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I S S U E S A N D IN N O V A T I O N S I N N U R S I N G E D U C A T I O N

Programme-related stressors among part-time undergraduate nursing students


Honor Nicholl
BSc MEd RN RSCN RM RCT RNT PGDipG&C AdDip Teaching Studies

Lecturer, School of Nursing and Midwifery Studies, Trinity College Dublin, Dublin, Ireland

Fiona Timmins

BNS BSc MSc RNT RGN FFNRCSI NFESC

Acting Director, BSc (Cur), School of Nursing and Midwifery Studies, Trinity College Dublin, Dublin, Ireland

Accepted for publication 25 May 2004

Correspondence: Fiona Timmins, School of Nursing and Midwifery Studies, Trinity College, 24 Dolier Street, Dublin 2, Ireland. E-mail: timminsf@tcd.ie

N I C H O L L H . & T I M M I N S F . ( 2 0 0 5 ) Journal of Advanced Nursing 50(1), 93100 Programme-related stressors among part-time undergraduate nursing students Aim. The aim of this paper is to report a study exploring the perceived stressors identied by a group of 70 students who undertook a part-time degree at one Irish university. Background. In the literature on stress, part-time nursing students who are undertaking continuing education programmes appear to have received little attention. Stress amongst nurses is evident within the nursing literature but little information is available on the specic stressors that affect Registered Nurses who undertake further academic study. Anecdotally, students attending part-time programmes while working full-time report high levels of stress. Method. Quantitative methods were used. While many instruments exist to measure overall stress, this study aimed to explore students perceptions of specic stressors associated with academic study. We used a questionnaire developed from the literature on the topic. Results. Factors related to writing assignments at degree level, fullling personal needs and academic demands, were perceived as major stressors by these students. Factors of little concern were nancial issues and attendance on the programme. Individual items receiving highest mean scores were: trying to balance work commitments and the required study (mean 389, SD 1) and the prospect of the nal examination (mean 386, SD 1). This study was limited by the use of convenience sampling and self-report methods. Larger studies are required to support the ndings. In addition, student stress was not observed or measured. Conclusion. Those involved in the delivery of nurse education programmes to parttime students need to consider the impact of the workload on student welfare, and to prepare students for demands of the programme.

Keywords: stressors, nurses, part-time studies, examination stress, post-registration.

Introduction
Nurse education at both undergraduate and postgraduate level in the Republic of Ireland continues to undergo major changes. There has been an increasing emphasis on the implementation of continuing professional development, which is now seen as a priority for nursing staff.
2005 Blackwell Publishing Ltd

Stress and the identication of potential stressors among nursing students have received much attention in the literature. In the past, research on nursing students focused on the students growth and development and questioned whether stressors emanated from the educational/clinical experience or from the development phase of the students (Carter 1982). Lo (2002) investigated the perceptions of stress and stressors,
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H. Nicholl and F. Timmins

coping mechanism used and self-esteem of Australian undergraduate nursing students, and the four main stressors identied were nursing studies, nance, family and health. Stressors in undergraduate medical education have also been investigated (Radcliff & Lester 2003). Findings indicated that pressure of work, especially preparing for examinations and acquiring professional knowledge, skills and attitudes were reported as the most stressful aspects (Radcliff & Lester 2003). In Ireland, Brady (1996) highlighted the stressors that new Registered Nurses face. In the USA, Beck and Srivastava (1991) investigated perceptions of levels and sources of stress among full-time baccalaureate nursing students. Data were collected using two instruments, the General Heath Questionnaire (GHQ) (Goldberg 1992) and the Stress Inventory. The results showed that the students reported a high level of stressors and the authors concluded that students were at risk of having mental health problems or physical illness. Bedaiwi et al. (2001) found similar results in a study of postgraduate medical students, and reported that 59% displayed minor psychiatric morbidity. This was gender-associated and more likely to occur in women. Studies by Lindop (1991), Thyer and Bazeley (1993), Jones and Johnston (1997) and Lo (2002) identied examinations and assessments as major stressors for nursing students. In a later study, Lindop (1999) reported increased levels of academic stressors associated with the demands of diploma rather than certicate level study for nurse preparation. Studies investigating stressors associated with nursing students undertaking study at post-registration level are limited in number. Dowswell et al. (1998) reviewed motivational forces affecting participation in post-registration degree programmes and the effect of attendance on home and work life. The participants were a group of 29 nurses, midwives and allied health professional staff. Data revealed that, with increasing numbers of graduates in the workforce, participants perceived a subtle pressure to attend, but both personal and professional reasons prompted many to attend. Negative feelings about themselves and their professional status were enhanced as other younger nurses overtook them academically. In addition, promotion opportunities were perceived to be limited without additional qualications. While there was a perceived pressure to attend, there were few incentives and little support to attend programmes of further study. Most participants experienced nancial burdens, and undertaking the course was associated with reported negative changes in home and family life. These ndings mirror the anecdotal reports of many nursing students attending post-registration degree-level programmes in the Republic of Ireland. The perceptions of many are that, despite years of clinical experience and completing
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other relevant courses, achieving a minimum of graduate level studies is becoming a requirement for promotion. Although nancial support is available for many through the Department of Health and Children, students report that many stressors affect upon their performance during the programme, in particular, the level of performance required at degree level. However, we found no evidence of any studies on this topic, despite numerous major changes in the delivery of nursing education.

