Stress is a natural physical, emotional, and mental reaction to a stimulus that disturbs the normal functioning of the body [1]. It is experienced when people recognize that the demands are greater than their individual and social resources [2]. Human beings respond to stress differently depending on their social, economic, environmental, and genetic backgrounds [3].
Nursing education-related stress levels range from medium to high [4, 5, 6, 7]. While some stressors are considered motivational and may encourage achievement [8], experiencing prolonged stress threatens the physical, mental, and psychological health of students [9]. Furthermore, experiencing unresolved chronic stress may have adverse effects on students’ academic performance [5, 10, 11]. Eventually, high levels of unresolved stress may discourage students from pursuing nursing education, therefore impacting the nursing workforce [5].
Studies in the literature have highlighted several education-related stressors among nursing students, including academic, clinical, and personal/social stressors [4, 11, 12]. Examples of academic stressors include heavy workloads, exams and assignments, the fear of failing and achieving low grades, and the lack of sufficient guidance from tutors [6, 13, 14, 15]. Clinical stressors include students’ heavy responsibilities in clinical settings, students’ uncertainty regarding what is expected from them, the pressure of meeting the expectations of staff, the fear of making mistakes and harming patients, and criticism from peers, senior staff, and physicians [6, 13, 15]. Personal and/or social stressors entail students’ health issues, family events, lack of recreation time, high parental expectations, and financial issues [6, 13, 14, 15].
Previous studies have indicated a link between certain sociodemographic characteristics and increased stress levels among nursing students. For example, students from low-income families have been found to experience higher levels of stress in comparison to other students, as they may worry about not being able to meet their scholastic requirements, tuition fees, basic needs (food, accommodation, and transportation), or personal needs [7, 14, 16]. Further, with many universities now using blended learning and/or e-learning, students from low-income families may worry about the costs of purchasing appropriate electronic devices, good internet services, and information applications [17]. Gender has also been found to impact students’ stress levels, with female nursing students frequently reporting higher levels of stress compared to males [7, 11, 16, 18]. Previous studies have attributed this to the hormonal disturbances generally experienced by females and the fact that females are more prone than males to psychological disorders [11]. As for the impact of academic year on students’ stress levels, studies in the literature have reported conflicting findings. For example, Aslan and Akturk [18] and Ribeiro et al. [7] found stress levels to be higher among senior students than students in other years, mainly due to the nature of the advanced theoretical and clinical courses that senior students must take. Meanwhile, Admi and colleagues [10] found that junior nursing students experience the highest levels of stress, attributing this to their lack of knowledge and training experience required for future courses.
Identifying stress levels, sources of stress, and the impacting factors is crucial for creating effective measures that help nursing students adapt and improve their educational performance. Moreover, identifying the stress levels and stressors experienced by students enables nursing faculties and administrators to resolve the causes of stress, support students, and gain the trust of students [15, 18]. Studies which have aimed to measure stress levels and sources among nursing students in Arab countries, including Jordan, are numerous [19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29]. However, all of these studies have used a single instrument which assesses clinical-related stress only and which was only recently psychometrically validated in the Arabic language [30]. Therefore, there is a need for a wider range of validated tools in order to ensure that various aspects of academic and clinical stress and stressors among nursing students are considered.
The Higher Education Stress Inventory (HESI) is a tool characterized by its ability to capture various aspects of higher education related stressors regardless of the setting or the student population. The instrument was developed by a group of psychiatry professors in Sweden to measure stress among medical students [31]. It has previously been used to assess stress levels among medical students [31, 32] and distance learning students [33]. Although the language of education in all nursing schools in Jordan is English, the presence of a translated and validated instrument in Arabic (the official language of Jordan) would yield more accurate results and a better understanding of the context [30]. Considering the fact that stress levels and stressors vary depending on various sociocultural aspects [34, 35], the psychometric properties of the Arabic-HESI needs to be evaluated using robust analyses like EFA and CFA. Therefore, the current study aimed to 1) translate the HESI from English into Arabic, and 2) examine the psychometric properties of the Arabic-HESI, which is to be used to measure education-related stress among nursing students in Jordan, by applying EFA and CFA.