Stress, resilience and psychological well-being in Chinese undergraduate

nursing students

Fang Yang, Graeme D. Smith

PII: S0260-6917(16)30233-7
DOI: doi:10.1016/j.nedt.2016.10.004
Reference: YNEDT 3403

To appear in: Nurse Education Today

Received date: 20 July 2015

Revised date: 28 September 2016
Accepted date: 17 October 2016

Please cite this article as: Yang, Fang, Smith, Graeme D., Stress, resilience and psy-
chological well-being in Chinese undergraduate nursing students, Nurse Education Today
(2016), doi:10.1016/j.nedt.2016.10.004

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 ACCEPTED MANUSCRIPT

Stress, resilience and psychological well-being in

Chinese undergraduate nursing students
Fang Yang1 & Graeme D. Smith2

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Fang Yang
BA, RN, PhD, Associate Professor

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Nursing School of Hangzhou Normal University, Hangzhou, China1
E-mail: yangfanglwy98@163.com

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Graeme D. Smith
BA, RN, FEANS, PhD, Professor
Faculty of Health and Life Science, Edinburgh Napier University,
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Edinburgh,UK2
Tel: 00852 90963778
E-mail: gd.smith@napier.ac.uk
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Correspondence to:
Dr Fang Yang-School of Nursing, Hangzhou Normal University,16
Xuelin Road, Higher Education Park, XiaSha, Hangzhou 310036,China.
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E-mail: yangfanglwy98@163.com
Professor Graeme D. Smith –School of Nursing, Midwifery and Social
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Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court,

Edinburgh EH11 4BN,UK.
E-mail: GD.Smith@napier.ac.uk
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Word count: 4985 words

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Stress, resilience and psychological well-being in Chinese undergraduate nursing

students

Summary

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Background
Globally, stress is a well-recognized feature of the life of undergraduate nursing
students. However, there currently is little evidence to suggest what role

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resilience plays in this issue.

Objectives

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To examine the relationship between stress and resilience on psychological well-
being in a cohort of Chinese undergraduate student nurses.

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Design/Participants
A cross-sectional study was conducted using multivariate logistic regression and
descriptive statistical analysis in three Chinese nursing schools. A total of 1538
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nursing students participated in the study, completing three validated self-
administered questionnaires.

Results
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Nursing students in their final year reported the highest mean General Health
Questionnaire 12 (GHQ-12) scores (Mean 4.50 SD 2.89) and Stress in Nursing
Student (SINS CN) scores (Mean 105.11 SD 25.37), Moderate levels of resilience
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were noted across all four years of nursing training programmes (Mean 121.59
SD 21.49). Resilience scale (RS) scores were negatively correlated with mean
total score for stress (r=-0.236, p<0.01) and negatively correlated with
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psychological well-being (r= -0.411, p<0.01).

Conclusion
Psychological well-being appears impaired in Chinese nursing students,
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particularly final year students, prior to registration. Globally, more attention

could be given to the potential role of resilience training and other forms
effective coping strategies to deal with the inevitable sources of stress in student
nurse training.

Keywords: Nurse education, stress, resilience, psychological well-being, support

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Introduction

Nursing is an inherently stressful profession and there is increasing evidence of

the contributory factors that can lead to its development (Watson et al 2010). In
studies to date, stress has been commonly used as a term to denote psychological
distress. There is an increasing body of evidence examining the impact of stress

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on health and well-being in nursing and student nurses, as they are known to
carry higher levels of stress than other student populations (Goff 2011).
Although student nurses do not carry the same level of clinical responsibility as

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qualified nurses, the student nurse experience is known to be an inherently
stressful one (Jones & Johnston 2000). It is therefore important to get some
insight into the experience of stress in nursing students, as it may influence

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future career decisions and could potentially have an impact on attrition from
the profession.

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Background

Stress has been identified as a disease of the 20th century, it has been studied
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extensively in student nurses (Grobecker 2106; Fornes-Vives et al 2016;
Edwards et al 2010). To date, the balance of evidence would suggest that
student nurses experience high levels of stress, particularly during the early and
latter stages of their education (Jones and Johnston 1999). Excessive levels of
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stress may lead to physical and mental health problems and may affect students’
academic performance (Lo 2002). Maintenance of good levels of psychological
well-being is an important component in student nurse development, poor
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concentration, high levels of anxiety, depression and sleep problems provide

examples of the detrimental impact stress can have on psychological wellbeing
(Timmins et al 2002; Gibbons et al 2008). It has been shown that nursing
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student’s employ a variety of coping strategies to deal with stressful situations