The study
Aim
The aim of this study was to describe the reported stressors experienced by a group of 70 Registered Nurses who were undertaking a part-time Bachelor of Nursing Science (BNS) programme, at an Irish university.

Design
A descriptive exploratory design using questionnaires was used.

Participants
The participants were a convenience sample of 70 students (out of a 90-student cohort) present on the day of data collection in the nal week of the programme. The programme required university attendance 1 day per week for a period of 26 weeks. The assessment strategy included written assignments and examination. The programme was designed for experienced nurses who did not hold a graduate-level qualication in nursing, and was specically aimed at meeting the needs of nurses at a time of implementation of an all-graduate nursing profession in Republic of Ireland in 2002.

Data collection
Several instruments exist to measure nurse stress or general health, including the Nurse Stress Index (Zalaquett & Wood 1997) and General Health Questionnaire (GHQ) (Goldberg 1992). However, given the specic context and potential student stressors identied in the literature, we decided to develop a tool specic to the aim of the study. This was not to measure stress levels per se, but to identify those aspects of the programme that students perceived as affecting their experience. There was no attempt to quantify physiological or psychological stress responses. The research tool designed was a 45-item questionnaire based on the stressors reported

2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(1), 93100

Issues and innovations in nursing education

Programme-related stressors among part-time nursing students

from the literature, and focusing on specic aspects of the structure, process and product of the programme. It was also informed by previous and ongoing course evaluations, teachers observations and student comments. The questionnaire had three sections. Section 1 elicited demographic data about the students. The second section had 39 items concerning four specic areas known to cause stress to students. These items were subdivided into four categories related to the perceived stressors in the structure, process and product of the programme and personal issues. A 5-point Likert response scale across was used. The nal section of the question contained four open-ended questions inviting students to give information about personal and professional benets from the programme. We ensured content validity of the questionnaire by presenting it to a panel of four nurse experts for examination. Each expert completed a form allowing numerical rating and provision of comments on the relevance of each question. Minor alterations were only made in response to suggestions. Reliability is concerned with the instruments accuracy of measurement (Pierce 1995). In this study, reliability denotes the extent to which the quantitative component of the questionnaire gave consistent results. Internal consistency refers to consistent responses to items within the questionnaire. This can be measured statistically using Cronbachs a coefcient. The a coefcient for the questionnaire was 095, which is much greater than the acceptable level of 05 (Mathers & Huang 1998).

order correlation coefcient was used to assess relationships between variables.

Findings
Characteristics of participants
Ninety-one per cent of the group was female. The age group varied, with 857% of respondents being under 40 years of age (Table 1). The mode was 2030 years.

