EXPLORING THE CHALLENGES IN THE LEARNING EXPERIENCES

OF THIRD-YEAR NURSING STUDENTS DURING CLINICAL

ROTATION

NURSING DEPARTMENT

JUSTINE HOPE J. AMORGANDA

CHRISTIAN HURVEY D. CALLE
LUCILE ANN B. BELLONID

NOVEMBER 2024
EXPLORING THE CHALLENGES IN THE LEARNING EXPERIENCES
OF THIRD-YEAR NURSING STUDENTS DURING CLINICAL
ROTATION

A Thesis Presented To The Faculty and Staff of Polytechnic College of

Davao del Sur, Inc., Digos City

In Partial Fulfilment of the Requirement for the

Degree of Bachelor of Science in Nursing

(BSN)

JUSTINE HOPE J. AMORGANDA

CHRISTIAN HURVEY D. CALLE
LUCILE ANN B. BELLONID

NOVEMBER 2024
 POLYTECHNIC COLLEGE OF DAVAO DEL SUR, INC.
McArthur Highway, Barangay Kiagot, Digos City
8002, Davao del Sur, Philippines

APPROVAL SHEET

In partial fulfillment of the requirement for the degree of Bachelor of Science in

Nursing, this undergraduate thesis entitled: “EXPLORING THE CHALLENGES IN
THE LEARNING EXPERIENCES OF THIRD YEAR NURSING STUDENTS DURING
CLINICAL PRACTICE” has been prepared and submitted by, Justine Hope J.
Amorganda, Christian Hurvey D. Calle, and Lucile Ann B. Bellonid.

MARILOU C. DIANA, MAED

Research Adviser

APPROVED and ACCEPTED by the Oral Examination Committee:

FERDINAND GALACIO, MAN SHEIKH ORTOUSTE, RN, MAN

Panel Member Panel Member

MORSID K. TULAO, PHD

Chairperson
 3

ACKNOWLEDGEMENT

The researchers would like to express a high sincere gratitude to the

following individuals who played a significant role in the successful completion of this
qualitative research project:

To the Divine Presence, the researchers acknowledge the guidance and

blessings bestowed upon by the Almighty, which have been the researcher's guiding
light throughout this research journey.

To the Institution of Polytechnic College of Davao del Sur, Inc., a sincere

appreciation goes to the institution for its continuous commitment to academic
advancements. The researchers extend a strong gratitude to the administration,
faculty, and staff for providing the essential resources, conducive environment, and
scholarly atmosphere necessary for the completion of this study.

To the Dean of Nursing Department, Morsid K. Tulao, PhDM, the

researchers express the deepest gratitude for this individual's visionary leadership,
steadfast support, and invaluable guidance, which have been instrumental in shaping
the course of this research.

To the Panelists, Ferdinand Galacio, MAN, and Sheik Ortouste, MAN, the
researchers extend a heartfelt thanks to these esteemed panelists for their expertise,
constructive feedback, and insightful contributions during the defense of the research.
Their rigorous examination and thoughtful recommendations have enhanced the rigor
and quality of the study, enriching the researchers' scholarly growth.

To the Research Adviser, Marilou C. Diana, MAED, a special recognition

is extended to a dedicated research adviser, whose unwavering support,
encouragement, and expertise have been pivotal in guiding the researchers through
the challenges of this research endeavor. Her mentorship, scholarly guidance, and
unconditional commitment to this success have been invaluable assets throughout this
 4

process.

To the Co-Researcher, the researchers extend sincere for their

collaboration, dedication, and shared commitment to the success of this study. Their
collaborative efforts, intellectual contributions, and teamwork have been essential in
overcoming challenges and achieving research goals.

THE RESEARCHERS
 ABSTRACT

This study employs a qualitative research design under the phenomenological

approach to delve into the challenges in the learning experiences of third-year nursing
students during clinical practices. Using a qualitative phenomenological approach, this
study involved 14 third-year nursing students enrolled in the academic year 2024-2025.
Participants were selected through homogeneous purposive sampling and data were
collected using semistructured interviews. This research aims to provide insights into
the challenges faced by nursing students and their learning experiences during their
clinical practice

Keywords: Challenges, nursing students, learning experiences, qualitative research,

clinical practices
 TABLE OF CONTENTS

Pages

TITLE PAGE
APPROVAL SHEET
ACKNOWLEDGEMENT
TABLE OF CONTENTS

CHAPTER I – INTRODUCTION 1
Background of the Study 1
Review of Related Literature and Studies 3
Theoretical Framework 9
Objectives of the Study 10
Significance of the Study 10
Scope and Limitation of the Study 11
Definition of Terms
11

CHAPTER II – METHODOLOGY 14
Research Design 14
Participants of the Study 15
Research Locale 16
Research Instrument 16
Data Sources 16
Data Analysis 17
Role of the Researcher 18
Trustworthiness 19
Ethical Considerations 20
REFERENCES 23
APPENDICES 26
Appendix A Letter to the Dean of Nursing 27
Appendix B Letter to the College Registrar 28
Appendix C Letter to the Participants 29
Appendix D Survey Questionnaire 30
CURRICULUM VITAE 32

