Clinical environmental stressors and coping behaviors among undergraduate nursing students in Saudi Arabia: A cross-sectional study

ObjectivesThis study aimed to explore the level of stress, stressors sources, and coping strategies used among female Saudi undergraduate nursing students during their clinical practice.MethodsA cross-sectional design was used. Using a convenience sampling technique, female nursing students in Riyadh, Jeddah, and Alahsa who enrolled in clinical courses were recruited from a governmental university from January to May 2022. Data were collected using a self-report questionnaire including socio-demographic characteristics, the Perceived Stress Scale (PSS), and the Coping Behavior Inventory (CBI).ResultsThe degree of stress perceived by the 332 participants ranged from 3 to 99 (54.77 ± 0.95). Stress from assignments and workload was the most common type of stressor perceived by nursing students, with a score of 2.61 ± 0.94, followed by stress from the environment, with a score of 1.18 ± 0.47. Meanwhile, the students used staying optimistic as the most adopted strategy, with a score of 2.38 ± 0.95, followed by the transference strategy, a score of 2.36 ± 0.71, and the problem-solving strategy scored 2.35 ± 1.01. The coping strategy of avoidance is positively correlated with all of the stressor types (P < 0.01), while the problem-solving strategy is negatively correlated with stress from peers and daily life (r = ?0.126, P < 0.05). Transference is positively correlated with stress from assignments and workload (r = 0.121, P < 0.05), and stress from teachers and nursing staff (r = 0.156, P < 0.01). Lastly, staying optimistic is negatively correlated with stress from taking care of patients (r = ?0.149, P < 0.01), and with stress from lack of professional knowledge and skills (r = ?0.245, P < 0.01).ConclusionsThese research findings are significant for nursing educators to identify nursing students’ main stressors and coping strategies used. Effective countermeasures should be taken to promote a healthy learning environment, decrease the level of stressors and improve students’ coping strategies during clinical practice.     

The relationship between professional values,ethical sensitivities and caring behaviors among nursing students: A structural equation modeling approach

AimTo examine the relationship between professional values, ethical sensitivity and caring behaviors among nursing students and determine whether professional values play a moderator role in the relationship between ethical sensitivity and caring behaviors among nursing students.BackgroundDeveloping professional nursing values, ethical sensitivity and caring behaviors is critical in nursing programs from the first year to graduation to prepare students for increasingly complex and diverse work environments.DesignA cross‐sectional study using structural equation modeling. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.MethodsThis study was conducted with 189 undergraduate nursing students. The study was conducted in a four-year nursing faculty in the Mediterranean region of Turkey from February to June 2022. Data were collected using a personal information form, the Nurses’ Professional Values Scale, the Moral Sensitivity Questionnaire and the Caring Behaviors Assessment Tool Nursing Version-Short Form.ResultsWe found that nursing students' perceptions of professional values and caring behaviors were high and their ethical sensitivity was moderate. Nursing students who are successful in high school have higher professional values. In addition, it was determined that nursing students who chose the nursing profession because of altruism had higher perceptions of caring behaviors. A positive relationship exists between professional values, ethical sensitivity (r = −0.258, p < 0.001) and caring behaviors (r = 0.431, p < 0.001) (p < 0.05). Professional values have a positive effect on ethical sensitivity and caring behaviors.ConclusionProfessional values, ethical sensitivity and caring behaviors are relationships and professional values positively predict nursing students' ethical sensitivities and caring behaviors. As the professional value perceptions of nursing students increase, their ethical sensitivity and caring behaviors increase. Improving the curricula in a way that will improve professional values may enable nursing students to increase their ethical sensitivity and caring behaviors. The research contributes to a broader understanding of nursing education curriculum content.     

Coping strategies and stressors of nursing students in the care of sex trafficking victims

During their clinical practice, nursing students face a number of complex clinical situations, which may include treating victims of sex trafficking. These clinical experiences can lead to stress for the nursing students, which may hinder their learning process. Nonetheless, there is very little educational training provided in nursing programmes on this topic. The objective of this study was to identify the coping strategies and stressors perceived by nursing students in the care of sex trafficking victims. A pre-post study of a single group was carried out. The TREND guidelines were followed. The Perceived Stress Scale (PSS) and Coping Behavior Inventory (CBI) were used for data collection. On the PSS, the average scores were lower after the intervention in all dimensions, except related to teachers and nursing staff and peers and daily life. Statistically significant differences were found when comparing the results of the total average score of the PSS and the time of measurement (pre/post-intervention) (t(106) = 38.811; P < 0.001). Regarding the Coping Behavior Inventory, the average scores in each dimension increased after the intervention, except transference behaviours. Statistically significant differences were found when comparing the total average score of the questionnaire and the time of measurement (Z = ?13.357; P < 0.001). The total stress levels and coping strategies of nursing students in caring for victims of sex trafficking improved significantly after the intervention. Nursing educators should promote the training of future nursing professionals as a potential effective strategy for the rapid identification and adequate care of sex trafficking victims.     

