Document Type : Original Article
Authors
Abstract
Background: Clinical learning environment is a complex social entity. This environment is
effective on the learning process of nursing students in the clinical area. However, learning
in clinical environment has several benefits, but it can be challenging, unpredictable,
stressful, and constantly changing. In attention to clinical experiences and factors
contributing to the learning of these experiences can waste a great deal of time and
energy, impose heavy financial burden on educational systems, cause mental, familial and
educational problems for students, and compromise the quality of patient care. Therefore,
this study was carried out with the goal of determining the learning challenges of nursing
students in clinical environments in Iran. Materials and Methods: In this qualitative study
carried out in 2012–2013, 18 undergraduate nursing students were selected by using
purposive sampling method from the Faculty of Nursing and Midwifery of Tehran and
Shahid Beheshti Universities. Semi‑structured interviews were used to collect data. The
content analysis method was used to determine relevant themes. Results: Two themes
were derived from the data analysis, which represented the students’ clinical learning
challenges. These two themes included insufficient qualification of nursing instructors
and unsupportive learning environment. Conclusions: Identification of the students’
clinical learning challenges and actions to remove or modify them will create more
learning opportunities for the students, improve the achievement of educational goals,
provide training to nursing students with the needed competencies to meet the complex
demands of caring and for application of theories in practice, and improve the quality
of healthcare services.
Keywords
1. Tiwari A, Lam D, Yuen KH, Chan R, Fung T, Chan S. Student learning
in clinical nursing education: Perceptions of the relationship between
assessment and learning. Nurse Educ Today 2005;25:299‑308.
2. Cheraghi MA, Salasli M, Ahmadi F. Factors influencing the clinical
preparation of BS nursing student interns in Iran. Int J Nurs Pract
2008;14:26‑33.
3. Killam LA, Heerschap C. Challenges to student learning in the
clinical setting: A qualitative descriptive study. Nurse Educ Today
2013;33:684‑91.
4. Chan DSK, Ip WY. Perception of hospital learning environment:
A survey of Hong kong nursing students. Nurse Educ Today
2007;27:677‑84.
5. Papp I, Markkanen M, Bonsdorff M. Clinical environment as a
learning environment: Student nurses’ perceptions concerning
clinical learning experiences. Nurse Educ Today 2003;23:262‑8.
6. Algoso M, Peters K. The experiences of undergraduate assistants
in nursing (AIN). Nurse Educ Today 2012;32:192‑202.
7. Najimi A, Sharifirad G, Amini MM, Meftagh SD. Academic failure
and students’ viewpoint: The influence of individual, internal and
external organizational factors. J Educ Health Promot 2013;2:1‑4.
8. Henderson A, Winch S, Grugan C, Henney R, McCoy R. Working
from the inside’: An infrastructure for the continuing development of
nurses’ professional clinical practice. J Nurs Manag 2005;13:106‑10.
9. Henderson A, Twentyman M, Heel A, Lloyd B. Students perception
of the psycho‑social clinical learning environment: An evaluation
of placement models. Nurse Educ Today 2006;26:564‑71.
10. Chan D. Development of the clinical learning environment inventory:
Using the theoretical framework of learning environment studies to
assess nursing students’ perceptions of the hospital as a learning
environment. J Nurs Educ 2002;41:69‑75.
11. Lewin D. Clinical learning environments for student nurses:
Key indices from two studies compared over a 25 year period.
Nurse Educ Pract 2007;7:238‑46.
12. Chan D. Development of an innovative tool to assess hospital
learning environments. Nurse Educ Today 2001;21:624‑31.
13. Rahmani A, Zamanzadeh V, Abdul‑zadeh F, Lotfi M, Bani S,
Hassanpour S. Clinical learning environment in viewpoints of
nursing students in Tabriz University of Medical Sciences. Iran J
Nurs Midwifery Res 2011;16:253‑6.14. Anthony M, Yastik J. Nursing students experienceswith incivility in
clinical education. J Nurs Educ 2011;50:140‑4.
15. Sharif F, Masoumi S. A qualitative study of nursing student
experiences of clinical practice. BMC Nurs 2005;4:1‑7.
16. Pearcey PA, Elliot BE. Student impressions of clinical nursing. Nurse
Educ Today 2004;24:382‑7.
17. Dehghan Nayeri N, Nazari AA, Salsali M. Iranian staff nurses’ views
of their productivity and human resource factors improving and
impeding it: A qualitative study. Hum Resour Health 2005;3:9.
