Table 2 Summary of reported stressors among nursing students in Middle East and North Africa (MENA) countries
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) | |
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) | |
Academic period (n = 15) | |
 Academic sources (n = 15) | |
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] | |
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] | |
Inadequate water provision (n = 1) [93] | |
Long waits to get service (n = 1) [77] | |
College environment (n = 1) [76] | |
Moving location (n = 1) [92] | |
Smell and unfavorable odors (n = 1) [90] | |
 Intrapersonal sources (n = 14) | |
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] | |
Anticipation of graduation (n = 1) [78] | |
Important decisions about future career (n = 7) [70, 77, 81, 86,87,88, 102] | |