Association between Problem Focused Coping with Stress among Nursing Students during Clinical Training at DHQ-Teaching Hospital, KDA Kohat, Pakistan

Abstract

Background: Stress among nursing students is a common concern in nursing education worldwide. Students may experience stress due to fear of making clinical errors, inadequate clinical knowledge, limited practical experience, heavy academic workloads, time constraints, challenging patient conditions, and difficulties communicating with patients and healthcare professionals. Objective: To assess the association between problem focused coping with degree and type of stress among nursing students during clinical training at DHQ-Teaching hospital, KDA Kohat, Pakistan. Methods: A descriptive cross-sectional study was conducted by a simple random sampling technique on 110 nursing students during their clinical training. The data were collected by a self-administered questionnaire that consists of demographic variables, perceived stress scale (PSS), and ways of coping checklist (WCCL). Results: The study sample consisted of 110 nursing students, with a prominent male majority of 72.7% (n = 80) and 84.5% (n = 93) being single. Academic demographics revealed that 47.3% (n = 52) were in their fourth year, 51.8% (n = 57) maintained a high CGPA between 3.5 and 4.0, and 40.0% (n = 44) had less than six months of clinical experience. Notably, a vast majority of 83.6% (n = 92) had received no formal stress-management training. The perceived stress provoking factors included Stress from taking care of patients (2.55 ± 0.80), stress from assignments and workload (3.1 ± 1.00), stress due to lack of professional knowledge (2.75 ± 0.96), stress from clinical environment (2.74 ± 0.84), and stress from teachers and peers (2.98 ± 0.65). Problem-focused coping strategies used by students to minimize stress include bargaining (2.78 ± 0.51), focus on positive (2.02 ± 0.61), social support (2.29 ± 0.73), and concentrated efforts (2.15 ± 0.71). Correlation analyses showed that social support acted as a key buffer, correlating negatively with stress from patient care (r = -0.207) and lack of professional knowledge (r = 0.219). Conversely, interpersonal and environmental pressures triggered reactive coping, as evidenced by positive correlations between concentrated efforts and stress from the clinical environment (r = 0.195) as well as teachers and peers (r = 0.170). Conclusion: Academic workloads (3.10 ± 1.00) and instructor/peer relationships (2.98 ± 0.65) are the main causes of the significant clinical stress experienced by nursing students at KDA Hospital. This stress is exacerbated by an 83.6\% deficiency in formal stress-management training. Although students actively use social support (2.29 ± 0.73) and negotiating (2.78 ± 0.51) to reduce direct patient care and knowledge worries, they do not have a formal, institutional framework for stress management. Rather, structural pressures lead to an increase in unguided "concentrated efforts" (2.15 ± 0.71), which puts this high-achieving group at risk for burnout. As a result, educational institutions need to move quickly away from expecting students to be resilient on their own and toward rigorous stress-coping programs and helpful faculty mentorship.