INTRODUCTION:

Stress refers to a dynamic interaction between the individual and the environment. This interaction may lead to cognitive, emotional and behavioral alteration.¹Nursing is a challenging profession which poses individuals to carry out different roles. And many students enter into nursing without having a clue of the roles performed. Current scenario is that, there are some nursing institutions, where there is an inadequate facility and exposure adequate enough to attain the objectives and competencies required for a nurse.

Nursing students have the same academic stressors as other college students, such as term and final examinations, research projects and other assignments. In addition, nursing students experience a Clinical component, which is highly stressful. Students have a large amount of preparatory work before their clinical assignments. More over the stress is more in their first academic year due to 9 subjects that they need to concentrate on. Studies indicate that nursing students may be more prone to stress than other students.²

A clinical source of stress includes; fear of the unknown, a new clinical environment, conflict between the theory and real clinical practice, also witnessing sickness, suffering death, death care, witnessing post-mortems also can be scary to the student, exposure to infection, may not know precautions to be taken and many other unfamiliarity with medical history, Providing physical, psychological and social care to patient and so on.³

Although there is preclinical orientation provided to them there is no formal sensitization programme developed so far to address these issues.

AIMS OF THE STUDY:

The aims of the study is to assess perceived stress of nursing students during their initial clinical posting, identify the contributing factors to stress among nursing students and to determine association of stress with selected baseline variables.

MATERIAL AND METHODS:

Design: Research design selected for the study was descriptive cross-sectional design.

Sample and Setting: The study was conducted among first year B. Sc and GNM nursing students of St. John’s College of Nursing, Bangalore. As per the inclusion criteria, 110 students were selected by stratified random sampling from each batch.

Measurements: It consisted of 2 sections. Section one provides nursing students baseline variables, which included age, area of posting, type of family, order of birth, family income, fluency in language, Accommodation, Choice of Nursing, State of domicile, any family members in nursing profession and been an attendant to a patient. Section two includes Perceived Stress Scale (PSS) Developed by Sheu et al. (1997) which are five-point likert-type scales that contain 29 items grouped under 6 sources of stress/stressor. These are (1) Stress from taking care of patients, (2) Stress from teachers and nursing personnel (3) Stress from assignments and workload (4) Stress from peers and daily life (5) Stress from the clinical environment and (6) Stress from lack of professional knowledge and skills. To determine the level of stress, the following scaling was used: 2.67–4.00 for high stress, 1.34–2.66 for moderate stress, and 0–1.33 for low stress.⁴

RESULTS:

The data collected was analyzed using descriptive and inferential statistics.

Figure1: Level of Perceived stress among nursing students.

From the figure 1, it is evident that 7.27% of the samples have High Stress, 54.55% has Moderate Stress and 38.18% has Low Stress during the initial period of their clinical posting.

Table 1: Mean, SD and Ranking on contributing factors to Stress n=110

STRESSORS	Max. Score	RANGE	MEAN	SD	Mean %	RANK
Stress from lack of Professional Knowledge and Skills	4	0-4	2.11	1.16	52.73%	1
Stress from Assignments and Workload	4	0.2-4	1.82	0.78	45.54%	2
Stress from Clinical environment	4	0-3.67	1.55	0.98	38.86%	3
Stress from taking care of patients	4	0.25-3.5	1.53	0.75	38.35%	4
Stress from the Teachers and Nursing staff	4	0.17-3.33	1.37	0.70	34.20%	5
Stress from Peers and Daily life	4	0-3.75	1.18	0.87	29.54%	6

Data resented in the table 3 shows that the most highest ranked stressor identified by students is stress from lack of professional knowledge and skills (2.11±1.16), followed by stress from Assignment and Workload (1.82±0.78), stress from Clinical Environment (1.55±0.98) then Stress from taking care of patients (1.53±0.75), stress from the Teachers and Nursing staff (1.37±0.70) and stress from Peers and Daily life (1.18±0.87) is the last ranked type of stressor.

