Perceived stress, coping behaviors, and environmental-relational stressors during first clinical placement among...

The transition to the first clinical placement is a psychologically demanding phase for nursing students, requiring adaptation to patient care responsibilities, academic expectations, and unfamiliar clinical settings. Stress during this period may be influenced by academic, clinical, environmental, and relational stressors, which can affect students' psychological well-being and coping behaviors.

This study aimed to assess the levels and sources of perceived stress and examine the relationship between coping behaviors and environmental-relational stressors among first-year nursing students during their initial clinical placement.

Design: Cross-sectional descriptive correlational study. A total of 467 first-year undergraduate nursing students undergoing initial clinical training in seven governmental hospitals participated. Data were collected using the Perceived Stress Scale for Nursing Students and the Coping Behavioral Inventory. The Perceived Stress Scale included domains related to the clinical environment and interactions with teaching and nursing staff, which were used to explore perceived environmental and relational stressors. Descriptive statistics, Pearson correlations, and multiple linear regression were used to examine associations between stress domains and coping behaviors.

Students reported high overall perceived stress (M = 62.99, SD = 9.76). The most prominent stressors were practical assignments and workload, patient care, examinations of personal competence, and environmental and staff-related factors, while stress related to lack of professional knowledge/skills and daily life was comparatively lower. Regarding coping behaviors, problem-solving and optimistic coping showed significant negative associations with total perceived stress (r = -0.75 and r = -0.36, respectively; p < 0.001) and were significant negative predictors in regression analysis (β = -0.76 and β = -0.32; p < 0.001).

First-year nursing students experienced high stress during initial clinical placement, mainly related to workload, patient care, evaluation, and environmental factors. Coping strategies showed associations with stress levels, where problem-solving and optimism were linked to lower perceived stress, while avoidance and transference showed weaker associations. These findings highlight the potential importance of structured orientation, mentorship, stress-management support, and supportive clinical training conditions during early clinical exposure.