Background: Clinical training is an integral part of nursing education; however, some studies have shown that it is not always

efficient.

Objectives: This study aimed to find out the factors that can impede nursing students’ clinical learning.

Materials and Methods: In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used,

and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method.

Results: Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practice

gaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatest

impact on student learning. The competence of clinical instructors and staff is an important factor affecting students’ training.

The clinical learning environment does not always integrate theory and practice together.

Conclusions: Nursing students did not experience effective clinical learning

Azodi, Farzan

Azodi, Parviz

Jahanpour, Faezeh

Khansir, Ali Akbar

PubMed

Background: Clinical training is an integral part of nursing education; however, some studies have shown that it is not always

efficient.

Objectives: This study aimed to find out the factors that can impede nursing students’ clinical learning.

Materials and Methods: In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used,

and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method.

Results: Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practice

gaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatest

impact on student learning. The competence of clinical instructors and staff is an important factor affecting students’ training.

The clinical learning environment does not always integrate theory and practice together.

Conclusions: Nursing students did not experience effective clinical learning. Having expert instructors and supportive communication

are important factors in creating a clinical learning environment

Bushehr University of Medical Sciences Repository

Nurs Midwifery Stud. 2016 June; 5(2):e26920.Published online 2016 May 21.doi: 10.17795/nmsjournal26920.Brief ReportBarriers to Practical Learning in the Field: A Qualitative Study ofIranian Nursing Students’ ExperiencesFaezeh Jahanpour,1 Parviz Azodi,2,* Farzan Azodi,3 and Ali Akbar Khansir41Pediatric Nursing Department, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, IR Iran2Department of Anesthesia, Paramedical Faculty, Bushehr University of Medical Sciences, Bushehr, IR Iran3Students’ Research Committee, Bushehr University of Medical Sciences, Bushehr, IR Iran4Foreign Languages Department, Bushehr University of Medical Sciences, Bushehr, IR Iran*Corresponding author: Parviz Azodi, Department of Anesthesia, Paramedical Faculty, Bushehr University of Medical Sciences, Bushehr, IR Iran. Tel: +98-7714550187, Fax:+98-7714550187, E-mail: f_jahanpour@yahoo.comReceived 2015 January 12; Revised 2016 January 02; Accepted 2016 January 03.AbstractBackground: Clinical training is an integral part of nursing education; however, some studies have shown that it is not alwaysefficient.Objectives: This study aimed to find out the factors that can impede nursing students’ clinical learning.Materials andMethods: In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used,and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method.Results: Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practicegaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatestimpact on student learning. The competence of clinical instructors and staff is an important factor affecting students’ training.The clinical learning environment does not always integrate theory and practice together.Conclusions: Nursing students did not experience effective clinical learning. Having expert instructors and supportive communi-cation are important factors in creating a clinical learning environment.Keywords: Nursing, Student, Communication, Learning, Practice, Qualitative Research1. BackgroundClinical training is an integral part of nursing educa-tion (1). Clinical practice gives students the opportunity tomake decisions, apply theories, prioritize those decisions,learn time management, and provides them with a chanceto practice their clinical skills (2, 3).In a supportive learning environment, clinical teach-ers encourage students to be independent in their learn-ing and they advise them to be self-reliant (4, 5). However,some earlier studies conducted in Iran have shown thatclinical learning is usually ineffective for nursing students(6), students experience high levels of anxiety (6), nursinginstructors are mostly inexperienced, and clinical learn-ing fails to integrate theory and practice (7). However, fewstudies are available on the reasons behind the ineffective-ness of clinical learning in nursing education.2. ObjectivesThis study aimed to find out the factors that can im-pede nursing students’ clinical learning.3. Materials andMethodsThis qualitative research study used reflective journalwriting as the main data collection method. Content analy-sis was used to identify categories in participants’ descrip-tions.3.1. Participants and Data GatheringParticipants were purposively selected among thenursing students who were studying in their seventhsemester of the baccalaureate program in 2014 and whohad clinical rotations in