APPROVAL SHEET

1
 ACKNOWLEDGEMENT

I am thankful to Purbanchal University, for their approval to conduct this study and am grateful
to my research advisor, Mrs Bhawana Bhandari, whose many hours of support and guidance
were an encouragement to obtain detailed accounts. I am also grateful to Professor Mr. salau Din
Miya, Campus Chief of Hope International College, Mrs Ganga Prajapati, HOD of nursing
faculty as well as research subject teacher, Mrs Rekha Gaha,, the co-ordinator of PBBN 3rd year
for their suggestion and encouragement throughout the research study.

I express my deep sense of gratitude to Mr. Krishna G.C for his guidance in the analysis and
interpretation of the research data. My deepest thanks are extended to all the research data. My
deepest thanks are extended to all the research advisor and research committee for valuable
suggestion and guidance. I would also like to thank all the staffs of Hope International College,
Library for their help with the literature review, as well as my colleagues for their
encouragement and support.

The contributions of the study participants who patiently responded to question on the topic
matters included in the study questionnaire are grateful acknowledged. The study would not have
been possible without their voluntary and enthusiastic participation.

As always, my parents and family members deserve much credit for supporting me in my
ambition to be a professional nurse and in my further studies to see this fulfilled.

2
 ABSTRACT

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe. Everyone has
feelings of anxiety at some point in their life for example, you may feel worried and anxious
about sitting an exam, or having a medical test or job interview. Thus, knowledge regarding
anxiety is a key factor for maintaining health, social life and further complication. The objective
of this study was to assess the knowledge regarding anxiety among Nursing Students.

A descriptive research design was used to observe a purposive sample of 50 Students attending
Hope International College, Lalitpur. A closed eneded questionnaire was developed from the
literature review. The variables used were dependent variable knowledge regarding anxiety,
effects in social and private life, age, sex, marital status, ethnic group. The collected Data were
analyzed and interpreted on the basis of frequency and percentage in SPSS 1.6.0.This finding
shows the. 92% were Unmarried and 8% were married. Hindu Religion were highest i.e 78%,
Chhetri Ethnic Group were highest i.e 36%. Total of 82% were living in Nuclear Family and
18% were living Joint Family, 100% knew about the anxiety. 68% feel the anxiety during
clinical exposure whereas 32% didnt feel anxiety during clinical exposure. 52% felt most
anxious during first clinical exposure in Surgical Ward78% dont feel anxiety when they have to
approach with medical staff in duty whereas 22% feel anxiety. 92% feel anxiety when they talk
to the patients and Visitors whereas 52% feel anxiety with critical patients. 92% respondents
share anxiety with family/peer and 8% dont share anxiety with family/peer 64% find worrying
about anxiety and 48% Discuss Situations with Close Friends / teacher when they feel anxiety
but minority of 6% pray God when They feel anxiety. among 64% nursing Students Confidence
and Close Supervision Creates anxiety due to unfamiliar area.

This study concludes that among PCL nursing students were familiar with anxiety with better
knowledge of prevention and its cause and effects. They practice like take a deep breath, pray a
god, discuss situation with close friends/teachers, face the situation to be familiar. Nursing
students mostly used discuss the situation with friends.

