The Experiences of Nursing Students in the Clinical Area

MORALES, RACHEL JULIANNE V.

MONTENEGRO, NIZI KATE P.
DAYO, LOVELY JHEZZA MAE
BARTOLOME, JACOB
ALUMNO, PETER PAUL

April 2023
 MOUNTAIN VIEW COLLEGE

THE EXPERIENCES OF NURSING STUDENTS IN THE CLINICAL LEARNING

ENVIRONMENT: A QUALITATIVE STUDY

A Thesis presented in partial fulfillment

Of the requirements for the degree
Bachelor of Science in Nursing

By
Morales, Rachel Julianne V.
Montenegro, Nizi Kate P.
Dayo, Lovely Jhezza Mae
Bartolome, Jacob
Alumno, Peter Paul

April 2023
 Chapter 1
INTRODUCTION

The Problem and Its Background

Nursing is a vocation constructed on theoretical grounding and practical training

acquired through nursing education programs. A significant component of nursing education
is clinical experience. One of the most vital factors influencing the method of instruction and
education in clinical settings is the students' exposure to the clinical learning area (Jamshidi
et al, 2016). However, nursing students are bombarded with problems and challenges during
their exposure to the clinical learning area thus affecting their learning process. A study from
the Scientific World Journal entitled “ The Experiences of Nursing Students in the Clinical
Learning Environment” shows that the findings obtained from this particular study
demonstrated that ineffective communication, improper treatment, discrimination, inadequate
knowledge, inadequate readiness, and inferiority complex as the experiences that student
nurses encountered during their exposure in the clinical learning area. To guarantee the
clinical area’s usefulness and efficacy in the student’s learning process, these experiences
must be identified, addressed, and examined.

As Baraz et al. (2015) stated, the clinical learning environment is a complex social
entity. This environment is effective in the learning process of nursing students in the clinical
area. Although there are many advantages to learning in a clinical setting, it may also be
difficult, unforeseeable, stressful, and by far-changing.

Fairbrother et al. (2016) also mentioned that student nurses face many trials that
negatively affect their personality and career development. Many student nurses report that
clinical internships are the most challenging part of learning. Aside from that, student nurses
follow several policies and requirements in clinical settings during nursing education.
Furthermore, nursing students are increasingly dealing with difficulties in both their
academics and clinical experiences. These difficulties have an impact on their capacity for
learning. Hence, inadequate nursing implementation is one of the most significant issues in
the clinical sector and throughout the training phase. Students need to gain knowledge about
behavioural principles in the nursing process. This knowledge is necessary for them to
provide proper care in clinical placement (Hagos, Alemseged, Balcha, Berhe, & Aregay,
2014).
 According to Akyüz and Ergöl (2022), high-quality nursing education depends on a
clinical learning environment. There has been a rise in interest in enhancing the conditions
for clinical learning throughout the past two decades. However, issues such as an
unsupportive learning environment, stressful psychosocial environment, and lack of access
to direct experience in clinical practice training have been documented in the study. These
issues have an impact on students' learning, making it difficult for them to perform well in
clinical practice settings (Drateru, 2019). Clinical knowledge is hampered by inappropriate
clinical education programming, organizational shortcomings, inappropriate clinical
evaluation, an unsupportive learning environment, insufficient clinical supervision, and
challenges in converting theoretical knowledge into clinical practice (Panda et al., 2021).

In the national setting, a cross-sectional study revealed that the clinical learning
setting and supervision aid future healthcare workers in developing their professional
competence. It was also found that the supervisory relationship between educators and
students significantly influences the outcomes of the student's experiences. Therefore,
proper supervision of students by clinical instructors fosters their improvement (Rivera et al.,
2022).

There have been only a few studies conducted by nursing professionals and those in
the nursing field that seek to delve into the experiences of nursing students in the clinical
learning area. Because of this, we would like to study and understand what are the
experiences of student nurses in the clinical learning area. Moreover, we intend this study to
open avenues of information for further studies concerning this research matter.

Statement of the Problem

This research intends to pinpoint nursing students' experiences in the clinical learning
setting. It specifically aims to respond to the following questions:
1 . What are the lived experiences of nursing students in the clinical learning environment?

Significance of the Study

The result of this study is beneficial to the following groups:

Nursing Education The reliable and substantial result of the study will give additional
information to educate and effectively prepare theoretical and practical training of nursing
students' experiences in the clinical learning environment.
Nursing Students The basic research information will give additional study to them to
improve training and could enhance the knowledge and skills of the students in a clinical
learning environment.

