INTRODUCTION:

Stress is a psychologic and physiologic imbalance resulting from adverse circumstances. College is probably a best phase of life for students. These crucial years can be undermined by stress and depression. Students are likely to experience stress due to heavy syllabus, new environment, new friends and dealing with myriad of various issues.

They also encounter a number of challenges in their life; therefore, their whole college life is unveiled by challenges which in turn causes stress and if not dealt with, can hamper their academic performance.¹In recent years, nursing colleges have increasingly reported as environments where students commonly grapple with heightened stress levels, adversely affecting both their academic performance and psychological well-being.²To gain a comprehensive understanding of the magnitude and complexity of this issue, numerous prior studies have been undertaken, offering insights into the experiences of nursing students across diverse contexts.

Postgraduate nursing students confront a distinct array of stressors, marked by the weight of academic expectations intertwined with the imperative to excel. They contend with uncertainties regarding their future trajectories and the complexities of assimilating into the educational milieu. These demographic exhibits considerable diversity in terms of age, professional experience, marital status, and other personal variables. Particularly noteworthy is the heightened risk faced by married postgraduate nursing students, who encounter additional challenges in balancing familial responsibilities with their educational pursuits.

While extensive literature exists concerning stress among undergraduate BSc nursing students³ research focusing on postgraduate nursing students remains relatively scant. The identification of stressors and their contributing factors within this cohort holds significant implications for nurse educators and curriculum developers, guiding their efforts in mitigating dropout rates and facilitating adaptation of post graduate nursing students throughout their educational journey.

METHOD:

A quantitative approach with descriptive design was employed to evaluate the level of stress among post graduate nursing students and identify its contributing factors in selected colleges in Kerala. Convenience sampling technique was utilized to recruit eligible postgraduate nursing students for this study from 4 Government and 5 private nursing colleges from Kerala. The researcher developed two distinct tools for data collection; one for assessing socio-demographic variables and another was a four-point scale to assess the stress of post graduate nursing students. The socio demographic tool comprised items designed to assess various demographic variables are age, gender, educational qualification, marital status, responsibilities in household work, transportation, type of family, years of clinical experience, availability of educational loan, area of specialization in MSc, years since completing the degree, previous job experience, current year of study, type of college and reasons for joining the course.

Variables collected by 4-point rating scale to assess the stress of Postgraduate Nursing Students were academic performance, technical skills, communication skills, health status, family and peer group factors and psychological factors. Reliability of the tool was 0.940. The total score of stress were 216 and the stress were classified as a score of less than 55 is considered as absence of stress, 55-108 mild stress, 109-162 moderate stress and 163- 216 as severe stress. Informed consent was taken from participants and from selected institutions.

RESULTS:

Demographic characteristics of sample:

The study included 100 post graduate nursing students (29 first year and 71 second year) from various nursing colleges of Kerala. The majority (59%) of the participants belonged to the age group of 20-30 years, and almost all respondents (99%) were females. About 71% of the participants came from nuclear families, and 79% had completed Basic BSc Nursing. Additionally, 64% of the participants were married, and nearly 39% had moderate household responsibilities. More than half of the participants (56%) resided in hostels, and 42% had less than 2 years of clinical experience. Furthermore, 81% of the participants did not have any educational loans. In terms of specialization, the majority specialized in Medical Surgical Nursing (25%), followed by Community Health Nursing (19%), Obstetrics and Gynecology Nursing (20%), and Mental Health Nursing (19%). Regarding job experience, 43% had more than 5 years of experience, primarily as staff nurses. Seventy-one percent were in the second year of the MSc Nursing program, and most participants (76%) were from government nursing colleges. A notable 91% of respondents were motivated by self-interest to pursue MSc in Nursing and 84percentage reported no significant health issues.

Level of stress and associated factors of stress among sample:

The stress levels among post graduate nursing students were categorized based on their responses. 69% reported moderate stress, 19% mild stress, and 12% severe stress.

Various factors influencing stress among postgraduate nursing students included academic factors such as research activities (42% reported severe stress), non-availability of holidays (41% reported severe stress), syllabus-related stress (48% reported moderate to severe stress), and stress related to attendance and compensation (16% and 24% reported stress, respectively). Curriculum-related stress was primarily associated with workload (37%) and relationship with faculty (19%). Classroom activities induced stress in 30% of participants due to teachers, while time management, presentations, and teaching practices caused stress in 18%, 15%, and 12% of participants, respectively. Stress associated with clinics was reported by 31% of participants, primarily due to assignments and workload (31%). Other stress factors related to clinics included night duty (28%), management of clinical and theory simultaneously (27%) and stress related to completion of work in time (26%).