CHAPTER 1
INTRODUCTION
Background of the Study
Nursing is a hands-on career that combines theoretical knowledge with practical
skills that complement one another. Nursing education allows nursing students to
develop suitable information, skills, communication, and attitudes, which significantly
influence community health. Clinical rotation experience is a set experience for a
specific nursing educational course in which students acquire experience in hospitals,
clinics, healthcare facilities, and the community. Clinical rotation is an essential exercise
because it allows students to integrate cognitive, psychomotor, and emotional abilities,
all of which influence their satisfaction, knowledge, skills, attitudes, and interest in
nursing patients. Exploration of such environments provides insight into the educational
functioning of students in clinical areas, allowing nursing instructors to provide
opportunities for students to learn in the clinical setting (Adam et al., 2021).

Clinical practice is essential to healthcare education, allowing students to apply

learned concepts in real-world settings. However, the transfer from classroom learning
to clinical environments can be difficult, affecting students' learning experiences and
overall performance. Although they may be capable in theory and able to discuss what
they learned in the classroom, sometimes they cannot use this capability in various
health-related situations during internships. Challenges that nursing students faced in
acquiring new skills were linked to problems with the clinical setting and learning
opportunities including the lack of educators and clinical staff, little support supervision,
shortage of materials, problems with student distribution, the deficiency of role models,
shortage of time for experiencing the clinical environment and problems with
interpersonal relationships. Furthermore, lack of collaboration and/or poor
communication among students, educators, and healthcare professionals are some of
the primary factors that have a negative effect on student learning (Akyüz & Ergöl,
2022).
Globally, many countries report having established standards for the duration
and content of nursing education, and a significant number also have accreditation
processes for educational institutions. Despite these measures, there remains
considerable variation in the level and quality of nursing education both across and
within the six World Health Organization (WHO) regions. In some cases, notable
discrepancies can even be found within a single country. These challenges underscore
the pressing need for nursing education to adapt and evolve to meet the demands of an
increasingly complex healthcare environment. This includes fostering higher-level
decision-making skills, enhancing clinical judgment, cultivating team leadership abilities,
and developing political acumen (Berhe & Gebretensaye, 2021).

In the Philippines, according to the Commission on Higher Education

Memorandum Order No. 14, 2009, a nursing student is required to complete 2,346
hours of RLE. This consists of teaching-learning opportunities meant to help nursing
students gain abilities in using processes in a variety of health-related contexts. Clinical
training or RLE for students is the most important component of nursing education
because it is mostly skills or practice-based, which distinguishes nursing from other
professions. However, this requirement can be challenging for the students. Their
clinical training might even impact how they perceive certain challenges in their future
nursing career. Clinical stressors include not being confident in one's abilities, not
knowing the clinical environment, technology, or equipment, and being afraid of making
mistakes, providing patient care, or hurting patients (Geraldine Sabate Ridad et al.,
2024).

This study addresses a significant gap in qualitative research concerning the

challenges and learning experiences of third-year nursing students during clinical
rotations at the Polytechnic College of Davao del Sur Inc. Clinical practice is a
cornerstone of nursing education, yet the distinct obstacles and learning dynamics
encountered by students in this context have received limited scholarly attention.
Recognizing the importance of these experiences, the researchers are motivated to
delve into the personal narratives of third-year nursing students, uncovering the
complexities of their journey. By doing so, this study seeks to provide a nuanced
understanding of their challenges, enrich the existing body of knowledge, and offer
valuable insights to enhance nursing education practices.
Review of Related Literature and Studies

The clinical rotation is a critical component of nursing education, bridging

theoretical knowledge and practical application. For third-year nursing students, this
phase serves as a foundation for developing clinical competence, professional identity,
and patient care skills. However, it is often accompanied by various challenges that
influence their learning experiences. This chapter presents the relevant studies that
form the basis of this research. The review offers insights into the validity of the problem
selected by the researchers as the focus of the study.

Foreign

Clinical education plays a critical role in preparing nursing students for the
workforce by facilitating the integration of theoretical knowledge into practical settings.
However, nursing students frequently face challenges, including anxiety and concerns
about their clinical competence. Nursing students often express anxiety about clinical
experiences, which can hinder their learning. it is found that students’ confidence in their
skills, such as communication and physical assessments, improved significantly after
clinical rotations, indicating the value of hands-on experience. Similarly, it highlights the
importance of supportive clinical environments and effective instructors in enhancing
students' self-efficacy and reducing anxiety. Strategies to improve students' clinical
experiences, such as providing orientation, simulation training, and fostering peer
support, are recommended to address these challenges and boost students’ clinical
competencies. By focusing on these aspects, educators can enhance the quality of
nursing education and better prepare students for the complexities of patient care
(Smith et al, 2020).
Nursing education has long been a crucial component in supplying the
healthcare sector with skilled professionals. Competent clinical nurses must possess
both comprehensive medical knowledge and substantial hands-on experience.
However, the journey to becoming a professional nurse involves rigorous learning
processes. Gaining practical experience in clinical settings is vital for honing the
fundamental skills required of nurses. As a result, the role of nursing education has
never been more critical. The clinical learning environment (CLE) plays a pivotal role in
shaping the educational process, though it presents challenges, especially when it
significantly differs from classroom settings. Modern technology, along with interactions
with doctors, patients, families, and fellow nurses, can become sources of concern in
this environment (Tran, 2019).