3
 LIST OF ABBREVIATIONS

PCL :- Proficiency in certificate level

BSN :- Bachelor in Science in nursing

SPSS :- Statistical Package for the Social Sciences

4
CONTENTS
APPROVAL SHEET ....................................................................................................................... 1
ACKNOWLEDGEMENT ............................................................................................................... 2
ABSTRACT..................................................................................................................................... 3
LIST OF ABBREVIATIONS .......................................................................................................... 4
CHAPTER-I ...........................................................................Error! Bookmark not defined.
INTRODUCTION...................................................................Error! Bookmark not defined.
1.1 Background of the Study ........................................................ Error! Bookmark not defined.
1.2 Rational of the Study ............................................................................................................. 9
1.3 Significance of the Study ..................................................................................................... 10
1.4 Research Question ............................................................................................................... 10
1.5 Objectives of the Study. ....................................................................................................... 10
1.6 Conceptual Framework ........................................................................................................ 11
1.7 Operational Definition: ........................................................................................................ 12
1.8 Limitations of the Study....................................................................................................... 12
CHAPTER- II.............................................................................Error! Bookmark not defined.
LITERATURE REVIEW ...........................................................Error! Bookmark not defined.
CHAPTER-III ............................................................................Error! Bookmark not defined.
METHODOLOGY .....................................................................Error! Bookmark not defined.
3.1 Design of the Study ................................................................. Error! Bookmark not defined.
3.2 Study Population ..................................................................... Error! Bookmark not defined.
3.3 Study Area .............................................................................. Error! Bookmark not defined.
3.4 Sample Technique ................................................................... Error! Bookmark not defined.
3.5 Sample Size............................................................................. Error! Bookmark not defined.
3.6 Eligibility Criteria ................................................................... Error! Bookmark not defined.
3.7 Research Instrument............................................................................................................. 19
3.7.1 Reliability.......................................................................................................................... 19
3.8 Ethical Considerations ......................................................................................................... 19
3.9 Data Collection Plan ............................................................................................................ 20
3.10 Data Analysis Plan. ............................................................................................................ 20
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CHAPTER IV.............................................................................Error! Bookmark not defined.
RESULT .....................................................................................Error! Bookmark not defined.
Part I: Socio-demographic Information .................................................................................... 22
Part II: Questions related to anxiety. .......................................................................................... 23
Part III: Question related to anxiety ........................................................................................... 24
Part IV: Questions related to anxiety. ........................................................................................ 25
Part V: Questions related to anxiety. ......................................................................................... 26
Part VI: Questions related to anxiety. ........................................................................................ 27
CHAPTER V ..............................................................................Error! Bookmark not defined.
DISCUSSION, CONCLUSION AND RECOMMENDATION ...Error! Bookmark not defined.
5.1 DISCUSSION ......................................................................... Error! Bookmark not defined.
5.2 Conclusions .......................................................................................................................... 29
5.3 Recommendation ................................................................................................................. 30
APPENDICES .............................................................................................................................. 31
Appendix I: Questionnaire ..................................................................................................... 31
Appendix II: Budget Plan ........................................................................................................ 31
Appendix III: Work Plan ........................................................................................................... 32

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7
Clinical experience is a significant learning environment that presents challenges may cause
nursing student experience anxiety. Lack of clinical experience, unfamiliar areas,
default patients, fear of making mistakes and being evaluated by faculty members were
expressed by the students as anxiety-producing situations in their initial clinical experience
(Moscaitolo, 2009).

A multitude of factors has been linked to students experiences of stress and anxiety in a clinical
setting. Themes that emerged from a review of the literature include:

a) Interpersonal relationships with nursing staff and the socialization process;

b) Relationships with medical staff,

c) Relationships with clinical teachers;

d) Feelings of incompetence and inadequacy;

e) A lack of knowledge needed to perform clinical procedures; and

f) The fear of making mistakes and possibly harming patients.

Student nurses express anxiety in different ways. Some students give voice to their anxiety. These
students verbalize to me that they feel anxious and nervous. For some students, anxiety is
expressed in a physical way. For example, their hands shake when doing procedures. Other signs
of anxiety may include lack of eye contact or little verbalization during my interaction with them.

The nursing students experience in their clinical practices provide greater insight to develop an
effective clinical teaching strategy in nursing education and anxiety as a result of felling
incompetent, develops lack of professional nursing skill and knowledge to take care of various
patients in the clinical setting(Dunn, SV; Burnett,P,1995).

8
1.2 Rational of the Study

Anxiety is painful or apprehensive uneasiness of mind usually over an impending or anticipated

ill, fearful concern or interest an abnormal and overwhelming sense of apprehension and fear
often marked be physiological signs (as sweating, tension, and increases pile), by doubt concerning
the reality and nature of the threat, and by self-double about ones capacity to copy with it.

