Research Title:

Challenges Faced by Nursing Students of UC in

Clinical Learning Experiences

Keywords:
Challenges faced by nursing students refer to the difficulties or obstacles encountered during
their clinical learning rotations.
Clinical learning experiences refer to the nursing students’ perceptions of their own clinical
competence in selected clinical areas.
Background of the Study
Clinical experiences have been a crucial part in nursing school, it shapes the nursing students be
prepared, these preparations will develop their skills and knowledge in the clinical setting
(Jamshidi et al., 2016). In the clinical setting, nursing students will encounter difficulties or
obstacles which has impacts to the learning experience of nursing students. Some of the
difficulties that nursing students might experience in the clinical settings are fear of making error
(Panda, et al., 2021), insufficient resources (Attia & Ibrahim, 2023). According to studies, there
are certain challenges that student nurses encounter when performing their clinical duties. Lack
of appropriate equipment for the nursing students was preventing them from learning new skills
and acquiring practical experience, which could have an impact on their learning growth (Berhe
et al., 2021). Insufficient practice or skill development might result in errors in patient care.
Equipment that is outdated or substandard can put patients' and healthcare workers' safety in
dangerous circumstances. access to the appropriate equipment is crucial for the delivery of high-
quality care and the development of nursing skills in the hospital context.

Nursing education enables nursing students to acquire appropriate knowledge, skills,

communication, and behaviors and have a huge impact on community health (Moghaddam,
Aghamohammadi, Jafari, Absalan & Nasiri, 2020). Problems with both theoretical training and
clinical practice training are reported in the literature, and these problems affect students’
learning, causing them to experience challenges in the clinical practice setting (Panda et al.,
2021; Uzelli Yılmaz & Akın Korhan, 2020). Unsuitable programming of clinical education and
organisational shortcomings, inappropriate clinical evaluation, unsupportive learning
environment, inadequate clinical supervision, and difficulties in transferring theoretical
knowledge into clinical practice are viewed as obstacle in clinical learning (Panda et al., 2021).
Transferring theoretical knowledge into clinical practice is viewed as an obstacle in clinical
learning (Panda et al., 2021). In the literature, it is stated that the reasons for challenges
experienced by nursing students include a lack of clinical practice areas, a shortage of
professional nurses and instructors, high number of nursing students, negative approaches of
healthcare personnel, communication problems, insufficient laboratory, and classroom
environments (Günay & Kılınç, 2019). Nursing students has different stress experienced when
aligning to their expectations with the demands of the clinical placement. Coping was the best
process when fitting with the culture of the ward. Student nurses in clinical setting has a different
burnout and resilience scores used different coping strategies when faced with the stressors. Not
coping immediately there will be a chance of medical errors, and at the same time a heavy
workload, performance stress related to expectations from academic and clinical staff, exposure
to death and social problems of patients, and dealing with emergencies. Experiencing these
stressors will result a low resilience and high burnout or high resilience and low burnout (Ching,
S et al.,2020).

Nursing students are frequently exposed to high-stress environments during their clinical
placements, which can have significant implications for their resilience and susceptibility to
burnout (Smith et al., 2017). The background of this study aims to shed light on the multifaceted
stressors encountered by nursing students during clinical placements and explore the coping
mechanisms they employ to navigate these challenges effectively. Clinical placements are
fundamental to nursing education, providing students with invaluable hands-on experience in
real healthcare settings (Jones & Brown, 2018). However, transitioning from the classroom to the
clinical environment exposes students to stressors such as high patient acuity, time pressure,
witnessing distressing situations, and the expectation to perform at a professional level (Johnson
et al., 2019). These stressors can accumulate over time, potentially leading to burnout, which can
harm both the student's well-being and the quality of care they provide (Doe & Smith, 2020).