Ranking of reported stressors


The overall mean results for individual items are presented in descending order of magnitude of means in Table 2. Trying to balance work commitments and the required study received the highest overall mean score (mean 389, SD 1). Other items reported in the top ve perceived stressors were The prospect of the nal examination (mean 386, SD 1), Doing the course assignments/preparing assignments for submission (both means 383, SD 09), The demands of writing an assignment to the necessary academic level (mean 363, SD 1), The course workload (mean 364, SD 09) and Keeping up with the work of the course (355, SD 09). Four individual items were attributed little or no stress response. These were Paying/negotiating the course fees, Attendance at classes, Relationships with lecturers and Paying other course costs. These items consistently revealed means of less than 2 (indicating little or no stress) (Table 2). Table 3 reports the distribution of the top 10 ranked items according to mean scores. Responses to item 10 Trying to balance work commitments and the required study received the highest overall mean score (mean 389, SD 1). The distribution of responses indicated that for very few individuals this item was perceived as a source of little or no stress. The majority (93%) reported this item to be a source of at least moderate stress, with almost one-third reporting severe stress. The prospect of the nal examination received the second overall highest mean score (mean 386, SD 1), and was a source of at least a little stress for all respondents. Eightyeight per cent rated this item as a source of at least moderate stress. Sixty-ve per cent reported that the nal examination
Table 1 Age distribution of respondents Number of respondents 2030 3140 4150 Over 51 years Total number 40 20 9 1 70 % 571 286 129 14 100

Ethical considerations
In order to ensure informed student consent, we gave students oral information about the study 4 weeks prior to questionnaire distribution. This included an outline of the study, method of data collection and the need for student agreement to be involved in the study. On the day of data collection, completion of the questionnaire was taken as consent to participate, and students were under no obligation to do this. We distributed the questionnaires on the nal day of the programme. At this point, students were also given written information outlining the background to the study, its aim and guidelines on questionnaire completion. We emphasized that completion was voluntary, and would not affect their progress on the course. They had 20 minutes to complete the questionnaire.

Data analysis
Descriptive data analysis was carried out using the Statistical Package for the Social Sciences (SPSS), and Spearmans rank

2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(1), 93100

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H. Nicholl and F. Timmins Table 2 Individual mean responses to each potential stressor identied in the questionnaire (three or more indicates moderate stress, two or less indicates little or no stress)

Item number 10 7 32 27 26 28 5 24 11 25 23 29 33 20 34 35 38 22 36 31 30 4 37 39 3 17 12 18 6 1 9 19 2 21 16 8 13 14 15

Description Trying to balance work commitments and the required study The prospect of the nal examination Preparing for the course examination Doing the course assignments Preparing assignments for submission The demands of writing an assignment to the necessary level The course workload Keeping up with the work of the course Trying to balance home commitments and the required study Personal time management Academic writing required on the course Studying at degree level Meeting personal needs while studying Meeting the academic demands of the programme Fullling my home responsibilities Neglecting home responsibilities Fullling my home responsibilities Finding time to go to the library Fullling my work/employment responsibilities Submitting assignments to a site not on college campus Adhering to course guidelines for assignments The theoretical level of content of the course Feeling that I have neglected work responsibilities Perceived pressure to keep up with other students Attendance at two study weeks The 5 PM nish time of the days Getting time off from work to attend Lectures lasting more than one hour The required classroom contact hours Travelling to attend the programme The level of writing skills required The teaching methods Attendance at weekly study day The expectations of the other students on the course The 9 AM start time of the study days Relationships with lecturers Paying/negotiating the course fees Paying other course costs Attendance at classes

Mean 389 386 384 383 383 363 364 356 344 337 333 331 333 324 321 321 321 306 297 2 9 277 272 264 2 4 239 234 232 229 221 214 304 209 204 204 203 143 1 9 181 193

Standard deviation 1 1 1 09 09 1 09 09 12 09 1 1 1 1 12 11 12 1 11 14 11 09 11 1 1 12 12 1 09 1 1 09 09 1 11 07 12 09 08

was either a source of a lot of or severe stress. The third item in rank order was Preparing for the course examination; reported by 64% of students as a source of a lot of (31%) or severe stress (33%). Other top ranking items were Doing the course assignments and Preparing the assignments for submission, which achieved equivalent scores (mean 383, SD 09). Distribution across categories was broadly similar, with these items emerging as a source of at least a little stress to all individuals. For most people, these items were a source of a lot of or severe stress. Students reported that The demands of writing an assignment to the necessary level were also a source of at
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least moderate stress (91%). More than half (54%) reported that this item caused a lot of (34%) or severe (20%) stress. The academic writing required on the course also featured in the top 10 items, with 79% reporting this as a source of stress. The course workload ranked 6 in the top 10 ranked items (mean 364, SD 09). Only 7% of respondents indicated that this was a source of little or no stress. The majority (93%) indicated that it was a source of a least moderate stress, with 17% reporting it a source of severe stress. Keeping up with the work of the course ranked 7th, with more than half the group citing this as a source of a lot of or severe stress. Trying to balance home commitments and the

