A Cross-Sectional Comparative Study of Academic, Clinical, and Social Stress Among Undergraduate Nursing Students in Public and Private Institutions in Swat

Abstract

Background: Undergraduate nursing students encounter academic, clinical, and social demands that may affect their well-being and educational performance, but evidence comparing stress across public and private institutions in Swat is limited. Objective: To determine academic, clinical, and social stress among undergraduate nursing students and compare stress-level distributions according to institutional sector, gender, and year of study. Methods: A multicentre comparative cross-sectional study included 237 second-, third-, and fourth-year nursing students from two public and two private institutions in Swat, Pakistan. Participants were recruited through convenience sampling and completed the 43-item Stress in Nursing Students questionnaire. Stress was classified as low, moderate, or severe. Data were analysed using descriptive statistics, Pearson’s chi-square tests, Cramér’s V, and unadjusted odds ratios with 95% confidence intervals. Results: Moderate academic, clinical, and social stress was reported by 62.0%, 59.9%, and 49.4% of participants, respectively. Severe stress was most frequent in the clinical domain (7.2%). Clinical stress differed by institutional sector (p=0.043), and public-sector students had higher odds of moderate or severe clinical stress than private-sector students (OR=1.83, 95% CI 1.06–3.17). Academic and social stress did not differ significantly by sector. Clinical stress varied by year of study (p=0.033), while academic and social stress were associated with gender (p=0.042 and p<0.001, respectively). Conclusion: Moderate stress was common across all domains, with the clearest institutional difference observed for clinical stress. Structured clinical preparation and student-support strategies are warranted, although adjusted and longitudinal studies are needed.