Association between Learning Environment and Perceived Stress among Nursing Students: A Cross-Sectional Study

Abstract

Background: Learning environment includes classroom learning, skill practice and clinical learning, could be identified as one of the key sources of perceived stress among nursing students. Objective: To assess the association between learning environment and perceived stress among nursing students Methods: A cross-sectional study was conducted among a convenient sample of 340 second year and third-year nursing students from a School of Nursing, Sri Lanka. A self-administered questionnaire, consisting of socio-demographic data, Perceived Stress Scale-10 (PSS-10) and Dundee Ready Education Environment Measure (DREEM) were used. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test and Spearman correlation test were used in data analysis. Results: The sample consisted of 311 females (91.5%) and 29 males (8.5%). The mean (±SD) scores of PSS-10 and DREEM were 20.09 (±5.33) and 133.04 (±12.97) respectively. Around 78% and 12% students showed moderate (score =14-26/40) and high stress levels (score ≥ 27/40). Nearly 92% of students reported learning environment as “more positive than negative” (score =101-150/200). The sub-domains of “academic self-perception” and “perception of atmosphere” in the DREEM showed the highest (70.13%) and the lowest (62.08%) scores respectively. Perceived stress was associated with learning environment (r = - 0.111, p = 0.04) and sub-domain of “academic self-perception” (r = -0.196, p <0.01). A significant difference in PSS-10 score was reported across the different reasons for selecting nursing as a career choice (H = 23.27, p <0.001). Significant differences in the DREEM score were reported depending on gender (U = 3214.50, p = 0.01), academic year (H = 57.31, p <0.001) and reasons for selecting nursing as a career choice (H = 9.30, p = 0.03). Conclusions: Nursing students experienced moderate to high levels of stress as well as positive learning environment. The learning environment was negatively related to perceived stress. Strategies are recommended to reduce the stress of nursing students. Reason for selecting nursing as a carrier choice is an important factor of perceived stress and perception of learning environment among nursing students; therefore, these aspects can be incorporated to student recruitment.