways of dealing with them. Framed by the feminist perspective, the researchers explored young nurses’ coping strategies in dealing with LV perpetrated by senior colleagues. Two themes were developed reflecting the coping strategies for LV: “making extra efforts” and “soothing emotional distress”. Three sub-themes were under the theme of “making extra efforts”: “catching up knowledge”, “making the most use of learning resources”, “adjusting communication manner”; another batch of sub-themes was under the theme of “soothing emotional distress”: “seeking support from schoolmates”, “living with family but crying alone”, and “adjusting lifestyle”. The study implied that young nurses exerted their agency in coping with LV in clinical practices. Nursing managers and educators should support young nurses’ efforts in overcoming power-based LV and incivility.

Effect of progressive muscle relaxation exercise on clinical stress and burnout in student nurse interns

PURPOSE

To determine the effects of progressive muscle relaxation exercise (PMRE) on clinical stress and burnout in student nurse interns.

DESIGN AND METHODS

This is a randomized controlled trial. Interns were divided into control group (CG; n = 78) or experimental group (EG; n = 67) randomly. PMRE was performed by students in the EG. Personal information form, Burnout Measure Short Version (BMS) and Physio-Psycho-Social Response Scale (PPSRS) for nursing students were administered to both groups in the first and last meeting.

FINDINGS

There was a significant difference in posttest scores between groups; EG posttest scores on the BMS, on the PPSRS, and subscales were lower than those of the CG.

PRACTICE IMPLICATIONS

PMRE training ameliorates burnout and PPSRs to stress during clinical practice in nursing students.

Detection of Emotional Sensitivity Using fNIRS Based Dynamic Functional Connectivity

In this study, we proposed an analytical framework to identify dynamic task-based functional connectivity (FC) features as new biomarkers of emotional sensitivity in nursing students, by using a combination of unsupervised and supervised machine learning techniques. The dynamic FC was measured by functional Near-Infrared Spectroscopy (fNIRS), and computed using a sliding window correlation (SWC) analysis. A k -means clustering technique was applied to derive four recurring connectivity states. The states were characterized by both graph theory and semi-metric analysis. Occurrence probability and state transition were extracted as dynamic FC network features, and a Random Forest (RF) classifier was implemented to detect emotional sensitivity. The proposed method was trialled on 39 nursing students and 19 registered nurses during decision-making, where we assumed registered nurses have developed strategies to cope with emotional sensitivity. Emotional stimuli were selected from International Affective Digitized Sound System (IADS) database. Experiment results showed that registered nurses demonstrated single dominant connectivity state of task-relevance, while nursing students displayed in two states and had higher level of task-irrelevant state connectivity. The results also showed that students were more susceptive to emotional stimuli, and the derived dynamic FC features provided a stronger discriminating power than heart rate variability (accuracy of 81.65% vs 71.03%) as biomarkers of emotional sensitivity. This work forms the first study to demonstrate the stability of fNIRS based dynamic FC states as a biomarker. In conclusion, the results support that the state distribution of dynamic FC could help reveal the differentiating factors between the nursing students and registered nurses during decision making, and it is anticipated that the biomarkers might be used as indicators when developing professional training related to emotional sensitivity.

Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews

BACKGROUND

In nursing students, high stress levels can lead to burnout, anxiety, and depression. Our objective is to characterize the epidemiology of perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa region.

METHODS

We conducted an overview of systematic reviews. We systematically searched PubMed, Embase, PsycInfo, and grey literature sources between January 2008 and June 2020 with no language restrictions. We included any systematic review reporting measurable stress-related outcomes including stress prevalence, stressors, and stress coping strategies in nursing students residing in any of the 20 Middle East and North Africa countries. We also included additional primary studies identified through a hand search of the reference lists of relevant primary studies and systematic reviews.

RESULTS

Seven systematic reviews and 42 primary studies with data from Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan were identified. Most studies included nursing students undergoing clinical training. The prevalence range of low, moderate, and high perceived stress among nursing students was 0.8-65%, 5.9-84.5%, and 6.7-99.2%, respectively. Differences related to gender, training period, or the type of tool used to measure stress remain unclear given the wide variability in the reported prevalence measures across all stress levels. Common clinical training stressors were assignments, workload, and patient care. Academic training-related stressors included lack of break/leisure time, low grades, exams, and course load. Nursing students utilized problem focused (dealing with the problem), emotion focused (regulating the emotion), and dysfunctional (venting the emotions) stress coping mechanisms to alleviate their stress.

CONCLUSIONS

Available data does not allow the exploration of links between stress levels, stressors, and coping strategies. Limited country-specific prevalence data prevents comparability between countries. Reducing the number or intensity of stressors through curriculum revision and improving students' coping response could contribute to the reduction of stress levels among students. Mentorship, counseling, and an environment conducive to clinical training are essential to minimize perceived stress, enhance learning, and productivity, and prevent burnout among nursing students.

Mediating effect of resilience on association among stress, depression, and anxiety in Indonesian nursing students

BACKGROUND

Studies on beneficial effects of resilience among nursing students are scarce, particularly in the context of Indonesian cultural characteristics and family socioeconomic status. Consequently, whether resilience affects the associations between clinical practice-related stress and mental health problems remains unknown.

