Influence of a b-learning model to improve perceived stressors in final-year nursing students during clinical placements: a quasi-experimental study

Identifier:  imarina:9470252

Handle: https://hdl.handle.net/20.500.11797/imarina9470252

Authors:  Reverte-Villarroya, Silvia; Gil-Mateu, Elsa; Fernandez-Saez, Jose; Martorell-Poveda, Maria-Antonia; Raventos-Torner, Rosa; Barcelo-Prats, Josep

Abstract:
Background Clinical placements are essential for nursing students' competence development but represent one of the most stressful components of their training. High levels of perceived stress may hinder learning, undermine confidence, and negatively affect clinical performance. Evidence on pedagogical strategies to mitigate these stressors remains inconsistent, and the potential of blended-learning models during placements is not well established. This study evaluated the effect of a tutored blended-learning model (i-MHA) on perceived stressors among final-year nursing students. Methods A prospective quasi-experimental pre-post study with a control group was conducted across three campuses of the Rovira i Virgili University (Spain) during the 2021-2022 academic year. The intervention group received a structured blended-learning model incorporating moderated online forums, guided reflection, and weekly tutor-led supervision. The control group followed the traditional supervision approach. Perceived stress was assessed before and after placements using the Kezkak questionnaire. Between-group differences were analysed using the Mann-Whitney U test, and within-group changes using the Wilcoxon test. Effect sizes (Cohen's d) and attrition analyses were performed to validate internal consistency. Results A total of 126 students participated (86.89% women; mean age 23.64 years). No significant baseline differences were found between groups across any Kezkak dimensions. After the intervention, the only significant between-group difference emerged in Factor 3 (Relationship with tutors and peers), with lower stress scores in the intervention group (p = 0.030). In the paired intragroup analysis (n = 61), the intervention group showed a significant improvement in the same dimension (p = 0.032), while no significant changes were detected in the control group. No sex-related differences emerged, and baseline comparisons between paired and unpaired participants indicated no systematic attrition bias. Conclusions The tutored b-learning model improved students' perceived relationship with tutors and peers during clinical placements, reducing stress associated with supervisory interactions. Although other stress dimensions did not change, the model strengthened communication and academic support, offering a promising strategy to enhance student well-being and learning during clinical practice. Further research with larger and diverse samples is warranted to explore its long-term impact on academic performance, psychological well-being, and transition to professional practice. Clinical trial number Not applicable.