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Nursing Students’ Stress in Clinical Practice: A Grounded Theory Study.

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Title: Nursing Students’ Stress in Clinical Practice: A Grounded Theory Study.
Alternate Title: Estrés de estudiantes de enfermería en la práctica clínica: un estudio de teoría fundamentada.
Estresse de estudantes de enfermagem na prática clínica: um estudo de teoria fundamentada.
Authors: dos Santos, Sara Soares1 sara.soares.sol@gmail.com, Silva, Ítalo Rodolfo2 italoufrj@gmail.com, Araújo, Agostinho Antônio Cruz1 agostinhocruz@usp.br, de Godoy, Simone1 sig@eerp.usp.br, Gardim, Lucas1 lucasgardim@usp.br, de Almeida, Emerson Willian Santos1 emersonwillian@usp.br, Gastmans, Chris3 chris.gastmans@kuleuven.be, Mendes, Isabel Amélia Costa1 iamendes@usp.br
Source: Investigación & Educación en Enfermería. May-Jul2026, Vol. 44 Issue 2, p44-56. 13p.
Subjects: Psychology of college students, School environment, Emotion regulation, Qualitative research, Patient safety, Research funding, Universities & colleges, Interviewing, Statistical sampling, Psychological adaptation, Confidence, Descriptive statistics, Thematic analysis, Psychological stress, Nursing practice, Research methodology, Academic achievement, Cognition disorders, Baccalaureate nursing education, Student attitudes, Grounded theory, Interpersonal relations, Teacher-student relationships, Nursing students, Nursing ethics
Geographic Terms: Brazil
Abstract (English): Objective. To explore nursing students’ perspectives on stress in clinical practice, focusing on causal conditions, intervening factors, and related consequences. Methods. This is a qualitative study conducted using grounded theory, following the Straussian perspective. Fifteen undergraduate nursing students enrolled in clinical training in two programs at a public university in southeastern Brazil. Semi-structured individual interviews were analyzed through open, axial, and selective coding. Informed consent forms were obtained from all participants. Results. Stress in clinical practice was perceived as a multifactorial and dynamic phenomenon, triggered by difficulties in adapting to the clinical environment, academic overload, interpersonal conflicts, and strained relationships with educators and preceptors. These causal and intervening factors produced persistent biopsychosocial consequences, including physical symptoms, emotional instability, cognitive impairments, diminished selfconfidence, and concerns about patient safety. Students emphasized that inadequate support, disrespectful interactions, and humiliating behaviors contradicted ethical expectations for safe, respectful, and inclusive learning environments, thereby intensifying moral distress and compromising learning. Conclusion. Stress arising from clinical practice is influenced by pedagogical, relational, and ethical dimensions. Creating ethically grounded clinical learning environments requires recognizing that student well-being is inseparable from the moral climate of teaching and supervision. Institutions and educators hold pedagogical, political, and ethical responsibilities to implement strategies that support student adaptation, safeguard well-being, and strengthen the quality of clinical education. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Objetivo. Explorar las perspectivas de estudiantes de enfermería sobre el estrés en la práctica clínica, centrándose en las condiciones causales, factores intervinientes y consecuencias relacionadas. Métodos. Se trata de un estudio cualitativo desarrollado con base en la teoría fundamentada, siguiendo la perspectiva straussiana. Participaron quince estudiantes de pregrado en enfermería, vinculados a actividades de formación clínica en dos programas de una universidad pública del sureste de Brasil. Las entrevistas individuales semiestructuradas fueron analizadas mediante codificación abierta, axial y