Clinical Instructors Research-based information will guide the instructors on essential

factors affecting the teaching-learning process in clinical settings. It will serve as a basis for
designing plans for effective interventions for nursing students.

Future Researchers This study would help the student researchers be aware of the
processes involved. Moreover, it will also aid future researchers in cultivating related studies
about nursing students' experiences.

Scope and Limitations of the Study

This study will be conducted at a faith-based institution located in Valencia City,

Bukidnon. Specifically, the study will be initially participated by 10 participants coming from
the third year nursing students who had been going to hospital exposure in the different
clinical areas since their second year of nursing school. Furthermore, this research shall be
delimited only to the experiences in the clinical learning area that are experienced by the
selected level three nursing students.

Operational Definition of Terms

The terms used in this study are operationally and conceptually defined as follows:

Clinical Learning Environment:Is the interactive network of forces within the clinical setting
that influences the students’ clinical learning outcomes, and it also has an impact on
students’ internship preparation and satisfaction with the nursing profession (Flott and
Linden, 2016).
Experiences: An event, encounter, observation of facts, or a feel ( an emotion) that nursing
students had practical contact with (Oxford Languages, 2023).
Clinical Area: a specific geographic area of the Hospital devoted to the diagnosis,
treatment, and care of patients on an in-patient, out-patient or day-care basis. ( Law Inside
Dictionary 2023)
 Chapter 2
REVIEW OF RELATED LITERATURE AND RELATED STUDIES

Theoretical Framework

This study From Novice to Expert by Patricia Benner proposed a holistic predictive
model of a nurse developing skills and an understanding of patient care over time from a
combination of a strong education and personal experiences. The five (5) major concepts in
From Novice to Expert comprise the following: novice, advanced beginner, competent,
proficient, and expert.

For novice levels, nurses are beginners. They do not have any experience in this
field. At this point, they need direct guidance from the instructors to perform their tasks well.
Due to the lack of clinical experience, they are nearly unable to have the independence and
flexibility to complete their work. In specific situations, they depend on the instructors and
make requests for specific instructions from their instructors in order to complete their tasks
(Benner, 1984). Advanced beginner nurses have gained some experience in dealing with
specific clinical situations. They are able to be independent in real situations and respond to
what they have experienced before. Competent-level nurses need to undergo clinical
practice for two to three years in a particular field. They can realize long-term goals as well
as make their own long-term plans. Proficient nurses have a comprehensive understanding
of the clinical field. They have the capacity to know what they are doing right and what needs
to be modified according to their plans to be more comprehensive. Finally, expert nurses are
experienced and are completely unfettered in the clinical experience. Their mission is geared
toward addressing the clinical situation quickly, proficiently, and at high-performance levels.

Benner (1984) proposed the new nurse needs to accumulate experience in care and
address issues based on clinical situations. To do so, they need to have many experiences
in the clinical environment. However, new nurses not only need to obtain practical
experience, but they also have to improve their analytical skills. Situational analysis is
required to make the right decision to solve the problem (Benner, 1984). The application of
Benner’s (1984) theory has been suitable for the field of clinical nursing education. This
framework fit this study because it underscored the importance of clinical practice in which
the clinical learning environment is the decisive factor. Benner's model suits professionals in
nursing education to be able to guide their students from the moment they are beginners.

From novice to expert is a long process of nursing education where the application of
background knowledge from classroom lectures is not enough. The role of practical
education becomes more important. The goal of nursing educators is to guide their students
to apply clinical experience in real situations as well as analysis and judgement to make
appropriate decisions. It is important that they know what to do and how to do it. However,
these novices are nursing students who have no clinical experience. Therefore, the clinical
learning environment and the stakeholders become the determining factors in the success of
nursing students. The role of clinical teachers becomes more important than ever. They are
direct instructors whose mission is to provide a learning environment that best encourages
these novices.

Jean Piaget was one of the first theorists of constructivism. His theories indicate that
humans create knowledge through the interaction between their experiences and ideas. His
view of constructivism is the inspiration for radical constructivism due to his idea that the
individual is at the center of the knowledge creation and acquisition process.

