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  • Subject Name : Nursing

Stress and Coping Among Nursing Students During Their Clinical Placements

Abstract on Stress Management Intervention

The literature review was conducted to assess the levels of stress and resilience of the first year before and after their clinical placement using a smartphone is decreased or not. Data were collected from 10 articles followed by CINAHL, Medline, Psych Info, and PubMed. The inclusion criteria followed were the papers that were published from 2015-20, published in English, include a focus on stress and nursing students specifically addressing placements in the clinical area. The articles were then selected based on appropriate quality fittingness, and quality of findings. However, the exclusion criteria were the articles that were not authentic and published before 2015. Different authors presented different views and the literature highlighted the initial clinical experience that is highly stressful for the nursing professionals. The results of the studies concluded that there was a lack of knowledge and skills used inpatient care.

Introduction to Stress Management Intervention

Nursing education is essential for professionals to attain experiencing clinical setting stress and duties. The major contributor found in the level of stress and perceptions of nursing students during the study and in professional life. The important thing for this is to develop and use resilience with the means to cope with the inevitable stress that nursing professionals face in their careers (Phang, C. K., Mukhtar & Ibrahim et al., 2015). This study will aim at investigating the levels of stress and resilience of the first year before and after their clinical placement with evaluating a stress management tool using a smartphone. The literature review would be done to collect the data and analyze it. The question will be formed by using PICO format to have defined population, intervention, comparison, and outcome. Stress in students is caused by several factors such as by experiencing poor work-life balance, population in general enrolled for nursing education, and examinations. This accelerates stress and has a great impact on student’s retention and personal career satisfaction (Dyrbye, Shanafelt & Werner et al., 2017).

Methodology of Stress Management Intervention

Period: The articles for literature review were selected from the period of 2015-20.

Databases: The data named CINAHL Medline, Psych Info, and PubMed are followed in this literature review.

Search terms: The articles were searched using keywords such as nursing students, stress, experience, training, clinical experience, initial clinical education, practice, undergraduate nurses, student nurses, initial clinical education, and clinical training. These terms were used in first research with the help of “AND”, “OR”, and “NOT”, which are Boolean operators.

In the second research, terms included were reducing stress, stress management, stress reduction, and intervention.

In the third research, the keywords used were student nurses, resilience, building resilience, intervention, and undergraduate nursing.

Articles found:

Characteristics of article – inclusion and exclusion criteria:

Inclusion criteria: Various points were noted in the inclusion criteria as the articles were included which were published from 2015-20, published in English, include a focus on stress and nursing students specifically addressing placements in the clinical area. The articles were then selected based on appropriate quality fittingness, and quality of findings.

Exclusion criteria: The exclusion was done for the articles which were found to be duplicate, stressing on poor research design, and the accessibility of the article. The total number of articles found from these sources was 100, but after considering all these points, only 10 articles were included.

PICO Question

Population

Nursing students

Intervention

Smartphones

Comparison/ contrast

Level of stress before and after the clinical placement

Outcome

Decreased level of stress

Research question:

Whether the levels of stress and resilience of the first year before and after their clinical placement using a smartphone is decreased or not?

Discussion and Critical Overview

The literature highlighted the initial clinical experience that is highly stressful for nursing professionals. The results of the studies concluded that there was a lack of knowledge and skills used inpatient care. Moreover, in the articles, it was stated that in the initial clinical placement there is a greater impact on nursing education (Van Rossiter & Kirby et al., 2015). The challenging relationships were found between staff, peers, and community like there is a lack of experience, lack of skills, fear of mistakes, and performing interventions on the patient for the first time. Several studies reported that there is an increased level of anxiety and stress in the initial clinical placement but most of the time nursing professionals do not understand the situation (Hintz, Frazier & Meredith, 2015).

