• Retneswari Masilamani Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia.
  • Myat Moe Thwe Aung Faculty of Medicine. Sultan Zainal Abidin University. 24000 Kuala Terengganu. Malaysia
  • Hamidah Othman School of Nursing Science. Faculty of Medicine. Sultan Zainal Abidin University. 24000 Kuala Terengganu. Malaysia
  • Aini Abu Bakar Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Tan Chung Keat Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Sugapriyan Ravichandran. Monash Health Centre. Clayton, Victoria 3168. Australia
  • Lim Kit Wing Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Chuah Wei Hong Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Lim Kok Hong Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Ng Elson Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Tan Jef Wayna Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Vickneshan Selvathurai Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Tan Ze Xuan Faculty of Medicine and Health Sciences. UCSI University, 56000 Kuala Lumpur. Malaysia
  • Surein Prasad Jagajarantan Faculty of Medicine and Health Sciences. 56000 UCSI University, Kuala Lumpur. Malaysia
Keywords: student nurses, stress, student nurse stress, stressors, coping strategies, university student nurses


Literature has documented that student nurses undergo stress in their academic and clinical setting. This raises concerns because stress during undergraduate training may result in psychological or emotional impairment during the nurses’ professional life and ultimately affect the quality of patient care. The Objective of the study was to study the prevalence of stress, and the association between sociodemographic factors, stressors and coping strategies with stress. This was a cross-sectional study on 96-year 1-3 nursing students from a government university done between 2015-2018. Bahasa Malaysia translated The General Health Questionnaire, Stressors in Nursing Student Scale Questionnaire and Brief COPE Questionnaire was used in this study. This study had Malay (95.9%) and female (91.7%) dominated population. The prevalence of stress in student nurses was 25%. No association was reported between sociodemographic factors and stress. Among the 4 stressors educational, clinical, confidence and financial, clinical stressor scored the highest mean 6.40 (SD±3.66). Confidence stressor (AOR=1.26 95% CI 1.04-1.53) was the only stressor associated with stress. The top 3 coping strategies practiced by the student nurses were religion (praying), acceptance and planning. Self-blame (AOR 8.18 95% CI 1.86-35.91) was the only coping strategy associated with stress. Stress management programmes, and workshops on stress and coping strategies should be conducted yearly to ensure a well-balanced environment for good learning experiences and prevent stress related health problems and improved academic performance.


1. Chan CK, So WK, Fong DY. Hong Kong baccalaureate nursing students' stress and their coping strategies in clinical practice. J Prof Nurs. 2009;25(5):307-13.

2. Evans W, Kelly B. Pre-registration diploma student nurse stress and coping measures. Nurse Educ Today. 2004;24(6):473-82.

3. Sheu S, Lin H-S, Hwang S-L. Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: the effect of coping behaviors. Int J Nurs Stud. 2002;39(2):165-75.

4. Jonsén E, Melender H-L, Hilli Y. Finnish and Swedish nursing students' experiences of their first clinical practice placement—A qualitative study. Nurse Educ Today. 2013;33(3):297-302.

5. Admi H. Nursing students' stress during the initial clinical experience. J Nurs Educ. 1997;36(7):323-7.

6. Beck DL, Srivastava R. Perceived level and sources of stress in baccalaureate nursing students. J Nurs Educ. 1991;30(3):127-33.

7. Junious DL, Malecha A, Tart K, Young A. Stress and perceived faculty support among foreign-born baccalaureate nursing students. J Nurs Educ. 2010;49(5):261-70.

8. Kang YS, Choi SY, Ryu E. The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse Educ Today. 2009;29(5):538-43.

9. Ratanasiripong P, Ratanasiripong N, Kathalae D. Biofeedback intervention for stress and anxiety among nursing students: a randomized controlled trial. ISRN Nurs. 2012;2012.

10. Tully A. Stress, sources of stress and ways of coping among psychiatric nursing students. J Psychiatr Ment Health Nurs. 2004;11(1):43-7.

11. Kumar R, Nancy O. Stress and coping strategies among nursing students. Nursing and Midwifery Research Journal. 2011;7(4):141-51.

12. Kurebayashi LFS, Do Prado JM, Da Silva MJP. Correlations between stress and anxiety levels in nursing students. J Nurs Educ Pract. 2012;2(3):128.

13. Papazisis G, Tsiga E, Papanikolaou N, Vlasiadis I, Sapountzi-Krepia D. Psychological distress, anxiety and depression among nursing students in Greece. International Journal of Caring Sciences. 2008;1(1):42.

14. Pryjmachuk S, Richards DA. Predicting stress in pre‐registration nursing students. Br J Health Psychol. 2007;12(1):125-44.

15. Sutherland VJ, Cooper CL. Understanding stress: A psychological perspective for health professionals: Chapman & Hall/CRC; 1990.

16. Carver CS, Scheier MF. Situational coping and coping dispositions in a stressful transaction. J Pers Soc Psychol. 1994;66(1):184.

17. Lees S, Ellis N. The design of a stress‐management programme for nursing personnel. J Adv Nurs. 1990;15(8):946-61.

18. Adejumo O, Brysiewicz P. Coping strategies adopted by baccalaureate nursing students in a problem-based learning programme. Educ Health. 1998;11(3):349.

19. Carver CS. You want to measure coping but your protocol’too long: Consider the brief cope. Int J Behav Med. 1997;4(1):92.