DISCUSSION OF FINDINGS:

The study samples in the present study consisted of 110 samples of which 23.63 (26) were GNM first year while 76.36% (84) were B.Sc. Nursing first year. In the present study, 72.7% (80) of the subjects were under 18 years of age and 27.3% (30) were above 18 years. Regarding type of family, 84.55% of the subjects belonged to Nuclear Family, 11.82% were from Joint Family and 3.64% are belonged to single parent. According to their birth order, 36.4% are Eldest in the family, 32.6% are 2nd birth order, 20.9% are youngest in the family and 10% are only child. Regarding family income, in this study, 79.1% of the subject’s family income were ≤50,000 and 20.9% had family income >50,001. It was seen in the present study that 97.27% subjects were staying in Hostel and remaining 2.73% were Day scholar. Regarding choice of nursing, 86.4% choose nursing on their own decision and only 13.6% joined based on other’s advice. According to state of domicile, 76.36% of the subjects were from South India, 12.73% were from North India, 8.18% were from East India and 2.73% were from West India. In the present study, there are 72.7% of the subjects who don’t have any family members in the nursing profession and 27.3% subjects does have. In the current study, 50.9% of the subjects have not been attendants to a patient and 49.1% have an experience in nursing care.

In this present study, it showed that 7.27% of the samples had High Stress, 54.55% had Moderate Stress and 38.18% had Low Stress during the initial period of their clinical posting. The findings were contradicting to another study done by Mahfouz R revealed that out of 51 nursing students 48 (94.1%) had high stress whereas 3 (5.9%) had moderate stress, while there is no one among the students who had a low stress.⁵

The present study shows that the most common type of stressor identified by students was stress from lack of professional knowledge and skills (52.73%), followed by stress from Assignment and Workload (45.54%), stress from Clinical Environment (38.86%) then Stress from taking care of patients (38.35%), stress from the Teachers and Nursing staff (34.20%) and stress from Peers and Daily life (29.54%) was the least reported type of stressor. The findings were contradicting to another study that was conducted in Philippines revealed that the most common type of stressor identified by students was “stress from assignments and workload” (mean=2.68, SD=0.58) followed by “stress from lack of professional knowledge and skills”, (mean=2.26, SD=0.46). Meanwhile, “stress from peers and daily life” (mean=1.92, SD=0.69) was the least reported type of stressor.⁶

In the present study, an open-ended question was used to get additional information on factors causing stress as well as their suggestions. Many of the students (62%) expressed that language is one of the major contributing factors for stress followed by difficulties in medical terms.6% students expressed that an in-depth orientation should be given just before sending for clinical posting. 9% of the students expressed staffs were not supportive. 4% students felt there were less positive reinforcements from the supervisors. 10% expressed difficulty in correlating theory with practice.

A present study shows that there is significant association between perceived stress and presence of nurses in the family (t=2.17, p=0.033). A similar study was done in Saudi Arabia where it revealed that there is association between the presence of relatives in nursing with perceived stress (t=8.02, p=0.001) and choice of nursing (t=11.47, p=0.001).⁷

IMPLICATIONS OF THE STUDY:

The implication of the study to nursing can be discussed under the following headings

Nursing Practice:

The finding of the study will

· Enable in creating a stress-free environment in clinical setting for student.

· Give an insight into different modalities that can be followed while students are in the clinical.

Nursing education:

· The information gathered from the study can help in integrating different strategies into clinical orientation for nursing students.

· The findings can help in giving a base to develop the sensitization programme for the students.

· The finding of the study has given insight into the need for assessing the stress level of students before they go to the clinical.

Nursing administration:

· The findings of the study will enable the nursing administrators in providing a suitable and need based clinical learning facilities for the student.

· The findings of the study give an evidence for nurse administrators to reinforce their staff nurses and supervisors to provide student friendly clinical environment.

Nursing research:

· The finding of the study will provide a database on stress experienced by the nurse initiate.

RECOMMENDATIONS:

· A comparative study on stress among students of different institutions such as private and government could be undertaken.

· A qualitative study can be done to explore in depth information on contributing factors to stress.

· A correlational study could be done between perceived stress and clinical performance.

· A study can be done to assess the effectiveness of sensitization programme.

· A study can be done to assess awareness among teachers regarding stress perceived by students.

CONCLUSION:

The study has shown that maximum students (54.55%) had moderate level of perceived stress during the initial period of their clinical posting. The study revealed that most common type of stressor identified by students was stress from lack of professional knowledge and skills and least was stress from Peers and Daily life. There was a significant association of perceived stress with selected baseline variable like presence of nurse in the family

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Received on 09.06.2020 Modified on 20.07.2020

Int. J. of Advances in Nur. Management. 2020; 8(4):331-334.

DOI: 10.5958/2454-2652.2020.00073.6