the hospitals affiliated to BushehrUniversity of Medical Sciences. After the researchers ex-plained the objectives of the study to the participants,12 students, out of 30, volunteered to participate and tokeep reflective journals. In a briefing session, the first re-searcher gave them a notebook and presented them witha verbal description of how to complete the journalingtask. The students were asked to write in their journalsabout their own experiences, important learning events,attitudes, feelings, and their own opinions on their clinicallearning experiences in after passing a week of their prac-tical course in each ward. They were asked to return theseCopyright © 2016, Kashan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided theoriginal work is properly cited.Jahanpour F et al.anonymous journals to the researcher at the end of eachweek.3.2. Ethical ConsiderationsThe research committee (ethics No. 46327) and reviewboard of Bushehr University of Medical Sciences approvedand granted the proposal of this study. All of the partic-ipants signed a written informed consent form and wereassured that their written texts would not be shown to anypersons other than the researchers and would not affecttheir clinical evaluation scores.3.3. Data AnalysisThe content analysis approach was used to analyze thecollected data. Thus, the researchers received each jour-nal from the participants, and then they considered themcarefully. The researchers used coding procedures in orderto transcribe the data. Analyses consisted of identifying,coding, and summarizing themes according the approachsuggested by Graneheim and Lundman (8).In order to evaluate the data’s trustworthiness, the re-searchers gave summarized results to a few participantsto confirm the credibility of the data analysis. The estab-lished relationship between the researchers and partici-pating students facilitated a trust-based relationship be-tween the parties in relation to data generation and treat-ment. Credibility was also enhanced because of the pro-longed engagement of the researchers with participantsand having experience in the practical field as an instruc-tor. There was no academic relationship between the re-searchers and the participants during the study.4. ResultsAll of the participants were in in their seventh semesterof studies. All were female, and ranged in age between 21and 24 years. Data analyses revealed three main categories,as outlined below.4.1. Inappropriate CommunicationThe participants believed that interpersonal commu-nication between students, nurses, teachers, physicians,and patients was one of the most important factors af-fecting clinical learning. From the students’ point ofview, a positive and friendly relationship between stu-dents, nurses, and instructors affects the clinical learningenvironment and increases their self-confidence and learn-ing. Students described that communication with theirclassmates in the educational environment was positiveand satisfying. One student wrote: “My friend and I al-ways are together, and ask each other questions that wehave, and this is good.” However, relationships were not re-spectful from the side of the qualified nurses, and this af-fected the students’ motivation to learn. One of the stu-dents commented: “Some nurses frowned at me, when Iasked them a question.” From the participants’ point ofview, some nurses did not trusted the students’ work, andthey blamed them when anything bad happened in theward.4.2. Ineffective Role ModelsParticipants emphasized that the competence of theclinical instructors and staff nurses -as a role models- was acrucial factor affecting their learning in the clinical field.To the students, their instructors’ kindness, knowledge,clinical skills, expertise, and self-efficacy were among themain characteristics that made them good role models.One of the students commented: “Some instructors havesufficient knowledge and skills, so they have a higher selfconfidence level, and they help us (students) to under-stand how to do our duties. Some of them say to followwhatever staff do. In this ward (NICU), the staff respects ourinstructor. Because of this, they are kind to us, too.” How-ever, the majority of the students believed that the lack ofclinical experience among instructors was the main bar-rier that decreased their competency to train students ef-fectively.Participants recognized staff members as role models,too. Nonetheless, although they were technically skillful,they did not always have a caring attitude and sometimesperformed procedures without upholding any standards.4.3. Theory-Practice GapParticipants revealed that there is a theory-practicegap in the clinical setting, and this hindered their clinicallearning. The participants indicated that they confrontedproblems such as confusion about how to do proceduresbased on theoretical knowledge or like nurses in real sit-uations. One student wrote: “We didn’t see many thingsthat we have learnt in theoretical class. It is a difference be-tween real and ideal practice. Many of nurses do not followestablished nursing standards. If we follow standards, thenurses may laugh us and I dread this.”Participants wrote in their journals that the nurseswere often unaware of