International Journal of Nursing Science 2015, 5(2): 66-75

DOI: 10.5923/j.nursing.20150502.05

The Real World: Lived Experiences of Student Nurses

during Clinical Practice
Steivy U. Tiwaken*, Lawrence C. Caranto, Juan Jose T. David

College of Nursing, Benguet State University, La Trinidad, Benguet, Philippines

Abstract This study examined the lived experiences of student nurses during their clinical practice from the
phenomenological point of view of nine student nurses. Student nurses are found to be on the verge of developing the sense
of responsibility for the health and well-being of others as having been introduced to the threshold of clinical practice at
early adulthood. Leaving the safe and supportive teaching environments of their school, they are placed into clinical
environments that are perceived as unfamiliar and complex and that require dealings with diverse human relations. Notably,
the group‟s experiences in clinical practice provide greater insight to develop an effective clinical teaching strategy in
nursing education. Focus group discussions and interviews were the main methods of data gathering. Employment of
Colaizzi's strategy in descriptive phenomenology established the data analysis. The participants considered clinical practice
to be an essential component of their learning process. The integration of both theory and practice and opportunities for
application and laboratory skills enable student nurses to learn effectively, to feel confident with their skills, and to become
competent in taking care of patients. Meanwhile, problems and concerns may be addressed better if good interpersonal
relations and sustained communication are practiced. Findings suggest that there is a need to rethink about the clinical skills
training in the field of nursing. Distinctly, approaches in order to decrease the gap that exists between the academic and the
clinical component of nursing education should be explored, clinical instructors on the other hand need to design strategies
and new innovative ways for more effective clinical teaching. Finally, there is a necessity to use approaches that facilitate
learning in clinical practice in beyond creating a conducive clinical learning environment.
Keywords Clinical practice, Clinical setting, Learning, Lived experiences, Qualitative research, Student nurses

[56] 2002) and rewarding (Hartigan-Rogers et al. [24] 2007)

1. Introduction and also viewed as the most important part of nursing
education (Myrick et al. [36] 2006). Regardless of the
One of the most critical experiences for student nurses is perspective on clinical placements, a plethora of studies have
their exposure to patients in the clinical. It is where they found that clinical placement experiences may influence
encounter the human side of nursing. From an educational positively on nursing students attitudes towards the clinical
perspective, the clinical placement is the venue where skills, setting in question (Fagerberg et al. [18] 2000, Abbey et al.
knowledge and attitudes developed in the theoretical part of [1] 2006, Happel & Platania-Phung [23] 2012 and a recent
the curriculum are applied, developed and integrated review by Happel & Gaskin [22] 2013). Graduate nurses
(Newton et al. [38] 2010). Learning in clinical practice contend that they are more likely to apply for work in
provides up to half of the educational experience for settings where they had positive experiences during
students taking Bachelor of Science in Nursing. Chan [11] undergraduate clinical placements (Edwards et al. [17] 2004).
(2009) accounts that among student nurses, the clinical It is therefore an important task to ensure good learning
nursing environments is perceived as the most influential environments in all clinical settings used in nursing
context for gaining nursing skills and knowledge. From a education. Ironically, in most cases, students are not versed
clinical perspective, the nurses who preceptor and guide as regards standards and measures of clinical work which
nursing students through weeks of learning experiences see consequently restricts them in terms of function in a health
them as potential new recruits to their specialty field of care setting. What could have these student nurses
nursing (Happel [21] 2008). From a student perspective, experienced during their placement in the clinical setting
clinical placements are both stressful (Timmins & Kaliszer through their training years?
In recent years, nursing education has been focusing on
* Corresponding author:
steivy.u.tiwaken@gmail.com (Steivy U. Tiwaken)
theoretical education and on the deep gap between
Published online at http://journal.sapub.org/nursing theoretical and clinical education created. This gap has been
Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved frequently mentioned in the research literature with
 International Journal of Nursing Science 2015, 5(2): 66-75 67