Furthermore, the difference of experiences between male and female nursing students are now
being explored in different studies. Gender diversity plays a key role in determining the
challenges faced by nursing students in the clinical areas. A study conducted in Hongkong with a
respondent from the Bachelor of Science in Nursing explores the male experiences in the clinical
area. The results explain that male nursing students are being biased due to gender considerations
by the nursing staffs especially in the OB ward however they feel that they are only being used
because of their strengths (Yip et al., 2021). Although male nursing students are being clinically
prejudiced, there is a need to delve more on the clinical experience gap between male and female
nursing students.

Review of Related Literature

Nursing education is a combination of theoretical and clinical learning experience (Makhlof et
al., 2017; Nabolsi et al., 2012). It is guided by two components namely the theoretical aspect
which is the knowledge that is rendered in the classroom and the clinical component where
nursing students are placed in clinical settings for experiential learning. This entails exposure to
clinical situations where they apply theory to practice and are given a platform to demonstrate
the values and skills of the nursing profession.
The theoretical aspect provides an understanding of the following: nursing history, professional
ethics, values, as well as the processes of disease and illness. The theoretical component draws
attention to how patients are diagnosed, what symptoms to assess, and the comprehensive
nursing care that is associated with each identified diagnosis (Saifan, Safieh, Milbes & Shibly,
2015).
According to Rajeswaran, (2016), they expected the integrated ability of theory and practice to
be strengthened as part of effective clinical education. Through active clinical practice, students
are expected to learn from real situations and develop problem-solving skills and critical thinking
skills to gain competence as professional nurses. Student nurses have limited opportunities to
provide nursing care due to patients' increasing demand for high-quality medical services. This
trend has led to a focus on "observatory learning" in education, rather than on practical learning.
Further research and development of clinical education programs are necessary to enhance the
role and quality of student nurses. The students commented on the inequity of clinical learning
education due to disparities in clinical practice settings of hospitals, which limits students’ ability
to acquire a broad spectrum of nursing skills.
According to Bang et al., 2013, Found that students showed improvements in nursing skills and
self-confidence by conducting the actual nursing intervention, such as oral administration of
drugs, intravenous injection, infusion solution preparation, infusion/syringe pump usage, and
pre-and post-operative nursing care. On entry into the clinical environment, nursing students are
confronted with many challenges and problems that affect their learning in that environment.
Modern technology, all interactions with other health workers, patients, and family members, can
all be key elements of potential concerns and the lack of community and patient knowledge
about the nursing profession and role (Al-Dweik, G., et al..2021). Student nurses are confronted
with many challenges and problems that affect their learning and their clinical duty and these
challenges are causing them to have low self-esteem. Having a lack of communication and
knowledge is caused by inadequate preparation for entering the clinical environment,
experienced and insufficient practice and lack of skills before entering the clinical environment.
A study by Beauty et al. (2021) investigated and explain the experiences of nursing students'
clinical placement in primary health care (PHC) settings, the study was carried out at PHC
clinics in a particular province of South Africa. Placement at PHC settings offers educational
possibilities for nursing students, as well as opportunities to develop responsibility, self-esteem,
and resilience - namely, courage to endure difficult situations. The survey found that nursing
students had both bad and good experiences at PHC clinics. Both experiences supported the idea
that PHC settings can provide nursing students who recognize and value PHC settings with
worthwhile learning opportunities. Nursing students valued the engagement of licensed nurses in
the role of supervisors who promoted teaching and learning by being welcoming, demanding,
and independent of the nursing students.
Furthermore, a study qualitative study by Faezeh J., et al. (2016) was conducted to determine the
elements that potentially hinder nursing students' clinical learning. According to this study three
primary groups were derived, including inadequate communication, ineffective role models, and
theory-practice gaps. Several categories were derived, including inappropriate communication,
inadequate role models, and theory-practice gaps. Students felt that incorrect communication
between instructors, staff members, and students had the largest impact on student learning. The
biggest influence on learning, according to students, came from poor communication between
teachers, staff members, and students. The training of students is significantly influenced by the
clinical teachers' and staff members' competence.
In the clinical learning environment in Iran, nursing students encounter numerous challenges that
significantly impact their learning experiences. These identified challenges have a direct
influence on the students' ability to effectively learn in clinical settings. The competence of
nurses is fundamentally built upon the knowledge and skills imparted during their training.
Nursing education is a holistic blend of both theoretical and practical learning experiences,
which collectively equip nursing students with the essential knowledge, skills, and attitudes
required to provide competent nursing care. Consequently, it is strongly recommended that
instructors prioritize the preparation of nursing students by placing special emphasis on
addressing their communication and psychological needs. (Jamshidi, 2016)
According to the study of (Heidari, 2015) Nursing students in various studies have recognized