In terms of health status, 36% reported stress due to lack of adequate rest, while anxiety (31%), lack of sleep (21%), improper food timings (19%), and frequent health problems (19%) also contributed to stress. Technological skills-related stress was influenced by factors such as typing skills (14%) and technical skills (13%). Communication skills-related stress was reported by 10% of participants, particularly academic communication and speaking in English. Family-related issues were most stressful for 38% of participants, while financial problems were a major stressor for 18%. Psychological factors such as lack of time for recreation (29%), loneliness (31%), worrying about the future (24%), traveling issues and less time for spiritual activities also contributed stress (12%).

Table No:1 Socio demographic variables associated with stress among postgraduate nursing students

Demographic variables		Stress Score		Chi-square	df	p value
		Mild	Moderate and severe
Age	≤30 years	15	51	1.75	1	0.186
	>30 years	6	26
Educational qualification	B.Sc. Nsg	15	64	1.00	1	0.999
	PBBSc. Nsg	4	17
Marital status	Single	6	29	0.121	1	0.728
	Married/Divorced	13	52
Household Responsibilities	None/Mild	6	40	1.964	1	0.161
	Moderate/Full	13	41
Place of stay	Day scholar	10	34	0.709	1	0.401
	Hosteler	9	47
Type of family	Nuclear	12	59	0.701	1	0.403
	Joint/Others	7	22
Years of clinical experience	<2years	12	30	4.311	1	0.038*
	>2years	7	51
Education loan	Yes	2	17	1.09	1	0.516
	No	17	64
PG specialization	Medical surgical nursing	4	21	8.15	4	0.086
	Community health nursing	2	17
	Child health nursing	6	17
	Obstetrics and gynaecology	7	13
	Mental health nursing	0	13
Years after degree	<3Years	7	24	.374	1	0.541
	>3Years	12	57
Previous job	Tutor	4	18	0.012	1	0.912
	Staff nurse	15	63
Years of study	I year M. Sc Nsg	3	26	1.988	1	0.159
	II-year M. Sc Nsg	16	55
Type of College	Government	16	66	0.078	1	1
	Private	3	15
Reason for entry/admission for M. Sc Nursing	Self-motivation	16	75	1.32	1	0.366
	Others	3	6
Health problems	Yes	6	12	2.93	1	0.103

The Chi square test revealed a significant association (p<0.05) between years of clinical experience and stress among post graduate nursing students. However, no significant associations were found for other tested variables.

DISCUSSION:

The study revealed that significant majority of the participants (69%) reported experiencing moderate stress, while 19% reported mild stress and 12% reported severe stress. These findings are consistent with existing national and international studies conducted among nursing students, highlighting a comparable level of stress Within this population.^4,5,6,7,8 interestingly, our results contrast with a study conducted in Morocco⁹which reported a lower prevalence of perceived stress (17%) among nursing students. This discrepancy could be attributed to various factors such as differences in the year of study, participation in professional and extracurricular activities, family income, and mode of transportation, which were identified as significant stress predictors in the Moroccan study. Notably, this study identified years of clinical experience significantly associated with stress.

Findings of this study is in align with a study conducted in Brazil and highlight the influence of socio-demographic and academic characteristics on stress levels among nursing students. Conversely, a study conducted in Pune 8 contradicts these findings, suggesting that socio-demographic variables may not directly correlate with perceived stress. Instead, headache frequency, sleep duration, and the need for holidays were identified as primary stress predictors in a study conducted at Pune.⁸

This study identified specific academic stressors contributing to student stress, with 48% of students experiencing moderate to severe stress related to the syllabus, and 16% and 24% reporting stress due to attendance and compensation duties, respectively. These findings are corroborated by qualitative research conducted at the Jamaica Urban School of Nursing ¹², emphasizing the multifactorial nature of academic stress and its association with rigid curricula.

Studies conducted at Cyprus University of Technology and an Australian regional university^13,14 have highlighted clinically significant mental distress among postgraduate nursing students, a trend consistent with our findings. Specifically, psychological stress related to loneliness was prevalent among our sample, with 32% experiencing mild stress, 15% moderate stress, and 16% severe stress.

In terms of clinical stressors, our study identified challenges such as assignments (39%), workload (31%), night duty (28%), simultaneous management of clinic and theory classes (27%), and time constraints (26%) as significant contributors to stress among postgraduate nursing students. Similar findings have been reported in the literature, including studies conducted during the pandemic in the United States¹⁵ which emphasized increased stress levels associated with clinical rotations.

Financial problems emerged as a major stress factor, with 18% of participants highlighting this issue. This finding is consistent with research conducted in Morocco 9 underscoring the impact of monthly income on stress levels among students.

Stress is a universal phenomenon among students across various disciplines, as evidenced by comparative studies among Medicine, Engineering, and Nursing students in Maharashtra.¹⁶ Furthermore, comparisons between nursing and management students^17,18 suggest varying stress levels between these academic streams, with management students generally experiencing higher stress levels.