Sandelands [50] (1990) observing that these two ideas were Student nurses are found to be on the verge of developing
mutually exclusive. Implication wise, students often the sense of responsibility for the health and well-being of
struggled to see the connection of the holistic grand others as having been introduced to the threshold of clinical
theorists with the practical world of nursing. Another practice at early adulthood. Leaving the safe and supportive
dimension to this challenge was that theoretical teaching environments of their school, they are placed into
developments informed by research often ran ahead of clinical environments that are perceived as unfamiliar and
clinical practice. The theory practice gap created a tension complex and that require dealings with diverse human
that moved the profession forward over time – new relations. Despite the difficulties brought primarily by the
knowledge led to new practices. From the student environment, the group‟s clinical practice provides deeper
perspective the theory practice gap has been noted as insight to develop an effective clinical teaching strategy in
demanding and sometimes left them confused and uncertain nursing education.
about their roles and practice (Corlett [13], 2000; Ousey & On a personal note, expressing whether excitement,
Gallagher [41], 2007, Hatlevik [25], 2012). Also, many happiness, fulfilment, concerns, or dissatisfaction with
nursing researchers reported that nursing students, in spite clinical learning experiences generated an interest to
of good knowledge base, weren‟t skillful in clinical settings. formally investigate the experiences of student nurses
As a result, the entrance of these unskillful students to the during placement in clinical learning environments that
nursing care system, the quality of such falls day to day. include hospital wards and units, the community and health
One of the most valuable components of a nursing clinics. These experiences could only be accessed through
program is the clinical learning environment (CLE). This the people- the student nurses who lived them. It is in such
setting provides students with unique learning opportunities light that the barest essentials of exploring through the lived
in which classroom theory and skills are put to the test with experiences of student nurses is underscored. Through this
real life situations. Clinical learning environments include endeavour, the group may be assisted in achieving their
hospitals, school clinics, health departments, hospice units, educational goals during clinical practice while investing on
and other health care settings utilized for student learning. having to develop an effective clinical teaching strategy in
The CLE differs from the classroom or lab setting in many nursing education.
ways. Typically, the classroom and labs are controlled by The research findings and recommendations may assist
instructors. This includes lectures, labs, tests, dress codes, nurse educators and unit managers in shaping effective
student conduct, break times, attitudes, and the learning clinical learning environments for student nurses,
environment atmosphere. consequently enabling the group to distinguish, anchored on
Massarweh [32] (1999) described the clinical setting as a their perspective attributes which positively or negatively
clinical class-room. However, the CLE is unpredictable and influence clinical learning. This knowledge contributes to
relatively out of the nursing instructor‟s control. Attitudes, the improvement of nursing education for the production of
work ethics, staff members, unit environment, equipment more efficient nurses. Also, it may cast some light on the
and supplies, census, and patients and family members are problems encountered by student nurses today. As to nurse
elements of the CLE that cannot be controlled by instructors. educators and unit mangers, the material may serve as basis
This unpredictable environment is very different from the for them to be able to assist and offer necessary support to
classroom and can be a major shock for students. the student nurses while in practice placement. These go in
For the application of the theoretical side of nursing in consonance with Quinn [45] (2000) who states that
the clinical learning settings, clinical teaching is highly qualified nurses are the key factor in influencing the
needed. learning environment of student nurses. It is then with this
Clinical teaching is the means by which student nurses study‟s aim to explore the experiences of student nurses
learn to apply the theory of nursing and facilitating during clinical practice and to recommend guidelines for
integration of theoretical knowledge and practical skills in improvement or enhancement of learning during the
the clinical setting which becomes the art and science of experience.
nursing. South African Nursing Council (SANC [55]) (1992)
states that the overall objective of clinical practice is to
provide student nurses with meaningful learning
2. Background
opportunities in every area of placement according to the Early studies in the 1990s examined multiple facets of
level of training to ensure that on completion of the student learning on clinical placement and demonstrated the
program, the student nurses are able to nurse efficiently. complexity and demanding nature of the clinical
This implies that the group should be able to demonstrate environment, indicating that this area of learning is
the ability to solve problems effectively. Application of a unpredictable and far beyond the control of faculty members
scientific approach to nursing from the initial assessment to (Twinn and Davies [57], 1996). Other studies questioned the
the rehabilitation of the patient or client along with an effectiveness of clinical settings, claiming that they fail to
environment which is conducive to learning and provides provide students with positive examples of behavior
the appropriate support from skilled practitioners and (Greenwood [20], 1993) and even recognized it as a source
educators is a must. of stress, creating feelings of fear and anxiety which in turn
68 Steivy U. Tiwaken et al.: The Real World: Lived Experiences of Student Nurses during Clinical Practice