(Klamin-Yobas et al 2014). Nursing students may resort to avoidance coping
strategies, including excessive alcohol intake, at stressful times (Pines et al
2012).
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Demographic factors aside, the most obvious categories for predictors of

perceived stress in student nurses have been grouped into three distinct areas;
academic, clinical and personal (Pryjmuchuk & Richards 2007). Academic
reasons for stress in student nurses include fear of failure, competitive
environment and heavy workload (Reeve et al 2013). In the clinical
environment, student nurses have reported stress associated with working with
dying patients, insecurity of clinical competence, fear of making mistakes and
interpersonal conflicts with patients and staff. Hostility from staff, patients and
relatives in clinical areas has been identified as a potential source of stress on
clinical placement (Jackson et al 2011). Personal reasons for stress in student
nurses include; low financial status and lack of time to see family and friends (Lo
2002).
Historically, determination of the overall extent of the impact of stress in student
nursing has been problematic because of diverse approaches to stress
measurement (Glossop 2001). Comparing studies is challenging due to the use
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of different measurement scales and methods (Pulido-Martos et al 2011).

Despite this, the General Health Questionnaire (GHQ) has been used in several
stress related student nurse studies and provides some scope for comparisons to
be made. Using this scale, Jones and Johnston (1997) reported that between a
half and two-thirds of students had high levels of stress. Using GHQ 12,
Pryjmachuk and Richards (2007) also reported high levels of stress in around

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one third of student nurses in the United Kingdom. Despite individual
geographic and cultural features, Burnard et al (2008) suggested that across the
world nursing students share many common elements that may result in stress

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during the course of their studies.

Globally, attrition from nurse education training programmes is a cause of

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concern for higher educational institutions and the nursing profession
(Prajmachuk et al 2008; Pitt et al 2012). Although there is no single reason for
student nurses to leave their programme of study, stress has commonly been

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cited as a major contributory factor (Baldwin et al 1998).
Van der Riet et al (2015) highlighted the potential benefits of specific stress
management interventions for student nurses. These include, mindfulness and
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cognitive appraisal, which can improve overall sense of well-being in students. It
has been suggested that further investment in stress management approaches
could potentially enhance professional nursing competence (Ranjbar 2015; Eng
& Pai 2015). However, to date, there limited evidence to support the long term
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benefits of these types of interventions (Galbraith & Brown 2010). In recent

years, it has been suggested that stress per se may not be the main cause of
attrition, rather the way that an individual person copes with perceived stressful
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situations (Pitt et al. 2012;Pryjmachuk et al 2009). The demographic profile of

the student nurse population in the United Kingdom may provide one reason for
the high levels of stress, the student population is becoming increasingly diverse,
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predominantly female, students tending to be more mature with dependents

(Thomas 2002). However in China the demographics of the student nurse
population is very different, most are young female adolescents who start
training directly from high school. As such, they may be more vulnerable and
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susceptible to the negative effects of stress (Hua et al 2006).

Chinese context
With one of the largest global nursing education systems, China holds a pivotal
role in the present day development of global perspectives of nurse education
(You et al 2015). It has a comprehensive nurse education system, including a
well-established baccalaureate undergraduate degree. Traditionally,
undergraduate nursing programmes have been delivered through lecture and
direct demonstration teaching methods. The structure and process of nursing
educational methods may contribute to the experience of stress in nursing
students (Zhou et al 2016). In the Chinese context, with the exception of
laboratory-based classes baccalaureate nursing students have limited clinical
experience, prior to their final year fulltime clinical practicum.
With recent rapid economic and social changes in Chinese society has seen an
increasing demand for more nurses with higher educational qualifications.
However, the nursing profession may not be the first choice of profession for
many students, consequently many may enter the profession with varying
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degrees of ambivalence and motivation (Xu et al 2000). In this context,

Salamonson et al (2014) concluded that choice of profession may be a predictor
of successful nurse programme completion.

