Effects of a Pre-clinical Preparation Program on Stress in Nursing Students

Abstract

Introduction Clinical learning management is a vital component of the Bachelor of Nursing Science curriculum, which aims to equip students with the competencies necessary to provide holistic healthcare services to the public. Stress during clinical practice often arises when nursing students encounter expectations, responsibilities, and unfamiliar situations. This phenomenon can be explained through Lazarus and Folkman’s stress theory, which posits that stress results from an individual’s appraisal of the interaction between themselves and their environment. When individuals perceive that a situation exceeds the resources available to them for coping, stress arises. Therefore, adequate preparation in terms of knowledge, skills, and psychological readiness serves to enhance personal resources, restore balance, and mitigate stress. Such preparation provides a foundation for advancing the nursing profession toward greater effectiveness in the future. 

Objective This study aimed to compare nursing students’ stress before and after participating in a pre-clinical preparation program prior to clinical practice in inpatient wards.

Design This study employed a quasi-experimental design with one-group pretest–posttest, applying Lazarus and Folkman’s stress theory to develop a preparation program prior to clinical practice in inpatient wards. Stress is conceptualized as the relationship between individuals and their environment, wherein individuals appraise events as having implications for their well-being and requiring the use of personal resources or abilities to adapt, sometimes to the extent of exceeding their coping capacity. In the context of pediatric and adolescent nursing practice, nursing students face unique challenges during their initial clinical experiences. These include the need for specialized communication skills with children of different developmental stages, interactions with parents and families, unfamiliarity with ward personnel and environments, assigned clinical tasks, and supervision by clinical instructors. Each student appraises these situations differently and adopts distinct coping strategies depending on their available resources and limitations. The preparation program was designed as an essential resource to reduce stress among second-year nursing students enrolled in the pediatric and adolescent nursing practicum. The program consisted of three structured activities delivered over four days, totaling 30 hours: 1) Course orientation and review of pediatric and adolescent nursing principles to enhance students’ understanding of practicum details, concepts, and theoretical foundations, 2) Ward orientation by staff nurses to familiarize students with the clinical context, work characteristics, and patient care approaches in each unit, and 3) Preparation in four core nursing skills: (a) growth and developmental assessment, (b) immunization practices, (c) administration of inhalation therapy, suctioning, and oxygen delivery, and (d) administration of oral, injectable, and inhaled medications. These activities were intended to strengthen students’ confidence and competence in pediatric and adolescent nursing practice.

Methodology The study participants comprised 98 nursing students from a nursing educational institution, selected through purposive sampling. The inclusion criteria were as follows: 1) second-year nursing students, enrolled in the Pediatric and Adolescent Nursing Practicum during the second semester of the 2024 academic year; 2) aged 18 years or older, both male and female; 3) able to communicate in Thai through speaking, reading, and writing; and 4) willing to participate in the study. The research instruments included: 1) the readiness program prior to clinical practice in inpatient wards, which was validated for content validity by three experts, yielding a content validity index (CVI) of .89; 2) a general information questionnaire; and 3) the Suan Prung Stress Test (SPST-20), with the original version reporting a Cronbach’s alpha coefficient of .70. Data were collected between January and March 2025. Following participation in the four-day readiness program, students undertook clinical practice in two pediatric wards and one well-child clinic, each for one week according to a rotation schedule. Upon completion of the practicum, students completed the posttest stress assessment. Data analysis was conducted using Paired t-test.

Results The majority of participants were female (91.83%), with a mean age of 20.28 years (SD = 1.00). More than half (58.16%) had a high cumulative grade point average (GPAX). After participating in the preparation program, students’ mean stress score (M = 37.85, SD = 7.51) was significantly lower than their pre-program score (M = 58.64, SD = 12.27), with statistical significance (t = 28.560, p < .001).

Recommendation Clinical learning within the Bachelor of Nursing Science curriculum can incorporate the preparation program prior to ward-based practice as part of the preparatory process to reduce nursing students’ stress before clinical training. This approach enhances students’ competencies in nursing practice, ensuring alignment with the learning outcomes of the course and curriculum. Moreover, it provides a framework for developing nursing practice competencies effectively in accordance with professional standards for the future.