affect the students‟ responses to learning (Chesser-Smyth community. Also, at this level, the students have covered
[12], 2005) almost all study disciplines for the four-year program
Studies similarly described other influences on student (SANC [55] 1985). They would therefore be able to reflect
nurse perceptions of CLE (clinical learning environments) on their various experiences during clinical practice.
experiences. Distinctly, Dunn and Hansford [16] (1997) Willingness to participate topped the criteria.
suggested good collaboration among nurse educators,
clinical sites, and other participants providing clinical 3.3. Sampling
education among student nurses promoting the creation of a Purposive sampling method was utilized in this research.
positive CLE and the development of well-educated, The participants were voluntarily selected by the researcher
competent nurses. for the purpose of sharing their knowledge and experiences
In support, Papp, Markkanen, and von Bonsdorff [42] with the researcher as to which it was explained to them.
(2003), in a study conducted among 16 student nurses The inclusion criteria were: being a final (fourth) year
showed three major factors: the appreciation and support student in the basic nursing programme; willingness to
received by students; the quality of mentoring and patient participate in the study; and having been exposed to the
care; and, students‟ self-directedness. Notably, students felt clinical learning environment in the hospitals, clinics and
clinical practice and available opportunities provided a community.
reflection of the process of becoming a professional nurse. A total of nine participants were interviewed, and at that
Contrastingly, Lipinge and Venter [29] (2003) reveal stage, data saturation appeared to have been reached by
negative experiences reported by student nurses in a clinical means of repeating themes. Those interviewed were two
setting, these cover: (a) expectations of the student nurses not males and seven females, with the age range of 19-21 years.
being met as the staff members are sometimes not aware of Participants were requested to give written consent for the
student nurses‟ learning objectives; (b) frustrations interviews to be audio-taped. All participants conformed to
experienced during daily practice due to poor integration of the sampling criteria.
theory and practice; and, (c) lack of tutorial support and
guidance by lecturers. 3.4. Data Collection
As regards supervision, leadership style of the ward To explore the lived experiences of the student nurses
manager remains an important element of learning during placement in the clinical setting, semi-structured
(Saarikoski and Leino-Kilpi [48], 2002); similarly, cultural interviews were facilitated. Bernard [6] (1988) and Banfield
and organizational factors in the ward often influence [3] (2004) describes that semi-structured interviewing is best
students‟ learning experience (Pearcey and Elliott [43], used when the researcher won't get more than one chance to
2004). Later empirical studies concentrated on the interview someone and when he will be sending several
supervisory relationships and supervision that takes place interviewers out into the field to collect data.
with an individual supervisor or in a group (Saarikoski and Semi-structured interviews are often preceded by
Leino-Kilpi [48], 2002). observation, informal and unstructured interviewing in order
Ranse and Grealish [46] (2007) explored nursing students‟ to allow the researcher to develop a keen understanding of
experience of learning in the clinical setting of a dedicated the topic of interest necessary for developing relevant and
education unit using communities of practice framework. To meaningful semi-structured questions. Participants were
quote, open forums should be held for clinicians to discuss interviewed until data saturation appeared to have been
their concerns regarding facilitating student learning and to reached by means of repeating themes.
collaboratively develop strategies to support student learning One (1) focus group discussion and nine (9) interviews
in practice. were facilitated. Interviews lasted with an average of 30
minutes and ranged between 15 minutes and 1 hour. The
interviews were tape recorded, taken down in notes and
3. Methods verbatim transcriptions were made. No adverse events
occurred. Participants did not receive any form of
3.1. Research Design
compensation at the conclusion of the interviews.
Qualitative, exploratory, descriptive and contextual Interviews typically began with a question about what they
designs were used employing the phenomenological method felt during their first placement in the clinical setting.
to explore the lived experiences of student nurses during
clinical practice. 3.5. Data Analysis
“Researchers in the phenomenological mode attempt to
3.2. Population understand the meaning of events and interactions to
Bonafide Benguet State University-College of Nursing ordinary people in particular situations”, Bogdan & Biklen
fourth year student nurses formed the target population. This [7], (2009). The researcher captured personal experiences
is so, understanding that the group has been exposed to and drew rich descriptions and deep meanings from those
different clinical settings as hospitals, clinics, and the shared. Transcripts were subjected to Colaizzi‟s
 International Journal of Nursing Science 2015, 5(2): 66-75 69