18. Adib Hagbaghery M, Salasli M, Ahmadi F. A qualitative study of
Iranian nurses’ understanding and experiences of professional
power. Hum Resour Health 2004;2:1‑14.
19. Salehi S, Taleghani F, Afghari P, Moghadasi MH. Investigating the
efficiency of nursing education program from the perspective of
graduate students of nursing and midwifery. Iran J Nurs Midwifery
Res 2012;17:284‑9.
20. Cheraghi MA, Salsali M, Ahmadi F. Iranian nurses’ perceptions of
theoretical knowledge transfer into clinical practice: A grounded
theory approach. Nurs Health Sci 2007;9:212‑20.
21. Halter MJ, Kleiner C, Hess RF. The experience of nursing students
in online doctoral program in nursing: A phenomenological study.
Int J Nurs Stud 2006;43:99‑105.
22. Munhall LP. Aqualitative perspective. 4th ed. Sudbury, Massachusetts:
Jones and Bartlett; 2007.
23. Streubert HJ, Carpenter DR. Qualitative Research in Nursing:
Advancing the Humanistic Imperative. 5th ed. Philadelphia, Pa:
Wolters Kluwer Health/Lippincott Williams and Wilkins; 2011.
24. Strauss A, Corbin J. Basics of Qualitative Research: Grounded
Theory Procedures and Techniques. Newbury. Park, CA.: Sage
Publications; 1998.
25. Green J, Thorogood N. Qualitative methods for health research.
1st ed. London: SAGE Publications; 2004.
26. Morse JM, Field PA. Nursing Research: The application of qualitative
approaches. Cheltenham, UK: Nelson Thornes; 1995.
27. Gbrich C. Qualitative data analysis: An introduction. 1st ed. London:
SAGE Publications; 2007.
28. Tabari Khomeiran R, Yekta ZP, Kiger AM, Ahmadi F. Professional
competence: Factors described by nurses as influencing their
development. Int Nurs Rev 2006;53:66‑72.
29. Griscti O, Jacono B, Jacono J. The nurse educator’s clinical role.
J Adv Nurs 2005;50:84‑92.
30. Edwards H, Smith S, Courtney M, Finlayson K, Chapman H.
Impact of clinical placement location on nursing students
competence and preparedness for practice. Nurse Educ Today
2004;24:148‑55.
31. Randle J. The effect of a 3 year pre‑registration course on
students’self‑esteem. J Clin Nurs 2001;10:293‑300.
32. Andrews GJ, Brodie DA, Andrew JP, Hillan E, Thomas BG,
Wong J, et al. Professional roles and communications in clinical
placements: A qualitative study of nursing students’ perceptions
and some models for practice. Int J Nurs Stud 2006;43:861‑74.
33. Jonsén E, Melender HL, Hilli Y. Finnish and Swedish nursing
students’ experiences of their first clinical practice placement ‑ A
qualitative study. Nurse Educ Today 2013;33:297‑302.
34. Loffmark A, Wikblad K. Facilitating and obstructing factors for
development of learning in clinical practice: A student perspective.
J Adv Nurs 2001;34:43‑50.
35. Cheraghi MA, Salsali M, Safari M. Ambiguity in knowledge
transfer: The role of theory‑practice gap. Iran J Nurs Midwifery Res
2010;15:155‑66.
36. Bourbonnais FF, Langford S, Giannantonio L. Development of
a clinical evaluation tool for baccalaureate nursing students.
Nurse Educ Pract 2008;8:62‑71.
37. Walsh T, Jairath N, Paterson MA, Grandjean C. Quality and
safety education for nurses clinical evaluation tool. J Nurs Educ
2010;49:517‑22.
38. Wass V, McGibbon D, Van der Vleuten C. Composite Undergraduate
Clinical Examinations: How Should the Components be Combined
to Maximize Reliability? Med Educ 2001;35:326‑30.
39. Allan HT, Smith PA, Lorenzon M. Leadership for learning: Literature
study of leadership for learning in clinical practice. J Nurs Manag
2008;16:545‑55.
40. Prato DD, Bankert E, Grust P, J J. Transforming nursing education:
A review of stressors and strategies that support students’
professional socialization. Adv Med Educ Pract 2011;2:109‑16.
41. Salminen L, Minna S, Sanna K, Jouko K, Helena LK. The competence
and the cooperation of nurse educators. Nurse Educ Today
2013;33:1376‑81.
42. Melincavage SM. Student nurses’ experiences of anxiety in the
clinical setting. Nurse Educ Today 2011;31:785‑9.
