In the qualitative phase, the NSPCSS (Nursing Students’ Perceptions of Clinical Stressors Scale) items were generated using the data from interviews with 19 nursing students and a literature review. Accordingly, in-depth semi-structured interviews were held for freshman to senior nursing students who were selected purposively from 4 nursing schools in southeast of Iran.

The students who successfully completed at least 1 clinical course were included in the study. The participants were recruited with maximum demographic variation in terms of age, gender, academic year, and grade point average. The interviews were held at the participants’ school or dormitory. During interviews, the students were asked to describe their experience of clinical stressors. Each interview started with a open and broad question (Please describe your experience of stressors in clinical setting.). Exploratory questions were asked whenever necessary (Can you explain more? Can you give an example?). Each interview was ended with the following question: Was there a question that I should have asked but did not? The length of each interview was 60–90 min.

To review the literature, Google Scholar, PubMed, ScienceDirect, Scopus, SID, and Magiran were searched using the following keywords: “clinical stress”, “clinical stressors”, “nursing student”, “stress-inducing factors”, “stressor”, “clinical training”, “clinical environment”, and “clinical setting.” The review process was done on peer-reviewed articles published in the last 10 years. The retrieved articles were assessed for complementing the data collected in the qualitative phase (Fig. 1).

PRISMA flowchart

Using the data from the interviews and the literature review, an item pool was generated. None of the items had negative wording. The items were scored on a 5-point Likert scale of 1 (not important at all) to 5 (completely important).