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Causes of high failure of student nurses at licensure examination

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Clinical learning is a main part of nursing education.

Identifying challenges of nursing students in the clinical learning environment could improve training and enhance the quality of its planning and promotion of the students. This is a qualitative study using the content analysis approach. The participants consisted of seventeen nursing students and three nursing instructors. The participants were selected through purposive sampling method and attended semistructured interviews and focus groups.

Three themes emerged after data analysis, including ineffective communications, inadequate readiness, and emotional reactions.

Nursing students in Iran are faced with many challenges in the clinical learning environment. Therefore, we recommend that the instructors prepare students with a specific focus on their communication and psychological needs.

Nursing training is a combination of theoretical and practical learning experiences that enable nursing students to acquire the knowledge, skills, and attitudes for providing nursing care [ 2 ]. Nursing education is composed of two complementary parts: A large part of nursing education is carried out in clinical environments [ 4 ]. In Iran and many other countries, clinical education forms more than half of the formal educational courses in nursing [ 5 ].

Therefore, clinical education is considered to be an essential and integral part of the nursing education program [ 6 ]. Moreover, the clinical area of nursing education is of great importance for nursing students in the selection or rejection of nursing as a profession [ 8 ]. Unlike classroom education, clinical training in nursing occurs in a complex clinical learning environment which is influenced by many factors [ 9 ].

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This environment provides an opportunity for nursing students to learn experimentally and to convert theoretical knowledge to a variety of mental, psychological, and psychomotor skills which are of significance for patient care [ 10 ]. The unpredictable nature of the clinical training environment can create some problems for nursing students [ 12 ]. This change can negatively affect their learning, progress in patient care, and professional performance.

Identifying problems and challenges with which these students are faced in the clinical learning environment can help stakeholders solve these problems and contribute to them becoming professional as well as their professional survival [ 11 ].

Failure to identify the challenges and problems the students are faced with in the clinical learning environment prevents them from effective learning and growth.

As a result, the growth and development of their skills will be influenced [ 4 ]. Some nursing students have left the profession as a result of challenges they face in the clinical setting [ 13 ]. Many studies have been done on the clinical environment.

Some relevant studies have also been carried out in our country; however, most of them have focused on clinical evaluation or stress factors in the clinical training. One study showed that nursing students are vulnerable in the clinical environment and this reduces their satisfaction with the clinical training [ 14 ]. According to a review of the literature, few studies have been done on the challenges nursing students are faced with in the clinical learning environment in Iran; these challenges are still unknown.

Identifying challenges with which nursing students causes of high failure of student nurses at licensure examination faced in the clinical learning environment in all dimensions could improve training and enhance the quality of its planning and the promotion of the students. We aimed to explain the challenges of the nursing students in the clinical learning environment. Materials and Methods 2. Study Design This paper is a part of a larger grounded theory study. Content analysis was used in this qualitative research so that rich and deep information could be obtained from the phenomenon under study [ 17 ].

Since qualitative research emphasizes trust, transparency, verifiability, and flexibility, it is considered a good method to develop insight and interpretation in the field of nursing education [ 18 ]. The population in this study consisted of seventeen nursing students from different academic semesters and three clinical nursing instructors.

Data Collection In this study, to better understand the challenges of nursing students in dealing with the clinical setting, individual interviews, group interviews, and observation were used. Individual interviews with nursing students and instructors were carried out face-to-face and in a convenient place based on the willingness of the participants in the School of Nursing, Shiraz University of Medical Sciences.

Group interviews with nursing students were also performed to achieve a deeper understanding of this phenomenon. A group interview is a way for people to express their experiences and views with regard to a subject in a group and, instead of a researcher, members of a group are responsible for encouraging each other to talk [ 19 ].

All the conducted interviews with the participants were recorded and immediately transcribed verbatim after the end of the interview sessions. Each interview lasted about 40 to 70 minutes and was 55 minutes on average.

Interviews were continued with participants until the data was saturated and sampling was ended with data saturation [ 17 ]. In addition, the observation method was used to investigate the exposure of students to the clinical setting. The observation method in this study focused on the relationship and the behavior of students, patients, staff, and instructors at the clinical setting. During this phase of the study, field notes and reminders were used to analyze the observations.