The clinical learning environment encompasses a range of physical,

psychological, emotional, and organizational factors that significantly influence students'
learning experiences and their ability to navigate and adapt to the setting. This
environment plays a crucial role in fostering students' positive learning outcomes and
emotional well-being while exposing them to the realities of their profession and the
practical functions of nursing. However, its inherent complexity and the dynamic nature
of the events that unfold within it often create tensions, making the environment
challenging to manage effectively. Despite these challenges, the clinical learning
environment remains indispensable for developing the skills, confidence, and
professional attitudes required for a successful nursing career (Kalyani et al., 2019).

Moreover, the clinical learning environment is seen as a multifaceted setting that

includes staff, patients, and nurse educators, all of which surround and influence
learners. This environment can either enhance or impede nursing students'
performance, ultimately impacting their career development. According to (Berhe, 2021)
The clinical learning environment plays a vital part in turning nursing students into
professionals and preparing them to function as nurses. However, the dual nature of
this environment means it can have both positive and negative impacts on learning.
Supportive staff, constructive feedback from educators, and meaningful patient
interactions can foster growth and competence. Conversely, factors such as high stress,
unsupportive colleagues, or overwhelming responsibilities can impede learning and
diminish confidence.

A study by (Hustad, et al., 2019) conducted in Botswana found that nursing

students needed more supervision in clinical settings to apply theoretical knowledge in
practice. Additionally, it has been noted that the attitudes of clinical instructors influence
the performance of nursing students during their clinical placements. Clinical
placements, which are official settings where students participate in organized clinical
experiences as part of a designated unit, are often reported as the most difficult aspect
of their education. These placements demand that students navigate complex
responsibilities while adhering to various institutional policies and guidelines. Despite
the difficulties, these settings are essential for bridging the gap between classroom
learning and professional practice, shaping students’ competencies and preparedness
for their roles as future nurses.

Furthermore, a study in Ethiopia revealed that nursing educators typically serve

as clinical instructors for undergraduate students starting in their second year of the
four-year program. However, these educators are often not readily available to students,
and one instructor is usually responsible for a large group. This limits opportunities for
individualized practical learning and demonstration sessions. The limited availability of
instructors means that students often struggle to receive timely feedback and support in
mastering essential nursing skills. This lack of direct supervision can hinder students’
ability to gain confidence in their abilities, effectively apply theoretical knowledge to
clinical practice, and develop a deeper understanding of complex clinical procedures.
Consequently, their overall learning experience and professional development are
negatively impacted, potentially leading to gaps in their preparedness for real-world
nursing responsibilities.(Andreas & Daniel, 2017; Berhe, 2021).

Moreover, a recent study by (Quayson, 2024) in Ghana revealed that nursing

students often face negative experiences during their clinical placements, including
bullying from patients' relatives. The study showed that 52.2% of nursing students had
encountered verbal abuse in clinical settings, and 12% had faced sexual harassment by
medical doctors, one of their most distressing experiences. Additionally, many students
expressed frustration over being restricted to basic and repetitive tasks, such as
monitoring vital signs, despite their level of training. This limitation not only stunts their
professional growth but also creates a disconnect between their academic knowledge
and practical application. Such experiences diminish students’ confidence, reduce the
value of their clinical exposure, and erode their motivation to pursue a career in nursing.
 A study by (Atakro, 2019) in Iran found that undergraduate students did not
acquire the right competencies during clinical placements as a result of inadequately
prepared clinical teachers and poor application of theory in practice by practicing
nurses. Undergraduate nursing students report similar difficulties in clinical learning
environments across many countries. The incompetence of clinical instructors emerged
as a significant barrier, with students often finding that their supervisors needed more
expertise or pedagogical skills to guide them effectively. This deficiency undermines
students’ confidence and hampers their ability to translate academic knowledge into
real-world practice. Furthermore, the negative attitudes of hospital staff toward students
create an unwelcoming and sometimes hostile learning environment, which further
detracts from their ability to learn and thrive during placements.

