Predictors of Taiwanese baccalaureate nursing students' physio-psycho-social responses during clinical practicum

Evaluation of stress, bio-psycho-social response and coping strategies during the practical training in nursing students: a cross sectional study

BACKGROUND

The aim of the study was to identify stress level, bio-psycho-social response and coping behavior of nursing students during the practical training.

METHODS

A cross-sectional study was carried out with the 1st, 2nd, 3rd, 4th-year nursing students (n = 1181) between September 2018-may 2019. Data was collected using by Socio-Demographic Questionnaire, The Student Nurse Stress Index, The Bio-Psycho-Social Response Scale and Coping Behavior Inventory.

RESULTS

The fourth-grade nursing students' stress level was found to be statistically significantly higher than of other graders. Nursing students have shown emotional symptoms and social-behavioral symptoms the most. To cope with stress, nursing students used the strategies transference, staying optimistic, problem-solving and avoidance, respectively.

CONCLUSIONS

These findings highlight the need to routinely evaluate nursing students for stress, bio-psycho-social response, and coping strategies during practical training. Thus, counseling units can be constituted by the nursing schools, and nursing students who have higher stress levels and inadequate coping strategies benefit from these units.

Nursing students' stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates

BACKGROUND

Understanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses' sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.

METHODS

A qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.

RESULTS

During their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students' clinical experiences. We extracted three main themes that described students' stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.

CONCLUSIONS

This qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

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.

Prevalence and Associated Factors of Stress and Coping Strategies of Nursing Students During Clinical Practice in School of Nursing, Wachemo University, Ethiopia

Background

The current professional nursing education program adopts various great attention for clinical practice to supply nursing students.

Objective

To assess the prevalence and associated factors of stress and coping strategies of nursing students during clinical practice in the school of nursing, Wachemo University, Ethiopia, 2024.

Methods

A facility-based cross-sectional design study was conducted between January 1 and 12/2024. The total number of students was 421. Data were collected using the validated tool and entered using Epi-data Version 3.1 and exported to SPSS Version 25 for analysis. Binary logistic regression was done, and variables with a p-value of <.05 were taken into the multivariable analysis. Statistically significant was declared at a p-value of <.05 with AOR and 95% CI.

Result

The prevalence of stress and coping strategies was 58.4% with 95% CI [53.6-62.8] and 52.0% with 95% CI [47.3-56.5] respectively. Male gender, private regular, and instructor guide were significantly associated with stress. Age group 19-24 years, having low grades, living in a university dorm, clinical staff guiding, instructor guiding, and asking unclear issues were significantly associated with coping strategies.

Conclusion

About six in ten nursing students have stress. Being male gender, being a private, living with families, and instructor guide are significantly associated with stress. Therefore, managing gender-related issues, attending regular programs, living in a university dorm, and guiding the students might reduce the burden of stress during clinical practice. About five in ten nursing students have good coping strategies. Being age group of lower years old, having low grades, living in a university dorm, clinical staff guiding, instructor guiding, and asking the instructor about unclear issues were significantly associated with coping strategies. Therefore, improving grades, living in a university dorm, clinical staff and instructor guidance, and asking about unclear issues might enhance coping strategies.

Predictors of Empowerment Among Undergraduate Nursing Students: A Cross-Sectional Study

Objective

To predict the factors that influence undergraduate nursing students' perception of empowerment.

Methods

A cross-sectional design was used, and fourth-year nursing students (n = 164) were selected using convenient sampling. The data collection methods included the Arabic version of self-reported questionnaires: The (LES), (LOGO-II), and (UNSASS).

Results

The results showed a positive correlation between nursing students' perception of empowerment and their attitudes toward learning. Also, the results showed a strong correlation between students' perception of empowerment and their academic satisfaction. In addition, in-class teaching was found to be the strongest predictor of students' perception of empowerment.

Conclusions

Verified the factors that may contribute to promoting the teaching-learning process to focus and stress on them. Teachers and instructors should utilize the available resources in the teaching environment to maximize the learning outcomes. All these factors are not limited and will enhance the nursing students' perception of empowerment.

Positive and negative aspects of psychological stress in clinical education in nursing: A scoping review

BACKGROUND

Even though clinical practice is crucial for nursing students' personal and professional development, it is recurrently associated with stress. However, stressful situations may not only elicit negative responses, but positive responses as well, and such aspects should be further investigated.

AIM

To explore the literature addressing the positive and negative aspects of stress experienced by nursing students during clinical practicum.

DESIGN

This scoping review followed the Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines.

DATA SOURCES

CINAHL, MEDLINE/PubMed, PsycINFO, Web of Science, IBECS, LILACS, BDENF and two theses and dissertations repositories.

