Development and Pilot Evaluation of “NurseStrong”: A Progressive Web App for Stress Management in Nursing Students
Aim and Research Question(s)
This study aimed to design, develop, and evaluate a Progressive Web App (PWA) giving Austrian nursing students accessible stress-management support. It asked what stressors and support gaps these students report and what they want from a digital tool (RQ1), how stress-management techniques and design features should be combined into a usable app (RQ2), and how students rate its usability, accessibility, and usefulness after using it (RQ3).
Background
Nursing students face high, simultaneous demands: theoretical coursework, clinical placements, and emotional exposure to patient suffering, all at once. This puts them at high risk of stress and burnout, which contributes to dropout at a time of growing workforce shortages. Digital tools could deliver that support on students' own schedules, but most apps are built for general users, not for the specific demands nursing students face.
Methods
The study used a three-phase, mixed-methods design with the same 10 nursing students from four Austrian institutions throughout. In Phase 1, semi-structured interviews identified stressors, coping habits, and feature preferences. These findings guided Phase 2, the build of NurseStrong with four modules (breathing, affirmations, grounding, self-care) running with no login and offline. Phase 3 was a 28-day pilot measuring stress (PSS-10), usability (SUS), and written feedback.
Results and Discussion
Over the 28-day period, adherence reached 74.3% and all participants completed the study. Perceived stress fell by a mean of 3.4 points, from 25.5 to 22.1; t(9) = 9.16, p < .001, dz = 2.90. Usability was rated "Good," with a mean SUS score of 77.5 (range 67.5–87.5), and 90% of participants rated the app Good or Excellent. Without a control group, these numbers cannot show that the app caused the change in stress and a sample this small (n=10) is easily swayed by a few individuals, so the large effect size should be read with caution. What the study does show is more modest: students kept using the app and rated it as easy to work with, early signs that the approach is worth testing in a larger, controlled study.
Conclusion
NurseStrong, a simple web app built around what nursing students said they needed, was well accepted and adds evidence from an underrepresented Austrian group. As an early-stage pilot, it shows the approach is feasible but not yet effective, that would need a larger controlled trial with longer follow-up
References
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