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Title: First year nursing students' perceptions of stress and resilience during their initial clinical placement and the introduction of a stress management app : a mixed methods approach
Author: Porter, Shannon Lee
ISNI:       0000 0004 7972 5767
Awarding Body: Edinburgh Napier University
Current Institution: Edinburgh Napier University
Date of Award: 2019
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Objective: This study aimed to investigate the perceived levels of stress and resilience of first year nursing students prior to and during their first clinical placement as well as their experience of using a stress management app delivered by smartphone. Methods: A mixed methods, convergent parallel design was used. All first year adult nursing students in a public higher education institution beginning their first clinical placement in January 2016 (n= 330) were invited to take part in this study and to use a tool delivered by smartphone, designed to help student nurses manage stress and build resilience. Fifty-two of these first year nursing students completed two questionnaires, Stress in Nursing Students (SINS) and Resilience Scale (RS) before and during (January and March, 2016) their first clinical placement. Seven of the 52 participants that completed both questionnaires took part in a semi-structured interview, and 3 of those 7 had used the stress management app. Data analysis included descriptive analysis, paired samples t-test analysis, Pearson's r correlation analysis and use of Cohen's d effect size for comparison of mean scores. Thematic analysis was used to analyse the qualitative interview data. In following with convergent parallel mixed methods design, data integration took place once both quantitative and qualitative data sets had been analysed separately and this involved narrative and joint displays. Results: The overall SINS mean score were, pre-clinical placement 2.83(0.52) and during clinical placement 3.07(0.51); while scores for the highest level of stress in different dimensions were: clinical pre: 2.85(0.59), during: 3.02(0.51) education pre: 3.19(0.60), during: 3.32(0.60), confidence pre: 2.29(0.54), during: 2.76(0.52) and finance pre: 3.19(1.03), during: 3.46 (0.85). There was a significant increase in levels of perceived stress with the most common stressors both prior and during the initial placement belonging in the clinical and education sub dimensions and significant increases in stress were found in the confidence and finance sub dimensions. There was no significant change in levels of resilience (RS) prior to and during the initial clinical placement. A moderate negative correlation was found between levels of resilience and perceived levels of stress prior to the initial clinical placement (p=0.009, r=-0.375). The qualitative thematic analysis uncovered three themes: sources of stress, coping and resilience and C-SMARTT App. The process of data integration resulted in expansion, clarification and confirmation of findings highlighting the impact of mentorship and social support on students' placement experience. Conclusions: First year nursing students experienced an increase in levels of perceived stress during their initial clinical placement. The most common stressors were related to clinical and educational dimensions. There was a correlation between levels of resilience and perceived stress prior to the initial clinical placement however this was lost during the initial clinical placement suggesting that further research is needed in investigating the role resilience plays in managing stress. First year nursing students showed interest in a stress management app and provided suggestions for improvements and this study supports the need for future research into the development and evaluation of a stress management app delivered by smartphone for use within clinical placements.
Supervisor: Smith, Stephen ; Donaldson, Jayne ; Smith, Graeme Sponsor: Edinburgh Napier University
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: stress management ; nursing students ; smartphone app ; resilience ; stressors ; clinical placements ; education ; 610.7 Medical education, research & nursing ; RT Nursing