Skip to main content

Table 2 Summary of reported stressors among nursing students in Middle East and North Africa (MENA) countries

From: Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews

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) [84,85,86,87,88,89]
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, 81,82,83,84, 90,91,92,93,94,95,96,97,98]
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) [86,87,88]
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) [72,73,74, 81, 85, 89, 91, 92, 95,96,97,98])
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) [72,73,74,75, 81,82,83,84,85,86,87,88,89, 91, 92, 95,96,97,98, 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) [72,73,74, 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, 81,82,83, 90, 92, 98, 101])
Feel stressed in the hospital environment where clinical practice takes place (n = 11) [72, 75, 81, 82, 84,85,86, 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, 86,87,88, 93, 100]
Imbalance between leisure and study time (n = 4) [86,87,88, 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) [86,87,88, 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, 86,87,88, 102]
Not well defined (Intrapersonal sources (n = 2) [99, 105])
  1. Clinical training stressors were classified as per the Perceived Stress Scale (PSS) [61]
  2. n Number of individual primary studies