The Rate and Resources of Stress in Clinical Education and its Relationship with Some Characteristics of Students, Instructors and Clinical Environment

Abstract
Introduction: Nursing students experience multiple stressors in their clinical education which can reduce their clinical learning and performance. The purpose of this study was to measure stress and stressful resources in nursing students and its relation with some characteristics of students, instructors and clinical environment.
Methods: In a descriptive and cross-sectional study, a sample of 256 subjects was selected by stratified random sampling among nursing students of Islamic Azad University, Falavarjan Branch in 2016. The instrument of this study consist three questionnaires including individual information, Cohen perceived stress scale and stressful sources of clinical education questionnaire. Data were analyzed by independent t-test, ANOVA and Pearson correlation coefficient tests at a significant level of 0.05, using SPSS/21 software.
Results: The majority of students (96.1%) reported moderate and high levels of stress. Age of students had a significant positive correlation with stress level (P = 0.037). The most and least stressful sources, respectively, relate to areas of unpleasant feelings and interpersonal communication. Most stressors were related to "distressing sick patients", "cleaning the patient after stool deification", "instructor note in the presence of doctors and personnel" and "communicating with the instructor" respectively. The scores of stress-related sources had a significant negative correlation with the clinical work experience (P = 0.014) and the age of instructors (P = 0.029).
Conclusions: High levels of stress can reduce the students learning and quality of clinical education. Therefore, providing stress management training courses, especially during the internship course for the students and communication skills courses for the clinical instructors are recommended.