The research studies present on different sources have documented the sources of stress and perceptions of stress in nursing students. This is stated as the major cause that is causing stress to students during their studies (Nguyen-Feng, Frazier & Greer et al., 2015). A review of current literature presented that there were some studies which only focused on clinical placement and the ways to improve the experience of students pursuing nursing. There was a lack of research that demonstrated the topic aimed at investigating the levels of stress and resilience of the first year before and after their clinical placement with evaluating stress management. Ahmed et al. (2019) stated that mobile technology is an effective tool for helping the students to overcome the gap and work on new methods to have access to the information. Moreover, there were more studies done that investigated the factors that contribute to a student's experience in the placement and their perception of stress.

There was no such proper methodology like a mixed approach followed to know the perceptions and causes of resilience and stress in the initial clinical placement (Babar, Hasan & Ooi et al., 2015). However, the topic of research states the looking into factors such as lack of confidence, poor management, attrition rate, poor clinical engagement, poor quality of patient care, and poor job satisfaction. The problem-solving approach was used by the education staff to overcome the stress of nursing students. The most common problems that students faced were the assignment and workload for which the nursing interventions should be done (Rathnayake & Ekanayaka, 2016). Social support will contribute as an essential factor to cope with mentors and stress in clinical placement. Factors like social integration, staff shortages, and organizational changes impact clinical students.

Summary table

S. No.

References

Description of article

characteristics of the article

1

Latif et al., 2019

The study aimed at conducting a study on stressors and Coping Strategies during Clinical Practice among Diploma Nursing Students. The study was confined to some groups of people; however, the focus was to find out strategies that stressors can follow in their clinical practice.

The article provided information that positive coping skills are required to deal with situations effectively. The empirical approaches allow to prevent and lessen the impact by conducting counseling programs, stress management, formulating policies, and establishing a family and peer support to help nursing students.

2

Ahmed et al., 2019

This study aimed at nursing students' stress and coping strategies during clinical training in KSA. Several students exposed to stress were studied during the training. The descriptive cross-sectional study was done on 125 samples in clinical practice.

The article provided information that there was a moderate level of stress faced by the selected participants. The problem-solving approach was used by the education staff to overcome the stress of nursing students. Moreover, clinical training is always helpful in conducting and developing clinical skills.

3

Ansari, 2017

This was the research study aiming at Stressors and Coping Strategies of the Saudi Nursing Students in the Clinical Training. This was the cross-sectional study done to identify strategies from which nursing professionals get relieved from stress. The sample of 200 students was taken and the test was conducted using the Perceived Stress Scale (PSS) and Coping Behavior Inventory (CBI). ANOVA test was used to do the analysis and a t-test was conducted on SPSS version 22.

The most common problem that students faced was the assignment and workload for which the nursing interventions should be done.

4

Kull et al., 2015

This was the descriptive comparative research study done to assess the level of stress. The study was done to assess three grade levels in two sophomores, seniors, schools, and juniors at the time of receiving education. The interventions were not made in this study to control and manipulate the environment.

The article stated that stress can lead to job satisfaction, absenteeism, and a high employee turnover rate.

5

Labrague et al., 2018

This study aimed at Stress and coping strategies among nursing students: an international study in which the consistency of stress was found out and was related to the issues in education. The cross-sectional study was done in the college among 346 participants. A simple random sampling method was used in the research. The inclusion criteria for this research was to include nursing students who were voluntarily willing to participate.

The findings from the articles were that clinical assignment was the main stressor for nursing students. Some activities must be involved to manage clinical assessments and knowledge.

6

Liu et al., 2015

This article has been published in the year 2015 and aimed at investigating the stress perceived by Macao nursing students in the clinical learning environment. This was the cross-sectional study in which 203 nursing students with higher education were selected for research. The scale used was Chinese Version to measure the stress of nursing students. A descriptive analysis was done to analyze the variance.

This article concluded that nursing students experience stress than other students. This was also suggested that learning and teaching modalities should be reviewed. It is because stress hampers the students and give negative effects on nursing graduates.

