Assessing anxiety and stress levels in undergraduate nursing students during their clinical placements: a quasi-experimental study

Abstract

Background Undergraduate nursing students’ perceived lack of skills to perform the different activities and techniques required is regarded as one of the most relevant stressors in clinical placements, which thus becomes a challenge in their training. Understanding the sources of stress and how it varies throughout their training makes it possible to plan appropriate intervention and support strategies to equip them with the necessary skills for their future professional careers.

Methods A prospective longitudinal study with pre- and post-test measures. 113 third-year undergraduate nursing students carrying out their clinical placements (Practicum I) in two tertiary hospitals in the public health system. In the 2021–2022 academic year, the validated Kezkak questionnaire was administered to assess stressors in clinical placements, and the State-Trait Anxiety Inventory (STAI) was used to measure student anxiety levels.

Results Ninety-three students participated in the study; 77.66% were female and 21.28% male, with a mean age of 23 ± 6 years. The overall mean score of the Kezkak was significantly reduced when comparing stress at the beginning of clinical practice with the end (2.84 ± 0.45 points vs. 2.53 ± 0.44 points; p < 0.001), with items such as lack of skills (2.98 ± 0.60 vs. 2.71 ± 0.58 points) and uncertainty and powerlessness (3.05 ± 0.50 vs. 2.65 ± 0.53) standing out. Female students reported higher stress levels than male students, and all stress factors analysed decreased after the clinical practice. Similarly, data on anxiety levels obtained from the STAI were reduced at the end of the internship (2.37 ± 0.21 vs. 2.23 ± 0.21; p < 0.001), with a significant decrease in the subsections of state anxiety(2.35 ± 0.22 vs. 2.23 ± 0.22 points; p < 0.001) and trait anxiety (2.40 ± 0.29 vs. 2.25 ± 0.23; p < 0.001).

Conclusions A decrease in the levels of anxiety and perceived stress was evidenced through factors linked to the clinical placements of undergraduate nursing students. The organisational implementation of Practicum I had a positive impact on nursing students. Implementing new teaching strategies prior to the beginning of the practicum, such as the visualization of knowledge pills, could decrease anxiety and stress levels at the beginning and improve students’ academic results.