Open Access Peer-reviewed Research Article

Stress, stressors, stress responses and coping strategies among student nurses in Anambra State, South-East Nigeria

Main Article Content

Anulika Johnson Afonne corresponding author
Nneka Regina Agbakoba
Clementina Ukamaka Nwankwo


The study was a cross-sectional survey, aimed at assessing the level of perceived stress, common sources of perceived stress, physio-psycho-social responses and coping strategies to stress among student nurses undergoing training in Anambra State, Nigeria. A multistage sampling technique method was adopted for the study in which 183 student nurses from 4 different institutions were surveyed. Perceived stress scale (PSS) was used to determine the respondent’s level of stress and sources of stress. Physio-psycho-social response scale (PPSRS) was used to ascertain the respondent’s physio-psycho-social well-being, while coping behaviour inventory (CBI) was used to assess the respondents coping strategies. Results showed that 77.66 % of the participants had moderate level of perceived stress (mean score range 1.34-2.66), while 8.83 % had high level of stress (mean score range 2.67-4.00) and 13.51 % low stress level (mean score range 0-1.33). The major source of stress for most of the students was from assignments and workload. The overall mean PPSRS indicated a best health status for most of the institutions. The scores for all the institutions fell within the moderate use of the coping strategies, and the most common coping strategy adopted by the students was problem-solving behaviour. It is recommended that institutions and nurse educators should adopt measures to reduce stress on the students, by giving out assignments at the commencement of a course to give ample time for students to accomplish the academic tasks.

academic performance, acute stress, coping behaviour, physio-psycho-social response

Article Details

How to Cite
Afonne, A. J., Agbakoba, N. R., & Nwankwo, C. U. (2023). Stress, stressors, stress responses and coping strategies among student nurses in Anambra State, South-East Nigeria. Advances in Health and Behavior, 6, 263-274.


