Stress Factors among Nursing Students in Public and Private Institutions

Abstract

Nursing education is renowned for its demanding nature, subjecting students to a multitude of stressors. This study investigates stress factors among nursing students in both public and private institutions, shedding light on their experiences in Pakistan. The research employs a quantitative approach, utilizing a 31-item questionnaire with a five-point Likert scale to assess stress-related factors, with values ranging from “Strongly Disagree” to “Strongly Agree.” The study encompasses a diverse participant pool, including 150 nursing students, revealing a relatively balanced gender distribution and representation from public and private institutions.

The results underscore academic-related stress as the most prominent challenge faced by nursing students, affecting sleep patterns, self-study abilities, and punctuality. Additionally, issues such as uncooperative clinical staff, difficulties in accessing basic facilities and language proficiency barriers contribute to the stress burden. These findings emphasize the need for proactive support mechanisms within nursing education, encompassing mental health support and language assistance.

Furthermore, the study outlines the limitations of using a self-generated questionnaire and highlights the necessity for future research in areas such as longitudinal studies, comparative analyses of different program formats, and the effectiveness of interventions to reduce stress and enhance well-being. By addressing these stress factors comprehensively, nursing institutions can better prepare students for the rigors of their profession, ultimately enhancing the quality of healthcare delivery in Pakistan.

Introduction

Nursing education is a demanding and rigorous journey, marked by academic pressures, clinical responsibilities, and the need for effective time management [3]. It is well-known that nursing students often face high levels of stress during their educational pursuits [17]. Understanding the specific stress factors that impact nursing students is crucial to improve their educational experience and overall well-being. The stress factors among nursing students can be categorized into several key areas. Firstly, academic pressure is a significant source of stress. Nursing programs often have demanding coursework, exams, and clinical requirements, leading to pressure to excel academically [3,13]. Secondly, clinical responsibilities add to the stress levels. Balancing clinical duties with academic coursework can be challenging, and students may worry about making mistakes in a clinical setting [12,14]. Time management is another crucial aspect that contributes to nursing student stress. Juggling coursework, clinical shifts, and personal life can be stressful, especially when there are tight schedules to adhere to [5]. Interpersonal relationships also play a role in nursing student stress. Conflicts with classmates, clinical instructors, or healthcare staff can contribute to stress [13]. Effective communication is vital in nursing, and students may feel stressed if they struggle with patient communication or interacting with healthcare teams [5]. Self-study is often required in nursing education, and some students may find it challenging to motivate them and manage their study time effectively [17]. Language barriers can also be a source of stress, particularly for students studying in a language that is not their first language. This stress can be exacerbated if coursework and clinical duties require fluency in the language (Nguyen et al., 2023). Financial concerns cannot be ignored as well. Tuition fees, living expenses, and the cost of study materials can create financial stress for nursing students [14]. The clinical environment itself may present stressful situations, including high patient acuity, ethical dilemmas, and exposure to illness and suffering [5]. Lastly, personal factors such as family problems, health concerns, or the loss of a loved one can add to the stress experienced by nursing students [14]. These stress factors collectively impact the mental and emotional well-being of nursing students, affecting their academic performance and overall quality of life [17]. It's essential for nursing programs to provide support and resources to help students cope with these stressors effectively.

Aim

The aim is to assess and analyze the stress-related factors experienced by nursing students in both public and private nursing institutes.

Methods

Study Design

The study employed a quantitative research design to collect and analyze data on stress factors among nursing students.

Data Collection

A cross-sectional approach was used to collect data conveniently from public and private nursing institutes students in Peshawar. The research employed a self-generated questionnaire based on existing literature. To ensure the validity and reliability of the tool, it underwent psychometric testing conducted by three nursing experts who have experience as MSN teachers in nursing institutes. Additionally, a psychologist and an English language expert reviewed the questionnaire. The questioner was developed in the English language.

Research Tool

The research tool employed in this study is a 31-item questionnaire aimed at evaluating stress-related factors among nursing students. Respondents were asked to rate their responses on a five-point Likert scale, ranging from "1 - Strongly Disagree" to "5 - Strongly Agree." The questionnaire encompasses various aspects of stressors encountered by nursing students, including academic pressures, clinical responsibilities, time management challenges, interpersonal conflicts, communication difficulties, self-study habits, language proficiency, financial concerns, clinical environment stressors, and personal life issues. To ensure the reliability of the tool, the internal consistency of its components was assessed using Cronbach's alpha, resulting in a high coefficient of 0.8 for each item. In the analysis, values were assigned as follows: "Strongly disagree" and "Disagree" were assigned a value of 1, "Neutral" was assigned a value of 2, and "Agree" and "Strongly Agree" were assigned a value of 3. Data collected through this questionnaire were subsequently analyzed using SPSS version 26 to investigate the impact of these stress-related factors on nursing students' well-being.