REVIEW METHODS

Searches were conducted from June to August 2022. Studies addressing the positive and negative aspects of stress experienced by nursing students during clinical practice were included regardless of the method adopted.

RESULTS

This review included 32 studies published between 1999 and 2022 in 25 countries across four continents: Africa, America, Asia, and Europe. Stress can positively influence academic performance, especially in mobilizing a search for learning and professional development and in integrating theoretical knowledge and improving clinical skills and competencies. Negatively, stress can cause biopsychosocial symptoms that compromise a student's academic performance and can cause doubts and uncertainties about the construction of their professional identity.

CONCLUSIONS

Although the negative aspects stand out over the positive ones, it is evident that both are present in the clinical practice environment. When considering stress of nursing students, educators should conduct the teaching-learning process in order to reduce the negative impact and promote the positive side of stressful situations.

The effects of mindfulness-based stress reduction on mindfulness and stress levels of nursing students during first clinical experience

PURPOSE

The purpose of the study was to examine the effects of mindfulness-based stress reduction (MBSR) on stress levels and mindfulness of nursing students.

METHODS

The study was quasi-experimental and included pretest-posttest control groups.

RESULTS

No differences were detected between the pretest scores of the scales of the students of both groups. Students in the intervention group demonstrated increased mindfulness and decreased stress levels (p < 0.05).

PRACTICAL IMPLICATIONS

MBSR applied in the present study effectively reduced the stress of nursing students and increased their mindfulness.

Stress and coping styles among nursing students during the initial period of the clinical practicum: A cross-section study

Objectives

This study aimed to explore the level of stress, types of stressors, type of coping styles, and factors influencing stress levels and coping styles among nursing students during the initial period of the clinical practicum.

Methods

A cross-sectional survey design was used. In September 2017, participants were recruited from a tertiary hospital in Zhejiang Province, China, using a convenience sampling method. A demographic characteristics questionnaire, the Intern Nursing Student Stressor Scale, and the Simple Coping Style Questionnaire were used to collect data. Data were analyzed using descriptive analysis, independent sample t-tests, one-way analysis of variance, Pearson’s correlation analysis, and multiple linear regression analysis.

Results

A total of 158 nursing students were recruited, most of whom were female, undergraduates, and from rural areas. The nursing students perceived a moderate level of stress during the initial period of the clinical practicum. The need for knowledge and skills was the most common source of stress. Positive coping styles were most commonly adopted. Nursing students who were undergraduates, only children, and chose nursing major involuntarily experienced higher stress levels than those who were junior college students, not only children, and chose nursing major voluntarily. Nursing undergraduates were more likely to use positive coping styles than junior college students. Male nursing students and those experiencing higher stress levels related to the “environment and equipment of the wards” and the “nature and content of the work” were more likely to use negative coping styles.

Conclusion

Nursing educators should offer targeted guidance based on the stress reported during the clinical practicum and the demographic characteristics of the nursing students. Guidance should be provided to encourage nursing students to adopt effective coping strategies and reduce stress.

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.

Factors associated with perceived stress of clinical practice among associate degree nursing students in Taiwan

Background

Clinical placements play an important role in helping nursing students to achieve clinical competence, but these placements can be highly challenging and stressful. It has been shown that stress can be either a trigger or aggravating factor for ill-health in general, but studies have seldom differentiated the impact of general health status on perceived stress.

This study examined factors associated with perceived stress of clinical practice among nursing students with a particular focus on the effect of general health status on stress.

Methods

This was a cross-sectional quantitative study conducted among 724 associate nursing degree students in Southern Taiwan.

Results

Health status scores varied from 28 to 139, with an average of 68.40 (SD = 25.75). Health status was reported to be ‘good’ (scores 28–55) in 35.5% of participants, moderate (scores 56–83) in 24.6%, and poor (Scores ≧ 84) in 39.9% of participants. Perceived stress scores ranged from 0 to 95 points with an average score of 36.65 (SD ± 15.95). The classification and regression tree (CART) analysis showed health status as the most important factor linked to perceived stress with a Normalized Importance value of 100%. Those who reported general health status (measured through General Health Questionnaire (GHQ)-28) score of ≤34.5 perceived mild stress and those with a score of > 34.5–< 84.5 perceived moderate stress. A score of 84.5 was found to be the point of transition to perceptions of severe stress. When health status score was greater than 84.5, perceived stress was at a severe or extremely severe level.

Conclusions

Our findings indicated health status as a potential measure to identify students who were most vulnerable to perceived stress. Given the cross-sectional design of this study and the bidirectional relationship between health and stress, more studies are needed to fully establish the predictive link between general health status and vulnerability to stress.