Nursing is one of the most stressful and challenging professions worldwide. More
so than other health-related disciplines, it has been well-established that nursing
students experience higher levels of stress than other non-nursing university students.
As they advance through their programs of study, nursing students are required to meet
multiple theoretical and clinical requirements, giving rise to their stress. In the
classroom, students learn and develop relevant knowledge to provide care for their
patients by learning about nursing theory and principles. In the clinical environment,
students apply theoretical principles learned in the classroom and ‘learn by doing’. By
experiencing the real work environment, they learn the required psychomotor skills and
become socialized into the professional nursing role. Although clinical education
provides rich opportunities to gain hands-on experience, the clinical component of
nursing education has been identified as providing the highest source of stress for
nursing students (Tremblay et al.,2022).

Stress is defined as a particular relationship between the person and the

environment appraised by the person as taxing or exceeding his or her resources and
endangering his or her well-being (Hutmacher, 2021). However, it may be defined
differently by people depending on the situation they are in In the life of nursing
students, juggling academic classes, clinical and community duties, and other
responsibilities or workload, stress is inevitable. For nursing students, stress is an
almost unavoidable part of their daily lives due to the complex nature of their academic
and professional responsibilities. The balancing act of managing rigorous academic
classes, demanding clinical duties, community service, and personal obligations often
results in overwhelming stress. Globally, nursing is considered the most challenging
and stress-provoking among all other professions Many studies claim that nursing
students endure more stress from various sources than other non-nursing students
(Ridad, 2024).

Nursing students have been found to encounter similar stress-related

occupational health risks to staff nurses. Stress could increase as the students progress
through their programs. Possible stressors of nursing students during their clinical
placement included: uncertainty, a lack of professional knowledge and skills, a fear of
committing medical errors, a heavy workload, performance stress related to
expectations from academic and clinical staff, exposure to death and social problems of
patients, and dealing with emergencies. The consequences of this stress can be
significant, potentially leading to burnout, anxiety, depression, and reduced academic
performance. Understanding the sources and impacts of stress on nursing students is
crucial for developing effective strategies to manage and alleviate stress (Ching et al.,
2019).
Most sources of stress have been categorized as academic, clinical, or personal.
Each person copes with stress differently and utilizes deliberate, planned, and
psychological efforts to manage stressful demands. Coping mechanisms are commonly
termed adaptation strategies or coping skills noted that students used critical coping
strategies to handle stress and suggested that problem-solving was the most common
coping or adaptation mechanism used by nursing students. Nursing students’ coping
strategies affect their physical and psychological well-being and the quality of nursing
care they offer. While stress is an inevitable part of nursing education, students who
develop effective coping strategies are better equipped to handle the challenges they
face. Therefore, identifying the coping strategies that students use to manage stressors
is important for early intervention (Dias, 2024).
 Furthermore, nursing students coexist with other stressors that are typical
considering their role as students, such as those related to their academic program and
their role as nursing students. This is because, as opposed to other degree programs,
nursing students are in touch with the job market which requires a certain responsibility
in the wellbeing of their patients, distancing them, at times from the student campus life
and especially, from normal social activities and enjoyed by their peers. This added
responsibility can lead to increased pressure and stress, as nursing students must apply
theoretical knowledge in real-world clinical settings, often with high stakes. Their
academic program is rigorous, requiring mastery of both complex medical concepts and
practical skills. This constant juggling between classroom learning and clinical duties
can create a sense of imbalance, distancing nursing students from the typical student
experience (Zafra, et al., 2020).

Furthermore, the way individuals cope significantly influences how they adapt to
stress. Prior research indicates that nursing students' stress levels during clinical
practice are strongly linked to their coping strategies. More specifically, higher stress
levels are associated with negative coping strategies, while positive coping styles are
connected to lower stress levels. It is found in the study of (Dias, et al., 2024), that
Israeli nursing students were found to adopt a range of coping mechanisms, including
talking to friends, engaging in sports, avoiding stress and sadness/misery, and
consuming alcohol. Further, the study of (Salam et al., 2019) revealed that high levels of
alcohol consumption and illicit drug use as a coping strategy among UK medical
students was related to high anxiety and is a major cause for concern.

Resilience in nursing students is critical for coping with the stresses of clinical
environments. Several studies emphasize the importance of resilience in managing
clinical challenges and stressors. According to Martin and Thieman (2020), nursing
students often face vulnerabilities such as uncertainty and professional struggles, which
can impact their well-being. However, peer support and positive role models can help
restore strength and promote growth. The integration of caring theory, which stresses
compassionate care, has been linked to enhanced resilience in students. This theory
underlines the importance of empathy, mentorship, and collaboration in building
resilience, suggesting that fostering supportive environments can significantly benefit
student learning and well-being during clinical education.

