Stress and Coping Strategies in Clinical Practice Among Nursing and Midwifery Students: A Multicenter Cross-Sectional Study

Abstract Background Clinical education is a fundamental component of nursing and midwifery training, enabling students to integrate theoretical knowledge with practical clinical skills. However, clinical placements are frequently associated with psychological stress due to academic expectations, patient care responsibilities, and ongoing interactions within a complex healthcare environment. Identifying the magnitude of stress, coping mechanisms, and contributing factors among students is essential for improving the clinical learning environment. This study aimed to assess perceived stress levels, coping strategies, and associated factors among nursing and midwifery students in Ethiopia. Methods A multicenter cross-sectional study was conducted among 906 undergraduate nursing and midwifery students of public universities in Ethiopia. Data were collected using a pre-tested structured self-administered questionnaire that incorporated the perceived stress scale (PSS). Bivariable and multivariable linear regression analysis were performed to examine the association between the predictor and the outcome variables. Regression coefficients (β) with 95% confidence intervals were used to identify independent predictors and statistical significance was set at p < 0.05 . Results The perceived stress level among nursing and midwifery students during clinical training was moderate (1.85±.47) (ß=23.15, p<.001) with a statistically significant model F (9, 894) = 18.48, p < .001, R2 = .329. Presence of relatives (ß=1.076, p=.035); study year (ß=2.437, p<.001), perception of the learning environment (ß=.072, p<.001), perceived clinical teaching effectiveness (ß=1.907, p=.001), avoidance coping strategy (ß=.162, p=.012), problem-solving coping strategy (ß=.275, p<.001) and transference coping strategy (ß=.903, p<.001) were predictors of perceived stress level. Conclusions Nursing and midwifery students experienced moderate stress during clinical training influenced by multiple variables. Improving clinical learning environments, and teaching effectiveness, and promoting adaptive coping strategies may help overcome stress. Departments should also consider implementing orientation programs and stress-management support. Trial registration: Not applicable