43. Gidman J, McIntosh A, Melling K, Smith D. Student perceptions of
support in practice. Nurse Educ Pract 2011;11:351‑5.
44. Killam LA, Mossey S, Montgomery P, Timmermans KE. First year
nursing students’ viewpoints about compromised clinical safety.
Nurse Educ Today 2013;33:475‑80.
45. Lofmark A, Wikblad K. Issues and innovations in nursing education:
Facilitating and obstructing factors for development of learning in
clinical practice: A student perspective. J Adv Nurs 2001;3:43‑50.
46. Thorkildsen K, Råholm MB. The essence of professional competence
experienced by Norwegian nurse students: A phenomenological
study. Nurse Educ Pract 2010;10:183‑8.
in clinical nursing education: Perceptions of the relationship between
assessment and learning. Nurse Educ Today 2005;25:299‑308.
2. Cheraghi MA, Salasli M, Ahmadi F. Factors influencing the clinical
preparation of BS nursing student interns in Iran. Int J Nurs Pract
2008;14:26‑33.
3. Killam LA, Heerschap C. Challenges to student learning in the
clinical setting: A qualitative descriptive study. Nurse Educ Today
2013;33:684‑91.
4. Chan DSK, Ip WY. Perception of hospital learning environment:
A survey of Hong kong nursing students. Nurse Educ Today
2007;27:677‑84.
5. Papp I, Markkanen M, Bonsdorff M. Clinical environment as a
learning environment: Student nurses’ perceptions concerning
clinical learning experiences. Nurse Educ Today 2003;23:262‑8.
6. Algoso M, Peters K. The experiences of undergraduate assistants
in nursing (AIN). Nurse Educ Today 2012;32:192‑202.
7. Najimi A, Sharifirad G, Amini MM, Meftagh SD. Academic failure
and students’ viewpoint: The influence of individual, internal and
external organizational factors. J Educ Health Promot 2013;2:1‑4.
8. Henderson A, Winch S, Grugan C, Henney R, McCoy R. Working
from the inside’: An infrastructure for the continuing development of
nurses’ professional clinical practice. J Nurs Manag 2005;13:106‑10.
9. Henderson A, Twentyman M, Heel A, Lloyd B. Students perception
of the psycho‑social clinical learning environment: An evaluation
of placement models. Nurse Educ Today 2006;26:564‑71.
10. Chan D. Development of the clinical learning environment inventory:
Using the theoretical framework of learning environment studies to
assess nursing students’ perceptions of the hospital as a learning
environment. J Nurs Educ 2002;41:69‑75.
11. Lewin D. Clinical learning environments for student nurses:
Key indices from two studies compared over a 25 year period.
Nurse Educ Pract 2007;7:238‑46.
12. Chan D. Development of an innovative tool to assess hospital
learning environments. Nurse Educ Today 2001;21:624‑31.
13. Rahmani A, Zamanzadeh V, Abdul‑zadeh F, Lotfi M, Bani S,
Hassanpour S. Clinical learning environment in viewpoints of
nursing students in Tabriz University of Medical Sciences. Iran J
Nurs Midwifery Res 2011;16:253‑6.14. Anthony M, Yastik J. Nursing students experienceswith incivility in
clinical education. J Nurs Educ 2011;50:140‑4.
15. Sharif F, Masoumi S. A qualitative study of nursing student
experiences of clinical practice. BMC Nurs 2005;4:1‑7.
16. Pearcey PA, Elliot BE. Student impressions of clinical nursing. Nurse
Educ Today 2004;24:382‑7.
17. Dehghan Nayeri N, Nazari AA, Salsali M. Iranian staff nurses’ views
of their productivity and human resource factors improving and
impeding it: A qualitative study. Hum Resour Health 2005;3:9.
18. Adib Hagbaghery M, Salasli M, Ahmadi F. A qualitative study of
Iranian nurses’ understanding and experiences of professional
power. Hum Resour Health 2004;2:1‑14.
19. Salehi S, Taleghani F, Afghari P, Moghadasi MH. Investigating the
efficiency of nursing education program from the perspective of
graduate students of nursing and midwifery. Iran J Nurs Midwifery
Res 2012;17:284‑9.
20. Cheraghi MA, Salsali M, Ahmadi F. Iranian nurses’ perceptions of
theoretical knowledge transfer into clinical practice: A grounded
theory approach. Nurs Health Sci 2007;9:212‑20.
21. Halter MJ, Kleiner C, Hess RF. The experience of nursing students
in online doctoral program in nursing: A phenomenological study.
