review of literature related to stress among nursing students

Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015

Affiliations.

• 1 University of Louisville, School of Nursing, Louisville, KY 40292, USA. Electronic address: [email protected].
• 2 University of Louisville, School of Nursing, Louisville, KY 40292, USA. Electronic address: [email protected].
• PMID: 27889624
• DOI: 10.1016/j.nepr.2016.11.002

Undergraduate nursing students experience significant stress and anxiety, inhibiting learning and increasing attrition. Twenty-six intervention studies were identified and evaluated, updating a previous systematic review which categorized interventions targeting: (1) stressors, (2) coping, or (3) appraisal. The majority of interventions in this review aimed to reduce numbers or intensity of stressors through curriculum development (12) or to improve students' coping skills (8). Two studies reported interventions using only cognitive reappraisal while three interventions combined reappraisal with other approaches. Strength of evidence was limited by choice of study design, sample size, and lack of methodological rigor. Some statistically significant support was found for interventions focused on reducing stressors through curriculum development or improving students' coping skills. No statistically significant studies using reappraisal, either alone or in combination with other approaches, were identified, although qualitative findings suggested the potential benefits of this approach do merit further study. Progress was noted since 2008 in the increased number of studies and greater use of validated outcome measures but the review concluded further methodologically sound, adequately powered studies, especially randomized controlled trials, are needed to determine which interventions are effective to address the issue of excessive stress and anxiety among undergraduate nursing students.

Keywords: Cognitive reappraisal; Intervention; Stress; Student nurses.

Copyright © 2016 Elsevier Ltd. All rights reserved.

Publication types

• Systematic Review
• Adaptation, Psychological*
• Anxiety / psychology*
• Stress, Psychological / psychology*
• Student Dropouts
• Students, Nursing / psychology*

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Coping strategies and social support in nursing students during clinical practice: A scoping review

Fernanda loureiro, ana cristina neves, ana vanessa antunes.

• Author information
• Article notes
• Copyright and License information

Correspondence , Fernanda Loureiro, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829‐511 Caparica, Almada, Portugal. Email: [email protected]

Corresponding author.

Revised 2023 Dec 21; Received 2023 May 11; Accepted 2024 Jan 16; Collection date 2024 Feb.

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

To identify the coping strategies and social support received by nursing students during clinical practice.

Scoping review.

Primary studies on coping strategies and social support, in full text, in English, French, Spanish or Portuguese and published in 2018 or later were included. Search was carried out in January 2023 on EBSCOhost, PubMed, SciELO, ScienceDirect, OpenAIRE, MedNar Search, WorldWideScience and the references of previously selected articles.

A total of 24 studies were identified. Seven studies mentioned social support as a useful strategy and several instruments were identified that allow measurement.

Conclusions

Few studies establish a direct relationship between the effectiveness of coping strategies with stressful situations. Positive coping strategies are associated with effective stress management. The relationship between social support and stress reduction is scarcely addressed.

Implications for the Profession and/or Patient Care

Stressful situations can have an impact on students' health and on the quality of care. Nursing schools and healthcare institutions must work together in programmes to improve students coping abilities.

This review addressed coping strategies used by nursing students during clinical practice. A set of relevant coping strategies were identified that can be used by teachers to improve students' outcomes.

Reporting Method

The review was performed according to Preferred Reporting Items for Scoping Reviews (PRISMA‐ScR).

Patient or Public Contribution

No patient or public contribution.

Keywords: literature review, nursing

1. INTRODUCTION

Students in nursing programmes participate in several internships that provide them the chance to improve their skills and contact with the professional demands. Nursing students may have higher stress levels than other higher education students and these are amplified in the clinical setting as opposed to the classroom (Bhurtun et al.,  2019 ).

Sources are multifactorial including assignment work, clinical environment, complex patients, lack of clinical skills, fear of the unknown, gap in practical/theoretical knowledge and communication difficulties with nurse staff, peers and patients and their families (Rudberg et al.,  2022 ). Stress may have a negative impact on academic performance (Hadi et al.,  2018 ) and physical and mental health lowering students' capacity for a respectful and safe interaction (Cornine,  2020 ).

According to a review by McCarthy et al. ( 2018 ), there are three main definitions of stress, regarding nursing students. These are focused on different stress characteristics: stress as a response to a stimulus, stress that emanates from an external source and stress as a dynamic process that includes both internal and external factors. The same authors also point that stress can be neutral, good or bad (McCarthy et al.,  2018 ). Stress is unavoidable and usually problematic to overcome. Therefore, an effective coping strategy might support nursing students to deal with stress.

Coping is defined as a “dynamic, behavioral and cognitive effort in controlling internal and external stress” (Rafati et al.,  2017 , p. 3). More recently Gurvich et al. ( 2021 ) indicated that coping is the ability to make use of mechanisms that aim to reduce psychological stress. Research on this matter traditionally is directed towards coping styles or coping strategies.

Coping styles refers to the disposition regarding defiant circumstances or stressors. Three basic coping styles are identified in literature: task‐oriented, emotion‐oriented and avoidance oriented (Endler & Parker,  1990 ). The coping style may remain consistent across a variety of situations and experiences, while the coping strategies employed within it may change and evolve. In literature studies employing coping instruments or measurements that measure coping strategies for specific situations or stressors have been found to be more valid and reliable (Daniels & Harris,  2005 ; Lazarus & Folkman,  1984 ).