The theory of constructivism is defined as the construction of new knowledge, which

is based on the learner's previous experiences (Kintsch, 1994). By designing an educational
process, the instructor must take into consideration the particular learning attributes of each
learner. Woolfolk (1993, p. 485) states that: “The basic idea is that students construct their
knowledge actively: the learner's mind receives stimuli from the outside reality and chooses
which of those that he learns is useful in his everyday life. Learning is a continuous energetic
process and not a passive perception of teaching. ”

Review of Related Literature and Related Studies

A long-standing demand for providing human resources to the healthcare industry is
nursing education. To advance fundamental abilities, practice is required in clinical settings.
The teaching and learning process is significantly impacted by the clinical learning
environment. Therefore, the goal of the literature review is to present a thorough picture of
how students evaluate their experiences in a clinical setting.

According to Movahedi et al (2013),the most vital part of nursing education is the

clinical area. It is necessary to comprehend the variables that affect the quantity and quality
of clinical education in order to address the matter at hand (Tavakoli et al, 2014).

Poor Learning Environment

A poor learning environment can have negative consequences on students'
professional development since a good clinical learning environment benefits students'
professional growth. Nursing students may have various difficulties due to the unpredictable
nature of the clinical training setting ( Jafarian et al., 2015). Some evidence has also
identified the clinical learning environment as one of the key factors to achieving the desired
outcomes in this dynamic open healthcare delivery system globally (AAl, 2015)
On the other hand, (Sercekus and Baskale, 2016) as cited in (Arkan, 2018) included
the other factors effective in clinical learning are the clinical environment which arises from
features of the clinical environment, the attitude of clinical personnel, and the number and
characteristics of patients. (Farzi, 2018) supports that students are affected negatively by
physical inadequacies such as a lack of equipment and the absence of a common room in
the clinical environment. Inappropriate behaviors of doctors and nurses with nursing
students and clinical educators and being neglected in the clinical environment by doctors
and nurses have reduced the participants' willingness to teach and to learn.

Emotional Work and Diversity

(Arieli, 2013) emphasizes that the students’ experiences are characterized by
emotional strains of various sorts—stress, ambivalence, disgust, frustration, and
conflict—that arise in three types of relationships: relationships with patients, with the clinical
instructors, and with other students who are on their teams. The data show that diversity has
an impact on all these relationships. This study also shows that the students cope with the
emotional strains by using several strategies of emotional work: distancing,
self-strengthening, self-motivation work, and minimizing significance.
Some evidence has also identified the clinical learning environment as one of the key
factors to achieving the desired outcomes in this dynamic open healthcare delivery system
globally (AAl, 2015)
The experiences of participants indicated that clinical educators' incessant criticism
during the procedure and students' fear of improper care of the patients have impaired the
learning process. Attendance of patient relatives at the bedside and evaluating the students
during the procedure were the participants' experiences that caused fear and inability in
students, and consequently, they could not transfer their skills to the clinical environment.
(Farzi, 2018)
Problems that nursing students run into while working in the clinical setting are
among the major difficulties in clinical teaching that have been previously mentioned in the
literature. Students complain about insufficient clinical staff supervision, unsafe clinical
placement, insufficient practical experiences, competition with other health programs for few
practice venues, a lack of trained clinical instructors, and a high workload for clinical
instructors. Nursing students may also have additional issues due to the fluid nature of the
practical learning setting. Determining the issues that are frequently faced by students in the
hospital can therefore lead to solutions that improve learning experiences and raise
satisfaction with nursing as a profession (Copeland, 2020).

Insufficient Knowledge

The failure to relate theoretical knowledge to practice is also a significant problem in

terms of clinical learning. In many studies, it is pointed out that the gap between theory and
practice affects students' learning negatively (Khater et al., 2014, Peyrovi et al., 2005, Sharif
and Masoumi, 2005, Elcigil and Sarı, 2007, Sercekus and Baskale, 2016) as cited in (Arkan,
2018)

Jamshidi et al (2016) mentioned that many students did not have sufficient knowledge to
care at the bedside when dealing with a clinical learning environment and providing care to
the patients was challenging for them. The clinical environment is a suitable setting for
honing the skills necessary to offer patient care. Yet, a number of these are recognized as
fundamental medical skills, and any shortcomings in them have an effect on the quality of
care. Students occasionally had trouble doing this since they lacked the essential skills.
Similarly, (Jamshidi, 2016) stated that many students did not have sufficient knowledge to
care at the bedside when dealing with the clinical learning environment, and providing care
to the patients was challenging for them.