2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(1), 93100

Issues and innovations in nursing education

Programme-related stressors among part-time nursing students

Table 3 Percentage distributions of responses within categories for the top 10 ranking individual items Percentage distributions of responses Item number 10 7 32 27 26 28 5 24 11 25 23 Rank order 1 2 3 4 5 6 7 8 9 10 No stress 4 0 1 0 0 3 1 1 7 0 4 A little stress 3 11 10 9 10 6 6 13 10 14 17 Moderate stress 20 23 24 20 21 37 37 29 37 46 33 A lot of stress 46 34 31 51 44 34 39 43 23 29 33 Severe stress 27 31 33 20 24 20 17 14 23 11 13

Description Trying to balance work commitments and the required study The prospect of the nal examination Preparing for the course examination Doing the course assignments Preparing assignments for submission The demands of writing an assignment to the necessary level The course workload Keeping up with the work of the course Trying to balance home commitments and the required study Personal time management Academic writing required on the course

required study was ranked 8th (mean 344, SD 12), and emerged as source of at least moderate stress to 83% of students and severe stress for over a quarter (27%). Personal time management also emerged in the top 10 (mean 337, SD 09). All students reported this as a source of at least a little stress. Although only 11% reported severe stress, the majority reported at least moderate stress from this item (86%). Relationships within these top 10 items were examined to elicit whether responses were in any way related. Responses in these categories were highly correlated and several statistically signicant relationships emerged (Table 4). Those participants who reported trying to balance work commitments and the required study as a programme stressor also reported: personal time management, preparing assignments for submission, preparing for the course examination, doing the course assignments, the demands of writing an assignment to the necessary level, keeping up with the work of the course and the course workload as perceived stressors. These correlations were signicant at the 001 level. It appeared that work/study balance affected their management of the programme in general rather than specic aspects. Academic writing required on the course and meeting the academic demands of the programme were not signicantly related to this item (not signicant at the 01 level). It also appeared that students were likely to perceive multiple stressors within the programme, and respond to these with similar magnitude.

Discussion
Rather than using a particular theoretical model of stress, this study may be dened as curiosity-driven research (Argyrous 2000). The impetus for the study was to elicit those items that

are potential sources of stress to students to inform local programme planning. This type of research, according to Argyrous (2000, p. 5), is as important a reason for undertaking research as the imperatives of social theories. The hitherto unknown stressors of post-registration students were explored, and the ndings support the presence of a wide range of academic stressors previously identied among full-time nursing students. These include examinations and assignments (Lindop 1991, Thyer & Bazeley 1993, Jones & Johnston 1997), the intense amount of work (Lindop 1991), theoretical course work (Clarke and Rufn, 1992), study (Clarke and Rufn, 1992, Thyer & Bazeley 1993, Jones & Johnston 1997) and general academic elements (Rhead 1995, Lindop 1999). While examinations and assignments are notoriously associated with stress, it is important to consider the magnitude of the responses reported in the study. The majority of the group reported at least moderate stress associated with the top 10 ranked items, and large percentages of the group reported severe stress associated with many items. It is also important to remember that the particular population under consideration had high intensity employment commitments, and in some cases little employer support. The ndings support the view that both the academic demands of nurse education programmes and the assessment processes are potential sources of stress to undergraduate nursing students. However, the intensity of stress related to factors such as examinations and assignments displayed in this study may be due to the extra demands associated with degree level study, which has received little empirical investigation. One previous study (Lindop 1999) has noted an increase in academic stress associated with moving from certicate- (equivalent to the rst year of a bachelors degree) to diploma-level (equivalent to the rst two years of a bachelors degree) nurse education programmes in the UK
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H. Nicholl and F. Timmins Table 4 Examination of relationships between top 10 ranking variables used in the study, using Spearmans rank order correlation coefcient Individual items Item 7 Correlation coefcient Signicance (two-tailed) n Item 10 Correlation coefcient Signicance (two-tailed) n Item 23 Correlation coefcient Signicance (two-tailed) n Item 25 Correlation coefcient Signicance (two-tailed) n Item 26 Correlation coefcient Signicance (two-tailed) n Item 28 Correlation coefcient Signicance (two-tailed) n Item 32 Correlation coefcient Signicance (two-tailed) n Item 27 Correlation coefcient Signicance (two-tailed) n Item 24 Correlation coefcient Signicance (two-tailed) n Item 20 Correlation coefcient Signicance (two-tailed) n Item 5 Correlation coefcient Signicance (two-tailed) n Item 7 Item 10 Item 23 Item 25 Item 26 Item 28 Item 32 Item 27 Item 24 Item 20 Item 5