selectiva. Todos los participantes firmaron el consentimiento informado. Resultados. El estrés en la práctica clínica fue percibido como un fenómeno multifactorial y dinámico, desencadenado por dificultades de adaptación al entorno clínico, sobrecarga académica, conflictos interpersonales y relaciones tensionadas con docentes y preceptores. Estos factores causales e intervinientes generaron consecuencias biopsicosociales persistentes, incluyendo síntomas físicos, inestabilidad emocional, deterioro cognitivo, disminución de la autoconfianza y preocupaciones sobre la seguridad del paciente. Los estudiantes enfatizaron que el apoyo inadecuado, las interacciones irrespetuosas y los comportamientos humillantes contradicen las expectativas éticas de entornos de aprendizaje seguros, respetuosos e inclusivos, intensificando el sufrimiento moral y comprometiendo el aprendizaje. Conclusión. El estrés derivado de la práctica clínica está influido por dimensiones pedagógicas, relacionales y éticas. La creación de entornos de aprendizaje clínico éticamente fundamentados requiere reconocer que el bienestar del estudiante es inseparable del clima moral de la enseñanza y la supervisión. Las instituciones y los educadores tienen responsabilidades pedagógicas, políticas y éticas en la implementación de estrategias que favorezcan la adaptación de los estudiantes, protejan su bienestar y fortalezcan la calidad de la formación clínica. [ABSTRACT FROM AUTHOR]
Abstract (Portuguese): Objetivo. Explorar as perspectivas de estudantes de enfermagem sobre o estresse na prática clínica, com foco nas condições causais, fatores intervenientes e consequências relacionadas. Métodos. Trata-se de um estudo qualitativo conduzido com base na teoria fundamentada, seguindo a perspectiva straussiana. Participaram quinze estudantes de graduação em enfermagem, inseridos em atividades de formação clínica em dois cursos de uma universidade pública do sudeste do Brasil. Entrevistas individuais semiestruturadas foram analisadas por meio de codificação aberta, axial e seletiva. Todos os participantes assinaram o termo de consentimento livre e esclarecido. Resultados. O estresse na prática clínica foi percebido como um fenômeno multifatorial e dinâmico, desencadeado por dificuldades de adaptação ao ambiente clínico, sobrecarga acadêmica, conflitos interpessoais e relações tensionadas com docentes e preceptores. Esses fatores causais e intervenientes produziram consequências biopsicossociais persistentes, incluindo sintomas físicos, instabilidade emocional, prejuízos cognitivos, redução da autoconfiança e preocupações com a segurança do paciente. Os estudantes enfatizaram que suporte inadequado, interações desrespeitosas e comportamentos humilhantes contradizem as expectativas éticas de ambientes de aprendizagem seguros, respeitosos e inclusivos, intensificando o sofrimento moral e comprometendo o processo de aprendizagem. Conclusão. O estresse decorrente da prática clínica é influenciado por dimensões pedagógicas, relacionais e éticas. A construção de ambientes de aprendizagem clínica eticamente fundamentados requer reconhecer que o bem-estar do estudante é inseparável do clima moral do ensino e da supervisão. Instituições e educadores possuem responsabilidades pedagógicas, políticas e éticas na implementação de estratégias que favoreçam a adaptação dos estudantes, protejam seu bem-estar e fortaleçam a qualidade da formação clínica. [ABSTRACT FROM AUTHOR]
Copyright of Investigación & Educación en Enfermería is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: MedicLatina
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  Data: Nursing Students’ Stress in Clinical Practice: A Grounded Theory Study.
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  Data: Estrés de estudiantes de enfermería en la práctica clínica: un estudio de teoría fundamentada.<br />Estresse de estudantes de enfermagem na prática clínica: um estudo de teoria fundamentada.