Finally, as eloquently stated by Gemuhay et al (2019), barriers to effective clinical

learning were reported by 70.1% of the participants and the barriers include student factors
such as lack of self-confidence and absenteeism, school factors such as improper
supervision, and poor preparation of clinical instructors or clinical facility factors. That is one
of the reasons why many nursing students lack knowledge when they are exposed to a
clinical environment. According to other studies, ineffective teachers, unfavorable attitudes,
and a lack of student support can all have a poor impact on learning (Anarado et al., 2016,
Juliana Lawal et al., 2016).

Deficiency in Practical Skills

As claimed by Jamshidi et al (2016), deficiency in practical skills in caring for patients

was a concern of many students in the clinical setting. Insufficiently developed
communication skills would sometimes cause disruption in providing care for patients. Many
students' communication skills are lacking, which mkes it difficult for them to interact with the
clinical learning environment. Additionally, the clinical environment is a suitable context for
learning skills needed to care for patients. However, some of them are considered basic
healthcare 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.

Dellefield et al (2015) from their point of view in Norwegian nursing education programs, as
in most other nursing educations, 50% of the curriculum is dedicated to practical studies
within a variety of clinical settings and in campus-based clinical training (Framework for
nursing education,2019). This provides the students with valuable insights into the nursing
profession and aids in the process of becoming competent nurse. Registered nurses (RN)
hold a multifaceted role in nursing homes, and nursing academics are encouraged to aid
nursing students’ recognition of clinical placements in nursing homes as challenging and
complex. In this dynamic global system of open healthcare delivery, some data has also
identified the clinical learning environment as a critical determinant in achieving the intended
results (AAl, 2015).

(Farzi, 2018) emphasizes that a clinical educator is one of the main components of
education, and if he/she does not pay attention to effective clinical education principles, this
can prevent the transfer of learning. Inadequate skills of clinical educators in doing nursing
procedures and indirect teaching were other problems noted by the participants. (Berhe &
Gebretensaye, 2021) confirms that the clinical learning environment component has a great
role in providing students with professional abilities by combining cognitive, psychomotor,
and affective skills. Evidence has identified the clinical learning environment as one of the
key factors to achieve the desired outcomes. Students often face challenges during the
courses of clinical learning, which may affect their competence. The aim was to explore
challenges faced by nursing students in clinical learning environment .

Inadequate readiness

According to Deasy et al (2011), nursing teachers and students both experience

difficulties as a result of the students' insufficient preparation for entering the clinical setting.
Nursing students do not have the time to practice and repeat these skills enough to fully
enter the clinic, despite the fact that they learn the principles of nursing in classrooms and
simulation labs. Killam and Heerschap discovered that the students had difficulties learning
in the clinic due to their lack of preparation and expertise before entering the clinical setting
(Killam & Heerschap, 2013). Additionally, it is clear that the students lack the necessary
skills to deal with real patients and the clinical setting (Joolaee et al, 2015). As claimed by
Sheu et al (2002), students' lack of expertise and poor prepping for the clinical setting
interfere with their learning processes and cause them anxiety.

In this regard, the participants' experiences showed that insufficient readiness of

students including insufficient self-confidence; students' inadequate mastery of cognitive
components of clinical skills; and inadequate mastery of clinical skills in the skill lab have
disturbed the clinical education process. (Farzi, 2018)

Discrimination

A subcategory that most students have encountered is discrimination. They were

expressing their annoyance at a number of discriminatory actions they had witnessed at the
bedside. The nurses' treatment of the pupils, the students indicated, showed the most
discrimination in the clinical environment. A decline in educational motivation and
professional attitude, decreased provision of quality care, jealousy of other students,
increased tendency to leave nursing, and reduced interest in attendance in clinical settings
were some effects of such discrimination identified by participants (Mamaghani et al., 2018)

Consequences of the perception of gender discrimination include stress and burnout,

decreased job satisfaction, and increased turnover rate (Celebi Cakiroglu & Baykal, 2021).