educational objectives and the stu-dents’ learning needs; further, their expectations of thestudents were not the same as the teachers’. One of themwrote: “The staff nurses demand that we do their routinetasks, such as checking vital signs and changing linens.These are not useful for us, because these are repeated eachday and we learnt them well, but we didn’t learn some spe-cial procedures, like CPR.2 Nurs Midwifery Stud. 2016; 5(2):e26920.Jahanpour F et al.5. DiscussionThe current study has shown that, despite the cru-cial role of appropriate relationships in students’ clini-cal learning experiences, it is not enough. This has neg-atively affected the students’ clinical learning and self-confidence. This finding was in line with findings of Jahan-pour et al., who studied clinical decision-making in seniornursing students (2).According the participants in this study, the compe-tence of their clinical instructors and the theory-practicegap were among the most important factors affectingthem and their learning in clinical settings. Some earlierstudies have also pointed out the role of clinical instruc-tors and staff nurses as role models for nursing studentslearning in clinical setting (6, 9, 10). In Iran, many ex-perienced nursing instructors who hold Master’s or PhDdegrees are reluctant to participate in clinical education,and so this role is mostly assigned to inexperienced, newlygraduated nurses with Master’s degrees, or those who arestill Master’s degree students. These people are not readyto fulfill their role as competent role models. On the otherhand, as Cheraghi et al. (7) reported, due to the domina-tion of task-oriented work in clinical settings, nurses’ clin-ical behaviors cannot support nursing students’ efforts tointegrate theory and practice.This study was only conducted in one nursing school,and this might limit the generalizability of the results.However, based on out findings, we can say that nursingstudents lack sufficient clinical learning due to unsupport-ive and inappropriate communication running through-out clinical settings, they lack effective role models, andthey are harmed by the theory-practice gap. Restructuringthe healthcare setting so that experienced nursing instruc-tors are encouraged to enter and participate in clinical set-tings, establishing appropriate workshops for preparinginexperienced nursing instructors for their roles as clini-cal instructors, and implementing appropriate strategiesto motivate staff nurses to take part in the education ofnursing students might help in decreasing the barriers toeffective learning in clinical settings.AcknowledgmentsThe author would like to thank the nursing studentswho participated in this study.FootnotesAuthors’ Contribution: Faezeh Jahanpour oversawthe management supervision and was responsible forthe study’s concept and design. Parviz Azodi did themanuscript revisions and data collection. Ali Akbar Khan-sir conducted the English-language review. Farzan Azodicompleted the language editing of the manuscript.Funding/Support: This study was supported by thedeputy of research at Bushehr University of Medical Sci-ences, Ethics code: 46327.References1. Andrews M, Roberts D. Supporting student nurses learning in andthrough clinical practice: the role of the clinical guide. Nurse Educ To-day. 2003;23(7):474–81. doi: 10.1016/S0260-6917(03)00076-5.2. Jahanpour F, Sharif F, Salsali M, Kaveh MH, Williams LM. Clinicaldecision-making in senior nursing students in Iran. Int J Nurs Pract.2010;16(6):595–602. doi: 10.1111/j.1440-172X.2010.01886.x. [PubMed:21129112].3. Azizi-Fini I, Hajibagheri A, Adib-Hajbaghery M. Critical thinking skillsin nursing students: a comparison between freshmen and senior stu-dents. Nurs Midwifery Stud. 2015;4(1):eee25721. [PubMed: 25830160].4. Adib Hajbaghery M, Rezaei Shahsavarloo Z. Assessing the nursingand midwifery students competencies in communication with pa-tients with severe communication problems. Nurs Midwifery Stud.2014;3(2):eee18143. [PubMed: 25414902].5. Yang J. Korean nursing students’ experiences of their first clinicalpractice. Journal of Nursing Education and Practice. 3. 2012;3(3):128–138.6. Sharif F, Armitage P. The effect of psychological and educationalcounselling in reducing anxiety in nursing students. J Psychiatr MentHealth Nurs. 2004;11(4):386–92. doi: 10.1111/j.1365-2850.2003.00720.x.[PubMed: 15255911].7. Cheraghi MA, Salsali M, Safari M. Ambiguity in knowledge trans-fer: The role of theory-practice gap. Iran J Nurs Midwifery Res.2010;15(4):155–66. [PubMed: 21589789].8. Graneheim UH, Lundman B. Qualitative content analysis in nurs-ing research: concepts, procedures and measures to achievetrustworthiness. Nurse Educ Today. 2004;24(2):105–12. doi:10.1016/j.nedt.2003.10.001. [PubMed: 14769454].9. Hagbaghery MA, Salsali M, Ahmadi F. The factors facilitating andinhibiting effective clinical decision-making in nursing: a qualita-tive study. BMC Nurs. 2004;3(1):2. doi: 10.1186/1472-6955-3-2. [PubMed:15068484].10. Peyrovi H, Yadavar-Nikravesh M, Oskouie SF, Bertero C. Iranianstudent nurses’ experiences of clinical placement. Int Nurs Rev.2005;52(2):134–41. doi: 10.1111/j.1466-7657.2005.00417.x. [PubMed:15842326].Nurs Midwifery Stud. 2016; 5(2):e26920. 3