phenomenological method of data analysis as it offers Clinical practice is the field for student nurses to study,
personal insights into how to present an auditable decision experience and develop nursing competence in relation to
trail in a phenomenological research study and explores different diseases and in different patient situations in
issues of rigor and trustworthiness. It provides practical cooperation with experienced professionals. It provides an
examples of how to illustrate the processes that can be anticipatory knowledge of the organizational contexts in
employed to interpret and make sense of the research which nursing care is delivered (Boyer [8], 1990). The
material when writing a thesis or research report. following transcribed responses go in consonance with the
The aim of this analysis stage is to understand more of the account: “It made me more flexible as early as being a
experiences reported by the participants (Knudson, B. & student nurse. I learned how to adapt with the different
Coyle, A [27], 2002) by the following methods: reading and situations that may occur any time. Now, I can somehow
rereading descriptions, extracting significant statements, manage my time as taught by my clinical experiences.”; and,
formulating meanings, and categorizing into clusters of “During my first exposure to the clinical area specifically in
themes and validating to identify experiences common to all the pediatric ward, I was so nervous. I was unsure with the
informants with original text. procedures I am to perform to my patient. I can still
remember the days I was so obsessed and compelled in
3.6. Ethical Considerations checking my patient‟s intravenous fluid not just once but
The participants were asked of their consent and were every minute during the entire shift. But, as the days passed,
assured of the confidentiality of the information to be shared. my level of anxiety was lowered and my continuous
Especially on having to audiotape the interviews, they were exposure to the hospital made me feel more at ease. Before I
requested to sign a consent form. Emphatically, their right on even realize how proficient I can be, I was able to adapt
having to withdraw at any stage of the study has been myself to the different situations that may happen.”
defined. Being knowledgeable of the different nursing concepts
and having been updated with the existing technologies as to
status quo lead the student nurses to delivering the care
4. Results and Discussion deserved by the patients. J expresses, “No letters from A to Z
would describe the clinical learning experiences I had during
Two broad domains: Cognitive Academic Proficiency and
my exposure in the clinical environment. It prepared me in
Practice, and Affect in Clinical Placements emerged from
becoming a competent registered nurse someday that I will
the group discussion and interviews done. Themes under the
be forever thankful. It taught me how to operate equipment
broad domain, Cognitive Academic Proficiency and Practice
that are new to me that are of great help for the patients.”
are Clinical Practice, Clinical Supervision and Interplay
Chapman [10] et. al. (2002) found that the students
between Theory and Practice while under the other broad
considered clinical practice as an essential component of
domain, Affect in Clinical Placements are Affective Barriers:
their learning process. Their participants also considered that
Anxiety over Confidence, and Timeless Radiating Aura:
clinical practice allowed them to develop interpersonal
Enjoyment and Appreciation.
relationships with others and what is more, to become aware
Cognitive Academic Proficiency and Practice of the political aspects of health care.
In this domain, the participants put premium on the areas Sharif [53] (2010) defines the clinical practice as an area
in their clinical experience‟ whether or not they be desirable, that allows students to have direct experience with the real
that helped them improve their knowledge and enhance their world of nursing, to practice the clinical skills required for
skills in the field. the job, to learn about general nursing routines and to learn
Clinical Practice. The student nurses considered the about the responsibility of the nurse that will hone and
clinical practice as a vital component of their learning improve their skills in preparation to becoming a registered
process as it plays an important role in enriching clinical nurse. Some of the student nurses approved stating, “I am
competencies of the students. F states, “Clinical experiences more at ease right now when I am on duty because of the
are the stepping stones as one goes to the path of being a previous exposures we had for the past years as compared to
nurse. Without these great experiences, I won‟t be able to my first clinical exposure which was nerve-racking. I always
perform interventions to the best of my abilities. These make sure that I am prepared and I have read my notes before
clinical experiences are the best learning experiences one can going for duty and to check if there are any updates in the
gain. Experiences are truly the best teachers.” In support, N nursing field.”; and, “I would like to describe my clinical
accounts, “My experiences in the clinical practice have been learning experiences as challenging, educative, extravagant,
a rollercoaster of feelings. It depends on the wards I have expect the unexpected and stressful. Despite all of these, the
been assigned and on my personal preferences. My best is that it felt rewarding every after duty.”
competence has been enhanced with the help of the clinical Clinical Supervision. Lambert V & Glacken M [28]
instructors, staff nurses and doctors.” Finally, G says, “My (2005) argues effective supervision by clinical teachers in
abilities have improved due to these experiences in the clinical environment is vital for students learning; the student
hospitals and I think I will be ready to be a staff nurse after nurse-clinical instructor relationship is crucial (Chan. D. [11],
graduating.” 2009). Working closely with clinical teachers can foster
70 Steivy U. Tiwaken et al.: The Real World: Lived Experiences of Student Nurses during Clinical Practice

