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      How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study

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          Abstract

          Introduction

          On entry into the clinical environment, nursing students are confronted with many challenges. It is a common problem throughout the world, including Iran. Although many studies have been conducted on the problems of nursing students in the clinical environment, limited information is available on nursing students’ experiences of the clinical learning environment and the way they respond to these experiences. Identifying nursing students’ experiences is essential to develop interventions to reduce challenges.

          Objective

          This study aimed to explore nursing students’ experiences in a clinical learning environment and the way they responded to these experiences.

          Design

          The present study was conducted based on the qualitative research design of the grounded theory methodology.

          Setting

          This study was conducted at schools of nursing in academic settings in Iran.

          Participants

          The participants included 19 nursing students, 4 nursing instructors and 3 clinical nurses.

          Methods

          The data were collected using semistructured interviews, field notes and observation, and were analysed using Strauss and Corbin’s approach.

          Results

          Students, as a result of the inadequacy of the educational environment, were faced with ‘confusion of identity’, stating this as their main concern. When confronted with this concern, they employed specific strategies, some of which prevented them from getting into unpleasant conditions. These strategies did not help students solve their problems and also prevented them from accepting their professional roles and responsibilities. Conversely, some other strategies led them to advanced professional development and enabled them to accept their role and the clinical environment.

          Conclusion

          According to the results of this study, educational policymakers should focus on improving the clinical environment. Identifying professional models and increasing their influence on management, education and clinical education, as well as teaching positive and constructive strategies, will promote positive strategies in coping with inadequate educational contexts. This is necessary for the professional development of nursing students.

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          Most cited references27

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          Perceived stress and social support in undergraduate nursing students' educational experiences.

          Nursing students experience high levels of stress. Coping mechanisms such as utilization of social support are effective in managing the effects of stress and promoting individual well-being. The use of social support from faculty members and peers in nursing programs has not been studied sufficiently. Faculty members who can perceive and understand student emotions add to the students' positive perception of the educational environment, making it more conducive to learning. To identify the stress experience and use of social support as a coping mechanism in traditional and second degree nursing students' educational experiences. A mixed method study was conducted. Undergraduate nursing students at a private university. 107 baccalaureate nursing students enrolled in either a traditional (n=49) or second degree (n=58) program during the Fall 2011 semester. Five instruments were combined to develop the quantitative and qualitative questions for an online survey. Traditional and second degree nursing students report high levels of anxiety, worry and depression in response to stress, resulting in feelings of rejection and inadequacy. Respondents used faculty members for support less frequently than they used their peers, spouse/significant other or parents. Second degree students and traditional students differ in their level of alcohol consumption with traditional students more likely to drink heavily than second degree students. In addition, traditional students are more likely to use fellow nursing students and other friends as social support, whereas second degree students rely more on their spouse/significant other. Students' high levels of maladaptive reactions to stress should encourage educators to help students develop positive coping strategies. Educators have the potential to impact the development of their students as they transition into nurses capable of handling the rigors of the profession. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Stress, coping and burn-out in nursing students.

            To explore the relationship between sources of stress and psychological burn-out and to consider the moderating and mediating role played sources of stress and different coping resources on burn-out. Most research exploring sources of stress and coping in nursing students construes stress as psychological distress. Little research has considered those sources of stress likely to enhance well-being and, by implication, learning. A questionnaire was administered to 171 final year nursing students. Questions were asked which measured sources of stress when rated as likely to contribute to distress (a hassle) and rated as likely to help one achieve (an uplift). Support, control, self-efficacy and coping style were also measured, along with their potential moderating and mediating effect on burn-out. The sources of stress likely to lead to distress were more often predictors of well-being than sources of stress likely to lead to positive, eustress states. However, placement experience was an important source of stress likely to lead to eustress. Self-efficacy, dispositional control and support were other important predictors. Avoidance coping was the strongest predictor of burn-out and, even if used only occasionally, it can have an adverse effect on burn-out. Initiatives to promote support and self-efficacy are likely to have the more immediate benefits in enhancing student well-being. Nurse educators need to consider how course experiences contribute not just to potential distress but to eustress. How educators interact with their students and how they give feedback offers important opportunities to promote self-efficacy and provide valuable support. Peer support is a critical coping resource and can be bolstered through induction and through learning and teaching initiatives. Copyright (c) 2010 Elsevier Ltd. All rights reserved.
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              Undergraduate nursing students' stress sources and coping behaviours during their initial period of clinical training: a Jordanian perspective.

              Baccalaureate nursing students often experience high levels of stress during training that may result in psychological or emotional impairment during their professional life ultimately affecting the quality of patient care they provide. Clinical instructors provide the needed support and guidance for students to relieve stress and promote a positive clinical experience. The aim of this study was to identify the level and types of stress perceived by baccalaureate nursing students in Jordan in their initial period of clinical practice and to identify the coping strategies that students used to relieve their stress. This descriptive cross-sectional study was conducted with 181 nursing students' representative of second year undergraduate students from two universities in Jordan. Proportions and t-tests were used to analyze the data. The results showed that the source of stress for these students came mainly from assignment work and the clinical environment. The most common coping strategy used by students was problem-solving behaviour followed by staying optimistic and transference attention from the stressful situation to other things while avoidance was the least frequent used.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                26 July 2019
                : 9
                : 7
                : e028052
                Affiliations
                [1] departmentNursing , School of Nursing and Midwifery, Shiraz University of Medical Sciences , Shiraz, The Islamic Republic of Iran
                Author notes
                [Correspondence to ] Dr Zahra Molazem; molazem@ 123456sums.ac.ir
                Author information
                http://orcid.org/0000-0002-7711-8184
                http://orcid.org/0000-0003-0169-6161
                Article
                bmjopen-2018-028052
                10.1136/bmjopen-2018-028052
                6661598
                31350243
                6db62a2a-693c-4bcb-b31d-9adf7436a3f8
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 21 November 2018
                : 28 May 2019
                : 03 July 2019
                Funding
                Funded by: Shiraz University of Medical Sciences, Shiraz, Iran;
                Categories
                Nursing
                Research
                1506
                1715
                Custom metadata
                unlocked

                Medicine
                organisation of health services
                Medicine
                organisation of health services

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