Gender bias and role stereotyping do exist in nursing education programs because
nursing faculties are often composed mainly of women (Anthony, 2004). The experiences of
the students revealed issues related to gender bias in nursing education, practice areas, and
societal perceptions that nursing is not a suitable career choice for men. Barriers identified
within educational programs for undergraduate male nursing students included lack of
support from friends and family, feelings of social isolation and low numbers of male mentors
and tutors, a feminized nursing curriculum, minimal imagery of men in nursing texts, and the
perception that male students were being assessed against a feminist pedagogy (O'Lynn et
al., 2020). Men remain a minority within the nursing profession. Nursing scholars have
recommended that the profile of nursing needs to change to meet the diversity of the
changing population and the shortfall of the worldwide nursing shortage. However, efforts by
nursing schools and other stakeholders have been conservative toward the recruitment of
men. (Meadus & Twomey, 2011)

Synthesis

The related literature and studies of this study tackle the lived experiences of nursing
students in the clinical environment in terms of emotional work and diversity, insufficient
knowledge, deficiency in practical skills, inadequate readiness, and discrimination. The
experiences that nursing students have throughout their clinical rotations should be viewed
as emotional difficulties, and their emotional work and coping mechanisms call for the right
kinds of support. When determining the type of support that students will require and
understanding their experiences and learning processes, it is crucial to take into account the
diversity of the clinical placement environment. (Areili, 2013). Additionally, the Clinical
learning environment is a significant component in relation to clinical learning and its
outcome, it is therefore of great significance to pay attention to the nurse students’ clinical
practice experiences and identify areas that need improvement (Mwai, 2014) as cited in
(Berhe & Gebretensaye, 2021). Thus, encouraging relationships will lead to students'
acceptance as members of the treatment team and facilitate effective learning. On the other
side, poor interactions between clinical nurses and students compromise their ability to learn
and jeopardize their ability to advance professionally and stay in the field (Shahram et al.,
2015) as cited in (Berhe & Gebretensaye, 2021).
 Chapter 3
Methodology
This chapter presents the methodology, research locale, research design, population
and sampling, participants of the study, and instrumentation. Aside from that, the data
gathering, procedure, ethical consideration, and results will be discussed in this particular
chapter.

Research Design

Phenomenology is a form of inquiry that seeks to understand human experience to

explore phenomena and how it is perceived and experienced by individuals in the
phenomenological event. According to German philosopher, Edmund Husserl(1859-1938)
phenomenology can be roughly described as the sustained attempt to describe experiences
and the “things themselves” without metaphysical and theoretical speculations. The goal of
phenomenology approaches is to understand the human experience as it is lived. Meaning is
the core of the transcendental phenomenology of science, a design for acquiring and
collecting data that explicates the essence of human experience.

Moustakas’ (1994) data analysis method of transcendental-phenomenological

reduction was the best suited methodologically for the study. It was used to achieve a
textural-structural synthesis and essence of the experience. A transcendental
phenomenology focuses on the study of rich, textural descriptions, structural descriptions,
and the essence of the study (Creswell, 2013; Moustakas, 1994). Transcendental
phenomenology helps describe the phenomenon using the participants’ experiences,
perceptions, and voices.

Munhall (2006) states that qualitative research provides meanings from individuals'
experiences and situations. As stated by Lopez and Willis (2004), the researcher's objective
in descriptive phenomenology is to acquire transcendental subjectivity, which is defined as a
state in which "the researcher's impact on the inquiry is constantly assessed, and biases and
preconceptions neutralized, so that they do not influence the object of study. Furthermore,
Moustakas’ (1994) data analysis method of transcendental-phenomenological reduction was
the best suited methodologically for the study. It was used to achieve a textural-structural
synthesis and essence of the experience. The focus of the study was the participants’ lived
experiences and not their interpretation of the experiences.

Research Locale
This study will be conducted in a-faith based college located in Valencia City,
Bukidnon, Philippines. The Annex campus is an extension of the School of Nursing as well
as the School of Medical Technology where junior nursing students, senior nursing students,
and senior medical technology students or interns reside. Furthermore, the Annex campus is
a 30-minute drive from the main campus itself. Moreso, the study will be conducted in April
2023.
Population and Sampling

This study will utilize the purposive sampling method. As claimed by Frost (2023),
purposive sampling, also known as selective and judgemental sampling, is a non-probability
way of gathering a sample in which researchers utilize their knowledge to select particular
volunteers who will aid the study in achieving its objectives. These individuals have specific
qualities that the researchers must consider when analyzing their study question. In other
words, the subjects are chosen by the researchers "on purpose." Additionally, choosing and
identifying people or groups of people who have particular expertise in or experience with an
interesting phenomenon entails utilizing the purposive sampling method (Cresswell & Plano
Clark, 2011).