1000 70 0366* 0002 70 0495* <00001 70

0366* 0495* 0002 <00001 70 70 1000 70 0261 0029 70

0352* 0411* 0531* 0878* 0423* 0419* 0449* 0451* 0003 <00001 <00001 <00001 <00001 <00001 <00001 <00001 70 70 70 70 70 70 70 70 0307* 0010 70 0319* 0007 70 0349* 0003 70 0319* 0411* 0007 <00001 70 70 0269 0451* 0025 <00001 70 70

0445* 0261 0029 <00001 70 70 1000 70

0414* 0508* 0727* 0473* 0560* 0632* 0670* 0436* <00001 <00001 <00001 <00001 <00001 <00001 <00001 <00001 70 70 70 70 70 70 70 70 1000 70 0434* 0426* <00001 <00001 70 70 1000 70 0354* 0574* 0490* 0567* 0420* 0003 <00001 <00001 <00001 <00001 70 70 70 70 70

0352* 0445* 0414* 0003 <00001 <00001 70 70 70 0411* <00001 70 0531* <00001 70 0878* <00001 70 0423* <00001 70

0307* 0508* 0434* 0010 <00001 <00001 70 70 70

0655* 0461* 0778* 0515* 0417* 0475* <00001 <00001 <00001 <00001 <00001 <00001 70 70 70 70 70 70 1000 70 0569* 0766* 0462* 0613* 0486* <00001 <00001 <00001 <00001 <00001 70 70 70 70 70 1000 70 0463* <00001 70 1000 70 0393* 0460* 0001 <00001 70 70 0370* 0002 70

0319* 0727* 0426* 0655* 0007 <00001 <00001 <00001 70 70 70 70 0349* 0473* 0003 <00001 70 70

0354* 0461* 0569* 0003 <00001 <00001 70 70 70

0319* 0560* 0574* 0778* 0766* 0463* 0007 <00001 <00001 <00001 <00001 <00001 70 70 70 70 70 70

0519* 0546* 0593* <00001 <00001 <00001 70 70 70 1000 70 0596* 0588* <00001 <00001 70 70 1000 70 0466* <00001 70 1000 70

0419* 0411* 0632* 0490* 0515* 0462* <00001 <00001 <00001 <00001 <00001 <00001 70 70 70 70 70 70 0449* <00001 70

0393* 0519* 0001 <00001 70 70

0269 0670* 0567* 0417* 0613* 0460* 0546* 0596* 0025 <00001 <00001 <00001 <00001 <00001 <00001 <00001 70 70 70 70 70 70 70 70

0451* 0451* 0436* 0420* 0475* 0486* <00001 <00001 <00001 <00001 <00001 <00001 70 70 70 70 70 70

0370* 0593* 0588* 0466* 0002 <00001 <00001 <00001 70 70 70 70

Item number descriptions are as provided in Tables 2 and 3. *Correlation is signicant at the 001 level (two-tailed). Correlation is signicant at the 005 level (two-tailed).

