The University provides countless new experiences, and many of which are stressful. At the same time, students face educational challenges, family or social crises (1, 2). Time pressure, workload, decision-making, continuous change (3), being away from parents for the first time, housing, achieving personal goals and being pressured by problems are some of the most common stressful factors for students (4, 5).The Association of National College Health Assessment) ACHA (showed that more than one third of all students ranked stress as the highest obstacle to their health, followed by sleep problems, depression and anxiety (6). Encountering stressful situations in nursing education also exists, and students cannot avoid it (7, 8). In addition to the stress factors that other students face, nursing students have stresses that are unique to their circumstances (9), and in addition to academic stress, they also worry about the possibility of harming the patients as a result of clinical procedures during the clinical internship (10). They believe that they are responsible for the life and health of other people. Therefore, they have the fear of making a mistake, harming the patient and facing negative reactions at the beginning of the bedside work (11); and studies conducted on first-year nursing students show that they often experience a high level of stress, which leads to low self-confidence, low self-esteem, inadequacy, irritability, and depression (15-12). High volume of tasks and workload, factors related to patient care and factors related to trainers, clinical environment (16), patient companions, health professionals and clinical actions are known sources of stress for nursing students (17). Moreover, Deary et al. reported that nursing students become stressed in four fields: academic, clinical, personal, and financial (18). Stress is a result of the nature of nursing education and a psychological factor affecting the academic performance and well-being of students (19). Among the negative effects of stress on a person are physical, mental and behavioral disorders (3).
Some of the physical symptoms related to stress include: shivering, sweating, physical weakness, back pain, changes in immunoglobulin levels, increased secretion of cortisol, decreased immunity against diseases, and psychological symptoms including: panic, anxiety, loneliness, sadness, exhaustion, and helplessness. Of course, anxiety is the most important symptom reported by students among all manifestations of stress (20).
Coping behavior is a continuous effort that is necessary to maintain a state of equilibrium, and a high level of stress reduces effective coping mechanisms. (21). When students enter new learning situations, they face several stress factors and their stress level increases (21). An inverse relationship between stress and learning has been reported. A number of studies suggested a moderate amount of stress or psychological pressure for healthy conditions and a positive learning environment. However, excessive stress or distress negatively affects students' physical and mental health, self-efficacy and academic success, and feelings of hopelessness, possibility of failure, and lack of self-confidence weaken the academic performance of nursing students (7, 13). In addition, research in this field showed that stress affects memory, concentration, and problem-solving ability and causes a decrease in learning, coping, academic performance, and skill retention (22).
Since clinical training is a necessary part of nursing students' education and its purpose is to create integration between theory and practice and to increase critical thinking and decision-making abilities, nursing students' awareness of the level of stress, its sources and how to react to it is an important factor in determining and planning effective interventions and strategies to reduce or prevent stress in nursing education. Furthermore, it is convenient for learning both in the university and in the hospital (23, 24). Since clinical training is a necessary part of nursing students' education and its purpose is to create integration between theory and practice and to increase critical thinking and decision-making abilities, nursing students' awareness of the level of stress, its sources and how to react to it is an important factor in determining and planning effective interventions and strategies to reduce or prevent stress in nursing education and learning facilitation both in the university and in the bedside (23, 24). It is very important to discover the stressful conditions of students and the factors that cause them, and it helps them develop stress management skills to improve their quality of life and prevent burnout (24).
Scientific and technological advances increase the expectations of nursing students regarding the adaptation and provision of qualified care for a large number of patients in a short period of time.
This affects how nursing students deal with the academic, personal, clinical and environmental pressures they experience during their studies, so it is necessary to measure them first to manage these stresses.
The review of the literature showed that there is no specific instrument in this field in Iran, so according to cultural differences of Iran as a Muslim majority country, localization of existing instruments is necessary. The Nursing Students' Stress Index (SNSI), which consists of 22 items (25), was developed by Jones and Johnston in 1999. This study was conducted with the aim of cultural compatibility and validity and reliability of the Persian version of the SNSI for Iranian nursing students.