Barriers to Practical Learning in the Field: A Qualitative Study of

Iranian Nursing Students’ Experiences

Nurs Midwifery Stud. 2016 June; 5(2):e26920.Published online 2016 May 21.doi: 10.17795/nmsjournal26920.Brief ReportBarriers to Practical Learning in the Field: A Qualitative Study ofIranian Nursing Students’ ExperiencesFaezeh Jahanpour,1 Parviz Azodi,2,* Farzan Azodi,3 and Ali Akbar Khansir41Pediatric Nursing Department, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, IR Iran2Department of Anesthesia, Paramedical Faculty, Bushehr University of Medical Sciences, Bushehr, IR Iran3Students’ Research Committee, Bushehr University of Medical Sciences, Bushehr, IR Iran4Foreign Languages Department, Bushehr University of Medical Sciences, Bushehr, IR Iran*Corresponding author: Parviz Azodi, Department of Anesthesia, Paramedical Faculty, Bushehr University of Medical Sciences, Bushehr, IR Iran. Tel: +98-7714550187, Fax:+98-7714550187, E-mail: f_jahanpour@yahoo.comReceived 2015 January 12; Revised 2016 January 02; Accepted 2016 January 03.AbstractBackground: Clinical training is an integral part of nursing education; however, some studies have shown that it is not alwaysefficient.Objectives: This study aimed to find out the factors that can impede nursing students’ clinical learning.Materials andMethods: In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used,and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method.Results: Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practicegaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatestimpact on student learning. The competence of clinical instructors and staff is an important factor affecting students’ training.The clinical learning environment does not always integrate theory and practice together.Conclusions: Nursing students did not experience effective clinical learning. Having expert instructors and supportive communi-cation are important factors in creating a clinical learning environment.Keywords: Nursing, Student, Communication, Learning, Practice, Qualitative Research1. BackgroundClinical training is an integral part of nursing educa-tion (1). Clinical practice gives students the opportunity tomake decisions, apply theories, prioritize those decisions,learn time management, and provides them with a chanceto practice their clinical skills (2, 3).In a supportive learning environment, clinical teach-ers encourage students to be independent in their learn-ing and they advise them to be self-reliant (4, 5). However,some earlier studies conducted in Iran have shown thatclinical learning is usually ineffective for nursing students(6), students experience high levels of anxiety (6), nursinginstructors are mostly inexperienced, and clinical learn-ing fails to integrate theory and practice (7). However, fewstudies are available on the reasons behind the ineffective-ness of clinical learning in nursing education.2. ObjectivesThis study aimed to find out the factors that can im-pede nursing students’ clinical learning.3. Materials andMethodsThis qualitative research study used reflective journalwriting as the main data collection method. Content analy-sis was used to identify categories in participants’ descrip-tions.3.1. Participants and Data GatheringParticipants were purposively selected among thenursing students who were studying in their seventhsemester of the baccalaureate program in 2014 and whohad clinical rotations in the hospitals affiliated to BushehrUniversity of Medical Sciences. After the researchers ex-plained the objectives of the study to the participants,12 students, out of 30, volunteered to participate and tokeep reflective journals. In a briefing session, the first re-searcher gave them a notebook and presented them witha verbal description of how to complete the journalingtask. The students were asked to write in their journalsabout their own experiences, important learning events,attitudes, feelings, and their own opinions on their clinicallearning experiences in after passing a week of their prac-tical course in each ward. They were asked to return theseCopyright © 2016, Kashan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided theoriginal work is properly cited.

Background: Clinical training is an integral part of nursing education; however, some studies have shown that it is not always

efficient.

Objectives: This study aimed to find out the factors that can impede nursing students’ clinical learning.

Materials and Methods: In this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used,

and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method.

Results: Three main categories were derived, including inappropriate communication, ineffective role models, and theory-practice

gaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatest

impact on student learning. The competence of clinical instructors and staff is an important factor affecting students’ training.

The clinical learning environment does not always integrate theory and practice together.

Conclusions: Nursing students did not experience effective clinical learning. Having expert instructors and supportive communication

are important factors in creating a clinical learning environmen

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Barriers to Practical Learning in the Field: A Qualitative Study of Iranian Nursing Students’ Experiences

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