  1. Evans W and Kelly B. Pre-registration diploma student nurse stress and coping measures. Nursing Education Today, 2004, 24(6): 473-482.
  2. Tan SY and Yip A. Hans Selye (1907-1982): Founder of the stress theory. Singapore Medical Journal, 2018, 59(4): 170-171.
  3. Motowidlo SJ, Packard JS and Manning MR. Occupational stress: Its causes and consequences for job performance. Journal of Applied Psychology, 1986, 71(4): 618-629.
  4. Behere SP, Yadav R and Behere PB. A comparative study of stress among students of Medicine, Engineering and Nursing. Indian Journal of Psychological Medicine, 2011, 33(2): 145-148.
  5. Shawna F. 3 Types of stress and health hazards, January 17, 2018.
  6. Sharma B, Kumar A and Sarin J. Academic stress, anxiety, remedial measures adopted and its satisfaction among medical students: A systematic review. International Journal of Health Sciences and Research, 2016, 6(7): 368-376.
  7. Onieva-Zafra MD, Fernández-Muñoz JJ, Fernández-Martínez E, et al. Anxiety, perceived stress and coping strategies in nursing students: a cross-sectional, correlational, descriptive study. BMC medical education, 2020, 20: 1-9.
  8. Shriver CB and Scott-Stiles A. Health habits of nursing versus non-nursing students: a longitudinal study. Journal of Nursing Education, 2000, 39(7): 308-314.
  9. Beddoe AE and Murphy SO. Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 2004, 43: 305-312.
  10. Hawton K, Simkin S, Rue J, et al. Suicide in female nurses in England and Wales. Psychological medicine, 2002, 32(2): 239-250. 10.1017/s0033291701005165
  11. Labrague LJ. Stress, stressors, and stress responses of student nurses in a government nursing school. Health Science Journal, 2013, 7(4): 424-435.
  12. Robotham D. Stress among higher education students: towards a research agenda. Higher Education, 2008, 56: 735-746.
  13. Waghachavare VB, Dhumale GB, Kadam YR, et al. Study of stress among students of professional colleges from an Urban area in India. Sultan Qaboos University Medical Journal, 2013, 13(3): 429-436.
  14. Sharma N and Kaur A. Factors associated with stress among nursing students. Nursing & Midwifery Research Journal, 2011, 7: 12-21.
  15. Wang W, Xu H, Wang B and Zhu E. The mediating effects of learning motivation on the association between perceived stress and positive deactivating academic emotions in nursing students undergoing skills training. Journal of Korean Academy of Nursing, 2019, 49(4): 495-504.
  16. Keller A, Litzelman K, Wisk LE, et al. Does the perception that stress affects health matter? The association with health and mortality. Health Psychology, 2012, 31(5): 677- 684.
  17. Pryjmachuk S and Richards DA. Mental health nursing students differ from other nursing students: some observations from a study on stress and coping. International Journal of Mental Health Nursing, 2007, 16(6): 390-402.
  18. Weiten W and Lloyd MA. Psychology Applied to Modern Life, 9th edt, Cengage Learning, Wadsworth, 2008.
  19. Carver CS and Connor-Smith J. Personality and coping. Annual Review of Psychology, 2010, 61(1): 679-704.
  20. Ajibade BL, Olabisi OO, Fabiyi B, et al. Stress, types of stressors and coping strategies amongst selected nursing schools’ students in South-West, Nigeria. European Journal of Biology and Medical Science Research, 2016, 4(3): 1-15.
  21. Samson-Akpan PE, John ME, Edet OB, et al. Stress and coping strategies among undergraduate Nursing students in Calabar, Nigeria. IOSR Journal of Nursing and Health Science, 2017, 6(3): 61-70.
  22. Murtala AS and Mohammad AS. Assessment of stress and physio-psychosocial response among student nurses in Northern Nigeria. LAUTECH Journal of Nursing, 2021, 9: 45-55.
  23. National Bureau of Statistics 2018, 2017 Demographic Statistics Bulletin, January 30, 2020.
  24. Cochran WG. Sampling Techniques, 3rd edn, John Wiley & Sons, New York, 1977.
  25. Lily-West RB. Stressors and counselling needs of undergraduate nursing students in Osogbo, Nigeria. Texila International Journal of Nursing, 2017, 3(2): 1-15.
  26. Sheu S, Lin HS and Hwang SL. Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: the effect of coping behaviors. International Journal of Nursing Studies, 2002, 39: 165-175.
  27. Nebhinani M, Kumar A, Parihar A, et al. Stress and coping strategies among undergraduate nursing students: A descriptive assessment from Western Rajasthan. Indian Journal of Community Medicine, 2020, 45(2): 172-175.
  28. Baluwa MA, Lazaro M, Mhango L, et al. Stress and coping strategies among Malawian undergraduate nursing students. Advances in Medical Education and Practice, 2021, 12: 547-556.
  29. Ngoc NB and Tuan NV. Stress among nursing students in Vietnam: Prevalence and associated factors. International Nursing Review, 2023.
  30. Zheng YX, Jiao JR and Hao WN. Stress levels of nursing students: a systematic review and meta-analysis. Medicine, 2022, 101: 36.
  31. Chaabane S, Chaabna K, Bhagat S, et al. Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews. Systematic Reviews, 2021, 10 :136.
  32. Zhao FF, Lei XL, He W, et al. The study of perceived stress, coping strategy and self-efficacy of Chinese undergraduate nursing students in clinical practice. International Journal of Nursing Practice, 2015, 21(4): 401-409.
  33. Aedh AI, Elfakai NK and Mohamed IA. Factors associated with stress among nursing students (Najran university-Saudi Arabia). IOSR-Journal of Nursing and Health Science, 2015, 4(6): 33-38.
  34. Karaca A, Yildirim N and Ankarali H. Nursing students’ perceived levels of clinical stress, stress responses and coping behaviors. Journal of Psychiatric Nursing, 2017, 8(1): 32-39.
  35. Ayaz-Alkya S and Simones J. Nursing education stress and coping behaviours in Turkish and the United States nursing students: A descriptive study. Nurse Education Practice, 2022, 59: 103292.
  36. Chan CKL, So WKW and Fong DYT. Hong Kong baccalaureate nursing students’ stress and their coping strategies in clinical practice. Journal of Professional Nursing, 2009, 25(5): 307-313.
  37. Sarier Y. The factors that affect students' academic achievement in Turkey: A meta-analysis study. Hacettepe University Journal of Education, 2016, 31(3): 609-627.