Most Chinese nursing students have to contend with the difficult transition from
adolescence to adulthood, whilst adapting to a new academic and clinical

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environment and establishing new social networks and may not be fully
prepared to meet the educational, physical, academic demands they will
encounter. For Chinese nursing students, stress is recognized to exert a direct

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effect on academic studies, everyday lifestyle and on future career aspirations
(Ni et al 2010). Such concerns have led to increasing attention around the mental
health of Chinese nursing students (Yang & Honghong 2009; Hu et al 2006). Liu

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& Jia (2008) reported high levels of absenteeism and suicide rates and reported
that up to 28.6% of Chinese nursing students suffer from some type of mental
health problem. Stress in undergraduate Chinese nursing students may also be

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intensified as many of them may not have entered nurse education by choice,
they may have joined under the influence of teachers and their parents. Another
unique feature of student life in China is the role of class leaders, placing
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students in a unique position of responsibility within the classroom setting.
Increasing attention has been given globally to the health and wellbeing of
student nurses. Gibbons et al (2007) reported that those who coped well with
their experience as a student nurse drew on effective support networks and
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adopted positive attitudes towards their studies. These students displayed

resilience and this type of behavior has led to the term stress-resiliency in nurse
education (Pines et al 2012).
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Resilience
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Resilience is viewed as an essential quality for success in the nursing profession

(Jackson et al 2007). It has been suggested that resilience may play an important
role in persistence through challenges faced by student nurses (Taylor and Reyes
2012). In relation to the student nurse experience, resilience has been defined as
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the ‘capacity to recover from extremes of trauma, deprivation, threat of stress

(Atkinson 2009 p137). Nursing students with limited resilience capacity may be
more vulnerable to adverse psychological outcomes, such as anxiety and
depression (Reeve et al 2013). One Iranian qualitative study examined the direct
relationship between resilience and stress in student nurses and demonstrated
that increased levels of resilience gave the student a greater life satisfaction and
improved their chances of success on their program of study (Abolghasemi &
Varaniyab 2010).

Although levels of perceived stress may be similar between student nurses in

China and their Western counterparts, little is currently known about the
relationship between stress, resilience and psychological well-being in Chinese
nursing students. In addition to the cultural differences, the structure and
content of the undergraduate nursing curriculum is very different from those in
the Western world. Traditionally, nursing clinical placements do not take place
in China until the final year. This time has been identified as a potentially a
stressful time for students (Chen & Hung 2014). It was therefore the aim of this
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study to examine this relationship directly to determine if there is a relationship

in Chinese nursing students.

The present study

The present study is designed to analyse the relationship between stress,

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resilience and psychological wellbeing in a large group of Chinese nursing
students. Lazarus and Folkman (1984) theoretical model of stress is the guiding
concept of this study. Stress being present when there is an imbalance between

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demand, resource and an individual’s ability to cope.
As such, it was hypothesized that resilience and perceived stress could
potentially act as a predictor of psychological wellbeing in Chinese nursing

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students.

Method

Design
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A cross-sectional survey designed study was carried out in 2013, across three
Nursing Schools in Zhejiang Province in Southeast China. These institutions
provide undergraduate nurse education regulated by the educational objectives
of Zhejiang Province in China.
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Participants
One thousand five hundred and eighty six students were initially given
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questionnaires, of which 1538 were fully completed and returned.

Ethical considerations
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Ethical approval was obtained from the Research Ethics Committee of Hangzhou
Normal University. A cluster and stratified sampling method was used to select
study participants. These nursing students agreed to participate in the survey
after receiving a brief introductory overview to the study at the end of a
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scheduled lecture. Participation by nursing students was voluntary and student

confidentiality and anonymity was assured throughout the study.

Outcome measures

The Stress in Student Nursing (SINS-CN) and Resilience Scale (RS-CN) were used
to respectively measure perceived stress and resilience in participants. The
General Health Questionnaire (GHQ 12) was also employed to measure
psychological well-being in the cohort. In addition, demographic details
including age, sex and number of siblings were recorded. Students were also
asked several questions unique to the Chinese context, whether they came from
a single one-child family and/or whether they were a class leader and what
influenced their decision to become a student nurse.
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Stressors in Student Nursing (SINS)

The Stressors in Student Nursing Scale (SINS) is a forty-three item self-

administered questionnaire that was developed for use with nursing students in

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Scotland in a longitudinal study (Deary et al 2003). Each item has a five-point
Likert scale response which runs from 1=’not stressful’ through to 5=’extremely
stressful’. The scale identifies four factors of stress in student nurses: clinical,

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confidence, education and finance. The original SINS has been back translated
into a Chinese version (SINS-CN) using simplified Chinese characters (Watson et
al 2013).