Coping strategies can be adaptative such as talking to friends and sports or maladaptive such as the use of alcohol (Reeve et al.,  2013 ). Lazarus and Folkman ( 1988 ) classified coping strategies as problem‐focused, when students seek to reduce the stressful demands or expand resources to deal with stress and emotion focused, when students aim to regulate the emotional response. Labrague, McEnroe‐Petitte, Al Amri, et al. ( 2018 ) presents a simpler arrangement by classifying them as active or passive coping strategies.

2. THE REVIEW

Educational institutions have the responsibility to help future nurses face their educational challenges through support (Gidman et al.,  2011 ). Support is a concept that means to sustain something and is defined by Sarason et al. ( 1983 , p. 127) as the “existence or the availability of people on whom we can rely, people who let us know that they care, value, and love you”. In nursing students' population, the existence of social support is a predictor of resilience (Narayanan & Alexius Weng Onn,  2016 ) and a protective factor (Wilks & Spivey,  2010 ).

The strategy of nursing students seeking support from family members is described (Labrague, McEnroe‐Petitte, De Los Santos, & Edet,  2018 ) however it is unclear what form of support is offered and by whom.

Previous literature reviews on this theme have been performed. Galbraith and Brown ( 2011 ) systematically reviewed interventions effectiveness for reducing stress in this population. The most effective interventions provided skills either for coping with stressful events or for changing maladaptive cognitions.

Later Pulido‐Martos et al. ( 2012 ) systematically reviewed the sources of stress in nursing students. They concluded that both academic and clinical practice were stressful for students irrespective of the students' year of education.

Labrague and colleagues presented different literatures revisions from 2017 to 2018. In the first review Labrague et al. ( 2017 ) assessed stress and coping strategies in nursing students. From the 13 studies found the authors concluded that stress levels ranged from moderate to high and were primarily caused by patient care, assignments and responsibilities, and negative staff and faculty interactions. Problem‐solving strategies were frequently employed as coping mechanisms (e.g., developing objectives to resolve problems).

Later (Labrague et al., 2018 ), a systematic review examined Saudi nursing students' stress perceptions and coping strategies. Stress levels ranged from moderate to high, with inconclusive findings on the influence of sociodemographic factors on stress. The authors of this review concluded that pupils employed both active and passive coping strategies. In the same year, Labrague, McEnroe‐Petitte, De Los Santos, and Edet ( 2018 ), in an integrative review, also assessed the coping skills of nursing students and its implications for policymaking. Students primarily employed problem‐focused coping strategies and specific coping behaviours, such as problem‐solving behaviours, self‐confident approaches, and support‐seeking from family and friends. The implementation of structured student orientation programmes was suggested as a means of enhancing the positive coping skills of nursing students. In the same year, other researchers published an integrative review on the stress and coping strategies of nursing and midwifery students during their educational programmes (McCarthy et al.,  2018 ). Although clinical, academic and financial contexts were identified as sources of stress, clinical practice emerged as the predominant one. Different kinds of adaptive and maladaptive coping strategies were utilized by students.

Numerous authors emphasize the significance of additional research on this topic and the need to evaluate the efficacy of interventions on student stress reduction. In recent years, there has been an increase in investment in this area of knowledge; however, as described previously, literature reviews are not current. To determine the coping strategies and social support received by nursing students during clinical practice, a literature review was conducted.

We chose a scoping review methodology based on the recommendation of Munn et al. ( 2018 ), as it is particularly well‐suited for systematically and comprehensively synthesizing a large body of literature. In addition, scoping reviews are appropriate for mapping the breadth and diversity of coping strategies used in this particular population.

Following the protocol defined by Johana Briggs Institute (JBI) updated methodological guidance (Peters et al.,  2021 ), a scoping review was conducted that aimed to identify the coping strategies and social support received by nursing students during clinical practice.

Research question was defined according to PCC (Pollock et al.,  2023 ): which are the coping strategies and the social support received by nursing students during clinical practice? (population: nursing students; concept: coping strategies and social support; context: clinical practice).

Scoping review steps Peters et al. ( 2021 ) were followed as detailed below.

4.1. Protocol and registration

The protocol was drawn according to JBI updated methodological guidance for scoping reviews and registered on Open Science Framework (OSF) ( https://osf.io/3n6be/ ).

4.2. Eligibility criteria

Published articles on coping strategies and/or social support in nursing students' clinical practice were considered for analysis. All types of methodological approaches were included (quantitative, qualitative, and mixed methods). Articles written in English, French, Portuguese, or Spanish available in open access and full text were considered. As far as publication dates were concerned, we only considered articles published in the last 5 years (in 2018 or later, based on previous literature reviews). If coping strategies and/or social support were evaluated during an academic course component, the manuscript was excluded. We also excluded articles about the COVID 19 pandemic because it was a period with unique characteristics. Advertising, blog articles, editorials, letters to the editor, literature reviews, methodological studies (for example, instrument validation/construction), opinion articles, protocols, and theoretical studies were also excluded.

4.3. Information sources

Review was conducted in a three steps approach as proposed by Peters et al. ( 2021 ).

In step one, search was performed in two databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) and PubMed. Both summary and title were analysed to determine the most pertinent search terms for articles. We sought to determine the optimal search terms to include in the equation.