Data Analysis Content analysis was used in this research in order to identify and understand the challenges of nursing students in dealing with the clinical setting. This method of analysis is an interpretive process that focuses on the subject and background and explores the similarities and differences between and within different parts of the text [ 20 ]. In this method, the script of the interview was read several times by the researcher to reach an overall understanding. The parts related to the experiences of the participants regarding the challenges of encountering the clinical setting were extracted from the interviews and placed in a separate text.

Then, words, sentences, and paragraphs relevant to each other in terms of both content and context were merged and coded. Codes and units of meaning were interpreted in the context of the study and compared in terms of similarities and differences. Finally, abstract subclasses were made based on the semantic line [ 20 ].

Rethinking about the codes and the subclasses resulted in the extraction of three main categories.

The Challenges of Nursing Students in the Clinical Learning Environment: A Qualitative Study

Trustworthiness of Data In order to validate the data, manuscripts were reviewed and data coding processes were reconducted by the colleagues and the whole process was peer reviewed causes of high failure of student nurses at licensure examination an outside observer. Extracted codes were sent to the participants and approved. In order to obtain the variability criterion, the scripts of a number of interviews, codes, and extracted classes were given to several colleagues who were familiar with the methods of analyzing qualitative research and were not present in the process of conducting this study, and the accuracy of the data coding process was evaluated.

Furthermore, allocating sufficient time to collect data and maintaining an objective and impartial view further added to the reliability of the research.

In order to obtain generalizability across environments, the results of the research were presented to a number of students who had not participated in the study and they were asked to judge the similarity between the results of the research and their own experiences. In the current study, in order to consider ethical principles, the purpose of the study was explained to all the participants and informed consent was obtained for each interview and voice recording.

The participants were assured of the confidentiality of the data. In addition, the recorded interviews were kept in a safe place and were only accessible by the researcher. Results The participants consisted of seventeen nursing students and three nursing instructors.

The students were in the second, third, and fourth year of study and aged 20—23 years. Moreover, three nursing instructors two women and one man participated in this study with an age range of 32 to 38 years and a clinical training experience of 5 to 8 years. After analyzing the interviews with the participants regarding the challenges of nursing students in dealing with the clinical learning environment, three main themes emerged: Ineffective Communications This main category consisted of two subcategories of improper treatment and discrimination.

Improper Treatment Students encounter some challenges in dealing with clinical learning environment and in interaction with instructors, patients, and department personnel. Many students stated that they had the most interactions with the instructors and believed that the way an instructor treats a student affects their exposure to clinical learning environment.

One student stated the following. Companions of the patient never trusted me again. He had many undue rigors…. In addition to the improper treatment of instructors toward the students, some behaviors of nurses are also oppressive to students. One of the students described how improperly the department nurse treated her. Suddenly, the department nurse appeared and urged us to get away!

Quickly put the card indices back…, said the nurse.

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Discrimination Discrimination is a subcategory that most students had experienced. They were complaining about a series of discriminatory behaviors they were seeing at the bedside that irritated them. According to what the students claimed, the greatest discrimination in the clinical setting was apparent in behaviors of nurses towards students.

One of the students said the following. In addition to behavioral discrimination, some students were also upset and complained about discrimination in the use of educational facilities. One of the students participating in the study said the following.

This room is only for residents and medical students to use…, they answer. Inadequate Readiness This category includes three subcategories of inadequate knowledge, deficient practical skills, and insufficiently developed communication skills.

Inadequate Knowledge Many students did not have sufficient knowledge to care at the bedside when dealing with clinical learning environment and providing care to the patients was challenging for them. I did not know to what medication category it belonged and did not even know it was causes of high failure of student nurses at licensure examination to treat gastric issues.

Deficient Practical Skills Clinical environment is a suitable context for learning skills needed to care for patients. However, some of them are considered basic health care skills and any deficit in them affects the quality of care. In this regard, students had difficulties in performing procedures in some situations, due to the lack of necessary skills. One of the participants said the following. Our professor urged us to care for a patient. However, I did not know how to take his blood pressure.

The reason was that I could not recognize the sound…. Deficiency in practical skills in caring for patients was a concern of many students in the clinical setting. One of the students stated the following. I got embarrassed in front of the patient…. Insufficiently Developed Communication Skills Many students mentioned the lack of communication skills as the reason for deficiency in communicating with the clinical learning environment.

There was a bulge on his hand. I asked him what that bulge was in front of the patient. The patient became upset and I myself regretted. Insufficiently developed communication skills sometimes cause disruption in providing care for patients.