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When I told one of my mentors that I was preparing this module she sent me an e-mail encouraging us to stress the need for clinical instructors to be aware of "student fear...stark, mind-numbing, fear”. She says, "In my opinion, effective instructors orient and prepare students, step by step, for each stage of their clinical experience, and furthermore they are not in themselves, sources of fear and intimidation. Instead, they are sources of information, support, encouragement, and "presence". They help students prioritize, and focus on the task at hand and not become overwhelmed by the environment. As we know from Benner's research, expert clinicians are able to see the "whole picture", however, beginning instructors who are expert clinicians may not understand that beginning students cannot and should not yet be ready to see the "big picture". Beginners need to begin with smaller pieces and gradually assume responsibility for more and more."

In Shipton's (2002) article, "The process of seeking stress-care: coping as experienced by senior baccalaureate nursing students in response to appraised clinical stress" she included a large literature search on the topic of student stress and fear. She found many articles identifying instructors as the perceived cause of clinical stress by students, but few articles on how to fix the problem. She found six categories of appraised and stressful clinical person-environment relationships identified by students:

* Actions of the clinical faculty
* Actions of the nursing staff
* Actions of peers
* Implementing nursing procedures
* Preparing clinical assignments
* Encountering new clinical rotations.

She further broke down the actions of clinical faculty that students found most stressful:

* Clinical evaluations
* Waiting for the clinical instructor
* Incompetent behavior
* Moody behavior
* Being observed by the clinical instructors.

The article focuses on how students seek and find stress care, and regain managed self. Strategies students found and used include the usual coping mechanisms, such as "relaxation, venting, escaping, seeking support, and taking actions." Certainly, when faculty recognize unusual stress levels in a particular student it is advisable to refer the student to one of the college’s counseling services. Her article points out how important a thorough orientation is for students and questions the value of rotating students to many different clinical settings. Post-conference time should be used to provide some social support. She recommends:

* Develop stress-care interventions that focus on ameliorating the chaos created in students' lives while they try to manage appraised clinical stress.
* Formulate a realistic perspective that clinical stress cannot be eliminated and focus on interventions to facilitate students' appraisal process.
* Incorporate and implement stress management measures within nursing programs.
* Develop guidelines to insure consistency in the requirements for nursing care plans, medication cards, and other student assignments throughout the nursing curriculum.
* Implement a hands-on clinical procedures review for students at the beginning of all clinical courses.
* Orient students to all new clinical agencies and facilities.

She stresses that "if the nursing community does not show them how to care, support and nurture one another, they will never change the mind set that nursing devours its young. Ultimately, if nurse educators, administrators, and practitioners do not take the necessary helpful actions with nursing students and new graduates who are seeking stress-care, nursing as a profession will fail to thrive."

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