A descriptive survey was conducted to enrolled 199 nursing students through simple random sampling (lottery method) and total enumeration technique. The study pointed out the importance of nursing institute teachers as well as students to be aware about stress management strategies (i.e., using active coping and avoiding self-blame) that may help to prevent deadly consequences of anxiety and stress on physical and mental health on nursing students.¹⁹

Other studies, such as those conducted among B.Ed. students and international postgraduate students in Kuala Lumpur, further illustrate the prevalence and varied sources of stress among different student populations. Experimental studies18 provide valuable insights into strategies aimed at alleviating stress among postgraduate students, underscoring the importance of proactive interventions to support student well-being and academic success.

REFERENCES:

1. Maneet Kaur, Satinderbir Kaur, Aditya Chauhan. A Study on Stress among Graduate College Students in Ludhiana. Asian J. Management. 2017; 8(3): 628-634. doi: 10.5958/2321-5763.2017.00100.7

2. Zheng YX, Jiao JR, Hao WN. Prevalence of stress among nursing students: A protocol for systematic review and meta-analysis. Medicine. 2022 Aug 5; 101(31): e29293.

3. Kaur Manpreet, Maheswari M K; Depression, anxiety, stress among post graduate nursing students. IJTA Publications. 2015; 21: 12-18.

4. 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 Dec; 10(1): 1-7

5. Shehadeh J, Hamdan-Mansour AM, Halasa SN, Hani MH, Nabolsi MM, Thultheen I, Nassar OS. Academic stress and self-efficacy as predictors of academic satisfaction among nursing students. The Open Nursing Journal. 2020 Jun 18;14(1).

6. Rathnayake S, Ekanayaka J. Depression, anxiety, and stress among undergraduate nursing students in a public university in Sri Lanka. International Journal of Caring Sciences. 2016 Sep 1; 9(3): 1020-32.

7. Cheung T, Wong SY, Wong KY, Law LY, Ng K, Tong MT, Wong KY, Ng MY, Yip PS. Depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong: a cross-sectional study. International journal of environmental research and public health. 2016 Aug; 13(8): 779.

8. Sheroun D, Wankhar DD, Devrani A, Lissamma PV, Chatterjee K. A study to assess the perceived stress and coping strategies among B. Sc. nursing students of selected colleges in Pune during COVID-19 pandemic lockdown. International Journal of Science and Healthcare Research. 2020 Apr; 5(2): 280-8.

9. El Madani H, El Harch I, Tachfouti N, El Fakir S, Aalouane R, Berraho M. Psychological stress and its related factors among Moroccan nursing students: A cross-sectional study. Enfermería Clínica (English Edition). 2023 May 1; 33(3): 205-15.

10. 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.

11. Sokratis S, Giorgos A, Rafailia Z, Maria K. Mental health status and Stressful life events among postgraduate students in Cyprus: A cross-sectional descriptive correlational study.

12. Leslie K, Brown K, Aiken J. Perceived academic-related sources of stress among graduate nursing students in a Jamaican University. Nurse Education in Practice. 2021 May 1; 53:103088.

13. El Madani H, El Harch I, Tachfouti N, El Fakir S, Aalouane R, Berraho M. Psychological stress and its related factors among Moroccan nursing students: A cross-sectional study. Enfermería Clínica (English Edition). 2023 May 1;33(3):205-15.

14. Sokratis S, Giorgos A, Rafailia Z, Maria K. Mental health status and Stressful life events among postgraduate students in Cyprus: A cross-sectional descriptive correlational study.

15. Rathnayake S, Ekanayaka J. Depression, anxiety, and stress among undergraduate nursing students in a public university in Sri Lanka. International Journal of Caring Sciences. 2016 Sep 1; 9(3): 1020-32.

16. Behere SP, Yadav R, Behere PB. A comparative study of stress among students of medicine, engineering, and nursing. Indian Journal of Psychological Medicine. 2011 Jul;33(2):145-8.

17. Ismail A, Ashur ST, Jamil AT, Lee CW, Mustafa J. Stress level and the common coping strategies among international postgraduate students at university Kebangsaan Malaysia medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia. Asean J Psychiatry. 2016 Jan 1; 17:9-20.

18. Mishra M. A comparative study on academic stress level of male and female B. Ed. students. Indian Journal of Health and Wellbeing. 2018 Jan 1;9(1).).

19. Ismail A, Ashur ST, Jamil AT, Lee CW, Mustafa J. Stress level and the common coping strategies among international postgraduate students at university Kebangsaan Malaysia medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia. Asean J Psychiatry. 2016 Jan 1; 17:9-20.

20. Rajesh Kumar. Experienced Stressors and Coping Strategies among Nursing Students – A Correlation with State Anxiety. Int. J. Adv. Nur. Management. 2015; 3(1): 20-25.

Received on 22.04.2024 Revised on 07.10.2024

Accepted on 15.01.2025 Published on 22.02.2025

Available online from March 20, 2025

Int. J. Nursing Education and Research. 2025;13(1):15-18.

DOI: 10.52711/2454-2660.2025.00003

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