Factors associated with perceived stress of clinical practice among associate degree nursing students in Taiwan

Background Clinical placements play an important role in helping nursing students to achieve clinical competence, but these placements can be highly challenging and stressful. It has been shown that stress can be either a trigger or aggravating factor for ill-health in general, but studies have seldom differentiated the impact of general health status on perceived stress. This study examined factors associated with perceived stress of clinical practice among nursing students with a particular focus on the effect of general health status on stress. Methods This was a cross-sectional quantitative study conducted among 724 associate nursing degree students in Southern Taiwan. Results Health status scores varied from 28 to 139, with an average of 68.40 (SD = 25.75). Health status was reported to be 'good' (scores 28-55) in 35.5% of participants, moderate (scores 56-83) in 24.6%, and poor (Scores >= 84) in 39.9% of participants. Perceived stress scores ranged from 0 to 95 points with an average score of 36.65 (SD +/- 15.95). The classification and regression tree (CART) analysis showed health status as the most important factor linked to perceived stress with a Normalized Importance value of 100%. Those who reported general health status (measured through General Health Questionnaire (GHQ)-28) score of <= 34.5 perceived mild stress and those with a score of > 34.5-< 84.5 perceived moderate stress. A score of 84.5 was found to be the point of transition to perceptions of severe stress. When health status score was greater than 84.5, perceived stress was at a severe or extremely severe level. Conclusions Our findings indicated health status as a potential measure to identify students who were most vulnerable to perceived stress. Given the cross-sectional design of this study and the bidirectional relationship between health and stress, more studies are needed to fully establish the predictive link between general health status and vulnerability to stress.