"When stress is the air we breathe": Contextual resilience sustains clinical excellence in nursing students amid chronic adversity - A cross-sectional study from war- and sanction-affected Southern Iran.

BACKGROUND

Dominant models assume chronic stress impairs clinical performance, yet students in crisis-endemic regions often maintain high standards despite persistent adversity. This raises a question: might stress become a normalized backdrop, enabling rather than eroding excellence?

OBJECTIVES

To examine the association between academic stress and clinical performance among nursing students in war-, sanction-, and dust storm-affected Abadan, Iran, and to interpret findings through the lens of contextual resilience.

METHODS

In a cross-sectional study (ethics code: IR.ABADANUMS.REC.1403.168), 177 nursing students completed the validated Student-Life Stress Inventory (SLSI; α = 0.78) and the 44-item Clinical Performance Questionnaire (α = 0.95). Hierarchical multiple regression controlled for demographic covariates.

RESULTS

Participants reported low-to-moderate stress (M = 105.41, SD = 4.89) and high clinical performance (M = 188.53, SD = 12.51). No significant correlation emerged between total stress and performance (r = -0.093, p = 0.220). In regression, stress remained non-significant (β = -0.072, p = 0.333), whereas marital status (β = 0.178, p = 0.022) and academic term (β = -0.170, p = 0.024) were significant predictors. The full model explained 10.5% of variance (adjusted R2 = 0.057).

CONCLUSION

In this cross-sectional sample, academic stress was not significantly associated with clinical performance, suggesting the operation of contextual resilience-a capacity where excellence is maintained within, rather than despite, chronic stressors. These findings challenge deficit models, urging resilience-focused training.