A Cross-Sectional Comparative Study of Academic, Clinical, and Social Stress Among Undergraduate Nursing Students in Public and Private Institutions in Swat
Jun 2026· Link Medical Journal· pp. 1-10· 0 citations· 20 references
TL;DR
Moderate stress was common across all domains, with the clearest institutional difference observed for clinical stress, although adjusted and longitudinal studies are needed.
Abstract
Background: Undergraduate nursing students encounter academic, clinical, and social demands that may affect their well-being and educational performance, but evidence comparing stress across public and private institutions in Swat is limited. Objective: To determine academic, clinical, and social stress among undergraduate nursing students and compare stress-level distributions according to institutional sector, gender, and year of study. Methods: A multicentre comparative cross-sectional study included 237 second-, third-, and fourth-year nursing students from two public and two private institutions in Swat, Pakistan. Participants were recruited through convenience sampling and completed the 43-item Stress in Nursing Students questionnaire. Stress was classified as low, moderate, or severe. Data were analysed using descriptive statistics, Pearson’s chi-square tests, Cramér’s V, and unadjusted odds ratios with 95% confidence intervals. Results: Moderate academic, clinical, and social stress was reported by 62.0%, 59.9%, and 49.4% of participants, respectively. Severe stress was most frequent in the clinical domain (7.2%). Clinical stress differed by institutional sector (p=0.043), and public-sector students had higher odds of moderate or severe clinical stress than private-sector students (OR=1.83, 95% CI 1.06–3.17). Academic and social stress did not differ significantly by sector. Clinical stress varied by year of study (p=0.033), while academic and social stress were associated with gender (p=0.042 and p<0.001, respectively). Conclusion: Moderate stress was common across all domains, with the clearest institutional difference observed for clinical stress. Structured clinical preparation and student-support strategies are warranted, although adjusted and longitudinal studies are needed.
Background: Medical education is highly demanding and exposes students to considerable psychological stress. First-year students often struggle with academic adjustment, whereas final-year students face clinical responsibilities, career uncertainty, and professional pressures.
Objective: To compare stress levels and coping strategies between first-year and final-year medical students enrolled in public and private medical colleges in District Swat, Khyber Pakhtunkhwa, Pakistan.
Methodology: A comparative cross-sectional study was conducted among 248 MBBS students from Saidu Medical College (public sector) and Swat Medical College (private sector). Participants were recruited using a non-probability convenience sampling technique. Data were collected using a structured 38-item questionnaire assessing demographic characteristics, perceived stress, stress-related factors, and coping strategies. Stress scores were categorized into predefined levels ranging from low to extreme stress. Coping mechanisms were classified as problem-focused, non-problem-focused, and maladaptive.
Results: Overall stress levels were higher among final-year students, particularly those enrolled in the private medical college, who demonstrated the highest mean stress score (46.7; 62.3%). Academic stressors constituted the most prominent source of stress (68%), followed by family-related (65%), personal (60.4%), and social stressors (60.2%). Major stressors included curriculum management, excessive academic workload, prolonged class duration, perceived poor educational quality, parental expectations, financial concerns, and uncertainty regarding future career opportunities. Problem-focused coping strategies were the most frequently adopted approaches (71.2%), with studying from the beginning of the academic year, effective schedule management, and seeking guidance from teachers or senior students being the most common adaptive behaviors. Religious activities and physical exercise were also frequently reported, whereas maladaptive coping strategies were comparatively less common.
Conclusion: Medical students experience substantial stress, with final-year students carrying a greater burden. Medical colleges should strengthen academic support, counseling, stress-management programs, and healthy coping practices.
Keywords: Coping Strategies, Medical Students, Psychological Stress, Stress, Undergraduate Medical Education.
M. Idrees, Anfal Khan, Ameer Afzal Khan et al.· Journal of Saidu Medical Col...· 0 citations
Stress has become a major concern among students, particularly those in health-related programs such as nursing. The demanding academic workload, clinical responsibilities, and limited sup-port systems place nursing students at high risk of psychological distress.
To determine the prevalence, major sources, coping mechanisms, and predictors of stress among undergraduate nursing students of Nursing and midwifery school of a public University in Ghana.
The study was a descriptive cross-sectional analytical study among 150 undergraduate nursing students in levels 100–400 selected through stratified random sampling. Data were collected using a structured questionnaire incorporating the Students’ Stress Inventory. Descriptive statistics,
t
-tests, analysis of variance, Pearson correlation, and multiple linear regression were used for analysis.
Most participants (58.67%) experienced moderate stress, while 26.67% reported high stress. The major stressors identified were lack of social support (87.33%), examination fears (85.33%), financial constraints (81.33%), and heavy workload (79.33%). Common coping mechanisms included prayer/meditation, watching movies, religious support, and listening to music. Regression analysis showed that age and academic level significantly predicted stress, with younger and Level 200 students reporting higher stress. Being in a dating relationship also significantly increased stress levels.
Stress is highly prevalent among undergraduate nursing students, driven largely by academic pressures, financial challenges, and inadequate social support. Coping strategies are primarily religious and socially oriented. Younger students and those in Level 200 are particularly vulnerable.
