J Korean Acad Soc Nurs Educ Search


The Journal of Korean Academic Society of Nursing Education 2004;10(1):54-63.
Published online December 31, 2004.
The Perceived Causal Structure Model on Stress Experienced by Nursing Students during Clinical Practice
Park, Mi-Young;
Hyechon College
간호학생의 임상실습스트레스에 관한 인지적 인과구조모형
혜천대학 간호과
The purpose of this study is to identify the factors that influence stress experienced by nursing students and to provide a perceived causal structure model among these variables. The ultimate goal of this study is to develop efficient guidance to clinical nursing education in this population. This study intends to apply perceived causal structure: network analysis method which was developed by Kelly(1983), and has been applied in nursing research. This method is selected to show dynamic relationship of stressor using network method. Data was collected from convenient sample of 186 junior college nursing students who had the clinical practice experience during 10 weeks. Data collection and analysis was conducted in 2 steps from December, 9, 2002 to February, 8, 2003. Step 1.: Data was collected using literature review(10 articles) to identify the causes of stress. Nine causes of stress were extracted. Step 2.: As perceived casual structure network study, data was collected using questionnaires which included 9 extracted cause and stress. The questionnaire contained a 10 X 10 grid table with 10 causes and effects printed. In network analysis, 'Yes' was scored as 1, 'No' was scored as 0, and the mean(maximum 1, minimum 0) was calculated. Construction of the network under inductive eliminative analysis which stopped the construction of the network when the consensual agreement level dropped near 50% was proceeded by adding causes in order of the mean rating level. In this study, construction of the final network was stopped by consensual agreement level of 52% of the total subjects. The results are summarized as follows : Step 1: Investigation of the causes of stress ; The extracted causes of stress from quality data was identified 9 categories ; negative nurse, lack of clinical practice opportunity, ambiguous role, negative patient, lack of nursing knowledge and skill, difficult of personal relations, inefficient clinical practice guidance, gap of theory and practice, lack of support. Step 2 : Construction of the perceived causal structure model ; 1) The most central cause of stress is ambiguous role in the systems of causation. 2) The distal cause of stress is inefficient clinical practice guidance 3) The causes that have a number of outgoing link are negative nurse, ambiguous role. 4) The causes that have a number of incoming link are ambiguous role, gap of theory- practice, lack of clinical practice opportunity, lack of nursing knowledge- skill. 5) There is a mutual relationship between stress and difficult of personal relations, stress and ambiguous role, ambiguous role and negative nurse, ambiguous role and lack of clinical practice opportunity, ambiguous role and lack of nursing knowledge-skill, lack of nursing knowledge-skill and gap of theory- practice. In conclusion, the network suggests that the first centre cause is related on ambiguous role and the second on negative nurse, inefficient clinical practice guidance in the systems of causation
Key Words: Nursing students, Clinical stress, Perceived causal structure model

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