Addressing Student Stress and Preparation for Upper Division Nursing Courses

Nursing students must be prepared to face a rapidly changing and increasingly complex health care environment.  This preparation requires a challenging curriculum that is often accompanied by an increased workload and student stress regarding their academic progress.  The purpose of the qualitative aspect of this mixed method study was to identify student perceptions of active learning practices incorporated into the junior year in a new curriculum.  A descriptive qualitative design utilizing focus group interviews for data collection was employed to explore student perceptions of stress, engagement and self-directed learning in an active learning environment.  Twenty-three students participated in focus group interviews lasting from 30 minutes to one hour during their junior year.  Students were encouraged to discuss the learning and study strategies they used prior to junior year and compare them with how they prepared and learned in a more active learning environment.   Interviews were recorded and transcribed.  The interviews were then analyzed by two experienced nurse researchers to identify common patterns of response to the incorporation of active learning strategies utilized in their junior year of nursing.  The central theme that emerged from the data was overwhelming levels of stress.   Although the quantitative data demonstrated moderate levels of stress when the students were interviewed they reported overwhelming stress in making the transition from lower division nursing courses to upper level clinical courses.  Students described disturbing results from the stress they felt during the junior year nursing courses.  Subthemes of stress included impacts to their physical and mental health, isolation and support, adversarial faculty/student relationships, and preparation for junior year of nursing school.  Students described the various ways they learned to cope with the additional stress of the junior year of nursing school.  Role modeling caring behaviors such as empathy and “looking out for” the student were considered helpful to the student in alleviating some of the stress.  The students in the study wanted to know that the faculty were there as partners in their journey through the curriculum.  Additionally, students described what they wished they had known prior to starting their junior year of nursing school.  Many of the students voiced the need to be able to “go deeper” into their learning.  Students reported relying on superficial learning strategies prior to junior year.  The results of this study highlight how students responded to the increased stress of junior year nursing courses and the lessons learned by both the students and the faculty teaching junior year nursing students.