Moral Resilience in Nursing Education: Exploring Undergraduate Nursing Students Perceptions of Resilience in Relation to Ethical Ideology

Introduction

Moral resilience has recently been proposed as one strategy to address moral distress in nurses and nursing students. Central to nursing students’ capacity for moral resilience is how they understood and enact resilience with an element of realism, suggesting an ethical, ideological influence. Resilience is shown to differ significantly across students, and possibly because of a disconnect between a students’ perceived resilience and their ethical ideology. Yet, resilience seldom has been explored in relation to ethical ideology.

Objective

This study aims to explore self-reported resilience in relation to ethical ideology in undergraduate nursing students, compare differences in scores, and explore relationships between study variables and selected demographic characteristics.

Methods

A descriptive cross-sectional research design was followed. An online encrypted survey was conducted among a convenient sample of nursing undergraduates who met the eligibility criteria and provided implied informed consent. This study complied with ethical principles outlined in the Canadian Tri-Council Policy Statement for research with human subjects. Ethical approval was secured from the University’s Research Ethics Board. Data were analyzed using mean scores, standard deviations, independent sample t-test, variance analysis with post hoc–testing, and Pearson correlation to explore differences in perceptions and associations between study and selected demographic variables.

Results

Undergraduate students have a high level of self-reported resilience. Statistically significant differences in self-reported resilience across selected demographic variables were observed. The association between resilience and ethical ideology was not significant. Ethical relativism was significantly correlated with age and year of study.

Conclusion

Findings suggest that faculty cultivating resilience in nursing students pays attention to gender’s influence discourses in students’ perceptions of resilience and ethical ideology and provides students with opportunities for ethical self-reflection and dialogue to critically examine their ethical ideological perspectives and the influence these may have on moral resilience development. Implications for future research are discussed.

Examining nursing students' wellness and resilience: An exploratory study

Undergraduate nursing students report high levels of stress which can negatively impact their overall wellness, and their academic and clinical performance. Despite this knowledge, there are few studies that have examined the well-being of nursing students and their ability to demonstrate resilience. Therefore, the purpose of this exploratory study was to examine resilience and wellness, together with the key factors that promote a well-being in nursing students from mid-western Canadian university. The sample of 196 undergraduate nursing students completed an online Nursing Well-being and Resilience Survey. Findings indicated that most nursing students had good health; however, many presented with anxiety and/or depression and a decreased sense of wellness in the physical, spiritual, and emotional domain. Other significant findings included participants >26 years old having lower burnout scores, higher ego-resilience and well-being scores compared to students ages 20 to 25; and, 2) there were differences between campus locations in terms of Professional Quality of life (compassion satisfaction, burnout, and traumatic stress) and sense of well-being. Understanding how resilience and wellness are influenced throughout the nursing program is a first step in developing targeted wellness initiatives for different nursing student populations.

The visualization of stress in clinical training: A study of nursing students' perceptions

Aim

To determine the perceived level and types of stress experienced by nursing students during clinical training.

Design

A descriptive correlational cross-sectional design.

Methods

A convenience sample of 238 nursing students was recruited. Level and types of stress were measured by Perceived Stress Scale. The data were collected in February 2020.

Results

The mean score of perceived stress was 2.58 (SD 0.92). Different sources of stressors perceived by students were identified in current study. The highest type of stressors perceived by students was stress from taking care of patients (mean = 2.81, SD 1.13). In addition, junior students perceived higher level of stress than senior students and female students experienced a higher level of stress than male counterparts. Students who have been supervised by clinical instructors whom their "primary" language is English scored a higher level of stress.

Anxiety, perceived stress and coping strategies in nursing students: a cross-sectional, correlational, descriptive study

BACKGROUND

For many nursing students, clinical training represents a stressful experience. The levels of stress and anxiety may vary during students' educational training, depending on their ability to adopt behavioral strategies for coping with stress, and other factors. This study aimed to investigate the relationship between anxiety, perceived stress, and the coping strategies used by nursing students during their clinical training.

METHODS

A cross-sectional correlational descriptive study. The sample consisted of 190 nursing students enrolled in the Nursing Faculty of Ciudad Real University in Spain. Participants provided data on background characteristics and completed the following instruments: the Perceived Stress Scale; the State-Trait Anxiety Inventory and the Coping Behavior Inventory. Relationships between scores were examined using Spearman's rho.

RESULTS

The mean age of participants was 20.71 ± 3.89 years (range 18-46 years). Approximately half of the students (47.92%) indicated a moderate level of stress with a mean Perceived Stress Scale score of 22.78 (±8.54). Senior nursing students perceived higher levels of stress than novice students. The results showed a significant correlation for perceived stress and state anxiety (r = 0.463, p < .000) and also for trait anxiety (r = 0.718, p < .000). There was also a significant relationship between the total amount of perceived stress and the following domains of the coping behavior inventory: problem solving (r = -.452, p < .01), self-criticism (r = .408 p < .01), wishful thinking (r = .459, p < .01), social support(r = -.220, p < .01), cognitive restructuring (r = -.375, p < .01), and social withdrawal (r = .388, p < .01). In the current study, the coping strategy most frequently used by students was problem-solving, followed by social support and cognitive restructuring.