Furthermore, a purposive sample is employed using five essential processes. The

first step is defining the research problem. Then, determining the population will follow. After
which is defining the characteristics of the chosen sample. After defining the characteristics
of the chosen sample, collecting the data using an appropriate method will then follow.
Finally, the last step in employing selective sampling method is by analyzing and interpreting
the results (Nikolopoulou,2022).

The target population of this study will initially include 10 nursing students from
Mountain View College in Valencia City, Bukidnon who are currently enrolled in the third year
level. Moreover, the participants will be chosen through a purposive sampling technique with
the following criteria:
 a) Students who are officially enrolled in MVC School of Nursing during the academic
year 2022- 2023
b) A nursing student who is currently in the third year level
c) Willing to participate in the research study.

Instrumentation

The instrument utilized in this study is a semi-structured interview using a guide

questionnaire and a recorder to record the face-to-face interview. The guided questionnaire
comprises eighteen questions, that focus on experiences perceived by student nurses in a
clinical environment.

Semi-structured interview guide. A data collection method for a qualitative study that
combines a formalized list of open questions to prompt discussion with the opportunity for
the interviewer to explore particular themes or responses further George, T. (2022). A
semi-structured interview is a data collection method that relies on asking questions within a
predetermined thematic framework George, T. (2022). A semi-structured interview is a
qualitative research method that combines a pre-determined set of open questions
(questions that prompt discussion) with the opportunity for the interviewer to explore
particular themes or responses further.

Conducting in-depth interviews is one of the most common qualitative research

methods. It is a personal interview that is carried out with one respondent at a time. This is
purely a conversational method and invites opportunities to get details in depth from the
respondent. These interviews can be performed face-to-face or on the phone and usually
can last between half an hour to two hours or even more. When the in-depth interview is
conducted face to face it gives a better opportunity to read the body language of the
respondents and match the responses. One of the advantages of this method provides a
great opportunity to gather precise data about what people believe and what their
motivations are.

Observation. Direct observation is the process of gathering data while using your
senses. By keeping an eye on small details, you can document people's actions, behaviors,
and physical characteristics of a scenario without relying on their willingness or capacity to
provide truthful answers to your queries ( Corrage Health Evaluation, 2023).
 Qualitative Observation is a process of research that uses subjective methodologies
to gather systematic information or data. Since the focus on qualitative observation is the
research process of using subjective methodologies to gather information or data.
Qualitative observation is primarily used to equate quality differences. Qualitative
observation deals with the 5 major sensory organs and their functioning – sight, smell, touch,
taste, and hearing. This doesn’t involve measurements or numbers but instead
characteristics.
Recorder. The skill of recording data involves the documenting of data and
observations in a variety of forms in order to preserve it for later use. It will be used to record
the information during the interview. We will be using an audio recording device during the
interview through a smartphone by the researchers.

Most researchers use audio recordings for individual interviews as a way to capture what is
said during the interview. Audio recording qualitative interviews can be useful both during the
interview itself and afterward. During the interview, recording the interview means that
qualitative interviewers can focus on listening, probing and following up (see later), and
maintaining eye contact with their interviewee.

Data Gathering Procedure

The researchers would seek approval from the research advisers and panel
members. After which, they will secure permission to conduct the study from the Dean of
the School of Nursing. The researchers will then ask permission from the President of the
college through a letter request to conduct the study inside school premises with residential
third-year students as the respondents. The data-gathering procedures will immediately
begin after the proposal was approved by the members of the research panel.
Then, the researchers randomly select respondents from the different students from
level three. All of the participants will receive an explanation of the study's purpose.
Additionally, the respondents will be told that taking part in the study is entirely up to them
and that they could stop at any time. They will also be given the assurance that all of the
interviews would be kept private and confidential. Informed consent will be given from each
participant to sign before participating in the study and will be informed that their interviews
shall be recorded. Information will be gathered through one-on-one interviews and will range
in length from 30 to 45 minutes.

Furthermore, data collection will be performed through interviews and based on the
actual experiences of students from learning in the clinical environment. The interview will be
conducted in a classroom in the nursing building. 10 third-year nursing students will be
initially interviewed, and the process will begin with several open-ended questions. In order
to increase the depth of the interviews and further collect the desired facts, there will be
additional follow-up questions. The participant will be requested to add any additional
information that the interviewer had missed at the conclusion of each interview session.
Concurrent data collection and analysis will be done, and the interview will be terminated
whenever data saturation is reached.

