**2. Stress and health in nursing students**

Exploring the effects of stress in students is important in many aspects, but two are outstanding. First, most of the students are young, and the effects of stressful events in young can last until adulthood, increasing the risk of suffering mental health disorders [13, 14] among other risks on health [15]. Mental health in nursing students will be reviewed in Section 5. Second, stress can reduce learning skills [16] indispensable in academic environments; the reduction of learning skills is a factor of great importance since it reduces the resources of students to achieve academic success. It is known that stress is triggered by stimulus according to the age of the person [17]. In this sense, school environments can expose individuals to stressors as harassment by peers, schoolwork pressure, and being treated careless by teachers; all these stressors can be severe enough to produce psychosomatic pain, psychological complaints such as feeling unsafe and nervous, irritability, sadness, and depression [18, 19]. The effects of stress in school can negatively impact social dynamics between peers and teachers, and these in turn can produce more stress that in consequence triggers mental health problems such as anxiety and depression [20, 21].

Finally, the authors demonstrated that nursing students experienced an adaptation to the stressful events during academic life when comparing last year students with the first year nursing students [26]. Similarly, stress and resilience scores in a cohort study of 1538 undergraduate nursing students in China showed an influence of academic progress (years) on the stress scores; senior students reported lower stress scores compared to less advanced students [30]. Also, a cross-sectional study of 474 nursing students from three different universities in China found high scores on two subdimensions of the stress role scale: role of conflict and role of ambiguity. This means that the main cause of stress is because most students have no idea what activities they are going to do during their stay in the hospital. Additionally, the authors demonstrate that when the student has a very well-defined identity as a nurse he or she tends

Stress in Nursing University Students and Mental Health http://dx.doi.org/10.5772/intechopen.72993 35

When students experience applied knowledge, stressful situations are mainly related to the nurse–patient interaction, which implies specific care according to the illness and needs of the patient, in addition to the application of knowledge and skills during nursing practices (see Section 4.1). For example, a qualitative study analyzed seven Iranian nursing students and found that the social environment of hospitals is stressful enough during their first practices, where students experience feelings of being inefficient, followed by being ignored, and also experience ineffective communication, sadness, and ambiguity of the activities they are assigned to do [24]. Additionally, experiencing the death of a patient is considered an extremely stressful situation for nursing students [32]. In another example, using an adaptation of the Student Nurse Stress Index (SNSI) to Turkish nursing students, it has been found that there are four stressors in students: academic load, clinical concerns, personal problems, and interface worries. The factor with greater influence was the personal problems of the patients, while the factor with the lower influence was the academic load. This means that the problems related to the patient tend to be more stressful than some other stressors [33].

Besides, it has been shown that the sense of self-efficacy is positively correlated to active coping styles as planning, positive reinterpretation of the context, acceptance of the event, and emotional support during the first clinical practice; all these are observed in 394 polish students during the first year of the career. This means that the student tends to experience less stress when they feel ready to successfully perform a procedure to the patient. In the same

In all previous studies, the stress levels were increased when the student started clinical practicing, i.e., the application of knowledge and ethical and legal responsibility about the care of the patient; this stress response can differ according to individual differences. One of those differences seems to be gender, as shown in a research in which 215 nursing students from Murcia showed that women had higher stress scores than men during clinical practice, in subjects related to emotional items (contact with the suffering of others, emotional implications with the patient); these findings do not mean in any sense that women are less prepare to cope with stress, but women are probably more empathic with the patient. Likewise, there is a statistically significant relationship between age and subjects experiencing impotence or uncertainty in a given situation, excessive overload of work, and lack of knowledge of a clinical situation, especially in students under 21 years of age [35]. In contrast, in a study that included

way, people with low perceived stress tend to have a high sense of self-efficacy [34].

to have low scores of stress [31].

Prevalence of academic stress is very high in health students, especially in nursing and medicine students according to several reports [22–26]. Thus, the importance of studying the stressors in nursing students lies in the deleterious effects on cognitive performance and health, i.e., the development of mental disorders such as depression, anxiety, eating disorders, sleep, and substance use [27], but also experience of stress can result in students experiencing ineffective communication and inefficient at work, decreasing the quality of health-care services [24].