Clinical experience is the most anxiety producing part of student in clinical experience. In this
study fear of making mistakes (fear of failure) and being evaluated by faculty members are
expressed by the students as anxiety - producing situations in their clinical experience. Developing
confidence is an important component of clinical nursing practice. Development of confidence
should be facilitated by the process of nursing education; as a result students become competent
and confident.

Difference between actual and expected behavior in the clinical placement creates conflicts in
nursing students. Nursing students receive instructions which are different to what they have been
taught in the classroom. Students feel anxious and this anxiety has effect on their performance. All
the students in this study clearly demonstrated that there is a gap between theory and practice, lack
of coping skills, lack of orientation, unfamiliar areas, and fear of making mistakes. These variables
influence anxiety level of nursing students in clinical experience.

So, I selected study anxiety factors among nursing students related to clinical exposure.

9
1.3 Significance of the Study

Nursing Research:
This study can be used as a source of reference in future.
This study can be done in large scale method.
The same study can be conducted an experimental setting.
Nursing Education:
To help the teacher to prepare the students prior to clinical setting.
Behavior modification can be done after the orientation to clinical setting.
Nursing Management:
Plan and policy regarding the orientation classes.
To provide counseling training to the teacher.
Prepare the adequate staffs in management to guide the students in clinical setting.

1.4 Research Question

What are the Anxiety Factors Among Nursing Students related to Clinical Exposure?

1.5 Objectives of the Study.

General Objective:
To assess the factors of anxiety among nursing students related to clinical exposure.

Specific Objective:
a. To identify the factors of anxiety among nursing students.
b. To determine the causes of anxiety among nursing students.

10
 1.6 Conceptual Framework

Independent Variables Dependent Variables

Demographic information:

1. Age

2. Religion

3. Ethnic
Anxiety
among
4. Residence
nursing
Other variables: student
1. Lack of theory knowledge.
s
2. Supervision by teacher and
staff.
3. Coping skills.
4. Performing procedure.
5. Orientation
6. Personal traits
7. Unfamiliar areas
8. Fear of making mistakes Presence of anxiety Absence of anxiety

Poor clinical performance Satisfactory clinical performance

11
1.7 Operational Definition:
Anxiety factors:
Those psychological factors that is responsible for creating anxiety.
Nursing Students:
Students from PCL 1st year and B.SC.1st year of B and B nursing college of Lalitpur district,
Gwarko.
Clinical Exposure:
Exposure of nursing students in various clinical setting for practical performance.

1.8 Limitations of the Study

1. Study will be limited to only 50 samples.
2. Data collection time will be of only 1 weeks
3. The study will be limited to nursing students.

12
13
A study was conducted regarding anxiety due to clinical exposure among nursing students. Quasi-
experimental pre-test/ post-test design (N=101) compared intervention (N=55) and control (N=46)
groups. Curriculum development implemented a high-fidelity. Human Patient Simulation (HPS)
program for pre-clinical nursing students. The methodology of State-Trait Anxiety (STAI-A) and
study finding no significant decrease in anxiety (p>0.05) in intervention when compared with
control group (Smith, 2014).

The study conducted regarding anxiety due to clinical exposure among nursing students.
Intervention study was used the sample size was 109 and finding was text anxiety mean scores
were 35.34 9.50 and 35.47 10.66 before the intervention in the control and intervention groups
respectively. The Mean SD of the anxiety scores increased to 36.48 9.34 three months after
the intervention in the control group (P=0.1). However, in the intervention group, the mean SD
test anxiety scores reduced immediately after(16.31 8.61) and three month after (27.72 10.09)
the intervention, compared to before the intervention (35.47 10.66)(P<0.001, paired T-test)
(Farkhondeh, sharif;Sara,Masoumi, 2005).