CONCLUSIONS

Nursing students in our study presented a moderate level of stress, in addition there was a significant correlation with anxiety. Nursing teachers and clinical preceptors/mentors should be encouraged to develop programs to help prepare nursing students to cope with the challenges they are about to face during their clinical placements.

Clinical stress among undergraduate nursing students: perceptions of clinical nursing faculty

Clinical faculty have a critical role in recognizing the stress students experience in the clinical environment. Despite an increasing body of research on stress and student perceptions of stress, faculty perceptions of student stress have been relatively unexplored. A qualitative descriptive design provided a rich description of clinical nursing faculty perceptions of undergraduate baccalaureate nursing student stress in the clinical environment. Colaizzi's method guided data analysis. Four themes that emerged from the interview data were: feeling overwhelmed when encountering the unknown, which included the sub-themes of facing self-doubt and experiencing insecurity in nursing actions; struggling with personal life factors; enduring uncivil clinical interactions; and contending with nursing faculty interactions. This study assists in filling the gap for nursing education by providing a rich description of student stress as described by faculty. Implications include providing faculty a clearer understanding of the stress phenomenon so they may better educate and evaluate students.

Trait Forgiveness Moderated the Relationship Between Work Stress and Psychological Distress Among Final-Year Nursing Students: A Pilot Study

This study was to explore the potential moderating effect of trait forgiveness and its facets on the relationship between perceived work stress and psychological distress among Chinese nursing students in clinical practice. A total of 182 Chinese nursing students who had been receiving final-year clinical training completed self-report measures of nursing work stress, trait forgiveness and psychological distress. Correlation analysis and hierarchical multiple regressions were mainly applied for data analysis. Results showed that trait forgiveness was negatively associated with psychological distress, even after controlling for the effects of perceived work stress and demographic/workplace related variables. Further analyses indicated that the ability to forgiveness of situations was particularly crucial in reducing the negative effects of perceived work stress on psychological well-being, especially when students perceived higher level of stress. These results demonstrated that alternative interventions targeting on trait forgiveness, especially those programs which can improve one’s ability to acceptance uncontrollable bad circumstances, may be beneficial for the well-being of nursing students in clinical practice.

Relationship between educational stress and psychological resilience in nursing students

Aim: The aim of this study was to determine the relationship between educational stress and psychological resilience in nursing students. Method: The descriptive and analytical design of the study consists of 602 students in the nursing department of the Faculty of Health Sciences of Ordu and Tokat Gaziosmanpasa University. Data were collected using Personal Information Form, Nursing Education Stress Scale (NESS), and Resilience Scale for Adults (RSA). Data, frequency distribution, descriptive statistics (mean, standard deviation) Mann Whitney U test, Kruskal Wallis test, and Spearman correlation test were used. Findings: The mean age of the students was 20.37±2.10, 73.8% of them were women, the mean NESS score was 66.76±16.56, and the mean RSA score was 99.99±5.19. There was a high positive correlation between NESS total, academic and application sub-dimensions, RSA structural style and future perception, NESS total and academic sub-dimension was negatively correlated with social resources and NESS academic and family cohesion. Conclusions: Acording to results,  nursing students experience moderate academic and practice stress. Among the factors that affect students' psychological well-being, there is a positive relationship between personal strength and future goals, quests and adaptation to future, and stress (in practice area). In addition, it can be said that the psychological resilience of the students is moderate when the scores of the students are evaluated. ​Extended English summary is in the end of Full Text PDF (TURKISH) file.   Özet Amaç: Bu çalışmanın amacı, hemşirelik öğrencilerinin eğitim stresi ile psikolojik dayanıklılıkları arasındaki ilişkiyi ve etkileyen faktörleri belirlemektir. Metod: Tanımlayıcı ve analitik tipte planlanan araştırmaya, Ordu ve Tokat Gaziosmanpaşa Üniversitesi Sağlık Bilimleri Fakültesi Hemşirelik Bölümünde öğrenim gören 602 öğrenci dahil edilmiştir. Veriler, Kişisel Bilgi Formu, Hemşirelik Eğitimi Stres Ölçeği (HESÖ) ve Yetişkinler için Psikolojik Dayanıklılık Ölçeği (YPDÖ) kullanılarak toplandı. Verilerin analizinde, frekans dağılımı ve tanımlayıcı istatistikler (ortalama, standart sapma), Mann Whitney U, Kruskal Wallis ve Spearman korelasyon testi kullanıldı. Bulgular: Öğrencilerin yaş ortalaması 20.37±2.10, %73.8’i kadın, HESÖ puan ortalaması 66,76±16,56, YPDÖ puan ortalaması ise 99,99±5,19’dur. HESÖ toplam, akademik ve uygulama alt boyutları ile YPDÖ yapısal stil ve gelecek algısı arasında yüksek derecede pozitif yönde, HESÖ toplam ve akademik alt boyutu ile sosyal kaynaklar arasında ve HESÖ akademik ile aile uyumu arasında negatif yönde ilişki olduğu saptandı. Sonuç: Hemşirelik öğrencileri orta düzeyde akademik ve uygulama alanlarında stres deneyimlemektedir. Öğrencilerin psikolojik iyi oluşlarını etkileyen faktörlerden kişisel özellikler ve geleceğe yönelik yeni amaç, arayışlar ve geleceğe uyumları ile stres (uygulama alanında) arasında pozitif ilişki bulunmaktadır.  Ayrıca, öğrencilerin YPDÖ puanlarına bakıldığında, psikolojik dayanıklılıklarının orta derece olduğu söylenebilir.

