Clinical Stress and Sleep Disturbances as Determinants of Academic Achievement in Undergraduate Nursing Students

Abstract

Background: Nursing students in their undergraduate years often face academic and clinical challenges that can lead to psychological stress, sleep disturbances and poor academic performance. These factors can contribute to diminished students' well-being and learning.

Objective: To determine the association between clinical stress, sleep quality, and academic performance among undergraduate nursing students.

Methods: A cross-sectional analytical study was conducted at the Institute of Nursing & Institute of Allied Health Sciences, Wah Medical College, POF Hospital, Wah Cantt, Pakistan from July 2025 to January 2026. Non probability consecutive sampling was used to include 93 undergraduate nursing students. A variety of demographic, clinical stress, sleep quality, and academic performance data was gathered. Clinical stress level was defined as low, moderate or high and sleep quality was measured by the Pittsburgh Sleep Quality Index. Academic performance was measured by recent examination results or other academic records. The analysis of the data was performed in SPSS version 25.0. Where appropriate, chi square testing, correlation analysis and multiple linear regression were performed and the p value < 0.05 was considered as statistically significant.

Results: The mean age of participants was 21.42 ± 1.73 years. Moderate clinical stress was observed in 44 (47.3%) students, while 28 (30.1%) experienced high stress. Poor sleep quality was present in 58 (62.4%) participants. The proportion of poor sleep quality increased from 33.3% among students with low clinical stress to 59.1% among those with moderate stress and 89.3% among those with high stress. Clinical stress was positively correlated with poorer sleep quality (r = 0.52, p < 0.001) and negatively correlated with academic performance (r = -0.41, p < 0.001). Poorer sleep quality was also associated with lower academic performance (r = -0.38, p < 0.001).

Conclusion: Clinical stress and poor sleep quality were common among undergraduate nursing students and were significantly associated with lower academic performance. Strategies aimed at reducing clinical stress and improving sleep habits may support better educational outcomes and student well-being.