A study was conducted regarding anxiety due to clinical exposure among nursing students. Explain
that students in Group I (n=51) had their first laboratory one week after orientation. Group II
(n=39) had their first laboratory the day following orientation. There was a significant difference
between the two groups on changes in state anxiety from orientation to the first laboratory. Group
I (laboratory one week after orientation) was more anxious than Group II (Laboratory one day
after orientation) (p=0.024). Both groups were significantly more anxious in the spring than fall
quarter (p=0.034). It was concluded that anxiety related to a new clinical experience might be
lessened if the first clinical day closely followed orientation Lucile lewis (1987).

14
A study was conducted regarding anxiety due to clinical exposure among nursing students. Pilot
study used a single group pre-test/post-test design (N=52).Curriculum development implemented
a new wellness course to decrease stress and improve self-concept. The methodology of the nurse
Self-Concept Questionnaire; Stress Warning Signals(SWS) checklist and study finding paired t
tests showed significant increases in self-concept (p=0.019) but mean SWS did not significantly
change and findings did not support a relationship between self-concept and stress (Hensel and
stoelting-Gettelfinger,2011).

A study was conducted regarding anxiety due to clinical exposure among nursing students. Quasi-
experimental intervention study (N=157) compared intervention (N=78) to control group (N=79).
Curriculum development assigned students to home hospitals as sites for all clinical courses
versus usual assignment to different sites for each clinical course. The methodology of State-Trait
Anxiety (STAI-A); Student Nurse Stress Index (SNSI) and study finding significant (p<0.05)
difference in state anxiety and greater decrease (p<0.001) in perceived academic load in
intervention group compared to control group (Yucha et al.2009).

A study was conducted regarding anxiety due to clinical exposure among nursing students. Mixed
methods pre-test/post-test design (N=61) randomly assigned convenience sample to intervention
(N=30) or control (N=31) groups.Curriculum development using a high-fidelity home healthcare
simulation in senior nursing students. The methodology of State-Trait Anxiety (STAI-A); Two
focus groups with 16 intervention group participants and finding no significant (p=0.05) changes
in anxiety. Qualitative results suggested simulation decreased perceived anxiety and increase
confidence (Crytzer, 2011).

15
An experimental study was done over the 5 week period among the biofeedback and control group
regarding the level of anxiety. A paired sample t-test for the biofeedback group indicated a
significant decrease in the state anxiety scale score: t (29) =2.93, p < 0.0. Cohens d=0.57 (a
medium effects). For the control group, the moderate increase from the mean pre-intervention state
anxiety score (M=16.40, SD=8.34) to the mean post intervention state anxiety score (M=19.00,
SD=8.69) was not statistically significant. When comparing the two groups the biofeedback group
had a significantly lower level of anxiety than the control group after the 5 week intervention, t
(58) =2.65, p<0.01 Cohens d=0.68 (a medium effect) (Duangrat kathal ,2011).

A study was conducted regarding anxiety due to clinical exposure among nursing students. Quasi-
experimental pre-test/ post-test design (N=117) with one intervention group (N=29) and two
control groups (N=44).Curriculum development using Personal Digital Assistants (PDAs) as a
reference tool during clinical rotations at three universities. The methodology of State-Trait
Anxiety (STAI-A) and study finding significant decrease in state anxiety in the intervention group
compared to control group (p=0.003) as well as pre and post intervention (p=0.02) (Davydov,
2010).

A study was conducted regarding anxiety due to clinical exposure among nursing students. Mixed
methods pre-test/post-test design (N=50) with qualitative data from focus groups (n=4, n=6).
Curriculum development using a simulation- based orientation program with standardized patient
actors among first year nursing students. The methodology of State-Trait Anxiety (STAI-A) and
focused group data analyzed using thematic content analysis and finding state anxiety significantly
decreased (p<0.001). Focus group data suggested increased self-confidence and satisfaction
(Dearmon et al. 2013).

16
A study was conducted regarding anxiety due to clinical exposure among nursing students. Mixed
methods pre-test/post-test design (N=206) surveyed participants post-intervention and analyzed
responses to open-ended questions. Curriculum development paired 136 senior nursing students
with 206 sophomore students in fundamental skills clinical learning course. The methodology of
investigator-developed Likert-type scale; Content analysis and finding participants agreed or
strongly agreed on decreased anxiety (79.6%) and increased confidence (78.1%), and learning
(74.2%) (Zentz et al. 2014).