students‟ confidence and help them find meaning in their “I‟m so scared with my clinical instructors. They should
practice learning experience (Bradbury-Jones, C. Irvine, F., be aware that they influence us with their actions and will
& Sambrook, S. [9], 2010). affect our performance during clinical practice”; and,
Clinical supervision by clinical instructors is another “Some clinical instructors are helpful if they encourage
theme that emerged under the domain. A great percentage of you but they are not when they always get angry. Clinical
the participants agreed that clinical instructors are always instructors should reflect on their teaching whether they are
there to supervise them and that they are helpful. They are in students‟ shoes to understand students‟ learning needs and
there to guide the students, to make sure that they are doing feelings.”
the right interventions and to improve their skills and Ping-Huang [44] et. al. (2012) stated that students‟
knowledge in preparation to becoming a full-fledge nurse. learning is hindered by teachers‟ unclear and non-useful
Beyond the acknowledged roles, ideas reveal that some feedback or teaching without a respectful attitude. Poor
instructors are rather distracting in some observed means. N student clinical teacher relationships could push students to
reveals, “Clinical instructors are of great help during clinical lose interest in learning and to lose a supportive resource in
practice and they teach us on almost everything we need to the clinical setting. Proper feedback can offer insight into
know to prepare us for our future. I sometimes find them students‟ clinical learning, thus improving their learning and
distracting when I‟m doing nursing interventions because performance and helping them fit into the setting.
they will tell you what to do even though you already know.” Nabolsi et. al. [37] (2012) says in her study that students
A statement by V reads, “Helpful! Sadly sometimes, the need the continuous support of their instructors or preceptors.
closer the clinical instructor while I am doing some Students were concerned about the manner in which faculty
procedures, the more I am making mistakes but all in all they staff interacted with them, believing themselves to be worthy
are helpful and supportive. Clinical instructors should be of respectful treatment.
aware that they have huge influence on students‟ learning The findings of Henderson, Cooke , Creedy and Walker
passion, professional identity, and future career [26] (2012) states that individualized supervision facilitates
engagement.” learning on the premise that one to one relationship with the
Anchored on direct observation, the following were noted: mentor or preceptor allows students to express about their
“We often notice that during clinical duties, most of the male learning experiences and feelings in the practice thus leading
clinical instructors make themselves busy playing games in to self-confidence, promote role socialization, professional
their mobile phones. Clinical supervision must be a building development and independence thereby attain clinical
block for students in developing and improving their skills competency.
that is why it must always be comprehensive in nature. Interplay between Theory and Practice. It has been a
Clinical instructors must have the heart to listen and able to common observation that theories taught do not equate the
communicate effectively with their students. They should type of environment designed for practice; a participant
not get angry without listening to the students‟ explanations.” remarks, “A lot of things they teach us at the college just
Some of the participants appeal that they feel more anxious don‟t happen when you're out there. It is a course you get
with their clinical instructors than having duty in the hospital. taught about what's right and what's wrong, but when you're
G adds, “They are always there to help and teach student out there you sort of get taught what you should do.”
nurses. Some of them give appropriate evaluation to students Students feel that what they had been taught in the classroom
but for some, they just can‟t get away from their personal was too ideological and not functional in the real world V
issues with students that will affect the grades of the students. states, “Theories in the classroom being taught differ when
Clinical instructors often get angry when student nurses do you are already in the hospital setting. It‟s like bookish ideas
something wrong without exactly hearing some are not always applicable given the situation of our country.
explanations.” Also, some procedures taught in the classroom differ on the
Chapman [10] (2002) emphasizes in her study that different hospitals we go for duty like providing newborn
personal characteristics of the clinical teacher and agency care which makes us confused.” In support, Chapman [10]
staff such as, being supportive, encouraging, resourceful, (2002) emphasizes that what students observed were taught
confident, approachable, friendly, available, helpful, in theory did not always connect in practice. Initially, this led
understanding, welcoming, and having the students‟ interests to conflict until the students were able to accept the
at heart, were all important aspects which the students differences. Accepting the differences required the students
perceived as enhancing their clinical performance to be versatile in how they performed on clinical practice.
Based on the above responses, the participants suggest A participant confessed, “What we get taught at university
that clinical instructors be aware of having a huge influence is too ideological, not the real world, once we get working
on students‟ learning passion, professional identity, and out there, we should know how things go in a certain hospital
future career engagement. The participants viewed clinical and we go with the flow which leaves us to ask ourselves,
supervision as a field for great support and guidance and “What should I follow, what my instructor taught me or what
where clinical instructors conduct timely and fair evaluations; the hospital is practicing?” They find themselves torn
contrastingly, as evidenced by the following statements, their between the demands of their clinical instructor and
views start to diminish over time: practicing nurses in real clinical situations.
 International Journal of Nursing Science 2015, 5(2): 66-75 71