In the next step, the research was performed in electronic platform EBSCOhost in the following database: Cumulative Index to Nursing and Allied Health Literature (CINAHL) [ complete ], MEDLINE [ complete ], Nursing & Allied Health Collection [ comprehensive ]; Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register; Library, Information Science & Technology Abstracts (LISTA), Cochrane Clinical Answers, MedicLatina, ERIC, Regional Business News, Academic Search Complete, Business Source Complete, APA PsycInfo, APA PsycArticles, Psychology and Behavioural Sciences Collection, Education Source, Humanities Source Ultimate and MLA Directory of Periodicals. Additionally, PubMed, SciELO, ScienceDirect and OpenAIRE were also searched. For grey literature we used: MedNar Search and WorldWideScience.org – The Global Science Gateway.

Finally, in step three, the references of the articles chosen in step two were thoroughly searched to identify additional relevant articles for inclusion in this review.

4.4. Search

The research equation was created using keywords and boolean operators and was tailored to the characteristics of each database/platform. In addition, the asterisk operator (*) was used, when permitted by the platform/database, to enable the identification of variants of the original term. In January of 2023, all authors conducted the research simultaneously. Search strategy is publicly available at OSF ( https://osf.io/3n6be/ ).

4.5. Selection of sources of evidence

Initially, articles were selected based on their titles. When it was uncertain whether the article was appropriate for this review, the abstract was read. After removal of duplicates, inclusion and exclusion criteria were applied. To increase consistency, all authors examined the same publications and discussed disagreements until a consensus was reached.

4.6. Data charting process

Researchers determined which variables to extract and combined them into a data‐charting table. Each author performed data extraction individually. To increase precision, all authors compared the extracted data and resolved any disagreements until the final extraction chart was approved.

4.7. Data items

Considering the aim of this review, data related to general characteristics (author, year, country, methodology, and key findings) as well as coping strategies and/or social support were extracted. In addition, we collected information regarding the instrument used in quantitative studies.

4.8. Critical appraisal of individual sources of evidence

To appraise article's quality, studies were assessed and all authors discussed evaluation until consensus was reached. Hawker et al. ( 2002 ) developed an evaluation instrument that considers nine factors: abstract and title; introduction and aims; method and data; sampling; data analysis; ethics and bias; results; transferability or generalizability; and implications and usefulness. Each item is graded on a four‐point scale (1 = very poor; 2 = poor; 3 = fair; 4 = good) and the final score ranges from 9 to 36. Higher scores indicate a higher quality article.

4.9. Synthesis of results

Quantitative data were synthesized using data tables. Descriptive synthesis was performed for qualitative data. After each article was reviewed, the results were summarized in a full data extraction table, available at OSF ( https://osf.io/mq43c ), which included evidence from all articles that had been separately extracted and approved by all authors. Information was reorganized in different tables to facilitate the synthesis of results presentation.

5.1. Selection of sources of evidence

4513 articles were included in our initial sample. After removing duplicates and applying inclusion/exclusion criteria, a total of 24 articles were included in the final sample. Studies that addressed other types of students (for example, medical students), methodological articles, literature reviews, study protocols, or studies that specifically addressed the recent COVID pandemic period were all excluded. We used the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) flow chart, in Figure  1 , to summarize the studies selection process.

PRISMA flow chart of study selection.

5.2. Characteristics of sources of evidence

Twenty‐four studies were identified for inclusion in this review. Only three studies used qualitative research methods, one used a mixed methods approach and the other used quantitative methods to identify stressors, stress levels and coping strategies. A table with all the data collected was constructed to synthetize findings (available at https://osf.io/3n6be/ ). Table  1 provides a summary of studies' main characteristics, including study identification (author, year and country), aim and methods (type of study, data collection method and sample).

Summary of studies characteristics.

Abbreviations: CG, control group; CR, Czech Republic; IG, intervention group; KSA, Kingdom of South Arabia; NS, nursing students; RCT, randomized control trial; USA, United States of America.

5.3. Critical appraisal within sources of evidence

Overall, the quality assessment of studies was quite high, ranging from 23 to 36 as shown in Table  2 . Principal limitations of the investigations were ethics and bias, implications and usefulness, and transferability or generalizability. Only two studies included information on how the authors' own bias was addressed (Tambağ,  2021 ; Wang et al.,  2021 ), only four studies fully addressed implications for policy and/or practice (Latif & Nor,  2019 ; Ma et al.,  2022 ; Tambağ,  2021 ; Wang et al.,  2021 ), and a detailed description of the context or setting in which the study was conducted fully described in only four studies (Alanazi et al.,  2023 ; Ma et al.,  2022 ; Tambağ,  2021 ; Wang et al.,  2021 ).

Quality appraisal.

5.4. Results of individual sources of evidence

Each study's findings were summarized in the primary table. To facilitate reading, we reorganized information into additional tables to illustrate our findings, including a summary of the characteristics of the studies (Table  1 ) and the instruments identified in quantitative studies (Table  3 ).

Instruments used in quantitative studies ( n  = 21).

5.5. Synthesis of results

To summarize our results, we followed the recommendations of Pollock et al. ( 2023 ) and Bradbury‐Jones et al. ( 2021 ).

All studies that compose our sample ( n  = 24) are focused on nursing students during clinical practice. Regarding methodology, three studies used a qualitative methodology (Kalyani et al.,  2019 ; Lavoie‐Tremblay et al.,  2022 ; Wang et al.,  2021 ), one used a mixed methods approach (Alshahrani et al.,  2018 ) and the remaining studies used quantitative methods.