Low interest in clinical practicum placement is associated with increased stress in nursing students in Taiwan: A cross-sectional survey study

BACKGROUND

Nursing students often find themselves in a highly competitive environment, and stress is a commonly acknowledged experience in nursing students.

OBJECTIVES

The aim of this study was to explore factors, particularly an interest in nursing and in clinical practicum placement, associated with stress in Taiwanese nursing students.

DESIGN

Cross-sectional survey study.

SETTINGS

A nursing college in central Taiwan and a university in eastern Taiwan.

PARTICIPANTS

814 nursing students.

METHODS

Level of stress of the participants was measured using the 43-items Stressors in Nursing Students (SINS) scale, which was translated into a traditional Chinese version (TC-SINS). Simple and multiple linear regression analyses were used to evaluate factors significantly associated with stress.

RESULTS

A total of 814 nursing students completed the questionnaire with a return rate of 83.6%. The mean age of the participants was 18.9 years and 94.8% was female. Regarding the students' interest in nursing, 2.6% expressed that they strongly or somewhat disagree. In addition, regarding the students' interest in clinical practicum placement, 7.2% indicated that they strongly or somewhat disagree. Results from multiple regression analysis showed that students who expressed somewhat or strong disagreement to interest in clinical practicum placement were significantly associated with a higher level of stress. Of the various strategies for stress relief, listen to music (75.2%) was the most popular choice, followed by talk to a friend (72.3%), and catch up on sleep (61.3%). A third of the participants used three strategies for stress relief.

CONCLUSIONS

Low interest in clinical practicum placement was associated with increased stress levels in nursing students in Taiwan. Future studies should explore the underlying reasons for stress induced by clinical practicum placement, and possible solutions for stress reduction in nursing students.

Reliability and Repeatability of the Instrument for the Assessment of Stress in Nursing Students (ASNS)

Background and objectives: Stress in nursing students is a very common experience, especially when they face clinical practice. The aims of this study were to perform a transcultural adaptation and to examine the reliability and repeatability of the Instrument for the Assessment of Stress in Nursing Students for a Spanish population. Methods: A test–retest analysis was carried out in two face-to-face sessions with the students with a lapse of 10 days between the two sessions. A cross-sectional descriptive study was carried out between the months of May and June 2018. Sixty-four nursing students were recruited with a consecutive sampling method that targeted individuals in the freshman class. Results: A good internal consistency was shown for the total score (α = 0.8861) and for each of the six domains. The test–retest reliability, using the Wilcoxon paired test, was not significant, indicating no differences between the total scores or the domain scores (p ≥ 0.05). Finally, Bland and Altman plots of visual distributions did not show differences between the total scores and the domain scores. Conclusion: The Instrument for the Assessment of Stress in Nursing Students was shown to be a reliable tool for measuring stress factors among Spanish nursing students.

Preliminary psychometric properties of the Arabic version of Sheu and colleagues Perceived Stress Scale among nursing students at Jordanian universities

Purpose

Nursing is known to be a stressful profession, as it necessitates constant interaction with different individuals in an environment that is described as highly stressed. The stress phenomenon mainly affects the students of nursing more than other health-related students. The Perceived Stress Scale (PSS), which is developed by Sheu and colleagues represents the most implemented instrument to examine stress among nursing students that belong to different cultures in different countries. Previous studies have not fully examined the psychometric properties of the PSS, especially in the Arab World. Therefore, this study aims to assess the psychometric properties of the Arabic version of Sheu and colleagues Perceived Stress Scale (PSS), which is used to measure the clinical stress among nursing students.

