Stress, anxiety, and cortisol levels in nursing students during clinical practice: a scoping review

Introduction: Nursing students are confronted with clinical demands in clinical practice. Literature points that when compared to other higher education students the stress levels experienced are superior in nursing education. Objective: To map the evidence available on stress and cortisol levels in nursing students during clinical practice. Materials and Methods: A scoping review was performed and quantitative, qualitative, and mixed methods studies in full text, in English, Spanish or Portuguese, published between January 1, 2001 and October 31, 2022 were included. Search was carried out in EBSCOHost, PubMed, SciELO, Mednar, Web of Science, ScienceDirect and Scopus. Results: Sixty-three studies were identified (54 quantitative and 9 qualitative). Studies spanned all academic years, but there is no consensus between stress and the academic year. The main causes of stress were: stress from teachers and nursing staff, students’ assignments, workload, and stress related to patient care. There is a lack of studies on the relationship between stress and the cortisol levels. Conclusions: Stress management programs should be implemented during the nursing degree to prepare students for clinical practice. Monitoring of the relationship between biochemical and psychological elements may be useful to evaluate the program’s effectiveness.