20. Deary IJ, Watson R, Hogston R. A longitudinal cohort study of burnout and attrition in nursing students. J Adv Nurs. 2003;43(1):71-81.

21. Goldberg DP. User's guide to the General Health Questionnaire. Windsor. 1988.

22. Yusoff MSB, Rahim AFA, Jamil M. The sensitivity, specificity and reliability of the malay version 12-items general health (GHQ-12) in questionnaire detecting distressed medical students. ASEAN Journal of Psychiatry [Internet]. 2010. Available from:

23. Zulkefly SN, Baharudin R. Using the 12-item General Health Questionnaire (GHQ-12) to assess the psychological health of Malaysian college students. Glob J Health Sci. 2010;2(1):73.

24. Yusoff MSB. The validity of the Malay Brief COPE in identifying coping strategies among adolescents in secondary school. Int Med J. 2011;18(1):29-33.

25. Wheeler HH. Nurse occupational stress research 4: the prevalence of stress. Br J Nurs. 1997;6(21):1256-60.

26. Caplan RP. Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers. BMJ. 1994;309(6964):1261-3.

27. Borrill C, Wall T, West M, Hardy G, Shapiro D, Carter A, et al. Mental health of the workforce in NHS trusts: Phase 1 final report. 1996.

28. Rimmer A. Staff stress levels reflect rising pressure on NHS, says NHS leaders. BMJ: British Medical Journal (Online). 2018;360.

29. Shamsuddin K, Fadzil F, Ismail WSW, Shah SA, Omar K, Muhammad NA, et al. Correlates of depression, anxiety and stress among Malaysian university students. Asian J Psychiatr. 2013;6(4):318-23.

30. Elias H, Ping WS, Abdullah MC. Stress and academic achievement among undergraduate students in Universiti Putra Malaysia. Procedia-Social and Behavioral Sciences. 2011;29:646-55.

31. Shaban IA, Khater WA, Akhu-Zaheya LM. Undergraduate nursing students’ stress sources and coping behaviours during their initial period of clinical training: A Jordanian perspective. Nurse Educ Pract. 2012;12(4):204-9.

32. Moreira DP, Furegato ARF. Stress and depression among students of the last semester in two nursing courses. Rev Lat Am Enfermagem. 2013;21(SPE):155-62.

33. Lo R. A longitudinal study of perceived level of stress, coping and self‐esteem of undergraduate nursing students: an Australian case study. J Adv Nurs. 2002;39(2):119-26.

34. Liu M, Gu K, Wong TK, Luo MZ, Chan MY. Perceived stress among Macao nursing students in the clinical learning environment. Int J Nurs Sci. 2015;2(2):128-33.

35. Bam V, Oppong G, Ibitoye M. Stress and coping mechanisms of nursing students during clinical practice in Ghana. Journal of Science and Technology (Ghana). 2014;34(2):50-9.

36. Seyedfatemi N, Tafreshi M, Hagani H. Experienced stressors and coping strategies among Iranian nursing students. BMC Nurs. 2007;6(1):11.

37. Shipton SP. The process of seeking stress-care: coping as experienced by senior baccalaureate nursing students in response to appraised clinical stress. J Nurs Educ. 2002;41(6):243-56.

38. Ab Latif R, Nor MZM. Stressors and coping strategies during clinical practices among diploma nursing students. Education in Medicine Journal. 2016;8(3).

39. Mahat G, editor Stress and coping: junior baccalaureate nursing students in clinical settings. Nursing forum; 1998: Wiley Online Library.

40. Ashmore R, Banks D. Self-disclosure in adult and mental health nursing students. Br J Nurs. 2002;11(3):172-7.

41. Goff A-M. Stressors, academic performance, and learned resourcefulness in baccalaureate nursing students. Int J Nurs Educ Scholarsh. 2011;8(1).

42. Sharif F, Masoumi S. A qualitative study of nursing student experiences of clinical practice. BMC Nurs. 2005;4(1):6.

43. Oner Altiok H, Ustun B. The Stress Sources of Nursing Students. Educational Sciences: Theory and Practice. 2013;13(2):760-6.

44. Idczak SE. I am a nurse: nursing students learn the art and science of nursing. Nurs Educ Perspect. 2007;28(2):66-71.

45. Hsiao YC, Chien LY, Wu LY, Chiang CM, Huang SY. Spiritual health, clinical practice stress, depressive tendency and health‐promoting behaviours among nursing students. J Adv Nurs. 2010;66(7):1612-22.

46. Tsai P-F. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45.

47. Al-Dubai SAR, Al-Naggar RA, AlShagga MA, Rampal KG. Stress and coping strategies of students in a medical faculty in Malaysia. Malays J Med Sci. 2011;18(3):57.
How to Cite
Retneswari Masilamani, Myat Moe Thwe Aung, Hamidah Othman, Aini Abu Bakar, Tan Chung Keat, Sugapriyan Ravichandran., Lim Kit Wing, Chuah Wei Hong, Lim Kok Hong, Ng Elson, Tan Jef Wayna, Vickneshan Selvathurai, Tan Ze Xuan, & Surein Prasad Jagajarantan. (2019). STRESS, STRESSORS AND COPING STRATEGIES AMONG UNIVERSITY NURSING STUDENTS. Malaysian Journal of Public Health Medicine, 19(2), 20-28. Retrieved from