(Project 2000). Clearly, further investigation is required to assess the impact of the increased academic demands of third level (bachelors) programmes on nurses, particularly at postregistration level, who have extra demands on their time. Educators need to explore mechanisms for easing the transition for students, such as optional study skills classes before programme commencement. Programme planners
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need to exercise caution to ensure that academic overload does not occur. Continuous curriculum evaluation is also required to ensure that appropriate teaching and assessing methods are in operation. The academic demands of this programme, in terms of the nal examination, course workload, completing assignments, the demands of writing at the necessary level, academic

2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(1), 93100

Issues and innovations in nursing education

Programme-related stressors among part-time nursing students

writing required on the course and keeping up with the work of the course were reported as potential sources of stress. These issues are worthy of further exploration. Little literature is available on specic stressors affecting students who are moving from traditional nurse education programmes or from diploma to degree level and the demands that this places on students. Lindop (1999) suggests that there is academic overload, due in part to the novelty of nurse education at the third level and associated attempts to gain academic credibility and status. These factors may have contributed to our ndings. Six of the top 10 items of purported stressors related to assessment, and this is an area that perhaps warrants careful scrutiny to ensure that methods are suited to student needs. Lo (2002) suggested that planners ensure that assessments are well spaced during the programme to allow adequate completion time, as this will be less stressful for students. However, many part-time graduate programmes for Registered Nurses in Ireland are currently of short duration, and adequately spacing the number of assignments causes difculty. There is a heavy reliance on academic papers and examinations at present, and perhaps educators need to consider alternative assessment methods, such as web-based assessments, presentations and group projects. Thought also needs to be given to how to support students during the progression to degree level. Rhead (1995) suggested that educators address the aspects of stress induced by the academic element at the outset of programmes. Given our ndings, we suggest that it would be appropriate to spend time at the beginning of the programme to ensure that students understand the demands of academic work at degree level and in giving advice and support to assist with meeting these demands. Unlike previous studies on the topic, nancial concerns did not emerge as a source of stress. Dowswell et al. (1998) studied students undertaking post-registration degree courses and found that payment of fees was associated with hardship. The lack of hardship evident in our study relates to the current situation in Ireland, in which funding for degree programmes is supported by the Department of Health and Children. However, should this situation change in the future, nancial pressure may emerge as a potential stressor and this needs to be considered by all those involved in parttime graduate programme planning and delivery. It was obvious from the study that the personal needs of students are being sacriced not only because of the demands of the programme, but also because for the most part these students are also in demanding employment roles and have other high intensity commitments. Maintaining a balance was an issue for many nurses. The top-ranking item was

Balancing work and study commitments. Both Trying to balance home commitments and the required study and Personal time management were among the top 10 reported stressors. This aspect of post-registration education has received little attention in the literature. Lo (2002) found that family emerged as the third greatest source of stress for full-time nursing students. Similarly, Brown and Edelmann (2000) and Cavanagh and Snape (1997) revealed balancing home and college demands as a stressor during pre-registration programmes and Dowswell et al. (1998) found that the demands of study inltrated the private sphere of home and family. Clearly, further empirical work is required in this area, and the specic needs of this group need to be further investigated to inform programme planning. Bedaiwi et al. (2001) suggested that failure to resolve student stress in the long term could have serious professional and personal consequences. He suggests that educators consider the development of programmes that promote individual skills in stress management and problem-solving. Unlike undergraduate pre-registration programmes, parttime post-registration programmes are time-restricted and often tend to focus on core teaching content, perhaps to the detriment of social and personal skills. If we are to develop practitioners to their best ability it is essential that educators address their psychosocial needs. Third level education institutions need to develop a coordinated approach to supporting the management of potential stressors for students undertaking part-time studies and develop a curriculum that puts students at the core of the learning process.