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Resilience Scale
The Resilience Scale (RS) has been designed and used to measure resilience

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directly (Wagnild & Young 1993). It has been used to measure resilience across
a variety of cultural, age and socio-economic groups (Wagnild 2009).
There are five distinct underlying characteristics of resilience; meaning, self-
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reliance, perseverance, equanimity and existential aloneness. The RS scale
contains twenty-five items and uses a Likert scoring scale ranging from ‘1’ for
‘strongly disagree’ to ‘7’ for ‘strongly agree’. The possible scores for RS range
from 25–175, scores greater than 145 indicated moderately high-to-high
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resilience and scores of 120 and below indicated low resilience (Wagnild &
Young 1993). The RS has demonstrated reliability with alpha-coefficients
ranging from 0.85 to 0.94 (Black & Ford-Gilboe 2004). A Chinese version of the
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resilience scale (RS-CN) has been developed and psychometrically tested (Yang
Fang et al 2015).
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General Health Questionnaire (GHQ 12)

The GHQ-12 is measure of current mental health status (Goldberg & Williams
1988). The twelve items in the scale focus on two distinct areas, the inability to
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perform normal functions and the presence of new distressing experiences. Each
item describes a symptom related to psychological distress, anxiety and
depression and has four possible answers: two that indicate the absence of the
symptom given ‘0’ and two that indicate the presence of the symptom given ‘1’.
The overall tally of the score of the scale will range between 0-12, the higher the
score the greater the psychological morbidity. GHQ-12 is a valid and reliable
measurement scale with alpha-coefficients around the value of 0.8 (Goldberg et
al 1998).

Analysis

All analyses were carried out using SPSS 16.0 statistical program. Each student
participant completed three self-administered questionnaires, which were
analysed using descriptive statistics, Pearson correlation coefficient and multiple
regression analyses. Significance was set at a level of 0.5.

Results
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Initially, 1561 nursing students provided formal informed consent to participate

in the study. A total of 23 returned questionnaires were incomplete and these
were excluded from final analysis, resulting in a total of 1538 completed
questionnaires, giving an overall response rate of 97.0%.

Descriptive statistics

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In this study the age of the nursing students ranged from 17 to 25 years (average
19.98 ± 1.36). The vast majority of them were female (97.3%) and approximately
a third came from a single one-child family. Under half of all student

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participants made the decision to join their nursing programme by themselves
(45.4%), most students were directed to join the nursing programme by either a
parent or teacher. Full demographic profile is shown in Table 1.

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Descriptive statistic for stress, resilience and psychological well-being

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Analysis of the SINS-CN revealed that Chinese nursing students stress scored
relatively high scores, in comparison to Western nursing students. The mean
value for stress total score was 105.11(standard deviation 25.37). There were
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significant differences in total stress mean scores among year one, year two, year
three and year four nursing students, however no significant differences in total
stress mean scores between the students whether they were a class leader or not
(Table 3 & Table 4).
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The student nurse overall mean resilience score was 121.59 (SD 21.49), which is
classed as a moderate level of resilience. The total score of resilience are
presented in Table 2. There were no significant differences in total resilience
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mean scores among students between the four years, however significant
differences in total resilience mean scores were noted between the students who
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were class leaders or non-class leaders. (Table 3 & Table 4).

The senior nursing students (year four) recorded higher than normal GHQ 12
mean scores 4.50 (SD 2.89). Analysis of the GHQ 12 revealed poorest
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psychological well-being scores in senior nursing students scored in the high

range, generally nursing students in other years scored normal levels. The total
mean value for overall psychological well-being score was 3.23(SD 2.54). There
were significant differences in total psychological well-being mean scores
between the four years, the higher and junior grades reporting poorer levels of
psychological well-being.

Table 5 shows the correlation matrix formed between the total score of the
resilience, stress, and psychological well-being. Total resilience scores were
weakly and negatively correlated with the total score of stress [r=-0.236, P＜
0.01), they were also negatively moderately correlated with psychological well-
being (r=-0.411, P＜0.01). In addition, the total score recorded for stress in the
student nurses was positively correlated with the total score for psychological
well-being (r=0.343, P＜0.01), supporting the link between stress and impaired
psychological well-being.
Discussion
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To date, this is the largest study of stress in nursing students in Mainland China,
supporting the view that being a nursing student can be a stressful experience.
Our study shows that the Chinese student nurses displayed high levels of stress,
particularly in the later stages of their training. Stress is clearly associated with
psychological well being in these students, also consistent with previous findings
in Western studies (Pryjmachuk & Richards 2007). The results also agree with

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other studies that have examined psychological factors in Chinese nursing
students (Ni et al 2010, Luo & Wang 2009, Hua et al 2006). High levels of
psychological morbidity have also been recorded in other smaller Chinese

