Table 2.
Summary of reported stressors among nursing students in Middle East and North Africa (MENA) countries
| Category of stressors | Specific stressors (number of primary studies) |
|---|---|
| Clinical training period (n = 26) | |
| Stress from patient care (n = 19) | Lack of experience and ability in providing nursing care and in making judgments (n = 7) [84–89] |
| Do not know how to help patients with physio-psycho-social problems (n = 3) [84, 85, 90] | |
| Unable to reach one’s expectations (n = 0) | |
| Unable to provide appropriate responses to doctors’, teachers’, and patients’ questions (n = 1) [84] | |
| Worry about not being trusted or accepted by patients or patients’ family (n = 1) [90] | |
| Unable to provide patients with good nursing care (n = 0) | |
| Do not know how to communicate with patients (n = 2) [84, 90] | |
| Experience difficulties in changing from the role of a student to that of a nurse (n = 1) [76] | |
| Unspecified (n = 14) [72, 81–84, 90–98] | |
| Stress from teachers and nursing staff (n = 16) | Experience discrepancy between theory and practice (n = 3) [85, 88, 90] |
| Do not know how to discuss patients’ illness with teachers, and medical and nursing personnel (n = 1) [85] | |
| Feel stressed that teacher’s instruction is different from one’s expectations (n = 0) | |
| Medical personnel lack empathy and are not willing to help (n = 3) [86–88] | |
| Feel that teachers do not give fair evaluation on students (n = 0) | |
| Lack of care and guidance from teachers (n = 1) [89] | |
| Not a specific stressor (Stress from teachers and nursing staff (n = 12) [72–74, 81, 85, 89, 91, 92, 95–98]) | |
| Stress from assignments and workload (n = 23) | Worry about bad grades (n = 2) [85, 98] |
| Experience pressure from the nature and quality of clinical practice (n = 2) [84, 99] | |
| Feel that one’s performance does not meet teachers’ expectations (n = 2) [84, 85] | |
| Feel that the requirements of clinical practice exceed one’s physical and emotional endurance (n = 3) [84, 90, 100] | |
| Feel that dull and inflexible clinical practice affects one’s family and social life (n = 1) [78] | |
| Not a specific stressor (stress from assignments and workload (n = 20) [72–75, 81–89, 91, 92, 95–98, 101] | |
| Stress from peers and daily life (n = 7) | Experience competition from peers in school and clinical practice (n = 0) |
| Feel pressure from teachers who evaluate students’ performance by comparison (n = 0) | |
| Feel that clinical practice affects one’s involvement in extracurricular activities (n = 0) | |
| Cannot get along with other peers in the group (n = 1) [93] | |
| Not a specific stressor (stress from peers and daily life (n = 6) [72–74, 86, 92, 101]) | |
| Stress from lack of professional knowledge and skills (n = 12) | Unfamiliar with medical history and terms (n = 0) |
| Unfamiliar with professional nursing skills (n = 0) | |
| Unfamiliar with patients’ diagnoses and treatments (n = 2) [87, 88] | |
| Not a specific stressor (stress from lack of professional knowledge and skills (n = 10) [72, 73, 75, 81–83, 90, 92, 98, 101]) | |
| Feel stressed in the hospital environment where clinical practice takes place (n = 11) [72, 75, 81, 82, 84–86, 92, 95, 98] | |
| Unfamiliar with the ward facilities (n = 1) [85] | |
| Feel stressed from the rapid change in patient’s condition (n = 0) | |
| Unspecified (n = 2) [78, 84] | |
| Academic period (n = 15) | |
| Academic sources (n = 15) | Examination load (n = 4) [87, 88, 102, 103] |
| Course load (n = 5) [76, 87, 88, 102, 103] | |
| Lack of enough break time; not enough leisure time (n = 7) [77, 82, 87, 88, 93, 102, 103] | |
| Getting lower grade than anticipated (n = 6) [77, 86–88, 93, 100] | |
| Imbalance between leisure and study time (n = 4) [86–88, 93] | |
| Unable to enjoy study (n = 1) [93] | |
| Inconsiderate and insensitive instructors (n = 2) [87, 88] | |
| Being in 4th year (n = 2) [100, 101] | |
| Unspecified (academic sources (n = 5) [87, 88, 99, 103, 104], academic workload (n = 5) [70, 77, 78, 82, 93]) | |
| Stressors external to training periods (n = 15) | |
| Physical environmental sources (n = 11) | External environment (n = 1) [82] |
| Accommodation problems (n = 1) [70] | |
| Congested classroom (n = 3) [70, 87, 88] | |
| Living environmental change (n = 2) [78, 93] | |
| Inadequate safety and security (n = 3) [86, 90, 93] | |
| Lack of recreation facilities (n = 4) [86–88, 93] | |
| Absence of calm environment (n = 3) [87, 88, 93] | |
| Inadequate water provision (n = 1) [93] | |
| Long waits to get service (n = 1) [77] | |
| College environment (n = 1) [76] | |
| Moving location (n = 1) [92] | |
| Noise (n = 2) [90, 92] | |
| Transportation difficulties (n = 2) [87, 88] | |
| Smell and unfavorable odors (n = 1) [90] | |
| Intrapersonal sources (n = 14) | Social/personal environment (n = 2) [76, 92] |
| Lack of confidence and inability to make decisions (n = 2) [87, 88] | |
| Anxiety and depression (n = 1) [70] | |
| Feeling of homesickness (n = 1) [93] | |
| Change in sleeping patterns/not enough sleep (n = 5) [77, 78, 87, 88, 93] | |
| Changes in eating habits (n = 1) [78] | |
| New responsibilities (n = 1) [78] | |
| Personal illnesses (n = 4) [87, 88, 92, 93] | |
| Financial problems (n = 3) [87, 88, 100] | |
| Anticipation of graduation (n = 1) [78] | |
| Important decisions about future career (n = 7) [70, 77, 81, 86–88, 102] | |
| Not well defined (Intrapersonal sources (n = 2) [99, 105]) | |
Clinical training stressors were classified as per the Perceived Stress Scale (PSS) [61]
n Number of individual primary studies