Ethical Considerations
Following the research panel's approval, the researchers will also seek clearance
from the dean of the school of nursing, research advisers, and the President of the college.
In terms of the participants' ethical rights, the researchers made sure that they will be aware
of the study's goal and that they shall be informed that the interview would be recorded. After
which, consent will be secured.
In order to maintain confidentiality, the data that will be collected will be handled with
care and will only be available to the researchers. To maintain anonymity, the participant
names will be identified by using codes. The information will be kept on a single laptop and
shall be organized into a single folder with a password that is only known to the researchers.
Participants will also be made aware that participation is optional and that they are free to
stop at any moment, without incurring any penalties. As to data management, all recordings
between the data and participants will be deleted after the research period is over.

Analysis of the Data

This study will employ data analysis by Moustakas in order to identify and understand
the challenges that nursing students face in the clinical learning area. It is a strategy used at
the start of the study by the researcher to allow him or her to set aside their opinions about
the phenomenon and concentrate on the opinions provided by the participants. Furthermore,
the strategy offers a road map for phenomenological inquiry's fundamental understanding
processes. The approach uses data related to the phenomenon through
the epoché and the reductions to gain a greater comprehension of the fundamental
meanings built into the data. The steps of the data analysis by Moustakas (1994) are
elaborated below.

The step begins with the phenomenological reduction and encompasses the
following:

1. Listing and preliminary grouping.

This is the beginning of horizontalization. Every relevant statement must be listed in this step
(Moustakas, 1994). Grouping the transcripts and interview questions from every participant
must be done first. Then, an excel spreadsheet will be used in order to categorize relevant
statements that will be extracted from the transcription (Moustakas, 1994).

2. Reduction and Elimination

The researcher is directed by Moustakas (1994) through a two-step procedure to assess if
the "moment of experience" is a "necessary" component of one's analysis. Moustakas
(1994) then inquires as to whether it is possible to "abstract and label" the experience.
Otherwise, they are not held onto. Furthermore, according to Moustakas, "overlapping,
repetitive, and vague expressions" either "eliminated" or "represented [in] more precise
descriptors."

3. Cluster like invariant constituents into themes.

The categorically remaining similar responses will be the thematic divisions of the transcript.
This comprehension will then lead to the fourth step, which is the final identification of
invariant constituents (Moustakas, 1994).

4. Create a final identification of the invariant constituents.

This stage will entail comparing the original record's invariant elements by theme.
This step is done in order to determine the answer of each participant whether they were
"explicit" in the original. If not, whether they were at least "compatible" with the original. If
neither was the case, it will be erased.

5. With the remaining, construct an “individual textural description” for each participant.

6. Create for each participant an “individual structural description”

After phenomenological reduction, "imaginative variation" is operationalized at this point
(Moustakas, 1994). The process of searching for all the potential interpretations connected
to the structural description is known as imaginative variation. It is a deconstruction to the
essences of meaning using the eidetic method (Moustakas, 1994).

7. Incorporate for each participant, a synthesis of the textural-structural descriptions, the

invariant constituents and the themes.
The "meanings and essences of the experience" are contained in this step (Moustakas,
1994, p. 121). It will be able to build a textural-structural description for each participant
using the theme categorical replies. The strategy mentioned above appears to be an easy
way to analyze data. It does have certain terminology that needs to be understood in more
detail. This includes horizontalization, imaginative variation, and the eidetic reduction.

Reflexivity Statement
Reflexivity is the researcher's deep introspection and reflection on how his or her own
biases and presence in the research situation may have affected how the data were
collected, analyzed, and interpreted (Patton, 2015). The aim of phenomenology is to explore
an experience as it is lived by the study participants and interpreted by the researcher.
During the study, the researcher's experiences, reflections, and interpretations influence the
data collected from the study participants (Creswell, 2013; Morse, 2012; Munhall, 2012).
Phenomenologists perceive the person as being in constant interaction with the environment
and making meaning of experiences in that context. The world is shaped by the self and
shapes the self. Beyond this, however, phenomenologists diverge in their beliefs about the
person and the experience. The key philosophers who helped develop phenomenology are
Husserl and Heidegger (Munhall, 2012).