7

Porter, 2019

This was the research study done aiming at First-year nursing students' perceptions of stress and resilience during their initial clinical placement and the introduction of a stress management app: a mixed-methods approach. Both the qualitative and quantitative data were analyzed to do this research. Thematic analysis was done to analyze the qualitative interview data. 

From this research, it was found that there was no significant change that was noticed before and during clinical placement. A high correlation was found between perceived stress and levels of resilience.

8

Rafati et al., 2017

This was the article published in 2017 that aimed at coping strategies of nursing students for dealing with stress in the clinical setting. The qualitative content analysis was done which carried out with twenty nursing students who were selected after purposive sampling at Razi nursing and midwifery school in Kerman in Iran. The data were collected using semi-structured face-to-face interviews for analysis.

The nursing students experienced coping with stress with an increase in awareness to cope up with strategies.

9

Miguel et al., 2020

The purpose of this research was to analyze clinical placement stress by testing self-efficacy as a possible mediator factor. The exploratory design was used to do this research. The number of participants chosen was 334 nursing students who completed KEZKAK stress analysis. In this study, socio-demographic information was also included. -

From this research, it was found that emotional and procedural stress is acceptable. There was a high level of academic and leadership overload found in the studies.

10

Shdaifat et al., 2018

This study was done to assess the levels of stress that are related to academic assignments along with clinical skills training. The descriptive cross-sectional study was carried out to determine the coping and stress strategies among nursing students. The level of stress was evaluated through the Perceived Stress Scale (PSS) and the way coping strategies were assessed by the use of the Coping Behavioral Inventory (CBI).

The study revealed that there was a moderate level of stress among the students and there is a need to address the stress management programs and provision of social support.

Conclusion on Stress Management Intervention

The literature review will be concluded that the students in their initial clinical placements will get benefited from support in managing stress throughout their nursing career and program. Although, there will be stress that clinical professionals will be facing during their education and placement. This will not be eliminated from the clinical experience at all, but the fact that social integration, staff shortages, and organizational changes impact clinical students. Several factors that have been found in the literature are that challenging relationships between staff and mentors, inexperience, and clinical performance that impact nursing students. Social support will contribute as an essential factor to cope with mentors and stress in clinical placement. Technological support should be emphasized for the optimal engagement of students to enhance their accessibility and usage.

References for Stress Management Intervention

Ahmed, W. A., & Mohammed, B. M. (2019). Nursing students' stress and coping strategies during clinical training in KSA. Journal of Taibah University Medical Sciences14(2), 116-122. https://www.researchgate.net/deref/http%3A%2F%2Fdx.doi.org%2F10.1016%2Fj.jtumed.2019.02.002

Alsaqri, S. H. (2017). Stressors and coping strategies of Saudi nursing students in clinical training: A cross-sectional study. Education Research International2017. https://doi.org/10.1155/2017/4018470

Babar, M. G., Hasan, S. S., Ooi, Y. J., Ahmed, S. I., Wong, P. S., Ahmad, S. F., ... & Malik, N. A. (2015). Perceived sources of stress among Malaysian dental students. International Journal of Medical Education6, 56. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417984/

Dyrbye, L. N., Shanafelt, T. D., Werner, L., Sood, A., Satele, D., & Wolanskyj, A. P. (2017). The impact of a required longitudinal stress management and resilience training course for first-year medical students. Journal of General Internal Medicine32(12), 1309-1314. https://link.springer.com/article/10.1007/s11606-017-4171-2

Hintz, S., Frazier, P. A., & Meredith, L. (2015). Evaluating an online stress management intervention for college students. Journal of Counseling Psychology62(2), 137. https://psycnet.apa.org/doi/10.1037/cou0000014

Kulland, E. P. (2015). Nursing student stress. https://library.ndsu.edu/ir/bitstream/handle/10365/27601/Nursing%20Student%20Stress.pdf?sequence=1&isAllowed=y