A study was conducted regarding anxiety due to clinical exposure among nursing students.
Randomized controlled pre-test/post-test design compared intervention (n=34 dyads) and control
(N=17) groups. Curriculum development implemented mentoring program using RN graduate
student nurse to mentor first semester nursing students over two academic years. The methodology
of State-Trait Anxiety (STAI-A); Baccalaureate Student Self-efficacy Questionnaire and finding
trait anxiety decreased (p=0.01) but state anxiety did not change significantly. Academic
performance (p=0.04), and career choice satisfaction increased (p=0.002) significantly (Kim et al.
2013).

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18
3.7 Research Instrument
Structured knowledge questionnaire will be used for the study. It consists of 2 components:
PART I: Socio- demographic information.

PART II: Knowledge questionnaires.

3.7.1 Reliability
The reliability of the instrument will be maintained by:

Pre-testing of 10 % of the total sample size, i.e. 5 students of PCL 1st year and B.Sc.1st year of B
and B nursing college of Lalitpur district, Gwarko.

3.7.2 Validity

The validity of instruments will be maintained by:

Consultation with advisor

Teacher expertise
Literature review
Discussion with colleagues

3.8 Ethical Considerations

1. Permission will be taken from research committee of HOPE international college.
2. Approval letter will be taken from B and B nursing campus to conduct study.
3. Informed verbal consent will be taken from the students.
4. The voluntary participation of the students will be highly appreciated.
5. Participants will be assured for their confidentiality
6.

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3.9 Data Collection Plan
1. Permission will be taken from each participant.
2. Informed verbal consent will be taken from the students.
3. Structured knowledge questionnaire will be provided to every participant.
4. Within the time limit of 30 minutes the questionnaire will be collected and coded for
further analysis.

3.10 Data Analysis Plan.

1. SPSS version 21.0 (Statistical Package for Social Science) software will be used for data
entry and analysis.
2. Descriptive statistics such as mean, median, mode, frequency table, averages and standard
deviation will be used.

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21
Part I: Socio-demographic Information
The table below shows that among 50 respondents, 54% were of age 16-18 years, whereas 72%
of them live in Kathmandu valley. 92% were Unmarried and 8% were married. Hindu Religion
were highest i.e 78%, Chhetri Ethnic Group were highest i.e 36%. Total of 82% were living in
Nuclear Family and 18% were living Joint Family.

n = 50

Variable Frequency Percentage (%)

1. Age in years
a. 16-18 27 54
b. 18-20 17 34
c. 20-22 2 4
d. 22 and above 4 8
2. Address
a. Kathmandu 9 18
b. Lalitpur 36 72
c. Bhaktapur 3 6
d. Out of valley 2 4
3. Marital Status
a. Unmarried 46 92
b. Married 4 8
4. Religion
a. Hindu 39 78
b. Buddhist 6 12
c. Christian 6 12
d. Muslim 0 0
5. Ethnic group
a. Brahmin 7 14
b. Chhetri 18 36
c. Newar 8 16
d. Others 17 34
6. Family type
a. Nuclear 41 82
b. Joint 9 18

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Part II: Questions related to anxiety.

The above table below shows that among 50 respondents, 100% knew about the anxiety.
68% feel the anxiety during clinical exposure whereas 32% didnt feel anxiety during
clinical exposure. 52% felt most anxious during first clinical exposure in Surgical Ward.
76% feel anxiety when They have to perform procedure and 80% feel anxiety because of
lack of confidence.

n = 50

Variable Frequency Percentage (%)

1. Knowledge of anxiety
a. Yes 50 100
b. No 0 0

2. Anxiety During Clinical Exposure

a. Yes 34 68
b. No 16 32

3. Most anxious Ward in first clinical exposure

a. Medical Ward 15 30
b. Surgical Ward 26 52
c. Maternity Ward 2 4
d. ICU and OT 7 14