PURPOSE

We aimed to reveal whether resilience mediates the associations among stress, depression, and anxiety.

METHODS

In this study, 336 nursing students were recruited and completed the Connor-Davidson Resilience Scale and the Depression, Anxiety, and Stress questionnaires. Students' economic status was assessed using the Self-Reported Questionnaire Family Socioeconomic Status. Data were collected in mid-2016 and analyzed using Pearson's correlation, independent t-test, one-way ANOVA, and simple linear regression with a mediation test.

RESULTS

Results demonstrated that resilience had a partial mediating effect on depression (B = 0.044) and anxiety (B = 0.017) after controlling for student age, living situation, and living allowance. These results indicated that resilience affects stress, depression, and anxiety.

CONCLUSION

Resilience is thus a crucial mediator of the relationship of clinical practice-related stress with depression and anxiety in nursing students. A well-balanced relationship between academic demands, private life, and financial support can counteract the influence of depression and anxiety in this population.

Stress and Coping Strategies Among Malawian Undergraduate Nursing Students

PURPOSE

Stress among nursing students has been widely investigated across the globe, and evidence suggests that nursing programs are stressful. Students from resource constrained contexts, such as Malawi, often find it difficult and over stressing to be socialized into the nursing profession. However, this area has not been adequately investigated in Malawi. The aim of the study was to investigate stress and its coping strategies among nursing students in Malawi.

METHODS

This was a quantitative study which used a descriptive cross-sectional design that included 102 students in years 2, 3 and 4. Data were collected using the adapted standard tools (Perceived Stress Scale and Adaptive Version of the Nurse Stress Scale) to comprehensively measure levels of stress categorised as clinical, academic and external. The brief Cope was used to measure common coping strategies. Independent samples t test and ANOVA were run at 5% level of significance to analyze the data.

RESULTS

Moderate levels of stress were perceived by this sample. Academic category contributed to more stress than clinical and external sources. Lecturers, clinical teachers and nursing staff were the major contributors of stress among students. Similarly, high levels of stress were found among year 2 and self-sponsored students. In terms of coping strategies, active coping and planning were the common coping strategies. However, substance use was also recorded as a coping strategy.

CONCLUSION

The study revealed that although nursing students face various challenges in under-resourced environments, teachers and clinical staff highly contribute towards stress. It was then established that stress among nursing students' can be contained by initiating stress reduction interventions. There is also need to further investigate the extent of substance use as it suggests that some students have not been able to cope with current stress levels hence resorting to use of substances.

Emotional intelligence and perceived stress among students in Saudi health colleges: A cross-sectional correlational study

Objectives

To date, little knowledge exists about perceived stress or emotional intelligence among Saudi students specialising in health sciences. This study uses sociodemographic factors to assess the correlations and divergences between emotional intelligence and perceived stress among health-science students in Saudi applied health-science colleges.

Methods

The present study adopted a cross-sectional, descriptive correlational design and recruited a convenience sample of 274 nursing and paramedic students. The participants were invited to complete a self-report questionnaire, which covered demographic factors, emotional intelligence (the MindTools test), and perceived stress (the Perceived Stress Scale).

Results

Almost all participants (97.1%) had average-to-high levels of emotional intelligence (mean = 50.58 in a 15-75 ranged scale); this was particularly true for nursing students and students in their first and third academic years. Overall, the students had a moderate level of perceived stress (mean = 1.75 in a 0-4 ranged scale), with assignments and workload causing the highest levels of stress. A negative non-significant correlation was found between emotional intelligence and perceived stress.

Conclusions

The research findings show that emotional intelligence does not differ significantly by nationality, gender, or specialty satisfaction. The students' gender, nationality, specialty, specialty satisfaction, and academic year were not significantly associated with levels of perceived stress. However, higher (although non-significant) levels of emotional intelligence were associated with lower levels of perceived stress. It is therefore essential to educate health-science students about emotional intelligence and teach them to identify and overcome stressors. Information about emotional intelligence and perceived stress should be incorporated into health-science curricula.

Nursing Student Experiences of Caring for Burned Patient: From Fearfulness to Normalization

OBJECTIVES

To describe the care experiences of students in burn units.

METHODS

Qualitative research of the phenomenological descriptive type which was conducted with the participation of eight senior nursing students in Shiraz College of Nursing and Midwifery, Iran. The method used for gathering data about Student experiences in Care Services for Burn Cases was the individual semi-structured interview. The Colaizzi method was used for analysing and interpreting the data.

RESULTS

Three main themes emerged: the attractive but stressful experience, trying to adjust and metamorphosis in attitude. Taking care of burned patients led to metamorphosis and adaptation to the requirements of burn care due to the students' improved attitudes, awareness and potentials. This finally turned the stressful nature of taking care of a burn patient into an attractive experience for them.

CONCLUSIONS

Students with little clinical experience of stressful working situations in burn units faced different challenges. Due to the specific nature of taking care of burned patients, the clinical experiences of nursing students who offer these services are unique.