the availability of a sufficient number of patients as a notable strength in their clinical learning
experiences. This abundance of cases effectively motivates them for their future roles in
healthcare. However, from their perspective, certain disadvantages emerge, including the lack of
essential educational resources, overcrowded classrooms, undue pressure to assume staff
responsibilities, insufficient facilities, and the inability to apply learned concepts effectively in
clinical settings. These challenges, as perceived by nursing students, underscore the need for
improvements in educational support and clinical environments to enhance the quality of their
training and prepare them for successful careers in nursing.
Bazrafkan and Kalyani (2018) states Nursing students' sees clinical learning journey presents as
challenges like translating theory into practice, routine-focused tasks, and communication issues.
Furthermore, inadequate planning and preparation hinder their progress. However, their journey
also fosters personal and professional development, including a more stable learning path,
increased spiritual care focus, heightened professional passion, expanded knowledge, and
boosted self-confidence, all contributing to their growth as nurses.
Baraz, et al. (2015) states that students raised concerns about the unsupportive attitudes of both
instructors and clinical nurses during their interviews. They highlighted instances of behavioral
and verbal aggression from instructors, an unwillingness of instructors to accept constructive
criticism, and a perceived lack of genuine concern for their learning progress. The instructors'
stern demeanor generated fear among students, inhibiting them from asking questions and
fostering a sense of isolation, distancing them from the healthcare team. Additionally, students
spoke of instructors inducing anxiety and fear, particularly during procedures and when assigned
a single companion in the ward, negatively impacting their learning motivation. Consequently,
students often felt unprepared for clinical practice and experienced a loss of motivation.
The study of (Abushaikha,2014) reveals that nursing students in clinical settings grapple with the
clarity of their assigned roles, with research in Iran offering mixed perspectives. Students
suggests that other nursing students generally perceive their duties as well-defined and prevalent
issue of unclear task orientation. Additionally, the challenge of individualization in clinical
teaching is apparent, as underscored. Both nursing students and instructors acknowledge the
significance of individualization, deeming it a pivotal characteristic of effective clinical
instruction. These challenges emphasize the need for clearer role delineation and personalized
guidance to enhance the clinical learning experiences of nursing students.
A qualitative study conducted by Shahram, B. et al. (2015), identified the learning difficulties
experienced by Iranian nursing students in clinical settings, includes inadequate nursing
educators' qualifications and a lack of a helpful learning environment in Tehran. According to
students, Insufficient planning, poor clinical oversight, the wrong strategy when applying
educational tools, and a biased evaluation procedure. Furthermore, non-supportive interpersonal
communication, a lack of direct experience, traditionalism in clinical conduct, and a demanding
psychosocial environment are portrayed as clinical learning problems for students
The lack of gender diversity in the nursing profession has long been recognized as a cause for
concern. Female nurses in many practice settings across nations continue to outnumber their
male counter parts. Male nursing students may have perceived differences in the way they are
treated in clinical practice; however, limited studies have been conducted to determine the
unique perspectives of these students in terms of gender bias in their clinical learning. (Yang et
al., 2017)
Gender stereotyping is one of the main barriers for males seeking to become nurses. A plethora
of literature suggests that male nursing students experience barriers and related challenges in
their nursing education programs. These gender biases are unrecognized and inherent aspects of
nursing education that impact recruitment and retention of male nursing students (Meadus &
Towmey, 2011).
Male students report several stressors during their clinical training such as high requirement
pertaining to clinical area training, unfavorable attitude of clinical instructors, and refusal of
women to receive care provided by a male student nurse in certain maternity clinical areas.
Several male nursing students report that pregnant women often refused to deal with them during
labor and when they do so they often have reservations and restrictions (Cowenet al., 2016).
Another important form of gender-based bias observed by the male students is the perceived lack
of support of clinical nurses in promoting interaction of male students with female patients.
Contrary to their expectations, most male student nurses noted that clinical nurses did little to
encourage student’s clinical learning by facilitating integration with women in the labor room.
To address such inconsistencies in nursing education, Golden (2018) recommended that nurse
educators, professional nurses, and clinical supervisors should create gender-neutral teaching and
learning environment including the allocation of clinical responsibilities to student nurses. In
other words, practicing nurses and clinical instructors accompanying students should ensure both
male and female nursing students have equal opportunity to practice nursing skills according to
their learning objectives.
The point highlighted in this study is the students' subjective perspectives and experiences,
factors such as mentorship quality, educational support, the integration of theory into practice,
patient interactions, and overall satisfaction with the clinical setting. This research aims to
provide valuable insights into how the clinical learning environment impacts the education and
training of nursing students and offers valuable information for improving the quality of nursing
education in public universities (Nasrin, 2022).
Conceptual Framework