We aimed to identify both coping strategies and social support received by nursing students during clinical practice. As far as coping strategies are concerned, in our sample, three studies evaluated coping styles (Hwang et al.,  2021 ; Liu et al.,  2022 ; Ma et al.,  2022 ; Wang et al.,  2021 ), four studies measured coping processes by identifying the thoughts and behaviours students employed (Bektaş et al.,  2018 ; Durgun Ozan et al.,  2020 ; Hou,  2019 ; Karaca et al.,  2019 ) and the remaining studies focused on coping strategies. Because most studies assessed coping strategies using instruments (Alanazi et al.,  2023 ; Al‐Gamal et al.,  2018 ; Alshahrani et al.,  2018 ; Bhurtun et al.,  2021 ; Bodys‐Cupak et al.,  2018 ; Dasgupta et al.,  2020 ; Karaca et al.,  2019 ; Labrague, McEnroe‐Petitte, De Los Santos, & Edet,  2018 ; Latif & Nor,  2019 ; Nebhinani et al.,  2020 ; Onieva‐Zafra et al.,  2020 ; Qalawa & Ibrahim,  2021 ), coping strategies appeared mostly categorized in each instrument, as detailed in Table  4 . The most used instrument was the Coping Behaviour Inventory (CBI), which categorizes coping strategies into four categories: avoidance, problem‐solving approach, staying optimistic and transference. Problem solving is identified as the most used strategy, as shown in Table  4 . In Gurková and Zeleníková ( 2018 ), the most used category of coping strategies is not mentioned because the authors focused on the relationship between supervisory approaches in clinical practice, experience level of nursing students, perceived stress, coping strategies and physio‐psychosocial status.

Most used coping strategies in our sample.

Social support was identified in seven studies (Alshahrani et al.,  2018 ; Durgun Ozan et al.,  2020 ; Fang et al.,  2020 ; Lavoie‐Tremblay et al.,  2022 ; Onieva‐Zafra et al.,  2020 ; Tambağ,  2021 ; Wang et al.,  2021 ). Studies identify social support received specifically from family and friends (Alshahrani et al.,  2018 ; Fang et al.,  2020 ), and also from peers (Tambağ,  2021 ). Social support is most often described as a type of coping strategy (Durgun Ozan et al.,  2020 ; Lavoie‐Tremblay et al.,  2022 ; Onieva‐Zafra et al.,  2020 ), but is also associated with resilience (Wang et al.,  2021 ) and reduced anxiety (Durgun Ozan et al.,  2020 ).

We used the PAGER framework (Bradbury‐Jones et al.,  2021 ) to synthetize our findings as detailed in Table  5 .

PAGER framework synthesis of review findings.

6. DISCUSSION

6.1. summary of evidence.

Throughout their nursing education, nursing students are exposed to numerous sources of stress, particularly during clinical practice, and they must develop effective coping strategies to manage it. To minimize the influence of stress on nursing students and their learning process, it is crucial to comprehend the use of coping strategies during this phase.

In this review, we identified a total of 24 studies, which demonstrates the global interest of the scientific community in this topic.

Four studies (Ahmed & Mohammed,  2019 ; Alanazi et al.,  2023 ; Latif & Nor,  2019 ; Tambağ,  2021 ) established direct relationship between coping strategies and stress reduction, which is essential for evaluating the effectiveness of strategies and enabling their implementation. Nursing students' stress levels during clinical practice and their coping strategies were assessed in the additional 18 studies included in this review. The study by Alanazi et al. ( 2023 ) is the only one that identifies specific stressful situations and links stress reduction to specific coping strategies. The authors conclude that avoidance is positively associated with all categories of stressors, whereas problem‐solving is negatively associated with stress from peers and daily life. Being pessimistic is negatively associated with both the stress of providing patient care and the stress of lacking professional knowledge and skills.

Moreover, there is a lack of definitions for concepts associated with coping since authors fail to distinguish between coping styles, coping processes and coping strategies. The concept of coping strategies is commonly used and Ma et al. ( 2022 ), Hwang et al. ( 2021 ), Nebhinani et al. ( 2020 ), and Bodys‐Cupak et al. ( 2018 ) use a formal classification system. In these studies, coping is classified as active coping or passive coping. The remaining studies mentioned the following strategies: problem‐solving; avoidance; religion; acceptance; humour; denial, disengagement; substance abuse; transference; keep optimistic; physical exercise; debriefing sessions; peer and family support; social support; escape; cognitive restructuring; and medical and phycological support. If the studies had considered open‐ended questions, it may have been possible to identify additional strategies to cope. Problem solving strategies appear to be the most common type of strategy used by nursing students. Problem solving skills are valued in nursing education (Yeung et al.,  2023 ) and should be a priority in nursing curricula program. Nursing students are inevitably submitted to stress during clinical practice. Identifying and teaching more effective coping strategies is essential, as is implementing strategies to create and maintain a supportive clinical learning environment (Pienaar et al.,  2022 ).

We also aimed to identify the social support provided to nursing students. Only seven studies on this topic were found. Social support is identified mainly as a coping strategy though it is clearly an understudied area. Social support is considered a health protective strategy that helps to build resilience after stressful situations, and mitigating negative stress reactions (Molero Jurado et al.,  2018 ). Social support is identified as a coping strategy, but studies fail to specify whether it is formal (debriefings, discussion forums, medical and phycological support…) or informal (peer support, family support, organizational support). The selected studies do not address the relationship between social support and stress reduction. In an increasingly technological society, it should be noted that social networks and the media are not mentioned in the studies reviewed. According to Demirtepe‐Saygili ( 2019 ), these are both a stressor and a coping mechanism. When used as a healthy coping mechanism, social networks and media can mitigate the negative effects of stress (as a source of social support). On the other hand, it can be associated with negative long‐term outcomes such as anxiety disorders, depression, and addiction. A pilot study on the stress management of medical students demonstrated that a stress management intervention based solely on Facebook helped them effectively manage stress. In addition, it indicates that online social networks are beneficial for stress management program and should be expanded to include other health professionals and students in other health disciplines (George et al.,  2013 ).

