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Nurse Educ Today. 2008 Feb;28(2):134-45. Epub 2007 Jun 7.

A comparative, longitudinal study of stress in student nurses in five countries: Albania, Brunei, the Czech Republic, Malta and Wales.

Author information

  • 1Cardiff University, Cardiff School of Nursing and Midwifery Studies, Wales, United Kingdom. burnard@cardiff.ac.uk



Stress amongst nursing students is a global issue. There is an absence of published international comparative studies which investigate this and so this paper sets out to explore the sources of stress among nursing students throughout their course of study and to determine whether they were more stressed by academic or clinical factors across five different countries (Albania, Brunei, the Czech Republic, Malta and Wales). Although each country, within this study, has a unique culture, a cross-cultural comparison can be made in an attempt to better understand stress in the student nursing population.


The study was undertaking using a descriptive quantitative design using the Stress in Nurse Education Questionnaire with 1707 nursing students across the five countries.


The mean score for the total sample for all the items on the stress scale was 52.3 (SD 17.1). The sample from Wales had the lowest mean score and those in Brunei had the highest. Students in Brunei and Malta were more stressed by the academic elements of the course than by the clinical elements. Whereas for those students in the Czech Republic For students in Wales and in Albania - Korçe there were no differences in stress experienced between the academic and clinical elements of the course. The results indicated that there were no significant differences in total stress scores by year of study for students in Albania - Tirana, Albania-Korçe, Malta and Wales. In Brunei however, ANOVA revealed that there were significant differences in total stress scores by year of study. Further analysis revealed that students in year 3 scored higher on the overall scale than students in year 1. The individual item on the stress scale with highest mean in the Albania - Korçe and the Albania-Tirana sample was "The death of a patient" whilst the Bruneian sample, Maltese sample and Welsh sample opted for "Revising for and sitting examinations" and the Czech sample chose: "Continuous pressure to meet deadlines for assessments".


This study has succeeded as the first of its kind to compare and contrast levels and sources of stress amongst an international sample. The findings indicate that student nurses worldwide do share much in common while still retaining individual cultural features relating to stress throughout their course of study.

[PubMed - indexed for MEDLINE]
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