Levels of Stress and Coping Strategies Used by Nursing Students in Asian Countries: An Integrated Literature Review

Introduction: High-stress levels can directly or indirectly impede academic learning, performance, and health of the nursing students. There is ample literature reporting levels of stress and coping strategies used by the nursing students from within western world. However, this may not be applicable to Asian context. Therefore, there is a need to synthesize evidence regarding stress and coping of nursing students from Asia. Purpose: The purpose of this paper was to critically review and appraise existing studies and identify data gaps regarding stress and coping strategies among nursing students in the Asian context. Methods: Literature search was performed using keywords and different combinations of keywords such as “level of stress, stressors, coping strategies, nursing students, interns, undergraduate nurses” from PubMed, EMBASE, Cochrane, CINHAL, ASSIA, PsycInfo, Science Direct, and Google Scholar and other sources such as research gate, websites, reference lists, and Higher Education Commission of Pakistan’s Electronic Library. The search limit was focused on Asian countries and limited studies were found in this area. The review included nine studies published between 2007 and 2014 from India, Pakistan, Iran, Philippines, Hong Kong, and Jordan. Results: The critical appraisal of the studies was done in terms of study population, purpose, methodology, and ethical considerations. The key findings of the studies were described under four themes; levels of stress, common stressors, coping strategies, and association among stress, coping, and the demographic variables. Most of the studies reported that the nursing students experience moderate stress levels. In terms of coping, students used more positive coping strategies than negative strategies. Conclusion: This review underlined the strength and limitations of the studies identifying the levels of stress and coping strategies of nursing students in Asian context. A number of methodological limitations were found in these studies indicating that this topic has not been adequately investigated. Therefore, further research is needed to expand the literature in this area.