Limitations
There are a number of limitations to this exploratory study. The use of a small convenience sample indicates that the ndings are contextual, and are not representative of all parttime degree students. It is also used as a self-report questionnaire, which gave no measurement of stress level but only subjective perceptions of the topic. It is also probable that the ndings cannot be generalized to students undertaking fulltime undergraduate nursing courses, as the stressors experienced by part-time post-registration students may well be different from those of students who enter college mostly as school leavers. The self-report questionnaire used also carried the risk that respondents would answer in a socially desirable manner. The unique geographical site further limits the study. Repeat of this study with a larger randomized sample would undoubtedly contribute further to knowledge development. However, the questionnaire needs further development and clarication of operational denitions. The subjective nature of the wording may limit the effectiveness
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H. Nicholl and F. Timmins Beck D.L. & Srivastava, R. (1991) Perceived level and sources of stress in baccalaureate nursing students. Journal of Nursing Education 30(3), 127133. Bedaiwi W.A., Driver, B. & Ashton C. (2001) Recognizing stress in postgraduate medical trainees. Annals of Saudi Medicine 21(12), 106110. Brady A.D.A. (1996) Stress and the newly registered nurse. Nursing Review 14(2), 710. Brown H. & Edelmann R. (2000) Project 2000: a study of expected and experienced stressors and support reported by students and qualified nurses. Journal of Advanced Nursing 31(4), 857864. Carter E.W. (1982) Stress in nursing students: dispelling some myths. Nursing Outlook 30, 248252. Clarke V.A. & Ruffin C.L. (1992) Sources of stress for student nurses. Contemporary Nurse 1(1), 3540. Cavanagh S.J. & Snape I. (1997) Education stress in student midwives: an occupational perspective. British Journal of Midwifery 5, 528533. Dowswell T., Hewison J. & Hinds M. (1998) Motivational forces affecting participation in post-registration degree courses and effects on home and work life: a qualitative study. Journal of Advanced Nursing 28(6), 13261333. Goldberg D. (1992) General Health Questionnaire, GHQ 12. NFERNELSON Publishing, Windsor. Jones M.C. & Johnston D.W. (1997) Distress, stress and copying in first-year student nurses. Journal of Advanced Nursing 26(3), 475 482. Lindop E. (1991) individual stress among nurses in training: why some leave and others stay. Nurse Education Today 2, 110 120. Lindop E. (1999) A comparative study of stress between pre and post Project 2000 students. Journal of Advanced Nursing 29(4), 967 973. Lo R. (2002) Experience before and throughout the nursing career. A longitudinal study of perceived level of stress, coping and self-esteem in undergraduate nursing students: an Australian case study. Journal of Advanced Nursing 39(2), 119126. Mathers N. & Huang, Y.C. (1998) Evaluating methods for collecting data in published research. In Research into Practice (Crookes P.A. & Davies S., eds), Balliere Tindall, London. Pierce A.G. (1995) Measurement instruments. In Principles and Practice of Nursing Research (Talbot L.A., ed.), Mosby, New York, pp. 292316. Radcliff C. & Lester H. (2003) Undergraduate medical education. Perceived stress during undergraduate medical training: a qualitative study. Medical Education 37(1), 3238. Rhead M.H (1995) Stress among student nurses: is it practical or academic? Journal of Clinical Nursing 4(6), 369376. Thyer S.E. & Bazeley P. (1993) Stressors to student nurses beginning tertiary education: an Australian study. Nurse Education Today 13(5), 336342. Zalaquett C. & Wood R.J. (1997) Evaluating Stress: a Book of Resources, Vol. 1. Scarecrow Press, Metuchen, NJ.

What is already known about this topic


The literature clearly identies pre-registration nursing students perceived stressors as course workload, examinations/assignments and nancial concerns. Increasing numbers of practising nurses are choosing to study at graduate and postgraduate level on a part-time basis. There are few reports of the stressors of Registered Nurses undertaking part-time graduate level studies.

What this paper adds


The main stressors experienced by part-time postregistration students were the demands of the programmes, undertaking assignments and the nal examination, and the theoretical level of the course. There were also challenges in performing at graduate level and balancing the many demands placed on their time. Nurse educators need to address the potential stressors of writing assignments at degree level and fullling personal needs. of some of the items. The word stress itself is subjective and was not dened in the study. This may have affected the ndings, as individuals attribute a level of stress to items based on their own interpretation of stress.

Conclusion
Despite its limitations, the study identied stressors that appear to differ from those reported for full-time preregistration students in other settings. The ndings therefore raise issues for consideration by other nurse educators working with part-time post-registration students at degree level particularly in terms of pre-course information and ongoing support. Topics for further research have also been identied, including the desirability of measuring stress levels rather than relying solely on self-reports, and extending the study to other settings.

References
Argyrous G. (2000) Statistics for Social and Health Research with a Guide to SPSS. Sage Publications, London.

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