Participants are also faced with diverse real clinical competent.” F adds, “I was always nervous when I am in the
situations which leave them unable to generalize what they hospital. I can‟t forget the time I was assigned to a patient
learned in theory. One of them proves, “In the wards they who has a watcher that is a registered nurse and it really
have their own way of doing things quite different from the didn‟t help me. The watcher always checked what I was
books and procedures as taught by the instructors at the doing to the patient and she asked unending questions maybe
college.” just to test my knowledge.” Although N hasn‟t been through
These findings concur with that of Davhana-Maselesele the scenario, she holds, “All of the clinical rotations I have
[15] (2000), who found that student nurses were having been were anxiety- producing but I would be more anxious if
difficulty in applying theory to practice, mainly because the the watcher of my patient will be a nurse or doctor. It would
theoretical content of the curriculum is too idealistic and be great if they are cooperative and you learn from each other
academic, and bears little relationship to the real needs of but if they‟re not, it will leave me questioning myself if I did
clinical practice. the correct interventions even though I know in myself that I
Some of the participants argue that due to the scarcity of did it right.”
materials in the hospital, concepts in the books can‟t be One of the factors that make the participants anxious
applied, to quote, “Ideally, the theories taught in school during clinical practice is being supervised by clinical
should also be the same with the procedures done in the instructors they are not in good terms with. Of the numerous
hospital and I think some are being done in the hospital just clinical rotations handled by few clinical instructors,
like what is being done inside the school. The only difference assessment as regards behaviour and relations towards the
is the completeness of the materials and strict compliance latter has long been structured. Here are some of the student
with the maintenance of sterility. J approves stating, “Most nurses comments:
of the theories that we learn from school is not the same as “I also feel anxious when I am being handled by clinical
that of the actual procedures and there are instances where in instructors I am not in tune with. I have been handled by all
due to the scarcity of resources/equipment, improvised of the clinical instructors in our college so I know who I am
materials are used. Performing the actual procedure is not that in good terms. Being handled by these clinical
definitely horrible than that of the return demonstrations instructors affects my performance which in turn makes me
done in the college.” anxious also with what my grade will be?”; and,
Rolfe [47] (1994) suggests that by reconsidering the “Clinical instructors that I feel hate me makes me nervous.
relationship between theory and practice, and facilitating They will always be checking you and try to look for
reflection on the realities of clinical life by nursing theorists, loopholes in the interventions you have done just right.”
the theory-practice gap will be reduced, if not closed. These findings are consistent with that of Nolan [40]
Sari and Elcigil [51] (2008) in Turkey and Safadi et al. [49] (1998) who found that student nurses experienced fear and
(2012) in Jordan, students reported disparities between what anxiety during clinical placement, which in turn affected the
was learnt in class and simulation laboratory and the actual student nurses‟ responses to their clinical learning
practice in clinical practice. environment.
Unfamiliarity to wards and procedures is another factor
Affect in Clinical Placements
that makes the student nurses tremble. F shares, “If there is
These accounts on what the participants mostly felt during one area that I feel anxious about, that would be the medicine
their clinical experiences. These involve details on why they ward especially the stroke unit and renal unit. I am not that
felt that certain emotion and its influence in their practice. familiar with these units aside from the fact that the smell
Affective Barriers: Anxiety over Confidence. The makes my stomach turn like a mixer. Administering
participants describe their clinical placements as stressful, medicines to patients whether what route they should be, it
nerve-raking and typified by a fear of making mistakes or needs proper guidance and conscience before administering.”
saying something foolish. Members were confronted with Patient safety is their greatest concern as G elaborates,
feelings of anxiety and apprehension as they traversed “Having duties in unfamiliar wards would make me anxious
different clinical placements. They confess that in all their for I will need great assistance to be knowledgeable in that
clinical rotations, anxiety has always been there and will ward and I will not be sure in the procedures I will perform.
always be present. The participants found the following as For me, it will be better to ask and let them know that you
reasons for such: patients having watchers that are a member don‟t have that enough knowledge rather than being
of the health care team, being supervised by clinical pretentious. The patient‟s safety is the greatest concern.” It is
instructors they are not in good terms with, and being better to admit not being knowledgeable in some aspects in
unfamiliar or lacking of experiences and knowledge in order to provide safety to both the patient and the student
procedures and unaccustomed wards. nurse.
Patients having watchers who belong to the healthcare V further explains, “Doing procedures without knowing
profession are nerve-racking as to what the participants said. how to will be anxiety-producing. Those “what ifs” will
D states “Having knowledgeable watchers of my patients come out from your mind and it will be better to ask first. ”
was the scariest moment I had. They asked questions they Melincavage [33] (2008) reveals anxiety has an effect on
already knew to make sure that I am that knowledgeable and how participants interact with each other in the health care
72 Steivy U. Tiwaken et al.: The Real World: Lived Experiences of Student Nurses during Clinical Practice