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cohorts (Lui & Jia 2008). Similarly, anxiety and depression have been reported in
Japanese nursing students, associated with the clinical component of their
training (Shikai et al 2009). Nursing students in our group scored higher than

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normal GHQ-12 scores for final year students. Our findings differ from the
conclusion of a systematic review of sources of stress in Western student nurses
suggesting no changes occur at different years of the student’s education

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(Pulido-Martos et al 2011). This may also represent cultural and religious
diversity in the perception and experience of stress between these different
populations (Papazisis et al 2014).
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Final year nursing students may encounter additional stress from the
combination of academic and clinical responsibilities as senior nursing students,
prior to registration. Using SINS-CN our study focused mainly on the negative
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aspects of stress and found similar finding to those reported previously in a

Chinese student nurse population (Watson et al 2013). As with psychological
well-being, the highest level of SIN-CN stress scores in our cohort were also
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recorded in the final year students. These findings clearly support the theory of
stress, as advocated by Lazarus & Folkman (1984). To date, limited attention has
been given to the measurement of resilience in Chinese student nurses. Taylor &
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Reyes (2012) have suggested the important role that resilience plays to help
student nurses overcome stressful experiences. Our student population
demonstrated moderate levels of resilience (mean score 121.59), which is lower
than previously reported scores for resilience in Chinese chronic disease
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patients (127.28 士 27.15) and ‘empty nest’ older people (133.25 士 21.92)
(Yang Fang 2013).
In comparison to Western populations, our student group also did less well than
Swedish people under the age of 29 years old (137.00 士 16.10)(Lundman et al
2007). From these findings, we can conclude that level of resilience may be a
good predictor of psychological wellbeing in this cohort.

The majority of students in our study were young adolescent females who had
just left school, they appear well suited for developing resiliency skills
(McAllister & McKinnon 2009). Kipping (2000) highlighted potential gender
differences in relation to perceived stress between male and female nurses. Male
student nurses were very much in the minority in our Chinese population
(2.7%), as such no indication of gender differences could be identified. There are
also some unique cultural differences between Chinese nursing students and
their counterparts around the world, firstly, in China the single one-child policy
means that many students do not have siblings. Interestingly, two-thirds of our
students were not from single child families. It could be speculated that those
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from single-child families may be less resilient as they do not have to compete
with siblings at home. However, no such difference was noted in our data.
Another cultural difference is the unique role that the class leader plays in
Chinese higher education system. We speculated that class leaders may be more
resilient than their counterparts and found that the mean resilience score for our
class leaders, which accounted for 33.9% of our student population, was higher

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than those who not in a class leading role. It would appear that those students in
leadership roles also display higher levels of resilience than other classmates.
Gibbons (2009) suggested that routine stress evaluation in all nursing students

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may help facilitate appropriate changes in course provision, taking into account
potential stressors. Nurse educators have the potential to influence, either
positively or negatively, student perception of challenges within the nursing

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profession (Alpers et al 2012). Failure to provide appropriate preparation will
potentially lead to more stress, burnout and attrition from the profession.

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Future research should focus on how student nurses can be helped to overcome
stressful experiences. We agree with Yearwood and Riley (2010) that small
changes in positive interactions between teaching faculty and nursing students
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may reduce stress and could enhance student confidence. Further study is also
required to gain insight into the relationship between perceived resilience,
perceived stress and psychological well-being and how these factors may affect
student outcomes, such as academic performance. A longitudinal study of
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nursing students would enable detection of any changes over the course of a
nursing programme. If conducted in a cross-cultural context, it would enable a
greater understanding of the concept of resilience, perceived stress and
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psychological well-being in student nurses from different cultures. In addition,

more qualitative studies may provide valuable insight into the experience of
stress during nurse training (Blomberg et al 2014).
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With the largest ageing population in the world, there is clearly a high demand
for newly trained nurses in China presently. However, there is evidence that
many nurses leave the profession because of high levels of burnout and
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occupational stress (Wu et al 2007). More attention needs to be given to creating

a positive, hostile-free environment for these students. Ongoing attention should
be given to the impact of the recent modification of the one-child policy by the
Chinese government.

Limitations

A convenience sample was used in this study raising the potential risk of
restricted generalizability, however this approach provides the advantage of
increasing accessibility and being inexpensive. The relatively large sample in this
study also reduces the risk of such bias. A cohort group study approach would
need to be employed to detect fluctuation of student responses across the four
years of study, this limitation is being addressed in ongoing research.