Ethical Considerations

Prior to data collection, informed consent was obtained from all participating students. Permission to conduct the research was granted by the respective heads of the nursing departments in the institutions involved. To ensure the protection of student identities, all personal information was kept confidential.

Results

The results of the study provide valuable insights into the stress factors experienced by nursing students in Pakistan. The study included 150 nursing students, with 60% being female and 40% male. Their average age was 21.4 years. Sample Composition: Among the 150 participants, 30 were enrolled in specialty nursing programs, 70 were pursuing Bachelor of Science in Nursing (BSN) programs, and 30 were in post-RN nursing programs. Gender Distribution: Among the 150 participants, there was a relatively balanced gender distribution, with 60% being female and 40% male. This balanced representation suggests that stress factors in nursing education are not significantly gender-biased in this context. Institutional Sector: The study revealed that 60% of the participants belonged to public nursing institutions, while the remaining 40% were enrolled in private institutions. This indicates a diverse representation of students across different sectors, each facing unique challenges and stressors in their educational journey.

The study results included that nursing students of Public and private nursing institutes were faced various challenges during their academic duration, with the most significant factor affecting their performance being academic-related stress. Study key findings include: 56.7% of participants experienced changes in their sleeping patterns. 53.4% had difficulty in self-study. 53.3% faced gate closure issues when arriving late. 50% reported a lack of recreational activities and homesickness. 46.7% encountered uncooperative clinical staff. 43.3% mentioned issues with water supply and transport facilities in their institutes. 43.3% had poor computer skills.

43.3% noted strict supervisor/senior nurse behavior in clinical setting. 43.3% expressed poor interest in studying. 43.3% faced social un-acceptance of nursing as a profession. 40% experienced changes in their living environment. 36.7% had concerns about poor toilet hygiene in the institutes. 40% were afraid from assigned night duties. 40% dealt with the death of a beloved person. 40% received lower grades than anticipated. 40% had inadequate chances for participation from teachers. 40% found it challenging to understand English. 36.7% faced insufficient financial support from family. 36.7% reported attendance without a scheduled class. 36.3% felt hesitation in class participation. 36.7% struggled with excessive absenteeism. 33.3% shared rooms with others. 33.3% had difficulty understanding complex terminology. 33.3% had limited vocational breaks. 33.3% lacked a proper class timetable. 30% complained about the poor quality of cafeteria food. 30% mentioned inadequate financial support. 26.7% experienced conflicts with close ones. 26.7% received no rewards for good performance. 23.3% faced no breaks between lectures.

These findings underscore the significant stressors experienced by student nurses during their academic journey, particularly related to academic pressures, self-study challenges, and difficulties in adapting to the nursing education environment. The table: 1 represents the results percentages and results of current research. Inserts table 1 here.

Discussion

The findings of this study highlight the presence of various stress factors among nursing students in Pakistan. Our study on stress factors among nursing students in Pakistan aligns with several recent studies that have explored stress and coping strategies among students in healthcare-related disciplines. The research by Nebhinani, Kumar, Parihar, and Rani (2020) in Western Rajasthan provides insights into stress levels and coping strategies among undergraduate nursing students. While their study focused on a specific region, it underscores the universality of stress factors in nursing education. Our study complements their findings by addressing similar issues among nursing students in Pakistan, demonstrating that these challenges are not unique to a particular location but are widespread concerns that necessitate attention.

In addition to nursing students, studies in related healthcare fields have also investigated stress factors and coping mechanisms. For instance, Jahan, Nerali, Parsa and Kabir (2022) conducted a scoping review examining the association between emotional intelligence, academic performance, and stress factors among dental students. Their work highlights the relevance of emotional intelligence in understanding and addressing stress among students in healthcare disciplines.

Furthermore, Reinkemeyer, Chrisman, and Patel (2022) conducted an integrative review on the use of escape rooms in nursing education. While their study focuses on a different aspect of education, it exemplifies the innovative approaches employed to engage and educate healthcare students. Incorporating such interactive and immersive methods in nursing education could potentially alleviate stressors by providing students with effective learning experiences. Together, these studies, including our research, contribute to a broader understanding of the challenges faced by students in healthcare-related disciplines and the various strategies employed to manage stress. By considering findings from these studies collectively, educators and policymakers can develop comprehensive support systems and innovative educational approaches to promote the well-being of students pursuing careers in healthcare.

