Perceived Stress and Associated Factors among Undergraduate Nursing Students during Academic Clinicals: An Analytical Cross-Sectional Study

Clinical Stress Among Undergraduate Nursing Students

Authors

  • Saleem Ullah City Institute of Health Sciences, Karachi, Pakistan
  • Fauzia Basaria Hasnani CHS and School of Nursing and Midwifery at Aga Khan University, Pakistan
  • Laila Akber Cassum School of Nursing and Midwifery at Aga Khan University, Pakistan
  • Yasmeen Nadeem Parpio School of Nursing and Midwifery at Aga Khan University, Pakistan
  • Tazeen Saeed Ali School of Nursing and Midwifery at Aga Khan University, Pakistan

Keywords:

Baccalaureate, Cross-Sectional Studies, Education, Nursing, Psychological, Perceived Stress Scale, Stress

Abstract

This analytical cross-sectional study aimed to determine perceived stress and examine its associations with demographic and academic clinical characteristics among BScN students during academic clinicals at a private nursing institution in Karachi, Pakistan. The data was collected from 136 students by using Perceived Stress Scale (PSS) and purposive sampling from August 2021 to October 2021. Independent-samples t-tests and one-way analysis of variance were used for bivariate comparisons. The statistical significance was considered at p < 0.05. 75% female and 25% male participated in the study. The mean total perceived stress score was 49.96 ± 17.26. The factors found to be significantly associated with specific dimensions of academic clinical stress included gender, with male students reporting higher stress related to teachers and nursing staff (p = .036) and lack of professional knowledge and skills (p = .049); marital status, with married students reporting higher stress related to taking care of patients (p = .043); number of academic clinicals, with differences in stress related to lack of professional knowledge and skills (p = .030) and the clinical environment (p = .017); and perception of stress during academic clinicals, with students who perceived themselves as stressed reporting higher stress related to peers and daily life (p = .034). Total perceived stress was not significantly associated with the demographic or academic clinical characteristics examined. These findings identify specific domains of academic clinicals that may warrant attention in clinical supervision and student-support strategies.

DOI: https://doi.org/10.59564/amrj/04.04/004

Author Biographies

Saleem Ullah, City Institute of Health Sciences, Karachi, Pakistan

Director/Principal & Associate Professor

Fauzia Basaria Hasnani, CHS and School of Nursing and Midwifery at Aga Khan University, Pakistan

Senior Instructor

Laila Akber Cassum, School of Nursing and Midwifery at Aga Khan University, Pakistan

Senior Instructor

Yasmeen Nadeem Parpio, School of Nursing and Midwifery at Aga Khan University, Pakistan

Assistant Professor

Tazeen Saeed Ali, School of Nursing and Midwifery at Aga Khan University, Pakistan

Professor

References

Labrague LJ. Umbrella review: Stress levels, sources of stress, and coping mechanisms among student nurses. Nursing Reports. 2024 Feb 5;14(1):362-75. https://doi.org/10.3390/nursrep14010028

Lavoie-Tremblay M, Sanzone L, Aubé T, Paquet M. Sources of stress and coping strategies among undergraduate nursing students across all years. Canadian Journal of Nursing Research. 2022 Sep;54(3):261-71.

https://doi.org/10.1177/08445621211028076

Baluwa MA, Lazaro M, Mhango L, Msiska G. Stress and coping strategies among Malawian undergraduate nursing students. Advances in medical education and practice. 2021 May 28:547-56. https://doi.org/10.2147/AMEP.S300457

Rafati F, Rafati S, Khoshnood Z. Perceived stress among Iranian nursing students in a clinical learning environment: a cross-sectional study. Advances in Medical Education and Practice. 2020 Jul 7:485-91. https://doi.org/10.2147/AMEP.S259557

Mazalová L, Gurková E, Štureková L. Nursing students’ perceived stress and clinical learning experience. Nurse Education in Practice. 2022 Oct 1;64:103457.https://doi.org/10.1016/j.nepr.2022.103457

Wu PL. The impact of clinical practice stress on nursing professional competence among undergraduate nursing students: a cross-sectional study. Florence Nightingale journal of nursing. 2024 Oct 1;32(3):312. https://doi.org/10.5152/FNJN.2024.24102

Kausar T, Ali TS, Gul R. Associated factors of stress among nursing students in their clinical settings. The Malaysian Journal of Nursing (MJN). 2014 Jan 2;5(2):20-6. https://ejournal.lucp.net/index.php/mjn/article/view/530

Mohamed NA, Ali SO, Ehrahim EE, Ahmed AL, Wahba AM. Predictors of academic and clinical stress among nursing students. SAGE Open Nursing. 2024 Oct;10:23779608241290392. https://doi.org/10.1177/23779608241290392