Additionally, during the COVID 19 pandemics, social media use has become crucial for stress management and psychological adjustment (Bae,  2022 ; Sun et al.,  2023 ). The studies indicate that more research should be conducted on the efficacy of coping strategies and that interventions to reduce stress must be implemented, but they do not provide guidance on how to do so. There are no recommendations regarding the implementation of social support strategies.

The select studies indicate that more research should be performed on the effectiveness of coping strategies and that interventions to reduce stress must be applied, but they don't suggest how to do it. No suggestions are made on the implementation of social support strategies. Therefore, the next step should be the implementation of ongoing orientation programmes that incorporate formal and informal social support strategies, to prepare students for clinical practice and assist them in coping with stressful situations, such as the following: planned discussion forums; debriefings; psychological and medical support; social network; peer and family support, financial support; group sessions; preparation programmes. In addition, academic leaders, professors, and clinical instructors play an important role in enhancing communication between health schools and healthcare institutions, to develop effective interventions.

6.2. Limitations

The present study has some limitations that should be addressed. First, the fact that only articles in English, French, Spanish and Portuguese were considered may exclude relevant studies on this subject. Second, the variety of instruments identified limits a comparison of study results. Also, some studies do not provide the instrument itself or its characteristics, so the information is extracted from the conclusions and not from the data itself. Third, we intended to focus our research on social support, but few studies explore this concept as a coping strategy, which limits our discussion and reveals a clear gap in the knowledge produced on this topic.

7. CONCLUSION

Nursing students are subject to high levels of stress during clinical practice, which can have an impact on their physical and mental health, on the teaching‐learning process and on the quality of care provided. Coping strategies and social support could be used as tools to minimize the effects of stress on students.

From what we could find, coping strategies are more studied, and several forms of classification appear in literature. This has the ability to allow comparisons across different contexts. However, it may fail to include other types of coping strategies that may be equally important. Few studies establish a direct relationship between the effectiveness of specific coping strategies with specific stressful situations in this population and context. Problem‐solving strategies appear to be the most common strategies in use by nursing students. Linking specific coping strategies to the main stressors for nursing students during clinical practice can help outline the construction of effective strategies to prepare and help them to deal with stressful situations.

Social support has been identified as a useful coping strategy, but has been understudied in the nursing student population. The relationship between social support and stress reduction is also not well understood.

This review provided an overview of nursing students' coping strategies and social support during clinical practice. It was possible to identify patterns, advances, and gaps that allowed us to provide useful evidence for practice and research recommendations.

AUTHOR CONTRIBUTIONS

Author Contributions: conceptualization, F.L., D.P., A.N. and V.A.; methodology, F.L., D.P., A.N. and V.A.; validation, F.L., D.P., A.N. and V.A.; writing – original draft preparation, F.L.; writing – review and editing, F.L., D.P., A.N. and V.A.; project administration, F.L. All authors have read and agreed to the published version of the manuscript.

FUNDING INFORMATION

The authors thank FCT/MCTES for the financial support to CiiEM (10.54499/UIDB/04585/2020) through national funds.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

This research was conducted ethically in accordance with the Declaration of Helsinki.

TRIAL AND PROTOCOL REGISTRATION

This protocol was registered in Open Science Framework under the protocol number CRF9B available on the registration site on the following link: https://osf.io/3n6be/ .

ACKNOWLEDGEMENTS

CiiEM has provided support through Project 10.54499/UIDB/04585/2020, funded by FCT.

Loureiro, F. , Peças, D. , Neves, A. C. , & Antunes, A. V. (2024). Coping strategies and social support in nursing students during clinical practice: A scoping review. Nursing Open, 11, e2112. 10.1002/nop2.2112