Local

The Philippines is widely recognized for producing competent and

compassionate nurses, a testament to the nation’s commitment to excellence in nursing
education. However, despite this reputation, nursing students face significant
challenges during their formative years, particularly in meeting the rigorous academic
requirements of the bachelor’s degree program. One of the primary stressors for Filipino
nursing students stems from the extensive workload and numerous assignments that
demand considerable time and effort. Nursing education, which integrates a solid
foundation in liberal arts and sciences with a transdisciplinary approach, further
amplifies the difficulty of the program. This complexity underscores the demanding
nature of nursing as a field of study, requiring students to balance theoretical learning
with practical application. These challenges reflect why nursing is often regarded as one
of the most stressful professions, highlighting the resilience required to succeed in this
noble and essential career (Haiy, 2023)

According to (Aljon Delmo Galang and Santos, 2021), nursing students often
encounter difficulties in mastering the specialized jargon integral to their education.
Linguistic development in nursing extends beyond language studies, requiring students
to engage with complex technical terminology essential for professional communication
and knowledge synthesis. While this terminology is critical for understanding and
conveying precise information in clinical settings, it frequently presents significant
challenges for beginners. Students often struggle with jargon that falls outside their
existing schemata—the mental framework of knowledge they rely on to process new
information. The unfamiliarity of these terms adds a layer of complexity to their learning
process, requiring extra effort to memorize and internalize them. This initial lack of
necessary lexemes poses a significant hurdle, marking the beginning of a challenging
learning journey.
 Critical care clinical placements play a crucial role in developing nursing students'
competencies, emphasizing the need for thoughtfully designed programs. The study
highlights five key characteristics of effective clinical placements: adequate exposure to
clinical settings, structured area orientation, mentorship by supportive clinical
instructors, exposure to diverse medical cases, and access to supplemental learning
resources. Notably, a supportive clinical instructor had the most substantial positive
effect on critical care skills, while area orientation influenced multiple competency
domains. These elements create an environment conducive to skill enhancement and
the development of professional attitudes. This framework suggests that optimizing
clinical placement programs can significantly enhance students' preparedness for
critical care roles, ensuring alignment with global demands for competent healthcare
professionals (Bongar et al., 2019).

A study by (Rose et al., 2024) reveals the emotional and practical challenges
faced by third-year nursing students during their oncology placement at the University of
San Carlos. The students experienced anxiety and excitement, reflecting their response
to a new environment. Initially, they felt inadequacy and perceived limitations, but
overcame these through strategic support systems and reflective practices. The
students experienced a range of emotions, from fear and stress to a growing sense of
confidence and accomplishment. The study also emphasizes the importance of
structured support and mentorship in helping nursing students manage the complexities
of cancer care, enhancing their ability to provide compassionate care while maintaining
their psychological well-being.

A study by (Ridad et al., 2024) focused on nursing students’ stress during

Related Learning Experiences (RLE), it was found that the clinical instructor was the
primary source of stress, with students also experiencing stress due to skill confusion
and interpersonal dynamics with peers and staff. To cope with these stressors, students
adopted various coping strategies, such as improving their self-concept, enhancing role
function, and building interdependence with colleagues. These coping mechanisms
were found to correlate with lower stress levels. The study suggests that nursing
programs and educators should incorporate strategies to alleviate stress and improve
students' emotional resilience. This could involve fostering supportive environments,
providing mentoring programs, and designing curricula that address both academic and
emotional aspects of nursing education. Furthermore, the findings emphasize the need
for greater communication and collaboration between clinical instructors, students, and
peers to reduce stress and enhance learning experiences.

According to the study, stress has been proven to negatively impact both the
academic performance and behavior of students, leading to challenges in maintaining
focus and productivity. This stress can arise from various sources, such as academic
pressure, clinical placements, and personal responsibilities. Coping strategies are
essential for managing stress, and students can benefit from tools and techniques that
help them navigate these challenges effectively. One important way to alleviate stress is
through social activities, which provide an outlet for relaxation and social interaction.
These activities, such as movie nights or event celebrations, allow students to unwind
and build a sense of community. For paramedical students, it is crucial to offer these
additional recreational opportunities to help them recharge and maintain a healthy work-
life balance (Ronald Yrog-Irog et al., 2023).

A study conducted by (Alviar et al., 2021) explored the impact of adaptive coping
behaviors on the stress levels of nursing students at the Adventist University of the
Philippines. The findings revealed that nursing students, particularly those in their
second and third years, experienced elevated levels of stress, primarily due to
academic examinations and heavy workloads. Despite these high stress levels,
students demonstrated effective adaptive coping behaviors, with listening to music
emerging as the most commonly preferred strategy for managing stress. Additionally,
significant variations in coping behaviors were observed based on students' year of
study and residential status. Female nursing students were found to report higher stress
levels compared to their male counterparts, emphasizing the need for targeted support
strategies for different demographic groups.

Theoretical Framework
 The framework for this study is the Novice Expert theory developed by Patricia
Benner. She is a nursing theorist, educator, and author. In her nursing career, she has
worked in a variety of settings, including nursing care, emergency nursing, intensive
care unit (ICU) nursing, and home care. She took part in a research project called
Achieving Methods of Interprofessional Consensus, Assessment, and Evaluation, which
helped her advance in her nursing career. In 1984, she published "From Novice to
Expert: Excellence and Power in Clinical Nursing Practice," which laid the groundwork
for the evolution of clinical nursing education. This book emphasized the value of clinical
practice, particularly in nursing practice. Benner (1984) proposed that 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 experiences, they also have to improve their
analytical skills. Situational analysis is required to make the right decision to solve the
problem. 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 more than the application of background knowledge from classroom
lectures is required. The role of practical education becomes more important (Tram,
2019).