Negm LM, Mersal FA, Fawzy MS, Rajennal AT, Alanazi RS, Alanazi LO. Challenges of nursing students during clinical training: A nursing perspective. AIMS public health. 2024 Mar 19;11(2):379. https://doi.org/10.3934/publichealth.2024019

Mangale N, Mbada AP, Mothoa MN, Rampedi MV, Ntho TA. Prevalence of stress and associated factors among nursing students in Limpopo province, South Africa. curationis. 2026;49(1):1-9. https://doi.org/10.4102/curationis.v49i1.2841

Welch SR. Clinical stress and clinical performance in prelicensure nursing students: A systematic review. Journal of Nursing Education. 2023 Jan 1;62(1):36-41. https://doi.org/10.3928/01484834-20221109-03

Shaban EE, Elmelliti H, Shaban A, Shaban A, Zaki HA. Impact of early clinical exposure on medical students' competency development: a systematic review of evidence from Asian and African countries. BMC Med Educ. 2025;25(1):1723. https://doi:10.1186/s12909-025-08103-9

Loureiro F, Peças D, Neves AC, Antunes AV. Coping strategies and social support in nursing students during clinical practice: A scoping review. Nursing open. 2024 Feb;11(2):e2112. https://doi.org/10.1002/nop2.2112

Sonmez, Y., Akdemir, M., Meydanlioglu, A. and Aktekin, M.R., 2023, February. Psychological distress, depression, and anxiety in nursing students: A longitudinal study. In Healthcare (Vol. 11, No. 5, p. 636). MDPI. https://doi.org/10.3390/healthcare11050636

Chaabane S, Chaabna K, Bhagat S, Abraham A, Doraiswamy S, Mamtani R, Cheema S. Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews. Systematic reviews. 2021 May 5;10(1):136. https://doi.org/10.1186/s13643-021-01691-9

Mazalová L, Gurková E, Štureková L. Nursing students’ perceived stress and clinical learning experience. Nurse Education in Practice. 2022 Oct 1;64:103457. https://doi.org/10.1016/j.nepr.2022.103457

Ksiksou J, Maskour L, Sfendla A, Alaoui MS. Psychometric evaluation of the Arabic version of the Perceived Stress Scale in clinical practicum: Validity and reliability in the Moroccan nursing students. Journal of Education and Health Promotion. 2022 Oct 31;11:327. https://doi.org/10.4103/jehp.jehp_598_22

Goudarzian AH, Nikbakht Nasrabadi A, Sharif-Nia H, Farhadi B, Navab E. Exploring the concept and management strategies of caring stress among clinical nurses: a scoping review. Frontiers in psychiatry. 2024 May 28;15:1337938. https://doi.org/10.3389/fpsyt.2024.1337938

Ullah, H., Arbab, S., Liu, C. Q., Du, Q., Khan, S. A., Khan, S., Dad, O., Tian, Y., & Li, K. (2025). Source of Stress-Associated Factors Among Medical and Nursing Students: A Cross-Sectional Study. Journal of nursing management, 2025, 9928649. https://doi.org/10.1155/jonm/9928649

Shah M, Hasan S, Malik S, Sreeramareddy CT. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC medical education. 2010 Jan 15;10(1):2. https://doi.org/10.1186/1472-6920-10-2

Aslan H, Akturk U. Nursing education stress levels of nursing students and the associated factors. Annals of Medical Research. 2018 Sep 19;25(4):660-6. https://doi.10.5455/annalsmedres.2018.06.108

Lazarewicz MA, Moksnes UK, Reidunsdatter RJ, Wlodarczyk D. Mental wellbeing of higher education students in challenging times. Frontiers in Public Health. 2025 Jan 7;12:1368443. https://doi.org/10.3389/fpubh.2024.1368443

Sabaliauskas S, Ingelevič K, Misiūnienė O, Jakavonytė-Akstinienė A. The relationship between stress, academic motivation, and subjective vitality among nursing students. Nursing Reports. 2025 Aug 15;15(8):300. https://doi.org/10.3390/nursrep15080300

Olson, N., Oberhoffer-Fritz, R., Reiner, B. et al. Stress, student burnout and study engagement – a cross-sectional comparison of university students of different academic subjects. BMC Psychol 13, 293 (2025). https://doi.org/10.1186/s40359-025-02602-6

Sheu S, Lin H, Hwang S, Yu P, Hu W, Lou M. The development and testing of perceived stress scale of clinical practice. Nursing Research (Republic of China). 1997;5(4):341-51.

Downloads

Published

2026-11-11