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

• Ahmed, W. A. M. , & Mohammed, B. M. A. (2019). Nursing students' stress and coping strategies during clinical training in KSA. Journal of Taibah University Medical Sciences, 14(2), 116–122. 10.1016/j.jtumed.2019.02.002 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Alanazi, M. R. , Aldhafeeri, N. A. , Salem, S. S. , Jabari, T. M. , & Al Mengah, R. K. (2023). Clinical environmental stressors and coping behaviors among undergraduate nursing students in Saudi Arabia: A cross‐sectional study. International Journal of Nursing Sciences, 10(1), 97–103. 10.1016/j.ijnss.2022.12.007 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Al‐Gamal, E. , Alhosain, A. , & Alsunaye, K. (2018). Stress and coping strategies among Saudi nursing students during clinical education. Perspectives in Psychiatric Care, 54(2), 198–205. 10.1111/ppc.12223 [ DOI ] [ PubMed ] [ Google Scholar ]
• Alshahrani, Y. , Cusack, L. , & Rasmussen, P. (2018). Undergraduate nursing students' strategies for coping with their first clinical placement: Descriptive survey study. Nurse Education Today, 69, 104–108. 10.1016/j.nedt.2018.07.005 [ DOI ] [ PubMed ] [ Google Scholar ]
• Bae, M. (2022). Coping strategies initiated by COVID‐19‐related stress, individuals' motives for social media use, and perceived stress reduction. Internet Research, 33(1), 124–151. 10.1108/INTR-05-2021-0269/FULL/XML [ DOI ] [ Google Scholar ]
• Bektaş, H. , Terkes, N. , & Özer, Z. (2018). Stress and ways of coping among first year nursing students: A Turkish perspective. Journal of Human Sciences, 15(1), 319. 10.14687/jhs.v15i1.4626 [ DOI ] [ Google Scholar ]
• Bhurtun, H. D. , Azimirad, M. , Saaranen, T. , & Turunen, H. (2019). Stress and coping among nursing students during clinical training: An integrative review. Journal of Nursing Education, 58(5), 266–272. 10.3928/01484834-20190422-04 [ DOI ] [ PubMed ] [ Google Scholar ]
• Bhurtun, H. D. , Turunen, H. , Estola, M. , & Saaranen, T. (2021). Changes in stress levels and coping strategies among finnish nursing students. Nurse Education in Practice, 50, 102958. 10.1016/j.nepr.2020.102958 [ DOI ] [ PubMed ] [ Google Scholar ]
• Bodys‐Cupak, I. , Majda, A. , Skowron, J. , Zalewska‐Puchała, J. , & Trzcińska, A. (2018). First year nursing students' coping strategies in stressful clinical practice situations. Journal of Education in Science, 4(1), 12–18. 10.21891/jeseh.387474 [ DOI ] [ Google Scholar ]
• Bradbury‐Jones, C. , Aveyard, H. , Herber, O. R. , Isham, L. , Taylor, J. , & O'Malley, L. (2021). Scoping reviews: The PAGER framework for improving the quality of reporting. International Journal of Social Research Methodology, 25(4), 457–470. 10.1080/13645579.2021.1899596 [ DOI ] [ Google Scholar ]
• Cornine, A. (2020). Reducing nursing student anxiety in the clinical setting: An integrative review. Nursing Education Perspectives, 41(4), 229–234. 10.1097/01.NEP.0000000000000633 [ DOI ] [ PubMed ] [ Google Scholar ]
• Daniels, K. , & Harris, C. (2005). A daily diary study of coping in the context of the job demands‐control‐support model. Journal of Vocational Behavior, 66(2), 219–237. 10.1016/J.JVB.2004.10.004 [ DOI ] [ Google Scholar ]
• Dasgupta, A. , Podder, D. , Paul, B. , Bandyopadhyay, L. , Mandal, S. , Pal, A. , & Mandal, M. (2020). Perceived stress and coping behavior among future nurses: A cross‐sectional study in west Bengal, India. Indian Journal of Community Medicine, 45(2), 204–208. 10.4103/ijcm.IJCM_200_19 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Demirtepe‐Saygili, D. (2019). Stress, coping, and social media use. In Desjarlais M. (Ed.), The psychology and dynamics behind social media interactions (pp. 241–267). IGI Global. [ Google Scholar ]
• Durgun Ozan, Y. , Duman, M. , Çiçek, Ö. , & Baksi, A. (2020). The effects of clinical education program based on Watson's theory of human caring on coping and anxiety levels of nursing students: A randomized control trial. Perspectives in Psychiatric Care, 56(3), 621–628. 10.1111/ppc.12477 [ DOI ] [ PubMed ] [ Google Scholar ]
• Endler, N. S. , & Parker, J. D. (1990). Multidimensional assessment of coping: A critical evaluation. Journal of Personality and Social Psychology, 58(5), 844–854. 10.1037//0022-3514.58.5.844 [ DOI ] [ PubMed ] [ Google Scholar ]
• Fang, L. , Fang, C. L. , & Fang, S. H. (2020). Student nurses' bullying, social support and their health status during clinical practicum programmes. International Journal of Nursing Practice, 26(6), e12869. 10.1111/ijn.12869 [ DOI ] [ PubMed ] [ Google Scholar ]
• Galbraith, N. D. , & Brown, K. E. (2011). Assessing intervention effectiveness for reducing stress in student nurses: Quantitative systematic review. Journal of Advanced Nursing, 67(4), 709–721. 10.1111/j.1365-2648.2010.05549.x [ DOI ] [ PubMed ] [ Google Scholar ]
• George, D. R. , Dellasega, C. , Whitehead, M. M. , & Bordon, A. (2013). Facebook‐based stress management resources for first‐year medical students: A multi‐method evaluation. Computers in Human Behavior, 29(3), 559–562. 10.1016/j.chb.2012.12.008 [ DOI ] [ Google Scholar ]
• Gidman, J. , McIntosh, A. , Melling, K. , & Smith, D. (2011). Student perceptions of support in practice. Nurse Education in Practice, 11(6), 351–355. 10.1016/j.nepr.2011.03.005 [ DOI ] [ PubMed ] [ Google Scholar ]