Bandura’s theory of social learning provides a useful framework for us to

consider how students learn via observational learning and modeling. For Bandura,
learning takes place in a social setting via observation, but it also involves cognitive
processes such as learners internalizing and making sense of what they see in order to
reproduce the behavior themselves. Bandura proposed that this type of learning
involved four different stages – attention, retention, reproduction, and motivation. The
first level is learning to pay attention to their behavior. They must genuinely observe the
behavior that they desire to emulate or that others want them to reproduce. Second,
they must internalize and retain what they have seen. This includes cognitive processes
in which a learner mentally rehearses the activities to be performed. Third, they require
the opportunity to imitate the behavior by putting the information gained from attention
and memory into action. Finally, learners must be motivated to copy observed behavior.
In this framework, nursing students learn by observing experienced nurses, imitating
their actions, and developing their own confidence in performing tasks during their
clinical practices (Horsburgh & Ippolito, 2019).

Another theory that will support this study is Peplau’s theory. She believed that
effective nursing care goes beyond the administration of medications and treatments – it
involves creating an environment where patients feel safe, heard, and understood. This
relationship is built on mutual respect, empathy, and collaboration, aiming to empower
patients to take an active role in their own recovery. Peplau's theory has profound
implications for nursing practice, shaping the way nurses interact with patients to create
therapeutic relationships that foster healing and well-being. By applying Hildegard
Peplau's nursing theory of interpersonal relationships to the nursing practice, nursing
students can communicate and work with the patient more efficiently toward the
common goal of wellness. As the foundation for effective, supportive work environments
and excellent patient care, professional communication skills and interpersonal
relationships must be one goal every nurse and nursing student strives to achieve
(Barta, 2023).

Research Questions
The primary objective of this study is to explore the challenges in the learning
experiences encountered by third-year nursing students during their clinical rotation.
Exploring and providing in-depth insights into the various dimensions of nursing
students’ experiences during their clinical placements. The research aims to address
the following specific questions:

1. What are the real-life experiences of third-year nursing students during their
clinical rotations?
2. What are the challenges that the participants experienced during their clinical
rotations?
3. How do they turn these difficulties into ways on how to improve their performance
during clinical rotations?
 4. What valuable insight can they share with their fellow students to help them
improve their overall performance during clinical rotations?

Significance of the Study

The findings of this study give a wealth of knowledge to society, especially to
students. Additionally, This study makes some important contributions to:

Nursing Students. This study would be helpful in shaping their ideas,

understanding, and techniques for dealing with challenges in learning experiences
during clinical practice. It will help them to improve and understand management
strategies.

Clinical Instructors. This study helps clinical instructors determine the student's
challenges in the learning experience in their clinical practice.

Staff Nurses. The research benefited staff nurses by providing insights into
students’ challenges and their learning experiences, creating a supporting environment,
reducing workplace stress, improving patient care, and fostering nurse-student
relationships.

Researcher. As a researcher, we would benefit from the study as we explore the

various challenges faced by students during their clinical practice, focusing on how
these difficulties impact their learning experience and development of practical skills.

Future Researchers. This study offers future researchers more information or

data for their prospective studies related to challenges in the learning experience during
clinical practice.

Scope and Limitation of the Study

This qualitative study will be conducted at Polytechnic College of Davao del Sur
Inc. in Digos City. This research study is only for third-year nursing students who have
experienced in clinical rotation. The inclusion criteria are the third-year nursing students
who are enrolled in the Bachelor of Science in Nursing program and who have
experienced any clinical rotation. This study excludes students who are not enrolled for
the second semester of s.y 2024-2025 at Polytechnic College of Davao del Sur, Inc.
and who are not a third year nursing students. Students from other academic levels and
those who are not enrolled in the stated institution's third-year nursing program are also
excluded. More importantly, the whole duration of the conduct of this qualitative study
was expected to cover the months of January – May 2025.

Definition of Terms
The following terms are operationally defined to help readers understand the
study's content.

Learning Experiences. It refers to the practical tasks, difficulties, and

interactions that third-year nursing students face during clinical rotations. These
experiences include the knowledge gained, skills developed, and professional progress
accomplished by getting involved in healthcare settings.

Challenges. It refers to the specific difficulties, obstacles, and pressures

encountered by third-year nursing students during their clinical rotations. These include
academic, emotional, social, and professional issues affecting their ability to adapt,
learn, and perform effectively in real-world healthcare environments.

Clinical Rotation. It refers to the hands-on training and supervised practical

experience that third-year nursing students undergo in various healthcare settings as
part of their academic curriculum. It involves direct patient care, interaction with medical
professionals, and application of theoretical knowledge in real-world clinical scenarios.