Int J Nurs Stud 2006;43:99‑105.
22. Munhall LP. Aqualitative perspective. 4th ed. Sudbury, Massachusetts:
Jones and Bartlett; 2007.
23. Streubert HJ, Carpenter DR. Qualitative Research in Nursing:
Advancing the Humanistic Imperative. 5th ed. Philadelphia, Pa:
Wolters Kluwer Health/Lippincott Williams and Wilkins; 2011.
24. Strauss A, Corbin J. Basics of Qualitative Research: Grounded
Theory Procedures and Techniques. Newbury. Park, CA.: Sage
Publications; 1998.
25. Green J, Thorogood N. Qualitative methods for health research.
1st ed. London: SAGE Publications; 2004.
26. Morse JM, Field PA. Nursing Research: The application of qualitative
approaches. Cheltenham, UK: Nelson Thornes; 1995.
27. Gbrich C. Qualitative data analysis: An introduction. 1st ed. London:
SAGE Publications; 2007.
28. Tabari Khomeiran R, Yekta ZP, Kiger AM, Ahmadi F. Professional
competence: Factors described by nurses as influencing their
development. Int Nurs Rev 2006;53:66‑72.
29. Griscti O, Jacono B, Jacono J. The nurse educator’s clinical role.
J Adv Nurs 2005;50:84‑92.
30. Edwards H, Smith S, Courtney M, Finlayson K, Chapman H.
Impact of clinical placement location on nursing students
competence and preparedness for practice. Nurse Educ Today
2004;24:148‑55.
31. Randle J. The effect of a 3 year pre‑registration course on
students’self‑esteem. J Clin Nurs 2001;10:293‑300.
32. Andrews GJ, Brodie DA, Andrew JP, Hillan E, Thomas BG,
Wong J, et al. Professional roles and communications in clinical
placements: A qualitative study of nursing students’ perceptions
and some models for practice. Int J Nurs Stud 2006;43:861‑74.
33. Jonsén E, Melender HL, Hilli Y. Finnish and Swedish nursing
students’ experiences of their first clinical practice placement ‑ A
qualitative study. Nurse Educ Today 2013;33:297‑302.
34. Loffmark A, Wikblad K. Facilitating and obstructing factors for
development of learning in clinical practice: A student perspective.
J Adv Nurs 2001;34:43‑50.
35. Cheraghi MA, Salsali M, Safari M. Ambiguity in knowledge
transfer: The role of theory‑practice gap. Iran J Nurs Midwifery Res
2010;15:155‑66.
36. Bourbonnais FF, Langford S, Giannantonio L. Development of
a clinical evaluation tool for baccalaureate nursing students.
Nurse Educ Pract 2008;8:62‑71.
37. Walsh T, Jairath N, Paterson MA, Grandjean C. Quality and
safety education for nurses clinical evaluation tool. J Nurs Educ
2010;49:517‑22.
38. Wass V, McGibbon D, Van der Vleuten C. Composite Undergraduate
Clinical Examinations: How Should the Components be Combined
to Maximize Reliability? Med Educ 2001;35:326‑30.
39. Allan HT, Smith PA, Lorenzon M. Leadership for learning: Literature
study of leadership for learning in clinical practice. J Nurs Manag
2008;16:545‑55.
40. Prato DD, Bankert E, Grust P, J J. Transforming nursing education:
A review of stressors and strategies that support students’
professional socialization. Adv Med Educ Pract 2011;2:109‑16.
41. Salminen L, Minna S, Sanna K, Jouko K, Helena LK. The competence
and the cooperation of nurse educators. Nurse Educ Today
2013;33:1376‑81.
42. Melincavage SM. Student nurses’ experiences of anxiety in the
clinical setting. Nurse Educ Today 2011;31:785‑9.
43. Gidman J, McIntosh A, Melling K, Smith D. Student perceptions of
support in practice. Nurse Educ Pract 2011;11:351‑5.
44. Killam LA, Mossey S, Montgomery P, Timmermans KE. First year
nursing students’ viewpoints about compromised clinical safety.
Nurse Educ Today 2013;33:475‑80.
45. Lofmark A, Wikblad K. Issues and innovations in nursing education:
Facilitating and obstructing factors for development of learning in
clinical practice: A student perspective. J Adv Nurs 2001;3:43‑50.
46. Thorkildsen K, Råholm MB. The essence of professional competence
experienced by Norwegian nurse students: A phenomenological
study. Nurse Educ Pract 2010;10:183‑8.
)