Impact of an intervention program with reinforcement on nursing students' stress and anxiety levels in their clinical practices.

BACKGROUND AND OBJECTIVE: Several interventions have resulted in effectively reducing stress and anxiety in nursing students, however the efficacy of these interventions has only been investigated in the short term. This study had to objectives 1) to determine the effect of an intervention program to manage stress and anxiety in nursing students during clinical practices with two phases, phase I composed by cognitive behavioral therapy and progressive muscle relaxation and phase II or reinforcement phase with progressive muscle relaxation and 2) to determine the effect of phase I of the intervention program to manage stress and anxiety in nursing students during clinical practices. DESIGN: An experimental, analytical, longitudinal and prospective study. METHODS: Data were collected between April 2018 to June 2019 with 4 measurements of KEZKAK questionnaire and State-Trait Anxiety Inventory. An intervention program composed of cognitive behavioral therapy and progressive muscle relaxation was developed. The intervention program was divided in two phases, phase I and phase II or reinforcement phase. Fifty-nine nursing students from a Spanish university participated. A control group (n = 29), an intervention group one (n = 15) that received phase I and an intervention group 2 (n = 15) that received phase I and phase II or reinforcement phase were formed. RESULTS: After completing phase I, significant differences were found in the state of stress and anxiety between nursing students who received this phase and those who did not and after 3 months they continued to show differences. After phase II or reinforcement phase, the inter-groups did not present significant differences between them. The inter-group comparison of the stress and anxiety values at the end of the intervention program minus the initial values indicated that the CG presented significant differences with both intervention groups in the total of the KEZKAK and also with the IG1 in factors 3 (p = 0.030) and 4 (p = 0.027) and with the IG2 in factors 1 (p = 0.006) and 7 (p = 0.018). On the other hand, no differences were found between both intervention groups, IG1-IG2, in levels of stress and anxiety (p > 0.05) CONCLUSIONS: The intervention program contributes to provide evidence on the effectiveness of cognitive behavioral therapy and progressive muscle relaxation for stress and anxiety management in nursing students during clinical practices. This study suggests that we should continue in this line of research to improve the available evidence.

Estrés y ansiedad al comienzo de las prácticas clínicas en estudiantes de Enfermería / Stress and anxiety in Nursing students at the start of their clinical practice

OBJETIVO: describir la percepción del estrés, los factores potencialmente estresantes y la ansiedad de los estudiantes de la Facultad de Enfermería de Soria al comienzo de sus prácticas clínicas, y determinar la influencia de factores sociodemográficos, académicos, situación familiar y estilos de vida sobre la percepción de estos. MÉTODO: estudio descriptivo transversal con 61 estudiantes de la Facultad de Enfermería de Soria (curso). Se estudiaron variables sociodemográficas (sexo, edad, actividad laboral), académicas (año de ingreso, cursar solo Prácticum I, beca, otros estudios), de situación familiar (residencia, pareja, personas a cargo, familiar sanitario, pérdida de familiar), estilos de vida (fumador/a, bebedor/a, ejercicio físico), estrés y factores potencialmente estresores (Cuestionario KEZKAK -mín. 0 a máx. 3 puntos-) y ansiedad estado-rasgo (Cuestionario STAI -mín. 0 a máx. 60 puntos-). Se realizaron análisis descriptivo y bivariantes para las variables psicológicas. RESULTADOS: participaron 60 estudiantes (edad mediana (Me) = 21 años). La puntuación global de estrés presentó una mediana de 1,89 (RIQ = 0,48). Los factores percibidos como más estresantes fueron "falta de competencia" (Me = 2,09; RIQ = 0,43) e "impotencia e incertidumbre" (Me = 2,05; RIQ = 0,54). La ansiedad estado-rasgo presentó una mediana de 17 (IQR = 8) y 17,5 (IQR = 10), respectivamente. El nivel de estrés, los factores potencialmente estresantes y la ansiedad estado se asociaron con el sexo (p < 0,05). CONCLUSIONES: los estudiantes de Enfermería en sus primeras prácticas clínicas percibieron niveles de estrés moderadamente altos y una ansiedad moderada, siendo los principales estresores "falta de competencia" e "impotencia e incertidumbre". El sexo está altamente asociado con el estrés y la ansiedad, siendo mayor en las mujeres

OBJECTIVE: to describe the perception of stress, the potentially stressful factors, and the anxiety among students from the School of Nursing of Soria at the start of their clinical practice; and to determine the impact on their perception of sociodemographical and academic factors, their family situation and lifestyles. METHOD: a descriptive cross-sectional study with 61 students from the School of Nursing of Soria (course). The study included sociodemographical variables (gender, age, occupation), academic (year of admission, practicum I only, scholarship, other studies), family situation (place of residence, partner, dependent persons, health professional relatives, loss of relatives), lifestyles (smoking, drinking, physical exercise), stress and potential stressors (KEZKAK Questionnaire -min. 0 to max. 3 scores-) and State-Trait anxiety (STAI Questionnaire -min. 0 to max. 60 scores). Descriptive and bivariate analyses were conducted for the psychological variables. RESULTS: the study included 60 students (median age (Me= 21-year-old). The overall stress score presented a median score of 1.89 (IQR = 0.48). The factors perceived as more stressful were "lack of competence" (Me = 2.09; IQR = 0.43) and "impotence and uncertainty" (Me = 2.05; IQR = 0.54). The State-Trait anxiety presented a median score of 17 (IQR = 8) and 17.5 (IQR = 10), respectively. The level of stress, potential stressors and state anxiety were associated with gender (p< 0.05). CONCLUSIONS: nursing students in their first clinical practice perceived moderately high levels of stress and moderate anxiety; the main stressors were "lack of competence" and "anxiety and uncertainty". Gender is highly associated with stress and anxiety, and it is higher in women