setting and how they provide patient care. practice.

The participants generally account that all the clinical Henderson et al. [26] highlights that an environment that
rotations and experiences make them anxious but they don‟t positively influences learning have been reported as where
let the anxiety and uneasiness interfere with their staff are happy, friendly with good morale and attitude,
concentration in doing interventions to provide the best care cooperative and willing to teach and guide students provide
to the patients. It coincides with the findings of Mlek [34] quality patient care Students feel confident and motivated to
(2011) which states that despite the anxiety and stress learn in an environment where they are respected, recognized,
experienced by the student nurses, most of them were able to supported and regarded as part of the team.
perform clinical skills and for the most part of the anxiety did
not affect their performance negatively.
Addressing anxiety- creating incidents for student nurses,
5. Conclusions and Recommendations
Sellek [52] (1982) reveals that the ward is the best place to Despite a wealth of research on clinical education learning
learn but very few of the learner's needs are met in this in clinical practice is still a problem (Croxon and Maginnis
[14]
setting. Incidents such as evaluation by others on initial 2008). Nevertheless, findings from the studies provided
clinical experience and total patient care, as well as insight into the experiences of nursing students learning in
interpersonal relations with staff, quality of care and the clinical practice on what impacts effective clinical
procedures are anxiety producing. learning.
Student nurses should be supported in addressing and The findings and the literature that supported each indicate
overcoming fear and anger, so as to provide quality nursing the need to rethink about the clinical skills training in the
care. Support should be given to student nurses to enable field of nursing. It is clear that all themes mentioned by the
them to identify and handle conflict associated with caring students play an important role in student learning and
for patients (Naude and Mokoena [38], 1998). The nursing education in general. Evidences as based on
accompanist for student nurses should develop strategies to literature revealed that students‟ experiences in the clinical
build trust and create a caring environment for student nurses practice can either positively or negatively impact their
(Naude and Mokoena [38] (1998). Bayoumi et. al. [5] (2012) learning. As noted, there were some similarities between the
states lack of clinical experience, unfamiliar areas, difficult results of this study with other reported studies and
patients, fear of making mistakes and being evaluated by confirmed that some of the factors are universal in nursing
faculty members were expressed by the students as education. It can be said that the integration of both theory
anxiety-producing situations in their initial clinical and practice with good clinical supervision could enable
experience student nurses to feel confident with their abilities and
Timeless Radiating Aura: Enjoyment and competent to take care of the patients.
Appreciation. Although most of the participants‟ feedback Participants in this study recognized that there was
regarding their experiences during the clinical practice conflict between what is taught in the classroom and what