4. Anxiety during procedure.

a. Yes 38 76
b. No 12 24
5. Reasons for anxiety during procedure
a. Lack of Theoretical knowledge 8 16
b. Absent during demonstration 3 6
c. Lack of confidence 40 80
d. Others 0 0

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 Part III: Question related to anxiety

The above table below shows that among 50 respondents, 78% dont feel anxiety when
they have to approach with medical staff in duty whereas 22% feel anxiety. 92% feel
anxiety when they talk to the patients and Visitors whereas 52% feel anxiety with critical
patients. 92% respondents share anxiety with family/peer and 8% dont share anxiety
with family/peer 64% find worrying about anxiety and 48% Discuss Situations with
Close Friends / teacher when they feel anxiety but minority of 6% pray God when They
feel anxiety.

n = 50

Variable Frequency Percentage (%)

6. Anxiety with medical staff in Duty
a. Yes 11 22
b. No 39 78
7. Anxiety when talking with patients and visitors
a. Yes 4 8
b. No 46 92
8. Anxiety with critical patients
a. Yes 24 48
b. No 26 52
9. Share anxiety with your family/peer
a. Yes 46 92
b. No 4 8
10. Worries about Anxiety
a. Yes 32 64
b. No 18 36
11. Activities you perform during Anxiety
a. Take a deep breath 12 24
b. Pray god 3 6
c. Discuss situations with close friends/ teacher 24 48
d. Face the situation to be familiar 13 26

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Part IV: Questions related to anxiety.

The table below shows that among 50 respondents, 86% know the anxiety as A state of
uneasiness marked by impaired physical and physiological function and Worried about
a event or situation. 62% of Total Respondents responded Hand shake is the physical
Sign of anxiety. Majority of 92% respondents believe Recent and prolonged exposure to
stressful situation are the risk factors of anxiety among nursing Students whereas 58%
feel anxiety when they are in a constant supervision by a Teacher.

n = 50

Variable Frequency Percentage (%)

12. Information of Anxiety
a. A state of uneasiness marked by impaired physical 3 6
and physiological function.
b. Worried about an event or situation. 4 8
c. A state of happiness. 0 0
d. Both a and b 43 86
13. Physical sign of anxiety
a. Hand sake 31 62
b. Fatigue 4 8
c. Feeling Guilt 6 12
d. Headache 13 26
14. Risk factors of anxiety in nursing students
a. Genetic 1 2
b. Recent and prolonged exposure to stressful 46 92
situation.
c. Excessive use of caffeine or tobacco 0 0
d. Childhood abuse 4 8
15. Anxiety under constant supervision by a teacher
a. Yes 29 58
b. No 21 42

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Part V: Questions related to anxiety.

The table below shows that among 50 respondents, 76% responded Fear of making mistakes is
the factors of anxiety related to clinical exposure and 96% feel fear while making mistakes. 66%
of Majority of respondents feel fear of making mistakes during clinical exposure due to Lack of
theoretical Knowledge and Lack of Confidence. Unfamiliar area in the clinical setting create
anxiety to the student nurses in 94% nursing Students.

n = 50

Variable Frequency Percentage (%)

16. Factors of anxiety related to clinical exposure
a. Poor attitude towards profession. 2 4
b. Fear of making mistakes. 38 76
c. Lack of theoretical knowledge. 5 10
d. Close supervision. 7 14
17. Fear of making mistakes
a. Yes 48 96
b. No 2 4
18. Reasons of fear of mistakes during clinical exposure
a. Lack of theoretical knowledge 3 6
b. Lack of confidence 15 30
c. Competent skill 0 0
d. Both a and b 33 66
19. Anxiety due to Unfamiliar area
a. Yes 47 94
b. No 3 6

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Part VI: Questions related to anxiety.