Cindy Agyekumwaa Abankwah, Senoo-Dogbey Vivian Efua, Thelma Donkor et al.· Nursing & Midwifery Rese...· 0 citations
Background: Examination anxiety is a widely reported concern among nursing students, arising from the demanding nature of the nursing curriculum, competitive assessment structures, and clinical performance expectations. Persistent or severe examination anxiety can impair concentration, recall, and overall academic performance, making its early identification essential for effective student support. Objective: To assess the perceived level of examination anxiety among first-year undergraduate (B.Sc.) nursing students and to determine its association with selected demographic variables. Methods: A descriptive, cross-sectional design was adopted among 50 first-year B.Sc. Nursing students at a nursing college in Coimbatore, India, selected through simple random (lottery) sampling. Data were collected using a demographic proforma and the Westside Test Anxiety Scale, a validated 10-item, 5-point rating instrument. Descriptive statistics (frequency, percentage) and the chi-square test were used for data analysis. Results: Of the 50 participants, 34% experienced moderately high anxiety, 28% slight anxiety, 26% high anxiety, 10% no anxiety, and 2% extreme anxiety. No statistically significant association was found between examination anxiety and demographic variables such as age, gender, medium of instruction, prior academic marks, or note-preparation habits (p>0.05), except for parental/teacher support, which showed a significant association (χ²=50.00, p<0.05). Conclusion: A substantial proportion of first-year nursing students experience moderate-to-high examination anxiety. Structured psychosocial support from parents and teachers, alongside institution-led self-study skill-building programmes, may help mitigate examination-related anxiety in this population.
Seethalakshmi S., V. G, J. D. et al.· Genetics and Molecular Resea...· 0 citations
INTRODUCTION
Undergraduate nursing students are exposed to substantial academic and clinical stressors that may adversely affect their mental health and academic performance. Although self-compassion is considered a positive psychological resource, its association with perceived stress as a cognitive appraisal process has been insufficiently examined, particularly among nursing students. Accordingly, this study aimed to examine the association between self-compassion and perceived stress among undergraduate nursing students.
METHODS
A cross-sectional descriptive-correlational study was conducted among 265 undergraduate nursing students at Tehran University of Medical Sciences between 2023 and 2024. Participants were selected using stratified random sampling with proportional allocation across academic semesters. Data were collected using a demographic questionnaire, Neff's Self-Compassion Scale, and the 14-item Perceived Stress Scale. Descriptive statistics and inferential analyses, including independent-samples t-tests, one-way ANOVA, Pearson's correlation, and hierarchical multiple regression, were conducted using SPSS version 16. A two-tailed significance level of P < 0.05 was adopted.
RESULTS
The mean self-compassion score was 89.99 ± 12.24, and the mean perceived stress score was 26.85 ± 7.16. Nearly half of the students reported moderate levels of self-compassion (49.8%) and perceived stress (49.4%). Self-compassion demonstrated a statistically significant negative correlation with perceived stress (r = - 0.450, P < 0.001). After controlling for employment status, self-compassion explained an additional 20% of the variance (ΔR² = 0.200, P < 0.001) and remained a significant negative predictor (β = -0.448, P < 0.001), with the final model accounting for 21.6% of the variance.
CONCLUSION
Higher levels of self-compassion were associated with lower perceived stress among nursing students. Although the cross-sectional design limits causal inference, the findings suggest that self-compassion may serve as a potentially influential psychological factor in the perception of stress among nursing students. Integrating self-compassion-focused educational strategies into undergraduate nursing curricula could be considered a supportive approach to strengthening students' stress management capacities. Future longitudinal and experimental studies are warranted to clarify potential causal pathways and better explain variability in perceived stress among nursing students.
Raoofeh Karimi, Esmaeil Mohammadnezhad, A. Manookian et al.· Discover Mental Health· 0 citations
Nursing curricula should integrate practice-centered and research-engaged strategies to support sustained EBP development across the academic–clinical transition, with future longitudinal and objectively measured studies needed to confirm developmental claims.
F. Mersal, M. Baqeas, Abdulhamid Gharib Alrwili et al.· Frontiers in Medicine· 0 citations
Community health nursing (CHN) is central to primary healthcare delivery, but undergraduate nursing students may encounter educational, organizational, resource-related, and sociocultural barriers that affect their readiness for community-based practice. This study aimed to identify and quantify perceived barriers to CHN practice among nursing students in Saudi Arabia and to examine their relationships with self-reported educational preparedness and organizational support.
A quantitative cross-sectional survey was conducted among nursing students enrolled in Saudi universities. A structured online questionnaire assessed perceived CHN practice barriers, educational preparedness, and organizational support. The instruments underwent cultural adaptation, forward-backward translation, expert-panel content validation, pilot testing, and internal-consistency assessment. Descriptive statistics, non-parametric tests, correlation analyses, and exploratory multiple linear regression were used.
A total of 139 nursing students completed the survey. Participants reported minor-to-moderate overall barriers (
M
= 2.69, SD = 0.96). Resource barriers were rated highest, with shortage of equipment (
M
= 2.93, SD = 1.38) and lack of educational materials (
M
= 2.86, SD = 1.32) identified as the most salient challenges. Educational preparedness (
M
= 3.25, SD = 0.98) and organizational support (
M
= 3.46, SD = 1.03) were rated moderately positive. Small-to-moderate positive correlations were observed between barriers and educational preparedness (
r
= 0.269,
p
= 0.001) and between barriers and organizational support (
r
= 0.242,
p
= 0.004); these findings were interpreted cautiously as potentially reflecting awareness effects, conceptual overlap, or shared-method variance. The multivariable regression model was not statistically significant and explained a small proportion of variance (
R
2
= 0.089,
p
= 0.052).
Nursing students in Saudi Arabia perceived meaningful, though not severe, barriers to effective CHN practice, with resource limitations and skills gaps as primary concerns. The findings support strengthened curriculum-practice integration, expanded simulation and community-immersion experiences, improved placement resources, and targeted faculty development aligned with healthcare transformation priorities.