Nursing Student. It refers to third-year nursing students who will be the

respondents of the study that the researchers focused on and actively participated in
academic coursework and clinical rotations as part of their training to become
professional nurses.
 CHAPTER II
METHODOLOGY

This chapter of the study is about the techniques and procedures that will be
utilized in gathering and analyzing information. It additionally contains the mediums to
be utilized for the data required for the viability of the study which includes the research
design, participants of the study, research locale, research instrument, data sources,
data analysis, the role of the researcher, trustworthiness, and ethical considerations that
are followed to avoid complications.

Research Design

This study will use a descriptive phenomenological approach, under the

qualitative research design to explore and understand the challenges encountered by
third-year nursing students during their clinical rotations. According to (Husserl, 1913),
phenomenology seeks to capture and describe the essence of lived experiences from
the perspective of those who experience them. This approach is well-suited for the
study as it provides a means to uncover the profound and nuanced realities of nursing
students' challenges within the clinical learning environment. The descriptive
phenomenological approach focuses on participants’ firsthand accounts of their
experiences, aiming to describe their perceptions, emotions, and insights without
imposing preconceived notions. This allows the researcher to gain an in-depth
understanding of the specific challenges that third-year nursing students face during
their clinical rotations and how these challenges shape their learning experiences
(Sinfield et al., 2023).

Participants of the Study

This study will include ten (10) participants who meet the established
inclusion and exclusion criteria.

Inclusion Criteria:
• Academic Level: Participants must be third-year nursing students from
Polytechnic College of Davao del Sur.
• Hospital Exposure: Participants must currently be undergoing hospital
exposure at Davao del Sur Provincial Hospital.
• Willingness: Participants must be willing to voluntarily participate in the
study.

Exclusion Criteria:

• Enrollment: Students who are not enrolled for the second semester
of S.Y. 2024-2025 at Polytechnic College of Davao del Sur will be
excluded.
• Academic Level: Students who are not third-year nursing students
will also be excluded.
• Institution: Students from other academic levels or institutions who
are not enrolled in the third-year nursing program at Polytechnic
College of Davao del Sur will not be included.

This selection process will ensure that the study focuses on the experiences of third-
year nursing students currently undergoing hospital exposure at the specified institution,
allowing for a more relevant analysis of their clinical experiences.
Research Locale

The study will be conducted at the Polytechnic College of Davao del Sur's
nursing department, primarily at MacArthur Highway, Barangay Kiagot, Digos City,
Davao del Sur, Philippines. This institution is known for its nursing program, which
integrates both theoretical and practical learning. Specifically, the study focuses on
third-year nursing students undergoing clinical rotations in various healthcare settings
affiliated with the college. These settings include local hospitals, community clinics, and
other medical facilities where students gain hands-on experience in patient care.

Figure 1: Site Map of Polytechnic College of Davao del Sur, Inc.

Source: Google Map

Research Instrument

A semi-structured interview guide serves as the research tool for the study,
Exploring the Challenges in the Learning Experiences of Third-Year Nursing Students
During Clinical Rotation. The purpose of the tool is to gather detailed qualitative data.
Important topics include general rotational experiences, particular difficulties faced, and
the general clinical setting. The questions will be thoughtfully crafted by the researchers
to ensure they are properly connected to the study's topic and objectives. To promote
deeper understanding and provide flexibility in responding to participants' answers,
probing questions are incorporated into the conversation to foster an honest and
encouraging environment. The gathering of accurate, accurate information that
represents nursing students' actual experiences during clinical rotations is guaranteed
by this careful design. The researchers will institute four main research questions, the
respondents were asked the following questions: (One) What are the real-life
experiences of third-year nursing students during their clinical rotations? (Two) What
are the challenges that the participants experienced during their clinical rotations
(Three) How do they turn these difficulties into ways to improve their performance
during clinical rotations? (Four) What valuable insight can they share with their fellow
students to help them improve their overall performance during clinical rotations?
Interview researchers used in-person interviews, also referred to as face-to-face
interviews. The interview is a method for gathering data in which the interviewer speaks
with the respondent directly while using a prepared questionnaire. This allows for good
communication and comprehensive expression of views and data.

Data Sources
In this study, the first step will involve identifying and selecting (Ten) third-year
nursing students in Polytechnic College of Davao del Sur, Inc. who are currently
engaged in clinical rotations. Once the participants are selected, the researchers will
provide informed consent from each participant to ensure that they are aware of the
study’s purpose, their role, and their right to confidentiality and voluntary participation.
The researchers will be conducting in-depth interviews with each student in order to
explore the personal and professional challenges they face during their clinical
rotations. During the interview, the researchers will note the answers of the participants
using recorded audio to gather accurate data. After collecting the data from the
participants, the information will be analyzed. The analysis will be thematic, looking for
recurring patterns, challenges, and themes that emerge across all sources of data. The
purposive sampling technique will ensure that only students with direct and current
experience in clinical settings are chosen, as their perspectives will provide the most
accurate and relevant data. Finally, the researcher will compile the findings, providing a
detailed narrative of the challenges faced by third-year nursing students during their
clinical rotations. The data will be presented in a way that reflects the experiences of the
purposively selected participants, offering an in-depth and nuanced understanding of
the key issues.