It is essential to discuss and contextualize these stressors to develop strategies for addressing them effectively. Gender and Stress: The relatively balanced gender distribution among the participants suggests that stress factors in nursing education do not significantly differ between male and female students in this context. While there may be some variation in the specific stressors experienced, the overall impact on both genders appears to be substantial. Institutional Sector and Stress: The representation of students from both public and private nursing institutions is notable. It is well-documented that nursing programs in public and private sectors may have different resources, facilities, and teaching methodologies. Therefore, the stressors faced by students in each sector may vary. Public institutions often face resource constraints, while private institutions may have different academic and financial pressures. Understanding these distinctions is crucial for providing targeted support to nursing students.

Recommendations and Suggestions

Based on the study's findings, several recommendations and suggestions can be made to address stress factors among nursing students: Mental Health Support: Nursing institutions, both public and private, should prioritize the mental health and well-being of their students. This includes providing access to counseling services, stress management workshops, and creating a supportive environment where students can openly discuss their challenges. Language Proficiency: One potential limitation identified in this study is the language barrier. Nursing programs should consider offering language support, especially for students who may struggle with understanding English-language materials. This support could include language courses, study aids, or additional resources in the local language.

Limitations

While this study provides valuable insights, it is essential to acknowledge its limitations: Self-Generated Tool: The research utilized a self-generated questionnaire. This approach has inherent limitations, as students may have varying levels of understanding of the English-language tool. Future studies may benefit from using validated and standardized assessment tools to ensure consistency and reliability.

Conclusion

In conclusion, this study sheds light on the stress factors experienced by nursing students in Pakistan, with a focus on gender and institutional sector representation. The findings suggest that stress is a significant concern for nursing students, regardless of their gender. However, the sector of the institution may introduce unique stressors that should be addressed accordingly. To mitigate these stressors, nursing institutions must take proactive steps to provide mental health support and address language barriers, ultimately fostering a more conducive learning environment for aspiring nurses. By recognizing and addressing these stress factors, nursing education can better prepare students for the challenges they will face in their professional careers, ultimately improving the quality of healthcare delivery in Pakistan. Further research is needed to explore additional factors contributing to stress among nursing students and to develop targeted interventions to mitigate these challenges effectively.

Future Researches

Certainly, here are some suggestions for future research on the topic of stress among nursing students in public and private institutes: Longitudinal Studies: Conduct longitudinal studies to track the changes in stress levels and coping mechanisms among nursing students throughout their educational journey. This would provide a more comprehensive understanding of how stress evolves over time.

Comparative Analysis

Compare stress levels between different cohorts of nursing students, such as those in traditional in-person programs and those in online or blended programs. Investigate the impact of program format on stress. Intervention Studies: Explore the effectiveness of stress management interventions and support programs tailored specifically for nursing students. Evaluate the outcomes of interventions aimed at reducing stress and improving overall well-being.

Impact of Clinical Experiences: Investigate the specific stressors encountered during clinical placements and assess how these experiences affect students' stress levels and preparedness for real-world nursing practice.

Resilience and Coping Strategies: Examine the role of resilience and coping strategies in mitigating stress among nursing students. Identify effective strategies that students can employ to reduce stress and enhance their overall resilience.

Cultural and Regional Variations: Explore how cultural and regional factors influence the perception and experience of stress among nursing students. Investigate whether stress levels differ among students from diverse backgrounds.

Faculty Support and Teaching Methods: Analyze the impact of faculty support, teaching methods, and the learning environment on stress levels among nursing students. Identify best practices for creating supportive educational environments.

Mental Health Outcomes: Investigate the long-term mental health outcomes of nursing students who have experienced high levels of stress during their education. Assess the potential implications for their future nursing practice. Technology and Education: Explore the role of technology in nursing education and its potential to alleviate or exacerbate stress among students. Investigate the impact of online learning platforms, virtual simulations, and e-health experiences on stress levels. Policy and Institutional Changes: Assess the effectiveness of policy changes and institutional interventions in reducing stress among nursing students.

Evaluate the impact of increased funding, reduced tuition fees, or changes in curriculum design. Inter-professional Collaboration: Investigate the benefits of inter-professional collaboration in nursing education, examining how collaborative experiences with other healthcare disciplines may influence stress levels among nursing students. Post-Graduation Transition: Study the transition from nursing student to practicing nurse and the stressors associated with this transition. Explore strategies to better prepare students for the demands of the profession. These research areas can provide valuable insights into the experiences of nursing students and contribute to the development of effective interventions and support systems to enhance their well-being throughout their educational journey and beyond.

Author Statements

Acknowledgement: We acknowledge research participants for their time and contribution towards completion of this survey.

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