As this was a cross-sectional study, which exclusively used self-reported

questionnaires, a number of additional potential limitations arise. Using self-
report questionnaires there is the potential risk of response distortions, however
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this type of subjective measurement provides clear practical and conceptual

advantages over more objective approaches.
Data was collected over a relatively short period of time, as such it may not be
truly reflective of the entire program. In addition, our data was only collected in
one geographical region of China, known for high socio-economic status,
therefore it may not be fully representative of all Chinese undergraduate

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baccalaureate nursing students. The high response rate (97%) raises the
potential issue of non-response bias, however as our findings are largely
consistent with previous literature published in this situation this form of bias

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may not be an issue.

Conclusion and recommendations

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This paper adds to the stress related literature in nurse education from the
unique Chinese context. Our study shows particularly high levels of stress and

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psychological morbidity in final year Chinese nursing students, this may relate to
the late exposure to the clinical environment. Presently, the absence of stress
management training in China would appear to result in the students adopting
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their own coping strategies. Rather than placing the focus on removal of the
stressful features of nursing programmes, we believe that more attention could
be given to the development of resilience through a more positive learning
experience for the student. In an academic world of constant curriculum
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changes, the need to acknowledge the differences between Eastern and Western
culture is required when making changes to enhance student satisfaction and
reduce levels of stress. Nurse educators should aim to better facilitate their
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student’s learning experience in both clinical and academic environment (Decker

& Shellenbarger 2012). Despite the hierarchical Chinese context, this should
include the creation of a more collaborative and supportive environment for
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nursing students with teaching faculty and clinical staff. Greater emphasis on
resilience and stress management in higher education institutions may enable
student nurses to thrive in both the clinical and academic arena, preparing them
to handle the rigors and challenges of our rewarding profession.
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Table 1 Demographic data for Participants（N=1538）

Category Classify Number Percentage

Age 17-20 879 57.2
21-25 659 42.8

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Grades Year one 480 31.2
Year two 429 27.9
Year three 413 26.9

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Year four 216 14.0

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Sex Female 1496 97.3
Male 42 2.7
Single child Yes 512 33.3

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No 1026 66.7
Are you a class leader? Yes 522 33.9
No 1016 66.1
Personal choice to join Voluntary 698 45.4
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the nursing profession? Involuntary 840 54.6
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Table 2 Mean value total scores for SINS-CN, RS-CN and GHQ 12（N=1538）

Standard
Min Max Mean Score

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Deviation

Stress 44.00 204.00 105.11 25.37

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Resilience 25.00 211.00 121.59 21.49

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Psychological
0.00 12.00 3.23 2.54
Well-being

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Table 3 Analysis for different year total scale scores（N=1538）

Test
Year one Year two Year three Year four p
Value
100.50±24.9 103.53±25.5 105.70±26.4 108.57±23.8
Stress 5.790 0.001

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1 2 9 3

122.13±22.4 121.73±20.8 121.93±20.4 119.50±22.5

Resilience 0.817 0.485

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7 4 5 4

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Psychologica
2.87±2.89 3.10±2.65 3.33±2.48 4.50±2.89 18.679 0.000
l
Well-being

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Table 4 Analysis for whether students are class leader to overall scale score（
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N=1538）
Class leader Non-class leader Test Value p

Stress 105.79±25.21 104.76±25.45 0.737 0.391

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Resilience 124.22±20.89 120.25±21.69 3.441 0.001

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Psychological 3.09±2.96 3.39±2.66 2.738 0.006

Well-being
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Table 5 Correlation for relationship between SINS-CN, RS-CN and GHQ 12 scale
scores.（N=1538）
Stress Resilience Psychological
Well-being
Stress 1.000

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Resilience -.236** 1.000

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Psychological .343** -.411** 1.000
Well-being

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Remarks：*P＜0.05; **P＜0.01
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Additional Table Comparison of SINS-CN, RS-CN and GHQ 12 mean score
between single child vs. more than one child family （N=1538）
Variable single child family more than one child
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Test value p value

Stress 104.85±26.59 105.23±24.74

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2.18 0.140

Resilience 121.91±21.00 121.43±21.75 0.41

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0.682

Psychological 3.25±2.76 3.31±2.77 -0.57

0.569
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NET Highlights
 Globally, stress is a well recognized feature of student nurse life
 Psychological well-being is impaired in Chinese undergraduate nursing
students, particularly in pre-registration students
 Resilient nursing students are better equipped to deal with stressful
events during their education

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 Nurse educators should be aware of potential role of resilience training
and other forms of effective coping strategies for their students.

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