focused on how anxious they were, they still managed and happens in the real world. The results should be considered
found grounds for enjoyment and appreciation. K approves by nursing education and nursing practice professionals.
saying, “Ever since, I always enjoy having duty for I can be Approaches in order to decrease the gap that exists between
able to share stories with my patients and their watchers as the academic and the clinical component of nursing
well about their lives and there are always things that I can education should be explored. It would also help the clinical
relate to. Some patients also speak the same dialect as me so instructors to design strategies and new innovative ways for
establishing rapport is easy.” The following support the more effective clinical teaching and there is a need to be
above: concerned about solving student problems in education and
“I was still able enjoy my clinical experiences despite clinical practice. There are also opportunities for both
being nervous at first. Particularly, the things I enjoy much educators and students to work within a more creative
are administering injections, responding to emergency cases environment that will promote and add to the professional
for I can be able to show how flexible I am, assisting in knowledge base (Barton [4], 1998).
deliveries and performing newborn care for they are so Further the study reflects that clinical teachers make a
cute.”; valuable contribution to the students learning process.
“I enjoy having duty especially in providing newborn Clinical instructors may enhance students learning by
care.”; creating a positive learning environment and participating as
“From the start of being in the clinical settings, I role models so students‟ anxiety will be lowered and their
appreciate all the things I am learning and I never thought it passion towards caring will increase. However, this research
was enjoyable. Nurse-patient interaction and performing has shown that the participants in this study considered
nursing procedures has always been my favorite.”; and, clinical practice to be an essential component of their
“I enjoyed all my clinical experiences which eventually learning process. From this perspective, nurse education
helped me to be a better person.” must commit itself to a high level of clinical practice for
The findings coincide with Chapman [10] R. (2002) in students of nursing. Skaalvik, Normann and Henriksen [54]
which participants expressed they 'loved' being on clinical (2009) states that in order to recruit graduated nurses to work
 International Journal of Nursing Science 2015, 5(2): 66-75 73

in hospitals, it is necessary that nursing students experience participated in the study, without their wholehearted input
positive clinical learning environments characterised by a this study could not have been possible. No manuscript is
pedagogic atmosphere conducive to teaching and learning ever a reality without the dedication and perseverance of
with a clear nursing philosophy and systematic individual editorial staff who were our colleagues. This was a
supervision in a one-to-one relationship. non-funded study and there is no conflict of interest.
A supportive clinical training environment is most
influential in the development of nursing skills, knowledge,
and professional socialization. The clinical educational
environment and the characteristics of the clinical instructors
play a major role in empowering students‟ learning, bridging
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