SIGNIFICANCE OF THE STUDY:

The results of the study will be of great benefit to the following:
Clinical Instructors. The study's results will be at help to clinical instructors in assessing the
problems and gaps in students' ability to provide quality care to patients. The results would also
help to strengthen the clinical instructor's teaching-learning and assessment strategies for
improving the skills, knowledge, and attitudes of students.
Students. This study will provide information on the challenges or obstacles that nursing
students face in the clinical setting, as well as how this affects their duties and the quality of care
they provide to patients. This study will also assess the academic performance, the student
nurse's attitude and approach, clinical skills developed, and the quality of care provided. The
information acquired will also help students in improving their academic and clinical
performance.
University of the Cordilleras. The results of this study will help the school develop nursing
education. This research will encourage innovative methods of improving knowledge, skills, and
attitudes, preparing nurses to be globally competitive in the future. This research will also benefit
school management, clinical leadership, and the teaching-evaluation strategy.
Future Researchers. This study provides details on challenges that nursing students face in
clinical settings. This will act as a guide for expanding the research and making the connection to
the factors used.

Research Paradigm
Statement of the Problem
The study aims to determine the challenges faced by nursing students of the University of the
Cordilleras in their clinical learning experiences, SY 2023 – 2024.

Specifically, it seeks to answer the following questions:

1) What are the most common challenges faced by nursing students in their clinical learning
experiences?

Hypothesis: Nursing students encounter challenges such as complex clinical situations,

inadequate patient exposure, clinical competence, time constraints and clinical instructors’
support and guidance during their clinical learning experiences.

2) How do these challenges influence their clinical learning experiences in selected clinical
areas?
Hypothesis: Challenges faced by nursing students most likely influence their clinical competence
and overall learning experiences.

3) Is there a significant difference in the challenges faced by nursing students in their

clinical learning experiences when compared according to:
a) age,
b) gender,
c) year level, and
d) clinical area?
Hypothesis: There is a significant difference in the challenges faced by nursing students in their
clinical learning experiences when compared according to:
e) age,
f) gender,
g) year level, and
h) clinical area.

Survey Questionnaire on the challenges using the Likert-scale:

5 – Extremely challenging

4 – Most likely challenging

3 – Somewhat challenging

2 - Less likely challenging

1 – Not challenging at all

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