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Table 1. Socio-demographic, mean scores of stress (Perceived Stress Scale) and coping (Coping Behavior Inventory) in the excluded group and final sample
Had previous experience in nursing 34.50% 36.60% 0.870
Has a family in nursing sector 55.20% 53.40% 0.875
Age (years) 25.12 6.01 26.44 8.96 0.309
Amount of experience before starting nursing (years) 1.38 3.14 1.39 3.17 0.985
Interest in nursing 1.16 0.37 1.15 0.38 0.894
Overall stress score 1.08 0.49 1.03 0.52 0.152
Stress from taking care of patients 1.35 0.56 1.21 0.55 0.104 Stress from assignments and workload 1.32 0.78 1.16 0.77 0.194 Stress from lack of professional knowledge and skills 1.45 0.75 1.51 0.85 0.695 Stress from the environment 1.09 0.68 0.92 0.69 0.105
No significant differences detected between excluded group and final sample, all p values > .05
Interest in nursing scale is from 1-4; 1 = very interested, 2 = Somwhat intersted, 3 = little intersted, 4 = Not interested Stress scale is from 0 - 4; 0 = never, 1 = infrequently, 2 = sometimes, 3 = frequently, 4 = always.
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Table 2
Average stress scores measured by the Perceived Stress Scale (PSS) of students who belonged to the final sample on the two moments M1 and M2 of this study (n= 131)
Unable to provide appropriate responses to doctors', teachers', and patients' questions 1 1.59 0.87 7 1.75 0.94 0.183
Worry about not being trusted or accepted by patients or patients' family 15 1.09 0.82 22 1.37 0.74 0.003 0.36
Feel that the requirements of clinical practice exceed one's physical and emotional endurance 18 0.86 0.90 21 1.38 0.96 < 0.001 0.56 Feel that dull and inflexible clinical practice affects one’s family and social life 10 1.29 1.13 11 1.61 1.23 0.004 0.27
3. Stress from lack of professional knowledge and skills 1 1.51 0.85 1 3.03 0.70 < 0.001 1.96
Unfamiliar with medical history and terms 6 1.53 0.96 1 2.08 1.03 < 0.001 0.55
Unfamiliar with professional nursing skills 3 1.57 0.98 8 1.69 0.88 0.237
Unfamiliar with patients' diagnoses and treatments 8 1.42 0.90 6 1.89 0.89 < 0.001 0.53
4. Stress from the environment 4 0.92 0.69 3 1.45 0.79 < 0.001 0.72
Feel stressed in the hospital environment where clinical practice takes place 22 0.76 0.87 16 1.53 0.99 < 0.001 0.82
Unfamiliar with the ward facilities 17 0.91 0.89 23 1.20 0.93 0.008 0.31
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Feel stressed from the rapid change in patient's condition 16 1.04 0.96 9 1.63 0.98 < 0.001 0.61
5. Stress from peers and daily life 6 0.61 0.62 6 1.04 0.68 < 0.001 0.67
Experience competition from peers in school and clinical practice 23 0.74 0.98 20 1.40 1.12 < 0.001 0.63
Feel pressure from teachers who evaluate students' performance by comparison 14 1.12 1.22 17 1.51 1.27 0.002 0.31
Feel that clinical practice affects one's involvement in extracurricular activities 28 0.30 0.66 29 0.57 0.93 0.002 0.35
Cannot get along with other peers in the group 29 0.26 0.52 28 0.67 0.76 < 0.001 0.63
6. Stress from teachers and nursing staff 5 0.80 0.59 5 1.40 0.72 < 0.001 0.92
Experience discrepancy between theory and practice 4 1.55 0.95 5 1.89 0.88 0.001 0.38
Do not know how to discuss patients' illness with teachers or medical and nursing personnel 27 0.45 0.68 25 0.82 0.85 < 0.001 0.48 Feel stressed that teacher's instruction is different from one's expectations 21 0.78 0.91 18 1.45 0.99 < 0.001 0.71
Doctors lack empathy and are not willing to help 20 0.78 0.85 13 1.58 1.04 < 0.001 0.85
Feel that teachers do not give fair evaluation on students 26 0.47 0.79 24 1.15 1.08 < 0.001 0.72
Lack of care and guidance from teachers 19 0.79 0.99 15 1.53 1.06 < 0.001 0.72
p value with statistically significant differences (p < 0.001) (in bold) using t-test for related samples between M1 and M2
dc = Cohen effect size
Stress scale is from 0 - 4; 0 = never, 1 = infrequently, 2 = sometimes, 3 = frequently, 4 = always.
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Table 3
Average coping behaviour scores measured by the Coping behaviour Inventory (CBI) of students who belonged to the final sample on the two moments M1 and M2 of this study (n= 131)
To save time for sleep and maintain good health to face stress 4 2.79 0.93 7 2.85 0.92 0.524
To relax via TV, movies, a shower, or physical exercises 5 2.71 1.00 6 2.92 0.92 0.032 0.22
p value with statistically significant differences (p < 0.001) (in bold) using t-test for related samples between M1 and M2 dc = Cohen effect size
Coping scale is from 0 - 4; 0 = never, 1 = infrequently, 2 = sometimes, 3 = frequently, 4 = always.
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Stress scale is from 0 - 4; 0 = never, 1 = infrequently, 2 = sometimes, 3 = frequently, 4 = always.
Figure 1. Changes in stress scores measured by the Perceived Stress Scale (PSS) of students who belonged to the final sample on the two moments M1 and M2 (n= 131)
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Stress scale is from 0 - 4; 0 = never, 1 = infrequently, 2 = sometimes, 3 = frequently, 4 = always.
Figure 2. Changes in coping scores measured by the Coping Behavior Inventory (CBI) of students who belonged to the final sample on the two moments M1 and M2 (n= 131)
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Highlights
• Nursing students’ stress levels evolve during their study years
• Lack of professional knowledge and skills remains a significant stressor
• Students cope by utilizing both problem-based and emotion-based strategies
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Disclaimer or disclosure information
The authors declare no conflict of interest.
List of all authors
Author 1 (corresponding author)
Hanish Dev BHURTUN, RN, M.Sc., PhD student
Department of Nursing Science, Faculty of Health Sciences,
University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
Tel. +358417536009
E-mail: hanishdevbhurtun@gmail.com / hanishb@uef.fi
Author 2
Hannele TURUNEN
Professor (Full) and Chair, PhD, RN, Nurse Manager (part time) Head of the Department of Nursing Science
Department of Nursing Science Faculty of Health Sciences, Kuopio Kuopio University Hospital
University of Eastern Finland +358403552629
E-mail hannele.turunen@uef.fi
Author 3 Matti ESTOLA
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Ph.D.
Senior Lecturer
University of Eastern Finland,
Faculty of Social Sciences and Business Studies, Joensuu Campus P.O. Box 111, FIN-80101, Joensuu, Finland.
E-mail: matti.estola@uef.fi
Author 4
Terhi SAARANEN, Professor (acting), Docent PhD, RN, PHN
Department of Nursing Science, Faculty of Health Sciences,
University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
E-mail: terhi.saaranen@uef.fi