The table below shows that among 50 respondents, among 64% nursing Students Confidence and
Close Supervision Creates anxiety due to unfamiliar area. 82% responded that Guidance and
Counseling can prevent anxiety among nursing students whereas 86% responded anxiety can be
managed by both Orientation and Psychotherapy among nursing students.

n = 50

20. Reason of anxiety due to unfamiliar area

a. Confidence 6 12
b. Close Supervision 0 0
c. Change environment 32 64
d. Both a and b 13 26
21. Programs to prevent Anxiety
a. Guidance and Counseling 41 82
b. Demonstration 1 2
c. Support therapy 7 14
d. Field visit 4 8
22. Methods to prevent anxiety
a. Orientation 1 2
b. Counseling 5 10
c. Psycho therapy 1 2
d. Both a and b 43 86

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28
The main objective of this study was to assess the anxiety and Preventive measures by students
during their initial clinical exposure There have been hardly any researches done regarding
anxiety faced by nursing students during initial clinical exposure.

According to farkhondes sharif, Clinical experience has been always an integral part of nursing
education. It prepares student nurses to be able of "doing" as well as "knowing" the clinical
principles in practice. the clinical practice stimulates students to use their critical thinking skills
for problem solving.

A descriptive correlation design was used and finding was 36% of the students experienced a
moderate level of anxiety. Clinical experiences related to arriving late, being observed by
instructors, responding to initial experiences, having a fear of making mistakes, and talking to
physicians were the most anxiety producing for these students. (Kim 2003)

In this study, majority of respondents belong to the age of 18-20 (34%). Majority of respondents
(60%) were studying PCL and remaining (40%) were studying BSC Nursing. (92%) of the
respondents were unmarried and (8%) of the respondents were married. Majority of respondents
(82%) were nuclear Family. Regarding the location of respondents whereas 72% of them live in
Kathmandu valley. Likewise in regard to Ethnic Group 78%, Chhetri Ethnic Group were highest.

In this study the null hypothesis couldnt be rejected we can conclude that there is no significant
relationship between educational level and anxiety.

The nursing Students clearly identified that the initial clinical experience is a cause of anxiety for
them.

5.2 Conclusions

This study was aimed at examining the level of stress in terms of its severity among the students
and examining which type (category) of stress student report more. It also examined the
differences in the levels of stress with regards to academic discipline and assessed the differences
in level of stress with regards to the biographical variables of Gender and Marital status. The
results indicate that there was generally severe stress among the students. Regarding which type
(category) of stress students reported more, it was seen that personal stressors were reported
more followed by academic and finally social ones. With regards to differences in stress based
on Ethnic Group , Religion or family Type, there were no significant differences. Males and
females also reported similar levels of stress. Finally, married respondents reported significantly

29
higher academic stress than their single counterparts although there was no significant difference
in overall stress with regard to marital status.

Based on the above findings, recommendations were made for stakeholders and future
researchers. Recommendations included educating newly admitted students as part of their
orientation on the stresses of college life to be expected and instituting counseling services in the
nursing training colleges as is the case in the universities in Ghana. Other recommendations
include focusing counselling on students personal concerns or worries as much as on academic
ones.

Furthermore, experiencing elevated levels of stress had a negative impact on the students
physical and psychological well-being. Increased levels of stress negatively impacted academic
performance, personal well-being, and led to burn-out among nursing students. Research to
identify stressors and evaluate means to reduce and mitigate stress levels in nursing students
would promote the general welfare of the students.

5.3 Recommendation

Preclinical demonstration/orientation class should be provided during initial clinical

exposure
Supervisor i.e. teacher and staff should be supportive during initial clinical exposure.
As this study was carried out within limited boundary with stated objectives, it is
recommended that further study in all nursing collages.
Individual Collages should be counseling department.

30
 APPENDICES
Appendix I: Questionnaire

Appendix II: Budget Plan

31
 Appendix III: Work Plan

Work Plan

S.N Activities Chaitra Baisakh Jestha Jestha Jestha Jestha Jestha Remark

Week 3rd 4th 1st 2nd 3rd 4th 5th

1 Research
Topic
Selection
2 Literature
Review

3 Proposal
Development
and
presentation
4 Instrument
development

5 Data
Collection

6 Data Analysis

7 Report
Writing
8 Report
Presentation
9 Report
Submission

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33