Patients and methods

This methodological study utilized a cross-sectional design to test the PSS preliminary psychometric properties among 320 nursing students at 5 Jordanian universities.

Results

The Arabic version of the PSS showed high internal consistency reliability (Cronbach’s α was 0.90 in addition to an excellent content validity (CVI was 0.94). The exploratory factor analysis indicated that 54.54% of the total variance was accounted for by the five factors model, which confirmed the construct validity of the Arabic version of PSS. The findings of this study revealed that the Arabic version of PSS can be appropriately implemented among nursing students.

Conclusion

This study supports and recommends the use of the Arabic version of PSS to measure clinical stress among nursing students at Jordanian Universities.

Examining stress perceptions and coping strategies among Saudi nursing students: A systematic review

OBJECTIVES

Stress is a perennial problem in nursing education and Saudi student nurses are not immune. Despite the growing literature examining stress in Saudi student nurses, a broader perspective on this concept has not been explored. This paper is a report of a review systematically appraising and synthesizing existing scientific articles reporting stress perceptions and coping styles in Saudi student nurses.

DESIGN

A systematic review method guided this review.

DATA SOURCES

Four (SCOPUS, CINAHL, PubMed, Ovid) bibliographic databases were searched to locate relevant articles.

REVIEW METHODS

An electronic database search was performed in August 2017 to locate studies published from 2010 onwards. The search words included: "stress" OR "psychological stress", "coping" OR "psychological adaptation", "Saudi Arabia", "student", and "nurse". Eleven (11) articles met the inclusion criteria.

RESULTS

Review of the findings showed moderate to high stress levels in Saudi student nurses that originated mainly from heavy workloads and taking care of patients. However, when the students' demographic characteristics were taken into account, inconclusive results were found, although some evidence showed higher stress levels in higher level students. Both active and passive coping styles were used by nursing students when dealing with stress.

CONCLUSIONS

Consistent with international studies, Saudi student nurses experience a considerable levels of stress from various sources. Findings may provide a direction for nursing faculty in formulating stress interventions that are empirically tested and culturally appropriate.

Stress and coping strategies among Saudi nursing students during clinical education

PURPOSE

The purpose of this study was to determine the stress level and coping strategies among undergraduate Saudi female nursing students during their clinical education.

DESIGN AND METHODS

In this study, a descriptive correlational cross-sectional design was used. The Demographic Information Questionnaire, Perceived Stress Scale, and Coping Behavior Inventory were completed by 121 female Saudi undergraduate nursing students.

FINDINGS

The findings showed that stress from taking care of the patient subscale (M = 12.0, SD = 5.0) was ranked the highest mean among all perceived stress subscale scores. The most commonly used coping strategies among nursing students in clinical practice was a problem-solving strategy (M = 15.8, SD = 4.3).

PRACTICE IMPLICATIONS

Facilitating the use of effective coping strategies in nursing students will promote quality of care for their patients.

Validation and application of the Chinese version of the Perceived Stress Questionnaire (C-PSQ) in nursing students

Objective

To translate the Perceived Stress Questionnaire (PSQ) into Chinese, validate its reliability and validity in nursing students and investigate the perceived stress level of nursing students.

Method

Forward- and back-translation combined with expert assessment and cross-cultural adaptations were used to construct the Chinese version of the PSQ (C-PSQ). This research adopted a stratified sampling method among 1,519 nursing students in 30 classes of Ningbo College of Health Sciences to assess the reliability and validity of the C-PSQ. Among them, we used the Recent C-PSQ (only the last month).

Results

The C-PSQ retained all 30 items of the original scale. Principal component analysis extracted five factors that explained 52.136% of the total variance. The S-CVI/Ave was 0.913. Concurrent validity was 0.525 and 0.567 for anxiety and depression respectively. The results of the confirmatory factor analysis were as follows: χ²/df = 4.376, RMR = 0.023, GFI = 0.921, AGFI = 0.907, CFI = 0.916, RMSEA = 0.048, PNFI = 0.832, PGFI = 0.782, CN = 342 and AIC/CAIC = 0.809. The scale’s Cronbach’s alpha was 0.922, and Cronbach’s α of each dimension was 0.899 (worries/tension), 0.821 (joy), 0.688 (overload), 0.703 (conflict), 0.523 (self-realization). The correlation coefficient between the first and second test, the first and third test and the second and third test was 0.725, 0.787 and 0.731, respectively. Mean values and distribution of overall PSQ index in nursing students was 0.399 ± 0.138. Different demographic factors were significantly associated with the perceived stress of nursing students.

Conclusion

The C-PSQ has an appropriate reliability and validity, which means that the scale can be used as a universal tool for psychosomatic studies. The perceived stress of nursing students was relatively high. Further studies are needed.