Associations between health behaviors and mental health in Australian nursing students

Aim: Nursing students experience high levels of stress, anxiety and depression. This study examined associations between health behaviors and stress, anxiety and depression in Australian nursing students. Design: this was a cross-sectional study. Methods: Participants completed an online survey providing demographic information and responses to the 21-item Depression Anxiety Stress Scale, Fagerström Test for Nicotine Dependence, short Food Frequency Questionnaire, Alcohol Use Disorders Identification Test, International Physical Activity Questionnaire and Workforce Sitting Questionnaire. Associations were evaluated using multivariate linear regression. Results: Mild to extremely severe stress (46.6%), anxiety (52.8%) and depression (42.2%) were prevalent. Intake of snack-foods was associated with higher depression (β = 8.66, p < 0.05) and stress (β = 3.92, p = 0.055) scores. More time spent sitting was associated with higher depression (β = 0.48, p < 0.001) and stress (β = 0.28, p < 0.05) scores. Skipping meals correlated with higher stress, anxiety and depression scores. Conclusion: More support must be provided to nursing students to manage psychological distress and mental health during university study.     

The impact of professional identity on role stress in nursing students: A cross-sectional study

BackgroundAs newcomers to the clinical workplace, nursing students will encounter a high degree of role stress, which is an important predictor of burnout and engagement. Professional identity is theorised to be a key factor in providing high-quality care to improve patient outcomes and is thought to mediate the negative effects of a high-stress workplace and improve clinical performance and job retention.ObjectivesTo investigate the level of nursing students' professional identity and role stress at the end of the first sub-internship, and to explore the impact of the nursing students' professional identity and other characteristics on role stress.DesignA cross-sectional study.SettingsThree nursing schools in China.ParticipantsNursing students after a 6-month sub-internship in a general hospital (n = 474).MethodsThe Role Stress Scale (score range: 12–60) and the Professional Identity Questionnaire for Nursing students (score range: 17–85) were used to investigate the levels of nursing students' role stress and professional identity. Higher scores indicated higher levels of role stress and professional identity. Basic demographic information about the nursing students was collected. The Pearson correlation, point-biserial correlation and multiple linear regression analysis were used to analyse the data.ResultsThe mean total scores of the Role Stress Scale and Professional Identity Questionnaire for Nursing Students were 34.04 (SD = 6.57) and 57.63 (SD = 9.63), respectively. In the bivariate analyses, the following independent variables were found to be significantly associated with the total score of the Role Stress Scale: the total score of the Professional Identity Questionnaire for Nursing Students (r = −0.295, p < 0.01), age (r = 0.145, p < 0.01), whether student was an only child or not (r = −0.114, p < 0.05), education level (r = 0.295, p < 0.01) and whether student had experience in community organisations or not (r = 0.151, p < 0.01). In the multiple linear regression analysis, the total score of the Professional Identity Questionnaire for Nursing Students (standardised coefficient Beta: −0.260, p < 0.001), education level (standardised coefficient Beta: 0.212, p < 0.001) and whether or not student had experience in community organisations (standardised coefficient Beta: 0.107, p < 0.016) were the factors significantly associated with the total score of the Role Stress Scale. The multiple linear regression model explained 18.2% (adjusted R² scores 16.5%) of the Role Stress Scale scores variance.ConclusionsThe nursing students’ level of role stress at the end of the first sub-internship was high. The students with higher professional identity values had lower role stress levels. Compared with other personal characteristics, professional identity and education level had the strongest impact on the nursing students’ level of role stress. This is a new perspective that shows that developing and improving professional identity may prove helpful for nursing students in managing role stress.     

Stress levels and coping strategies among undergraduate nursing students in Greece during economic recession: a cross-sectional study

AimTo identify factors contributing to Greek nursing students’ stress and the coping strategies used.BackgroundStress experienced by nursing students in the context of ongoing economic recession is as yet unexplored.DesignA cross-sectional study .MethodologyUndergraduate nursing students (n = 424) completed the Student Nurse Stress Index (short version) and the Brief COPE questionnaires during the year 2017.ResultsMost of the participants stated that their current financial status (81.7%) contributed towards their experience of stress, and they had higher scores on the interface worries subscale (p < 0.001). Female gender (p < 0.001) seniority (p = 0.005) and stress of transportation from home to university (p = 0.019) significantly increased the SNSI total score as well as most of the stress subscales scores. As far as coping subscales were concerned, higher means were shown in active/positive coping (mean 2.95), seeking support (mean 2.84), expression of negative feelings (mean 2.71) and avoidance (2.47). However, the use of higher maladaptive coping strategies was noted in cases presenting higher SNSI Total score, interface worries and personal problems.ConclusionThe introduction of stress management training and conflict management skills ought to be considered. Fund raising initiatives should be considered to provide financial assistance to those in need.     

Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: the effect of coping behaviors.

Initial clinical practice is stressful. Nursing students entering clinical practice for the first time in a five-year associate degree program in Taiwan are young and have questionable coping skills, all of which can affect their own health. This study examined the following: (1) the degree of stress perceived and types of stressful events; (2) the physio-psycho-social status of nursing students during the practice; (3) the coping behaviors of these students; and (4) the effect of different coping behaviors on their physio-psycho-social health. The subjects were 561 nursing students who had completed their initial clinical practice at the largest nursing school in Taiwan. Three measurements, including Perceived Stress Scale (PSS), Physio-Psycho-Social Response Scale (PPSRS), and Coping Behavior Inventory (CBI), were adopted. Results showed that stress for these students came mainly from the lack of professional knowledge and skills as well as caring of patients. The most common response to stress was social behavioral symptoms. Staying optimistic had a positive main effect, which reduced the occurrence of physio-psycho-social symptoms and improved physio-psycho-social status. Finally, problem-solving behavior also had a positive main effect, while avoidance had a negative main effect, which deteriorated physio-psycho-social status. This study has important implications for nursing educators in helping their students to overcome stress during clinical practice.     

Factors affecti̇ng health-promoting behavi̇ors i̇n nursi̇ng students: A structural equation modeling approach

BackgroundThe purpose of this study is to evaluate the effectiveness of the Mindfulness-based Stress Reduction program applied to a sample of Turkish nursing students.MethodThe study was designed as a randomized controlled trial. Program sessions of 90-95 minutes were given twice a week for 12 weeks. The data were collected using the Nursing Education Stress Scale, the Mindfulness Scale, and the Stress Management Styles Scale.ResultsA statistically significant difference was found in the mean post-test and mean follow-up scores obtained by the control group and the experimental group on the Nursing Education Stress Scale and its sub-dimensions. On the Mindfulness Scale, a statistically significant difference was found between the mean pre-test and post-test scores obtained by the experiment and control groups.ConclusionThe results derived from this study suggest that the mindfulness-based stress reduction program is effective in reducing the stress experienced by students during nursing education, increasing their mindfulness, strengthening their coping mechanisms for stress, increasing their use of self-confident and optimistic approaches, and decreasing their use of the helpless approach.     

军校护理本科学生临床学习初期教师支持、应对方式、应激对身心反应的影响研究

目的 探讨军校护理本科学生临床学习初期教师支持、应对方式、应激对身心反应的影响.方法 采用《护理专业学生感知教师支持问卷》《应对行为问卷》《感知应激量表》《生理-心理-社会行为反应量表》对64名二年级军校护理本科学生进行调查.结果 军校护理本科学生在临床学习初期感知的教师支持、解决问题行为和乐观应对行为与身心反应呈负相关(P＜0.05),回避行为与身心反应呈正相关(P＜0.05),应激、回避行为、乐观应对行为对军校护理本科学生的身心反应主效应显著(P＜0.05).结论 护理教师亟需了解并重视护理本科学生在临床学习初期的应激体验,增强对他们的支持,帮助他们发展有效的应对方式,以期减轻他们的应激程度,提高他们的身心健康水平.     

护理本科生临床学习初期应激和应对方式对身心反应的影响

目的探讨护理本科生临床学习初期的应激源、应激程度、应对方式对身心反应的影响。方法采用感知压力量表、应对行为问卷、生理-心理-社会行为反应量表对64名二年级护理本科生进行调查。结果护理本科生在临床学习初期会遭遇中等水平的应激,应对方式频率由高到低依次为乐观应对、转移注意力、解决问题和回避,身心反应与应激水平呈正相关,乐观应对对身心反应起负性的主效应,应激水平对身心反应起正性的主效应。结论教师应鼓励护理本科生采取乐观应对和解决问题的应对方式,以减轻其应激水平。     

Association between COVID-19-related stress and self-directed learning ability among Korean nursing students