• Gurková, E. , & Zeleníková, R. (2018). Nursing students' perceived stress, coping strategies, health and supervisory approaches in clinical practice: A Slovak and Czech perspective. Nurse Education Today, 65, 4–10. 10.1016/j.nedt.2018.02.023 [ DOI ] [ PubMed ] [ Google Scholar ]
• Gurvich, C. , Thomas, N. , Thomas, E. H. X. , Hudaib, A. R. , Sood, L. , Fabiatos, K. , Sutton, K. , Isaacs, A. , Arunogiri, S. , Sharp, G. , & Kulkarni, J. (2021). Coping styles and mental health in response to societal changes during the COVID‐19 pandemic. The International Journal of Social Psychiatry, 67(5), 540–549. 10.1177/0020764020961790 [ DOI ] [ PubMed ] [ Google Scholar ]
• Hadi, M. A. , Ali, M. , Haseeb, A. , Mohamed, M. M. A. , Elrggal, M. E. , & Cheema, E. (2018). Impact of test anxiety on pharmacy students' performance in objective structured clinical examination: A cross‐sectional survey. The International Journal of Pharmacy Practice, 26(2), 191–194. 10.1111/ijpp.12389 [ DOI ] [ PubMed ] [ Google Scholar ]
• Hawker, S. , Payne, S. , Kerr, C. , Hardey, M. , & Powell, J. (2002). Appraising the evidence: Reviewing disparate data systematically. Qualitative Health Research, 12(9), 1284–1299. 10.1177/1049732302238251 [ DOI ] [ PubMed ] [ Google Scholar ]
• Hou, Y. (2019). Nursing students' coping behaviors under the stress of using english in clinical practice. The International Journal of Humanities Education, 17(1), 37–46. 10.18848/2327-0063/CGP/v17i01/37-46 [ DOI ] [ Google Scholar ]
• Hwang, E. , Kim, M. , & Shin, S. (2021). Initial clinical practicum stress among nursing students: A cross‐sectional study on coping styles. International Journal of Environmental Research and Public Health, 18(9), 4932. 10.3390/ijerph18094932 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kalyani, M. N. , Jamshidi, N. , Molazem, Z. , Torabizadeh, C. , & Sharif, F. (2019). How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study. BMJ Open, 9(7), e028052. 10.1136/bmjopen-2018-028052 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Karaca, A. , Yildirim, N. , Cangur, S. , Acikgoz, F. , & Akkus, D. (2019). Relationship between mental health of nursing students and coping, self‐esteem and social support. Nurse Education Today, 76, 44–50. 10.1016/j.nedt.2019.01.029 [ DOI ] [ PubMed ] [ Google Scholar ]
• Labrague, L. J. , McEnroe‐Petitte, D. M. , Al Amri, M. , Fronda, D. C. , & Obeidat, A. A. (2018). An integrative review on coping skills in nursing students: Implications for policymaking. International Nursing Review, 65(2), 279–291. 10.1111/inr.12393 [ DOI ] [ PubMed ] [ Google Scholar ]
• Labrague, L. J. , McEnroe‐Petitte, D. M. , De Los Santos, J. A. A. , & Edet, O. B. (2018). Examining stress perceptions and coping strategies among Saudi nursing students: A systematic review. Nurse Education Today, 65, 192–200. 10.1016/j.nedt.2018.03.012 [ DOI ] [ PubMed ] [ Google Scholar ]
• Labrague, L. J. , McEnroe‐Petitte, D. M. , Gloe, D. , Thomas, L. , Papathanasiou, I. V. , & Tsaras, K. (2017). A literature review on stress and coping strategies in nursing students. Journal of Mental Health, 26(5), 471–480. 10.1080/09638237.2016.1244721 [ DOI ] [ PubMed ] [ Google Scholar ]
• Latif, R. A. , & Nor, M. Z. M. (2019). Stressors and coping strategies during clinical practice among diploma nursing students. Malaysian Journal of Medical Sciences, 26(2), 88–98. 10.21315/mjms2019.26.2.10 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lavoie‐Tremblay, M. , Sanzone, L. , Aubé, T. , & Paquet, M. (2022). Sources of stress and coping strategies among undergraduate nursing students across all years. The Canadian Journal of Nursing Research = Revue Canadienne de Recherche En Sciences Infirmieres, 54(3), 261–271. 10.1177/08445621211028076 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lazarus, R. , & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publisher. [ Google Scholar ]
• Lazarus, R. S. , & Folkman, S. (1988). Manual for the ways of coping questionnaire: Research Edition. Consulting Psychologists Press. [ Google Scholar ]
• Liu, J. , Yang, Y. , Chen, J. , Zhang, Y. , Zeng, Y. , & Li, J. (2022). Stress and coping styles among nursing students during the initial period of the clinical practicum: A cross‐section study. International Journal of Nursing Sciences, 9(2), 222–229. 10.1016/j.ijnss.2022.02.004 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ma, H. , Zou, J. M. , Zhong, Y. , Li, J. , & He, J. Q. (2022). Perceived stress, coping style and burnout of Chinese nursing students in late‐stage clinical practice: A cross‐sectional study. Nurse Education in Practice, 62, 103385. 10.1016/j.nepr.2022.103385 [ DOI ] [ PubMed ] [ Google Scholar ]
• McCarthy, B. , Trace, A. , O'Donovan, M. , Brady‐Nevin, C. , Murphy, M. , O'Shea, M. , & O'Regan, P. (2018). Nursing and midwifery students' stress and coping during their undergraduate education programmes: An integrative review. Nurse Education Today, 61, 197–209. 10.1016/j.nedt.2017.11.029 [ DOI ] [ PubMed ] [ Google Scholar ]