Coping with stressful events: A pre-post-test of a psycho-educational intervention for undergraduate nursing and midwifery students

BACKGROUND

Knowledge of coping mechanisms is important for nursing and midwifery students to cope with stressful events during undergraduate education.

OBJECTIVES

To evaluate the impact of a psycho-educational intervention "Coping with Stressful Events" with first year undergraduate nursing and midwifery students.

DESIGN

A quasi-experimental, one-group pre-post-test.

SETTINGS

One school of nursing/midwifery in one university in Ireland.

PARTICIPANTS

A convenience sample of all first year undergraduate nursing and midwifery students (n=197). Of these 166 completed the pretest and 138 students completed the post test.

METHODS

Using the COPE Inventory questionnaire (Carver et al., 1989) data was collected pre and post-delivery of the psycho-educational intervention "Coping with Stressful Events" by two research assistants. Data were analysed using the IBM SPSS Statistics version 22 (NY, USA).

RESULTS

Results demonstrated improved coping skills by students. There were statistically significant differences between pre and post intervention for some coping subscales. For example, the mean subscale scores were lower post-intervention for restraint and mental disengagement, and higher for use of emotional and instrumental social support indicating improved coping strategies.

CONCLUSIONS

This intervention has the potential to influence undergraduate nursing and midwifery students coping skills during their first year of an undergraduate programme.

Nursing and midwifery students' stress and coping during their undergraduate education programmes: An integrative review

OBJECTIVES

The aim of this review is to examine the literature related to the sources of stress, coping mechanisms and interventions to support undergraduate nursing and midwifery students to cope with stress during their undergraduate education.

DESIGN

Integrative literature review.

DATA SOURCES

The databases CINAHL, PubMed and PsycINFO were searched for articles published between 2010 and 2016. Search terms in various combinations were used for example; student nurse, student midwife, undergraduate, stress, coping and interventions.

REVIEW METHODS

An integrative review based on Whittemore and Knafl's approach was used to conduct the review.

RESULTS

The search generated 25 articles that met the inclusion criteria. The key sources of stress emanated from clinical, academic and financial issues but predominantly from the clinical environment. Students used a variety of coping strategies, both adaptive and maladaptive. These appear to be influenced by their past and present circumstances such as, their needs, what was at stake and their options for coping. Interventions for student nurses/midwives to cope with stress were varied and in the early stages of development. Mindfulness showed some promising positive results. Interventions focussed on the individual level excluding the wider social context or organisation level.

CONCLUSIONS

Stress is pervasive in all aspects of undergraduate nursing and midwifery education. Nursing and midwifery educators need to be aware of this impact and provide appropriate support to students in both the clinical and academic environments. Further research is needed to capture the experience of stress from the students' perspective as well as the barriers and facilitators to supporting students from the preceptors'/mentors' perspectives. Finally, more intervention studies are needed to identify and compare what interventions are effective in supporting students to cope with stress during their undergraduate education.

Stress and coping strategies among nursing students: an international study

BACKGROUND

Mounting literature on stress and coping in nursing students are available; however, most of the findings are confined to a single cultural group.

AIMS

This study was conducted to determine the level of stress, its sources and coping strategies among nursing students from three countries: Greece, the Philippines and Nigeria.

METHODS

Using a descriptive, comparative research design, 547 nursing students (161 Greek nursing students, 153 Filipino nursing students, 233 Nigerian nursing students) participated in the study from August 2015 to April 2016. Two standardized instruments were used, the Perceived Stress Scale (PSS) and the Coping Behavior Inventory (CBI).

RESULTS

Findings revealed that the degree of stress and the type of stressors and coping styles utilized by nursing students differ according to the country of origin. The year of study predicted overall stress (β = -0.149, p < 0.001) while advanced age predicted overall coping (β = 0.008, p = 0.037) in the nursing students.

CONCLUSIONS

Strengthening nursing students' positive coping skills may be helpful for them to effectively deal with various stressors during their educational experiences while maximizing learning. Implementing empirically tested approaches maybe useful to prevent the recurrence of stress and lessen its impact such as stress management counseling, counseling programs, establishing peer and family support systems, and formulating hospital policies that will support nursing students.

Stress, resilience and psychological well-being in Chinese undergraduate nursing students

BACKGROUND

Globally, stress is a well-recognized feature of the life of undergraduate nursing students. However, there currently is little evidence to suggest what role resilience plays in this issue.

OBJECTIVES

To examine the relationship between stress and resilience on psychological well-being in a cohort of Chinese undergraduate student nurses.

DESIGN/PARTICIPANTS

A cross-sectional study was conducted using multivariate logistic regression and descriptive statistical analysis in three Chinese nursing schools. A total of 1538 nursing students participated in the study, completing three validated self-administered questionnaires.