PurposeTraditional face-to-face classes for nursing students due to the COVID (Coronavirus Disease)-19 pandemic around the world made it inevitable to operate education delivery method using remote/hybrid fashion. This study was aimed to validate the Korean version of the Student Stress Inventory-Stress Manifestations (SSI-SM) and assess the association between COVID-19 pandemic related stress level and self-directed learning ability competence in nursing students.DesignThis research was a cross-sectional study design.MethodsThe study was conducted from December 2020 to January 2021, with a convenience sample of 172 nursing students in the 3rd and 4th grades in South Korea. The Korean version of SSI-SM(K-SSI-SM) was translated and adapted according to standard guideline, and tested construct validity and reliability. In addition, a multiple linear regression analysis was used to examine the associations between the COVID-19 related stress level and the self-directed learning ability.ResultsAn exploratory analysis showed that K-SSI-SM composed of 13-item in three factors (uncertainty, non-sociability, and somatization) accounted for 68.73% of the total variance after it was modified. The internal consistency was good with 0.91. Multiple linear regression analysis revealed that higher self-directed learning ability was associated with lower stress levels (β = −0.19, p = 0.008), positive toward online learning (β = 0.41, p = 0.003) and scored higher in theory (β = 0.30, p < 0.001) in nursing students.ConclusionThe K-SSI-SM is an acceptable instrument for assessing stress levels in Korean nursing students. And nursing faculties need to pay attention to related factors of self-directed learning ability, in order to achieve the course's self-directed learning goal in students attending online classes.     

The Turkish version of the Casey-Fink Readiness for Practice Scale: A validity and reliability study

AimThe aim was to translate and adapt the Casey-Fink Readiness for Practice Scale (CFRPS) into Turkish and assess its validity and reliability for senior nursing students.BackgroundNursing students’ readiness for practice is important for quality nursing care and to support new graduate nurses and orient them quickly for their professional life. Nurse educators and nurse managers are responsible for develop nursing students’ and new graduate nurses’ readiness for practice. Currently, there is no valid and reliable tool to assess this metric for senior nursing students in Turkey.DesignThe study was conducted using a methodological approach.MethodsThe sample of the study consisted of 179 students who were enrolled in the last year of nursing school across three state universities in one region of Turkey. A socio-demographic form and the Turkish version of the CFRPS were used for data collection. Data were collected online between 12 April – 17 May 2021. Content validity was assessed using expert approval. Confirmatory factor analysis, exploratory factor analysis and structural equation modelling were used to assess validity. Cronbach's alpha and test–retest were performed to assess reliability.ResultsNursing students’ mean age was found to be 22.3 ± 1.12. The content validity index of the scale was calculated as 0.94. Confirmatory and exploratory factor analysis identified 15 items, which could be categorized under one factor, that were obtained differently from the original scale. The factor loads were found to be between 0.39 and 0.70. The Cronbach's alpha of the scale was 0.881. One factor model achieved a good fit.ConclusionsThe study demonstrated that the Turkish version of the CFRPS is a valid and reliable assessment tool to evaluate senior nursing students’ readiness for practice. Information in the Turkish version of the CFRPS was obtained differently from the original scale. Nurse educators can use this tool to assess their students’ progress in readiness for practice before they graduate.     

The impact of a sense of self-efficacy on the level of stress and the ways of coping with difficult situations in Polish nursing students

IntroductionDuring their first practical classes at a clinical ward nursing students face a new environment; they take on new roles which is associated with stress and a need to handle it.ObjectiveThe aim of this study was to evaluate the effect of a sense of self-efficacy on the level of stress and the ways of coping by Polish nursing students during the first practical classes at a clinical ward.Material and MethodsThe study included 394 undergraduate subjects studying nursing at two universities in Southern Poland. The study used the method of diagnostic questionnaire and estimation. The research tools included: an original questionnaire, Stress Scale (PSS10), Inventory to measure coping with stress (Mini Cope) and Generalized Self-efficacy Scale (GSES). Data analysis was performed using the IBM Statistical Package for Social Sciences, version 21 for Windows. The verification of differences between variables was performed using χ² independence test, Kruskal-Wallis test, and Spearman rank correlation coefficient. The level of significance was accepted at α = 0.005.ResultsThe level of stress and a sense of self-efficacy in majority of tested nursing students were high. The people with low levels of perceived stress had a significantly higher sense of self-efficacy (rhoSpearman = − 0.196; p = 0.0001). The people with a higher sense of self-efficacy significantly more often used active strategies in stressful situations, such as Active coping (rhoSpearman = 0.284; p < 0.0001), Planning (rhoSpearman = 0.318, p ≤ 0.0001), Positive revaluation (rhoSpearman = 0.228, p < 0.0001), Acceptance (rhoSpearman = 0.188; p = 0.0002), Seeking Emotional Support (rhoSpearman = 0.123; p = 0.0143).ConclusionsA sense of self-efficacy had a significant impact on the level of stress and the ways of coping with difficult situations in nursing students.