• Molero Jurado, M. D. M. , Pérez‐Fuentes, M. D. C. , Gázquez Linares, J. J. , & Barragán Martín, A. B. (2018). Burnout in health professionals according to their self‐esteem, social support and empathy profile. Frontiers in Psychology, 9, 424. 10.3389/fpsyg.2018.00424 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Munn, Z. , Peters, M. D. J. , Stern, C. , Tufanaru, C. , McArthur, A. , & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), 143. 10.1186/s12874-018-0611-x [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Narayanan, S. S. , & Alexius Weng Onn, C. (2016). The influence of perceived social support and self‐efficacy on resilience among first year Malaysian students. Kajian Malaysia, 34(2), 1–23. 10.21315/km2016.34.2.1 [ DOI ] [ Google Scholar ]
• Nebhinani, M. , Kumar, A. , Parihar, A. , & Rani, R. (2020). Stress and coping strategies among undergraduate nursing students: A descriptive assessment from Western Rajasthan. Indian Journal of Community Medicine, 45(2), 172–175. 10.4103/ijcm.IJCM_231_19 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Onieva‐Zafra, M. D. , Fernández‐Muñoz, J. J. , Fernández‐Martínez, E. , García‐Sánchez, F. J. , Abreu‐Sánchez, A. , & Parra‐Fernández, M. L. (2020). Anxiety, perceived stress and coping strategies in nursing students: A cross‐sectional, correlational, descriptive study. BMC Medical Education, 20(1), 370. 10.1186/s12909-020-02294-z [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Peters, M. D. J. , Marnie, C. , Tricco, A. C. , Pollock, D. , Munn, Z. , Alexander, L. , McInerney, P. , Godfrey, C. M. , & Khalil, H. (2021). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Implementation, 19(1), 3–10. 10.1097/XEB.0000000000000277 [ DOI ] [ PubMed ] [ Google Scholar ]
• Pienaar, M. , Orton, A. M. , & Botma, Y. (2022). A supportive clinical learning environment for undergraduate students in health sciences: An integrative review. Nurse Education Today, 119, 105572. 10.1016/j.nedt.2022.105572 [ DOI ] [ PubMed ] [ Google Scholar ]
• Pollock, D. , Peters, M. D. J. , Khalil, H. , McInerney, P. , Alexander, L. , Tricco, A. C. , Evans, C. , de Moraes, É. B. , Godfrey, C. M. , Pieper, D. , Saran, A. , Stern, C. , & Munn, Z. (2023). Recommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evidence Synthesis, 21(3), 520–532. 10.11124/JBIES-22-00123 [ DOI ] [ PubMed ] [ Google Scholar ]
• Pulido‐Martos, M. , Augusto‐Landa, J. M. , & Lopez‐Zafra, E. (2012). Sources of stress in nursing students: A systematic review of quantitative studies. International Nursing Review, 59(1), 15–25. 10.1111/j.1466-7657.2011.00939.x [ DOI ] [ Google Scholar ]
• Qalawa, S. A. A. , & Ibrahim, S. S. (2021). Student nurses' perception of bulling experience and its coping strategies during clinical training: A cross sectional study. International Journal of Nursing Education, 13(4), 63–75. 10.37506/ijone.v13i4.16590 [ DOI ] [ Google Scholar ]
• Rafati, F. , Nouhi, E. , Sabzevari, S. , & Dehghan‐Nayeri, N. (2017). Coping strategies of nursing students for dealing with stress in clinical setting: A qualitative study. Electronic Physician, 9(12), 6120–6128. 10.19082/6120 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Reeve, K. L. , Shumaker, C. J. , Yearwood, E. L. , Crowell, N. A. , & Riley, J. B. (2013). Perceived stress and social support in undergraduate nursing students' educational experiences. Nurse Education Today, 33(4), 419–424. 10.1016/j.nedt.2012.11.009 [ DOI ] [ PubMed ] [ Google Scholar ]
• Rudberg, S. L. , Westerbotn, M. , Sormunen, T. , Scheja, M. , & Lachmann, H. (2022). Undergraduate nursing students' experiences of becoming a professional nurse: A longitudinal study. BMC Nursing, 21(1), 219. 10.1186/s12912-022-01002-0 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sarason, I. G. , Levine, H. M. , Basham, R. B. , & Sarason, B. R. (1983). Assessing social support: The social support questionnaire. Journal of Personality and Social Psychology, 44(1), 127–139. 10.1037/0022-3514.44.1.127 [ DOI ] [ Google Scholar ]
• Sun, X. , Li, B. J. , Zhang, H. , & Zhang, G. (2023). Social media use for coping with stress and psychological adjustment: A transactional model of stress and coping perspective. Frontiers in Psychology, 14, 1201. 10.3389/fpsyg.2023.1140312 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Tambağ, H. (2021). Examination of nursing students' anxiety levels related to clinical practice with respect to peer support. Perspectives in Psychiatric Care, 57(3), 1114–1119. 10.1111/ppc.12664 [ DOI ] [ PubMed ] [ Google Scholar ]
• Wang, L. H. , Lin, C. C. , Han, C. Y. , Huang, Y. L. , Hsiao, P. R. , & Chen, L. C. (2021). Undergraduate nursing student academic resilience during medical surgical clinical practicum: A constructivist analysis of Taiwanese experience. Journal of Professional Nursing, 37(3), 521–528. 10.1016/j.profnurs.2021.02.004 [ DOI ] [ PubMed ] [ Google Scholar ]
• Wilks, S. E. , & Spivey, C. A. (2010). Resilience in undergraduate social work students: Social support and adjustment to academic stress. Social Work Education, 29(3), 276–288. 10.1080/02615470902912243 [ DOI ] [ Google Scholar ]
• Yeung, M. M.‐Y. , Yuen, J. W.‐M. , Chen, J. M.‐T. , & Lam, K. K.‐L. (2023). The efficacy of team‐based learning in developing the generic capability of problem‐solving ability and critical thinking skills in nursing education: A systematic review. Nurse Education Today, 122, 105704. 10.1016/j.nedt.2022.105704 [ DOI ] [ PubMed ] [ Google Scholar ]

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