Elsevier

Nurse Education Today

Volume 24, Issue 6, August 2004, Pages 473-482
Nurse Education Today

Pre-registration diploma student nurse stress and coping measures

https://doi.org/10.1016/j.nedt.2004.05.004Get rights and content

Abstract

The aim of this study is to examine the stress experiences and coping abilities of student nurses. A survey design was employed to examine the stress experiences of Diploma student nurses in a large Dublin Teaching Hospital. A questionnaire was utilized that measured and explored five specific constructs pertinent to student nurse stress. These included clinical stress, academic stress, coping, emotions and personal factors which assist students nurses during periods of stress. Findings showed that examinations, the level and intensity of academic workload, the theory–practice gap and poor relationships with clinical staff were the leading stressors identified. Emotional reactions to stress included feeling exhausted and upset under pressure. Students adopted short-term emotion focused coping strategies when attempting to deal with stress. A sense of achievement, and determination, were personal factors, which assisted students to continue in the event of stress being present. Content analysis of the open questions shed further light in relation to the stress phenomenon, particularly in relation to clinical stress. The provision of adequate support services from a clinical and academic perspective, a lecture–practitioner model of education delivery, and curriculum changes which focus on developing student self awareness skills are the suggested study recommendations.

Introduction

Throughout the last decade nurse education in the Republic of Ireland has undergone tremendous change. It is presently facing its greatest challenge to date, with the implementation of a four-year degree programme (Timmins and Kaliszer, 2002). There is an onus on all practitioners, including educationalists, constantly to review and examine current practice in order to accomplish and strive for quality goals. During this radical period in nurse education, there is an urgent need for educationalists to address issues such as student stress, which can disrupt physiological and psychological health (Sarafino, 1998). Furthermore, it is necessary to identify whether students are equipped sufficiently with effective coping skills to deal with future clinical stress.

It is well recognised that Diploma nurse education produces stress (Hamill, 1995; Lindop, 1999) which can also adversely affect the quality of nursing care (Beck and Srivastava, 1991). Although student nurses are to a greater extent regarded as supernumerary, they do participate in extensive hands-on patient care (Holland, 2002). However, student nurses are currently juggling several roles, which demand a high level of commitment and competence. Much recent research has been replete with suggestions as to how nurse educators might reduce student nurse stress and enable them subsequently to cope more effectively (Sawatzky, 1998; Jones and Johnston, 2000). From an Irish perspective there has only been a scant, anecdotal acknowledgment of the issues pertaining to student stress within the literature.

The study endeavoured to isolate unwanted stress and ultimately to develop curriculum structures which will optimise the educational experience of student nurses from an academic and clinical perspective.

Section snippets

Background

Stress has been identified as the 20th century disease (Bailey, 1980). Previous research has been criticised for failing to clarify its underlying theoretical conceptualisation and definition (Wheeler, 1997). There are three models of stress identified in the literature; the Stimulus Model, the Response Model and the Transactional Model (Bailey and Clarke, 1989).

In the Transactional Model of Stress, stress is viewed as a complex and dynamic transaction between individuals and their environments

Methodology

Research questions were formulated following review of the literature. These questions are detailed below:

  • What specific types of clinical and educational stress are student nurses exposed to?

  • What are the specific coping strategies student nurses employ when exposed to stress?

  • What emotions do student nurses experience when exposed to stress?

  • What personality factors help student nurses to carry on during periods of stress?


Clinical stress relates to any stress that arises within the clinical

Results

The Likert stress questionnaire contained a five-point scale with one indicating strong disagreement, two indicating disagreement, three indicating don't know, four indicating agreement and five indicating strong agreement. The coefficient alpha of internal consistency for the questionnaire was 0.94, which indicated significant reliability. For analysis purpose, the one student in the 38–45-age category was eliminated. All constructs; clinical stress, academic stress, emotional responses to

Discussion

The predominant stress factors found in this study arising as result of academic activity, support the findings of Lindop, 1989, Lindop, 1999 studies and also Timmins and Kaliszer (2002) Irish study findings. (i.e. examinations and the intense amount of academic work). A preoccupation with assessment may encourage students to be externally motivated, learning only because they are being assessed. This emphasis, essentially contradicts the present aspirations of molding students who will possess

Limitations

The major limitation of this study was that it represented students in only one higher education establishment in the Republic of Ireland owing to the sampling technique chosen (i.e convenient sampling). The sample size (n=52) unearths a further limitation. The results therefore need to be considered with caution as they are not generalisable. However although this was a relatively small-scale study it did highlight pertinent issues locally in relation to student nurse stress.

Conclusions

It is clear from the results of this study that these student nurses are exposed to a variety of stressors from academic and clinical perspectives, which is not unique when compared to the literature. The emotional consequences of stress are evident, with students in this study experiencing exhaustion and pressure. Nursing students are in a unique position academically and multiple demands are made on them. Curriculum developers need to be cognisant of this.

Nurse educators and curriculum

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