Labrague, L.J., McEnroe-Petitte, D.M., Papathanasiou, I.V., Edet, O.B., Tsaras, K., Leocadio, M.C., Colet, P., Kleisiaris, C.F., Fradelos, E.C., Rosales, R.A & Vera Santos-Lucas, K., (2018). Stress and coping strategies among nursing students: An international study. Journal of Mental Health27(5), pp.402-408. https://doi.org/10.1080/09638237.2017.1417552

LAtif, R., & Nor, M. Z. M. (2019). Stressors and coping strategies during clinical practice among diploma nursing students. The Malaysian journal of medical sciences: MJMS26(2), 88. https://dx.doi.org/10.21315%2Fmjms2019.26.2.10

Liu, M., Gu, K., Wong, T. K., Luo, M. Z., & Chan, M. Y. (2015). Perceived stress among Macao nursing students in the clinical learning environment. International Journal of Nursing Sciences2(2), 128-133. https://doi.org/10.1016/j.ijnss.2015.04.013

Nguyen-Feng, V. N., Frazier, P. A., Greer, C. S., Howard, K. G., Paulsen, J. A., Meredith, L., & Kim, S. (2015). A randomized controlled trial of a web-based intervention to reduce distress among students with a history of interpersonal violence. Psychology of Violence5(4), 444. https://psycnet.apa.org/record/2015-32794-001

Phang, C. K., Mukhtar, F., Ibrahim, N., Keng, S. L., & Sidik, S. M. (2015). Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study. Advances in Health Sciences Education20(5), 1115-1134. https://link.springer.com/article/10.1007/s10459-015-9591-3

Porter, S. L. (2019). The first-year nursing students' perceptions of stress and resilience during their initial clinical placement and the introduction of a stress management app: a mixed-methods approach (Doctoral dissertation, Edinburgh Napier University). https://www.napier.ac.uk/~/media/worktribe/output-2086663/first-year-nursing-students-perceptions-of-stress-and-resilience-during-their-initial.pdf

Rafati, F., Nouhi, E., Sabzevari, S., & Dehghan-Nayeri, N. (2017). Coping strategies of nursing students for dealing with stress in the clinical setting: A qualitative study. Electronic physician9(12), 6120. https://doi.org/10.19082/6120

Rathnayake, S., & Ekanayaka, J. (2016). Depression, anxiety, and stress among undergraduate nursing students in a public university in Sri Lanka. International Journal of Caring Sciences9(3), 1020-1032. https://www.internationaljournalofcaringsciences.org/docs/31_rathnayaky_originial_9_3.pdf

Sánchez de Miguel, M., Orkaizagirre‐Gómara, A., Ortiz de Elguea, J., Izagirre Otaegi, A., & Ortiz de Elguea‐Oviedo, A. (2020). Factors contributing to stress in clinical practices: A proposed structural equation model. Nursing Open7(1), 364-375. https://doi.org/10.1002/nop2.397

Shdaifat, E., Jamama, A., & AlAmer, M. (2018). Stress and coping strategies among nursing students. Global Journal of Health Science10(5), 33-41. https://doi.org/10.5539/gjhs.v10n5p33

Van der Riet, P., Rossiter, R., Kirby, D., Dluzewska, T., & Harmon, C. (2015). Piloting a stress management and mindfulness program for undergraduate nursing students: Student feedback and lessons learned. Nurse Education Today35(1), 44-49. https://doi.org/10.1016/j.nedt.2014.05.003

Yasmin, S., Hussain, M., Parveen, K., & Gilani, S. A. (2018). Coping strategies of the nursing student against academic and clinical stress at public sector Lahore. International Journal of Social Sciences and Management5(3), 209-218. file:///C:/Users/Acer/Downloads/20613-Article%20Text-65351-2-10-20180726.pdf

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