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  Data: <searchLink fieldCode="AR" term="%22dos+Santos%2C+Sara+Soares%22">dos Santos, Sara Soares</searchLink><relatesTo>1</relatesTo><i> sara.soares.sol@gmail.com</i><br /><searchLink fieldCode="AR" term="%22Silva%2C+Ítalo+Rodolfo%22">Silva, Ítalo Rodolfo</searchLink><relatesTo>2</relatesTo><i> italoufrj@gmail.com</i><br /><searchLink fieldCode="AR" term="%22Araújo%2C+Agostinho+Antônio+Cruz%22">Araújo, Agostinho Antônio Cruz</searchLink><relatesTo>1</relatesTo><i> agostinhocruz@usp.br</i><br /><searchLink fieldCode="AR" term="%22de+Godoy%2C+Simone%22">de Godoy, Simone</searchLink><relatesTo>1</relatesTo><i> sig@eerp.usp.br</i><br /><searchLink fieldCode="AR" term="%22Gardim%2C+Lucas%22">Gardim, Lucas</searchLink><relatesTo>1</relatesTo><i> lucasgardim@usp.br</i><br /><searchLink fieldCode="AR" term="%22de+Almeida%2C+Emerson+Willian+Santos%22">de Almeida, Emerson Willian Santos</searchLink><relatesTo>1</relatesTo><i> emersonwillian@usp.br</i><br /><searchLink fieldCode="AR" term="%22Gastmans%2C+Chris%22">Gastmans, Chris</searchLink><relatesTo>3</relatesTo><i> chris.gastmans@kuleuven.be</i><br /><searchLink fieldCode="AR" term="%22Mendes%2C+Isabel+Amélia+Costa%22">Mendes, Isabel Amélia Costa</searchLink><relatesTo>1</relatesTo><i> iamendes@usp.br</i>
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  Data: <searchLink fieldCode="JN" term="%22Investigación+%26+Educación+en+Enfermería%22">Investigación & Educación en Enfermería</searchLink>. May-Jul2026, Vol. 44 Issue 2, p44-56. 13p.
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  Data: <searchLink fieldCode="DE" term="%22Psychology+of+college+students%22">Psychology of college students</searchLink><br /><searchLink fieldCode="DE" term="%22School+environment%22">School environment</searchLink><br /><searchLink fieldCode="DE" term="%22Emotion+regulation%22">Emotion regulation</searchLink><br /><searchLink fieldCode="DE" term="%22Qualitative+research%22">Qualitative research</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+safety%22">Patient safety</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Universities+%26+colleges%22">Universities & colleges</searchLink><br /><searchLink fieldCode="DE" term="%22Interviewing%22">Interviewing</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+sampling%22">Statistical sampling</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+adaptation%22">Psychological adaptation</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence%22">Confidence</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Thematic+analysis%22">Thematic analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+stress%22">Psychological stress</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+practice%22">Nursing practice</searchLink><br /><searchLink fieldCode="DE" term="%22Research+methodology%22">Research methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Academic+achievement%22">Academic achievement</searchLink><br /><searchLink fieldCode="DE" term="%22Cognition+disorders%22">Cognition disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Baccalaureate+nursing+education%22">Baccalaureate nursing education</searchLink><br /><searchLink fieldCode="DE" term="%22Student+attitudes%22">Student attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Grounded+theory%22">Grounded theory</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+relations%22">Interpersonal relations</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher-student+relationships%22">Teacher-student relationships</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+students%22">Nursing students</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+ethics%22">Nursing ethics</searchLink>
– Name: SubjectGeographic
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Brazil%22">Brazil</searchLink>
– Name: Abstract
  Label: Abstract (English)
  Group: Ab
  Data: Objective. To explore nursing students’ perspectives on stress in clinical practice, focusing on causal conditions, intervening factors, and related consequences. Methods. This is a qualitative study conducted using grounded theory, following the Straussian perspective. Fifteen undergraduate nursing students enrolled in clinical training in two programs at a public university in southeastern Brazil. Semi-structured individual interviews were analyzed through open, axial, and selective coding. Informed consent forms were obtained from all participants. Results. Stress in clinical practice was perceived as a multifactorial and dynamic phenomenon, triggered by difficulties in adapting to the clinical environment, academic overload, interpersonal conflicts, and strained relationships with educators and preceptors. These causal and intervening factors produced persistent biopsychosocial consequences, including physical symptoms, emotional instability, cognitive impairments, diminished selfconfidence, and concerns about patient safety. Students emphasized that inadequate support, disrespectful interactions, and humiliating behaviors contradicted ethical expectations for safe, respectful, and inclusive learning environments, thereby intensifying moral distress and compromising learning. Conclusion. Stress arising from clinical practice is influenced by pedagogical, relational, and ethical dimensions. Creating ethically grounded clinical learning environments requires recognizing that student well-being is inseparable from the moral climate of teaching and supervision. Institutions and educators hold pedagogical, political, and ethical responsibilities to implement strategies that support student adaptation, safeguard well-being, and strengthen the quality of clinical education. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label: Abstract (Spanish)
