A Qualitative Study of Nursing Student Experiences of Clinical Practice

Research problem and purpose

Clinical practice is a fundamental component of nursing education and the nervousness felt by students is confirmed by this qualitative study of nursing clinical experiences. Additionally, the divided roles of nursing clinical preceptors as evaluators and teachers enhance the anxiety felt by nurses in clinical training this study shows.  As student nurses prepare to become professional nurses, the clinical experience has been reported to be the most anxiety-inducing portion of their training. The impact of this anxiety is relevant to nursing practice as their competency, professionalism, and attitude of the clinical nurse is developed in this critical time and honed over years in the profession. It is at this initial point where professional identity is established and therefore ultimately directly affects patient outcomes and nursing competence. Therefore, the anxiety of nurses in going into clinical training is worthy of academic inquiry as it affects nursing practice and affects patient outcomes. Sharif and Masoumi study the psychological effect of clinical education on nursing students to identify specifically what prompts anxiety in nursing students and whether that has an impact on patient outcomes or whether the method of nursing training should be changed to accommodate for these factors. This will also assist in nursing remediation. This question is explored using qualitative measures confirming conclusions from previous research.  

Research objective

Addressing the research problem of anxiety in student nurses during clinical rotation, Sharif and Mosoumi examine qualitatively the experiences of 90 BSN candidates to identify the most stressful moments of their nursing education. The research question is to review survey data to identify consistencies in response. Like all qualitative research, the question is presented, and the results evaluated. This differs from quantitative theory where the study is designed to prove a hypothesis. Evaluation of the qualitative data may enhance understanding of a phenomenon.

As an example of qualitative research design, the relevance of the study to nursing practice was stated as, “Awareness of the existence of stress in nursing students by nurse educators and responding to it will help to diminish student nurses experience of stress” (Sharif Masoumi, 2005, 1). This follows from the notion that a less stressful teaching environment is a better teaching environment. However, this notion was inferred and not questioned for purposes of this study. 

Frame of reference qualitative method

Sharif and Masoumi concluded that most nursing students were unsatisfied by their clinical experiences because of the anxiety generated from the stress of the clinical training component. Four areas were identified as most stressing to nursing students including, “Point of view”, “initial clinical anxiety”, “theory-practice gap”, “clinical supervision”, and “professional role”. These points were identified by a qualitative survey of randomly selected nursing students. The study design randomly selected 90 students from a potential data pool of 200. This design duplicated similar research on the topic using a focus group design (Sharif Mousimi, 2005, 2). Following each focus group, a debriefing occurred where survey data was collected. Transcripts of the focus groups were augmented with nonverbal observations confirming stated responses to the survey question. Three levels of coding were used for sorting responses; meaning unit, categories, and themes.  

All students in the study identified a theory-practice gap with reported stress when conflicting instruction comes from what they have learned in the classroom and their clinical preceptors. This study duplicated similar findings elsewhere and cited here. Another consistent response from this study showed that the students felt that their clinical faculty had more of an evaluative role than a teaching role. Head nurses and managers had divided time where they needed to attend to their nursing duties and incorporate teaching. This particular aspect of clinical training could be helped by identifying preceptor nurses that were also interested in teaching and exhibited the personal and professional skills to teach, evaluate, and practice well.

Literature review

This study showed that previously identified stressors for nursing students continue suggesting that changes have not been made to address the research problem. In their literature review, the authors of this study made 42 citations, six of which were less than five years old from the date this study was published. All citations appear to be topically relevant to the questions of anxiety in clinical nursing experiences during training and the bulk are qualitative in nature. This is permissible as the question has been researched before and this study further showed that the same problem continues. There was not a discussion of whether a quantitative approach to the research question would affect the outcomes of this research. 

As students in the clinical setting, the student is at an inherent disadvantage because they do not have the practical experience of the clinical nurses. It's important that this not deter the student as there is a significant nursing shortage in America. However, they will never gain this competence without clinical exposure. It is during the clinical encounters that “professionalization” occurs, where students are exposed to practicing nurses and emulate their professional identity. Simulated encounters were not discussed in this study as a remedy for improving preparation for the clinical experience. Other suggestions for change were not made. There is a point in all nursing education where theory must be put into practice and there really is no better way than trial by fire. However, this study evaluates the effect on the clinical experience on training nurses, continuing previous research, therefore confirming similar findings. This adds to the body of knowledge to help critically evaluate nursing education to improve the process to educate skilled, knowledgeable, and confident nurses. From this study, it is confirmed that clinical training continues to make the student nurse nervous.  

References

Burns, N., Grove, S. K., & Gray, J. (2011). Understanding nursing research: building an evidence-based practice (5th ed.). Maryland Heights, MO: Elsevier/Saunders.

Creswell, J. W. (2003). Research design: qualitative, quantitative, and mixed method approaches (2nd ed.). Thousand Oaks, Calif.: Sage Publications.

Sharif, F., & Masoumi, S. (2005). http://www.biomedcentral.com/content/pdf/1472-6955-4-6.pdf. BMC Nursing, 4(6), 1-7. Retrieved March 16, 2013, from http://www.biomedcentral.com/content/pdf/1472-6955-4-6.pdf