Stress, coping and satisfaction in nursing students

Aim. This article is a report of a study conducted to explore the relationship between sources of stress and psychological well-being and to consider how different sources of stress and coping resources might function as moderators and mediators on well-being.


Background. In most research exploring sources of stress and coping in nursing students, stress has been construed as psychological distress. Sources of stress likely to enhance well-being and, by implication, learning have not been considered.


Method. A questionnaire was administered to 171 final year nursing students in 2008. Questions were asked to measure sources of stress when rated as likely to contribute to distress (a hassle) and rated as likely to help one achieve (an uplift). Support, control, self-efficacy and coping style were also measured, along with their potential moderating and mediating effects on well-being, operationalized using the General Health Questionnaire and measures of course and career satisfaction.


Findings. Sources of stress likely to lead to distress were more often predictors of well-being than were sources of stress likely to lead to positive, eustress states, with the exception of clinical placement demands. Self-efficacy, dispositional control and support were important predictors, and avoidance coping was the strongest predictor of adverse well-being. Approach coping was not a predictor of well-being. The mere presence of support appeared beneficial as well as the utility of that support to help a student cope.


Conclusion. Initiatives to promote support and self-efficacy are likely to have immediate benefits for student well-being. In course reviews, nurse educators need to consider how students’ experiences might contribute not just to potential distress, but to eustress as well.

Cholinesterase Inhibitor and Memantine Use in Newly Admitted Nursing Home Residents with Dementia

OBJECTIVES: To quantify the use of cholinesterase inhibitors (ChEIs) and memantine in nursing home (NH) residents with dementia upon NH admission and 3 months later and to examine factors associated with reduction in therapy.

DESIGN: Retrospective cohort study.

SETTING: Nationwide sample of U.S. NHs.

PARTICIPANTS: Three thousand ?ve hundred six NH residents with dementia newly admitted in 2006.

MEASUREMENTS: Data from pharmacy dispensing records were used to determine ChEI and memantine medication use upon NH admission and at 3-month follow-up. The Minimum Data Set was used to determine resident- and facility-level characteristics. Severity of dementia was de?ned using the Cognitive Performance Scale (CPS).

RESULTS: Overall, 40.1% (n51,407) of newly admitted NH residents with dementia received ChEIs and memantine on NH admission. Use of ChEIs and memantine on admission was significantly greater in residents with mild to moderately severe dementia (41.2%) than in those with advanced dementia (33.3%, P5.001). After 3 months, ChEI and memantine use decreased by about half in both groups (48.6% with mild to moderately severe dementia vs 57.0% with advanced dementia, Po.05). NH residents with advanced dementia were significantly more likely reduce their use of ChEIs and memantine than those with mild to moderately severe dementia (odds ratio 51.44, 95% con?dence interval 51.03–2.01, P5.04).

CONCLUSION: Many NH residents with advanced dementia receive ChEIs and memantine upon NH admission, and approximately half of these decrease their medication use over the ensuing months. Further study is required to optimize use of ChEIs and memantine in NH populations and to determine the effects of withdrawing therapy on resident outcomes.

Stress, coping and burn-out in nursing students

Aim: To explore the relationship between sources of stress and psychological burn-out and to consider the moderating and mediating role played sources of stress and different coping resources on burn-out.

Background: Most research exploring sources of stress and coping in nursing students construes stress as psychological distress. Little research has considered those sources of stress likely to enhance well-being and, by implication, learning.

Method: A questionnaire was administered to 171 final year nursing students. Questions were asked which measured sources of stress when rated as likely to contribute to distress (a hassle) and rated as likely to help one achieve (an uplift). Support, control, self-efficacy and coping style were also measured, along with their potential moderating and mediating effect on burn-out.

Findings: The sources of stress likely to lead to distress were more often predictors of wellbeing than sources of stress likely to lead to positive, eustress states. However, placement experience was an important source of stress likely to lead to eustress. Self-efficacy, dispositional control and support were other important predictors. Avoidance coping was the strongest predictor of burn-out and, even if used only occasionally, it can have an adverse effect on burn-out. Initiatives to promote support and self-efficacy are likely to have the more immediate benefits in enhancing student well-being.

Conclusion: Nurse educators need to consider how course experiences contribute not just to potential distress but to eustress. How educators interact with their students and how they give feedback offers important opportunities to promote self-efficacy and provide valuable support. Peer support is a critical coping resource and can be bolstered through induction and through learning and teaching initiatives. 

Stress and eustress in nursing students

Aim. This paper is a report of a study to identify experiences that led to both distress and eustress and to make recommendations to help students cope with course demands.

Background. Much of the research on stress in nursing students is quantitative in focus and all draws on their experience of distress, with little attempt to understand experiences of eustress.

Method. A series of focus groups were carried out with a volunteer sample of final year nursing students (n = 16) in the United Kingdom in 2007. The data were thematically analysed.

Findings. The themes identified were clinical experience, support, learning and teaching experience and course structure. There were experiences within each that were perceived as sources of distress and eustress. Many of the sources of distress concur with earlier findings but they are more likely to be experienced and commented on because the demands of present-day programmes and the profile of many nursing students mean that more effort is invested in meeting educational demands. The experiential learning and patient-care opportunity that placements provided was an important source of eustress.

Conclusion. Students who coped well drew on effective support networks and adopted a positive, optimistic perspective towards programme issues. Effective educators did not offer more time than those perceived as less effective but seemed more effective at tuning into students' concerns, showing more empathy and offering clearer guidance.

Relationships between adrenocorticotropic hormone and cortisol are altered during clustered nursing care in preterm infants born at extremely low gestational age

Little is known about the effects of clustered nursing care on hypothalamic pituitary axis (HPA) responses in preterm infants in the neonatal intensive care unit.

Pneumonia and lower respiratory infections in nursing home residents:Predictors of hospitalization and mortality

OBJECTIVES: To compare predictors of hospitalization and death in nursing home residents with pneumonia and other lower respiratory infections (LRIs). DESIGN: A nested cohort study. SETTING: Nine nursing homes in southern Ontario. PARTICIPANTS: Three hundred fifty-three nursing home residents with LRIs (enrolled in the control arm of a clinical trial). MEASUREMENTS: Comorbidities, vaccination status, age, health-related quality of life, functional status, and vital statistics were evaluated as potential predictors of hospitalization and mortality at 30 days. RESULTS: Moderate to high disease severity score on a practical severity scale was a strong independent predictor of hospitalization (odds ratio (OR)=7.12, P