Factors influencing perceived stress and anxiety reported by physiotherapy students during clinical placements – qualitative data

Kathy Stiller1, Deborah Gallasch2, Amy Conlon-Leard3, Michelle Hardy4, Anna Phillips5, Gisela Van Kessel5

1Central Adelaide Local Health Network, Adelaide, Australia, 2Royal Adelaide Hospital, Adelaide, Australia, 3The Queen Elizabeth Hospital, Adelaide, Australia, 4Hampstead Rehabilitation Centre, Adelaide, Australia, 5University of South Australia, Adelaide, Australia

Background: Clinical placements can be stressful for physiotherapy students as they are often the first exposure to ‘real’ patients. Although some stress can aid effective learning, it can negatively affect learning, academic performance and well-being if excessive. Anecdotally, our students have demonstrated higher levels of stress and anxiety compared to previous years, often struggling with clinical placements. This qualitative study sought students’ opinions regarding factors influencing their stress/anxiety, coping strategies and whether stress/anxiety affected their performance during clinical placements.

Methods: Data were collected from March – December 2018. University of South Australia physiotherapy students undertaking their clinical placements (i.e. acute care, rehabilitation or primary/ambulatory care) at any Central Adelaide Local Health Network site in 2018 were eligible for participation. Perceived levels of stress and anxiety were measured using visual analogue scales. Qualitative data included participants’ opinions on placement and personal factors influencing their stress/anxiety, coping strategies and the impact of stress/anxiety on their placement performance. These data were analysed thematically.

Results: Data were obtained from 159 of 175 (91%) clinical placements (85 [54%] females; mean [SD] age 24 [5] years; 137 [86%] undergraduates). Levels of stress and anxiety were highly variable between participants. Placement factors influencing stress/anxiety levels included patient-related factors, assessments, the amount and quality of support from clinical educators and peer support. Personal factors such as health, family and external commitments also influenced stress and anxiety. The majority felt their clinical placement performance was adversely affected by their levels of stress and anxiety. Coping strategies included, most frequently, support from family and friends, exercise and taking breaks.

Discussion: High levels of stress and anxiety during clinical placements were evident for some students, with stress/anxiety affected by various placement and personal factors. Strategies to better identify those at risk of excessive stress and anxiety and improve coping mechanisms are required.


Kathy Stiller is allied health research coordinator for the Central Adelaide Local Health Network. She worked as a senior physiotherapist in ICU at the RAH for over 20 years.

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