Research in practice

Exploring students' perceptions of stress levels

What are healthcare students’ perceptions on their own stress levels and coping strategies during clinical placement?

What are healthcare students’ perceptions on their own stress levels and coping strategies during clinical placement?

Relaxing with colleagues during breaks can help to relieve stress. Picture: Charles Milligan


Healthcare students are required to complete a mandatory amount of theory and practice hours throughout the duration of their course, including clinical placements. These have been identified as a major source of stress for students, as explored in a systematic review carried out by Pulido-Martos et al (2006). This stress can lead to poor health, absenteeism and attrition from the course of study (Eick et al 2012, Galbraith et al 2014).

However, Wray et al (2010) found that stress caused by clinical placements is an area where healthcare students could receive more support to reduce stress levels, therefore improving practice, and avoiding absence and attrition.

Aim and method

The aim of the research project was to explore healthcare students’ perceptions on their own stress levels and coping strategies during clinical placement.

A qualitative approach was the most appropriate to extract detailed data from participants, as it provides details about human emotions and behaviour that a quantitative study cannot match. Semi-structured, one-to-one interviews were chosen for data collection, as they allow the interviewer to discuss relevant topics, or elaborate on certain discussion points.

Convenience sampling was used to select participants who fit the inclusion and exclusion criteria, of being an English-speaking healthcare student at the University of Huddersfield, who had completed at least one clinical placement, and who had no diagnosis or medication for stress and/or anxiety. This was achieved by sending out an email to the relevant population, and selecting the first five eligible participants to respond.

Following a pilot study, interviews were conducted, recorded, and transcribed by the researchers. These transcriptions were analysed to find codes and themes to form the study’s results.


Three main themes were identified:

  • Recognising stress: Students recognise physical signs such as a headache, tiredness, and low mood as signs of stress, therefore being aware of their own stress levels.
  • Stressors: Included problems with mentors, staff, travel, competencies and the work-life balance.
  • Coping strategies: Showed a variety of ways that students motivate themselves, and cope with high stress levels, including relaxation, exercise, positive mental attitude and talking to others.


These findings are tentative due to the small size of the study, however are consistent with existing literature. An appropriate data collection method was used, increasing credibility. Participants were varied in age, but mostly female, which could limit the applicability of findings to a wider population (Graneheim and Lundman 2004).

Conclusion and implications for practice

Recommendations for future practice could include removing or reducing unnecessary stressors, such as academic work while on placement. More training and assessment of mentors would ensure a more positive experience for students on placement. Further research on effective coping strategies for students, and how university and placement staff can assist in these, would be useful.


  • Eick S, Williamson G, Heath V (2012) A systematic review of placement-related attrition in nurse education. International Journal of Nursing Studies. 49, 10, 1299-1309.
  • Galbraith N, Brown K, Clifton E (2014) A survey of student nurses’ attitudes toward help seeking for stress. Nursing Forum. 49, 3, 171-181.
  • Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 24, 2, 105-112.
  • Pulido-Martos M, Augusto-Landa JM, Lopez‐Zafra E (2012) Sources of stress in nursing students: a systematic review of quantitative studies. International Nursing Review. 59, 2, 15–25. doi:10.1111/j.1466-7657.2011.00939.x
  • Wray J, Barrett D, Aspland J et al (2010) Staying the course: factors influencing pre-registration nursing student progression into Year 2 – a retrospective cohort study. International Journal of Nursing Studies. 49, 11, 1432-1442.

Katrina Gardiner was a children’s nursing student at the University of Huddersfield when she undertook this study as part of a dissertation. She is now a staff nurse at Calderdale and Huddersfield NHS Foundation Trust

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