  Group: Ab
  Data: Objetivo. Explorar las perspectivas de estudiantes de enfermería sobre el estrés en la práctica clínica, centrándose en las condiciones causales, factores intervinientes y consecuencias relacionadas. Métodos. Se trata de un estudio cualitativo desarrollado con base en la teoría fundamentada, siguiendo la perspectiva straussiana. Participaron quince estudiantes de pregrado en enfermería, vinculados a actividades de formación clínica en dos programas de una universidad pública del sureste de Brasil. Las entrevistas individuales semiestructuradas fueron analizadas mediante codificación abierta, axial y selectiva. Todos los participantes firmaron el consentimiento informado. Resultados. El estrés en la práctica clínica fue percibido como un fenómeno multifactorial y dinámico, desencadenado por dificultades de adaptación al entorno clínico, sobrecarga académica, conflictos interpersonales y relaciones tensionadas con docentes y preceptores. Estos factores causales e intervinientes generaron consecuencias biopsicosociales persistentes, incluyendo síntomas físicos, inestabilidad emocional, deterioro cognitivo, disminución de la autoconfianza y preocupaciones sobre la seguridad del paciente. Los estudiantes enfatizaron que el apoyo inadecuado, las interacciones irrespetuosas y los comportamientos humillantes contradicen las expectativas éticas de entornos de aprendizaje seguros, respetuosos e inclusivos, intensificando el sufrimiento moral y comprometiendo el aprendizaje. Conclusión. El estrés derivado de la práctica clínica está influido por dimensiones pedagógicas, relacionales y éticas. La creación de entornos de aprendizaje clínico éticamente fundamentados requiere reconocer que el bienestar del estudiante es inseparable del clima moral de la enseñanza y la supervisión. Las instituciones y los educadores tienen responsabilidades pedagógicas, políticas y éticas en la implementación de estrategias que favorezcan la adaptación de los estudiantes, protejan su bienestar y fortalezcan la calidad de la formación clínica. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label: Abstract (Portuguese)
  Group: Ab
  Data: Objetivo. Explorar as perspectivas de estudantes de enfermagem sobre o estresse na prática clínica, com foco nas condições causais, fatores intervenientes e consequências relacionadas. Métodos. Trata-se de um estudo qualitativo conduzido com base na teoria fundamentada, seguindo a perspectiva straussiana. Participaram quinze estudantes de graduação em enfermagem, inseridos em atividades de formação clínica em dois cursos de uma universidade pública do sudeste do Brasil. Entrevistas individuais semiestruturadas foram analisadas por meio de codificação aberta, axial e seletiva. Todos os participantes assinaram o termo de consentimento livre e esclarecido. Resultados. O estresse na prática clínica foi percebido como um fenômeno multifatorial e dinâmico, desencadeado por dificuldades de adaptação ao ambiente clínico, sobrecarga acadêmica, conflitos interpessoais e relações tensionadas com docentes e preceptores. Esses fatores causais e intervenientes produziram consequências biopsicossociais persistentes, incluindo sintomas físicos, instabilidade emocional, prejuízos cognitivos, redução da autoconfiança e preocupações com a segurança do paciente. Os estudantes enfatizaram que suporte inadequado, interações desrespeitosas e comportamentos humilhantes contradizem as expectativas éticas de ambientes de aprendizagem seguros, respeitosos e inclusivos, intensificando o sofrimento moral e comprometendo o processo de aprendizagem. Conclusão. O estresse decorrente da prática clínica é influenciado por dimensões pedagógicas, relacionais e éticas. A construção de ambientes de aprendizagem clínica eticamente fundamentados requer reconhecer que o bem-estar do estudante é inseparável do clima moral do ensino e da supervisão. Instituições e educadores possuem responsabilidades pedagógicas, políticas e éticas na implementação de estratégias que favoreçam a adaptação dos estudantes, protejam seu bem-estar e fortaleçam a qualidade da formação clínica. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Investigación & Educación en Enfermería is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lth&AN=194710372
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        Value: 10.17533/udea.iee.v44n2e05
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        Text: English
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              Text: May-Jul2026
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