As student nurses who were already exposed to different units of the clinical area, we
encountered several challenges that affected our learning process and attitude toward this
particular aspect of our nursing journey. Reflecting on these very moving and challenging
experiences, we would like to address these concerns through our research study in order
for us to have a better learning experience in the clinical setting. Additionally, we would also
like to discover the challenges that other fellow nursing students experienced during their
hospital exposure so that we would be able to analyze and come up with solutions to these
certain problems.

Rigors of the Study

Rigor is a technique used in qualitative analysis to build trust or confidence in a
research project. It allows the researchers to be consistent and fairly portray the community
under investigation. a demand for qualitative methods among researchers
to provide adequate justification, transparency, and evidence to make their conclusions
reliable (Williams & Kimmons, 2022). These four qualities, referred to as trustworthiness,
may comprise (1) credibility, (2) dependability, (3) confirmability, and (4) transferability to
evaluate the rigor of qualitative investigations (Nowell & Albrech, 2019).
 Credibility. Refers to the extent to which a research account is believable and
appropriate, with particular reference to the level of agreement between participants and the
researcher (Lincoln & Guba, 1985). Trust in the reliability of data and its interpretations is
meant by this (Polit & Beck, 2010) as well as the validity of the results (Lincoln & Guba,
1985). This guarantees the degree of the researchers' confidence in the accuracy of the
study's findings. According to Polit and Beck (2010), qualitative researchers must make an
effort to increase confidence in the conclusions for the particular study participants and
situation. Checking the participants' membership status is one approach to prove this.
Member Checking. This method of verifying the validity of results is sometimes
referred to as participant or respondent validation (Birt et al., 2016). In order to ensure that
the data or analysis accurately captured what the participants intended, it is necessary to
ask them to examine the results. By requesting the participants to review their responses in
the interview transcript for comments, member checking was used in this study. Also, the
researchers took use of this chance to clarify some data points by asking the individuals
about them.

Dependability. This is referring to the accuracy and consistency of the study.

Conclusions and the degree of documentation of the research methods (Streubert, 2007).
Williams (2018) contends that the more reliable the outcomes are, the more consistent the
research procedure must be. This will assess the researchers' consistency. Upon
conceptualization, data gathering, and data analysis throughout the project. The researchers
made sure the study procedure was rational, traceable, and thoroughly recorded in order to
accomplish this (Tobin & Begley, 2004). To assure dependability, an external audit was
performed in this inquiry.
External Audit. This is done in order to assess a study's reliability. It attests to the
study's methodological dependability, and confirmability by assessing the data, analysis, and
interpretations and determining whether or not the conclusions accurately represent the data
(Miller, 1997). To make sure that the conclusions were supported by the data, this entailed
consulting a person outside the research team who is qualified to examine and audit the
research process. Our research adviser performed external auditing for this study, checking
the accuracy of the data and conclusions as well as the overall consistency of the
investigation process.

Confirmability. This addresses the concern for the neutrality or fairness of data
interpretation. This ensures that the research’s interpretations and findings were derived
from the participants and not from the researcher's “biases, motivations, interests, or
perspectives” (Lincoln & Guba, 1985). To achieve this, the researchers described how the
conclusions and findings have been reached and one way to do this is through the use of an
audit trail.
Audit Trail. Several authors have suggested using this to establish the
fidelity of qualitative research (Carcary, 2009). The audit trail also enables readers to follow a
researcher's reasoning and determine whether the study's conclusions can serve as a
springboard for more research. This includes describing the data collection and evaluation
processes and proving that the conclusions are based on participant narratives. The method
of data collection, which also includes raw data, is thoroughly described by the researchers.
The researchers would also clarify how the analysis was done, with each decision's
justification included.

Transferability. This refers to the extent to which qualitative findings can be applied
or transferable in other contexts (Nieswiadomy & Bailey, 2018). This ensures that the
findings of the research study are relevant to similar situations, populations, and events. This
can be met by providing a thick description.
Thick Description. Ponterotto (2006) claims that a thick description goes beyond
appearances on the outside and takes context, emotion, motivation, and intention into
account. describing the context of the conduct and events as well, so that they make sense
to someone who is not familiar with them (Korstjens & Moser, 2018). It is a
method by which a qualitative researcher presents a comprehensive and in-depth account of
their data collection activities. Detailed descriptions were provided by the researchers in this
study so that readers could gauge and assess the degree of transferability of
making their own discoveries.
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