RESULTS

Nursing students in their final year reported the highest mean General Health Questionnaire 12 (GHQ-12) scores (Mean 4.50 SD 2.89) and Stress in Nursing Student (SINS CN) scores (Mean 105.11 SD 25.37), Moderate levels of resilience were noted across all four years of nursing training programmes (Mean 121.59 SD 21.49). Resilience scale (RS) scores were negatively correlated with mean total score for stress (r=-0.236, P<0.01) and negatively correlated with psychological well-being (r=-0.411, P<0.01).

CONCLUSION

Psychological well-being appears impaired in Chinese nursing students, particularly final year students, prior to registration. Globally, more attention could be given to the potential role of resilience training and other forms effective coping strategies to deal with the inevitable sources of stress in student nurse training.

Nursing students' perceived stress and coping behaviors in clinical training in Saudi Arabia

BACKGROUND

Clinical training has been recognized as a stressful experience for nursing students.

AIMS

The aims of this study were to identify levels and types of stressors among nursing students during their clinical training and their coping behaviors.

METHODS

Data were collected using a purposive sampling method from 100 nursing students using a self-reported questionnaire composed of Perceived Stress Scale and Coping Behavior Inventory.

RESULTS

Results showed that "assignments and workload" as well as "teachers and nursing staff" were the highest sources of stress in clinical training. The most common coping behaviors used were "problem-solving" and "staying optimistic". There was a significant difference in perceived stress among students in regard to the way of choosing nursing. There were significant differences in coping behaviors in regard to the presence of relatives in nursing, living status and mothers' educational level. The predictors of perceived stress were self-choosing for nursing and the presence of relatives in nursing, while the predictors for coping behaviors were stress from peers and daily life as well as mothers' educational level.

CONCLUSIONS

Nursing teachers and staff are encouraged to develop strategies that decrease level of stress and promote adaptive coping behaviors among nursing students during their clinical training.

Determinants of nursing competence of nursing students in Taiwan: the role of self-reflection and insight

BACKGROUND

A nursing practicum course is critical to strengthening the nursing competence of nursing students. Research has found that practice stress and coping behaviors can have either a negative or positive influence on the learning and practice performance of nursing students. Nevertheless, there are few evidence-based studies related to the relationship between self-reflection and insight and nursing competence in Taiwanese nursing students.

OBJECTIVE

To test the determinants and the effect of self-reflection and insight on nursing competence in nursing students during the first 2 months of their practice experience.

DESIGN

Cross-sectional and correlational research designs were employed.

METHODS

From September to November 2013, a total of 312 nursing students at a junior college in southern Taiwan served as participants in this study. Four questionnaires were used to collect data: Self-reflection and Insight Scale (SRIS), Perceived Stress Scale (PSS), Coping Behavior Inventory (CBI), and Holistic Nursing Competence Scale (HNCS). The research model was evaluated through structural equation modeling (SEM), with the use of the partial least squares (PLS) method.

RESULTS

Results indicated that self-reflection and insight, practice stress, and practice coping behavior were statistically significantly associated with nursing competence. In addition, self-reflection and insight were significantly and positively associated with practice coping behavior and negatively associated with practice stress. Students' coping behavior partially mediates the effect of self-reflection and stress on nursing competence. Overall, these variables explained 39.4% of the variance in these students' nursing competence.

CONCLUSION

Self-reflection and insight affected nursing competence during the practice period. These variables have not only had a direct influence on nursing competence but also an indirect effect through the mediating effect of coping behavior and stress.

Perceived stress and coping strategies among Jordanian nursing students during clinical practice in psychiatric/mental health courses

Clinical practice in the psychiatric/mental health nursing (PMHN) field is considered a highly-stressful experience for nursing students. The purpose of the present study was to identify the degrees of stress, the types of stressors, and coping strategies perceived by undergraduate nursing students during their clinical practice in PMHN courses. A descriptive, longitudinal design was used. Sixty-five students registered in PMHN clinical courses were recruited from five Jordanian universities using a systematic random-sampling method. Data collection was conducted in the second semester of the 2012-2013 academic year at two points of time: pre-PMHN clinical training and post-PMHN training. The Basic Information Questionnaire, Perceived Stress Scale, and Coping Behavior Inventory were administered. Students' ages ranged from 20 to 25 years. The findings illustrate that the highest reported types of stressors at both data-collection times were taking care of patients, stress related to teachers and nursing staff, and from assignments and workloads. The most utilized coping strategy at both data-collection times was problem solving. The findings of the present study are useful for clinical educators in identifying nursing students' stressors, easing their learning in the clinical setting, and establishing an efficient PMHN course programme.