Prevalence of Stress and Coping Strategies Among Nursing Students During Clinical Rotations in Bannu

Abstract

Background: Clinical rotations are a high-demand learning context for nursing students and can precipitate stress that undermines psychological well-being and clinical learning if not effectively managed. Objective: To estimate the point prevalence and severity distribution of stress and to describe coping strategies among BSN nursing students during clinical rotations in Bannu. Methods: A quantitative cross-sectional observational study was conducted among BSN students (2nd, 4th, 6th, and 8th semesters) from government and private nursing colleges in Bannu. Using proportionate stratified sampling, 160 students completed a structured online questionnaire. Stress was measured using the DASS-21 stress subscale and categorized into standard severity bands; coping strategies were assessed using a structured Likert-scale questionnaire and summarized as individual strategy frequencies and overall coping level (poor/moderate/good). Results: Normal stress was observed in 51.9% (83/160), while 48.1% (77/160; 95% CI 40.3–55.9) had elevated stress (≥ mild), including 11.3% (18/160) with severe/extremely severe stress. Elevated stress differed by semester (p=0.032; Cramér’s V=0.23) and clinical exposure duration (p=0.041; Cramér’s V=0.21), peaking in the 6th semester (62.5%) and among those with 6–12 months exposure (73.3%). Common “always” coping strategies were prayer/religious practices (67.5%), positive reframing (61.3%), and planning (37.5%). Poor coping was associated with higher odds of elevated stress versus good coping (OR=3.14; 95% CI 1.29–7.66; p=0.002; Cramér’s V=0.28). Conclusion: Nearly half of nursing students experienced elevated stress during clinical rotations, with a distinct mid-program peak and a strong inverse association between coping capacity and stress burden, supporting targeted mentorship and structured stress-management interventions during higher-risk training phases.