Thematic Analysis
The researchers will use the Modified Stevick-Colaizzi-Keen (1978) data analysis
method to explore the challenges in the learning experiences of third-year nursing
students during clinical rotations. This method is well-suited for this research study
since it will provide an understanding and interpretation of the lived experiences of the
participants. The process of descriptive phenomenology will typically be structured
around four key steps: bracketing, intuiting, analyzing, and describing.

In analyzing the data that will be gathered, the researchers will bracket their own
experiences in nursing education to avoid shading the student's experiences with
personal biases. This process will ensure that the researcher approaches the
phenomenon with an open mind, focusing solely on the participants' experiences rather
than their own interpretations or existing theories. After that, during interviews, the
researcher will practice intuiting by attentively listening to the students' stories about
their clinical challenges, paying close attention to their feelings, emotions, and reactions
in the clinical setting. The researcher will aim to capture the full depth of what it means
for the student to experience stress, communication difficulties, or time management
struggles during rotations. Next, the researcher will analyze recurring themes, patterns,
and structures within the data, which will reveal how participants perceive and make
sense of their experiences. The final step is describing. he researcher will capture the
essence of the lived experiences by weaving together the identified themes and
providing a narrative that will convey the participants’ experiences. In this step, the
researcher will be tasked with articulating the universal essence of the experience,
addressing the "what" and "how" of the phenomenon. The description will be detailed
enough to enable readers to grasp the full depth and significance of the experience
while remaining faithful to the participants' perspectives.
Role of the Researchers
In a qualitative study, the role of the researcher is both dynamic and crucial. The
researcher oversees the explanation of the study's goals to participants and ensures
that a positive rapport is established, promoting trust and open communication. They
facilitate conversations, demonstrating receptivity to new ideas and possessing the
ability to elicit meaningful information while maintaining neutrality and ethical integrity.

The researcher also acts as an advocate for participants, ensuring their stories
are contextualized within the broader framework of nursing education and clinical
practice. By engaging in critical reflection and dialogue, the researcher aims to
contribute actionable insights to improve the clinical learning environment for nursing
students.

Trustworthiness
Lincoln and Guba's (1986) "parallel criteria," referred to as "the Four-Dimensions
Criteria," consist of credibility, transferability, confirmability, and dependability.

Credibility. The researchers will ensure that all data collected from the
participants are accurate, reliable, and verified before integrating them into the study.
This will entail developing thorough data validation techniques and closely evaluating
the efficacy of research instruments such as interview prompts. By performing these
steps, the researchers hope to establish the credibility of the study process and ensure
that the material gained reflects the participants' true experiences and viewpoints.

Transferability. The researchers allow future researchers access to the data

acquired in this study. This paper is open to those individuals who will study topics
connected to this research, showing that their findings may be used in different
situations. This would also demonstrate that the research study's conclusions may be
used in various contexts.
 Confirmability. Researchers ensure that the data and findings are rooted in the
participants' responses, with a commitment to avoiding biases. All data originated from
primary sources, The data collected from participants will directly reflect the study or
paper under investigation, underscoring the researchers' dedication to data accuracy.

Dependability. The researchers ensure that the data are consistent by using
data measurement and procedures like pre-validation questions and guide questions in
which the data are obtained through primary sources and questionnaires that have
already been conducted. The degree to which the study's findings were reliable and
repeatable by other researchers. To ensure the validity and dependability of the
research, the researcher upholds rigor and transparency throughout the entire
procedure.

Ethical Considerations

By respecting the participants' rights and privacy throughout the process, the
researcher will ensure the confidentiality of the information they share. The researcher
also ensures that the study will be utilized only for academic reasons and no other
purposes. Researchers will ensure the study has acquired the school's research
publication's approval before proceeding. Participants will fill out a questionnaire without
their names but will be requested to provide information about their age and sexual
orientation. Confidentiality will be upheld. The participant questionnaires were also
maintained under the researcher's control, and the researcher guaranteed
confidentiality and acknowledged all works by others used in this study. After the letter
is approved, the researcher will distribute and reclaim the questionnaire from the target
participants. Data gathered will be analyzed and categorized according to answers from
the participants.

Respect for person. The researchers will try to prevent them from being taken
advantage of because of their vulnerability. They will ensure that the participants are
treated with courtesy, avoid negative use of words if possible, and see to it that their
emotional capability is handled in a nice and healthy way. Researchers ensure that the
participants are comfortable telling their stories without judgment from the researchers.
 Beneficence and Non-Maleficence. The researchers will minimize the dangers
connected to their work, including psychological and social hazards while increasing the
rewards given to study subjects. Also, while the study was conducted, the research will
benefit persons who participated and caused no damage. Researchers will ensure that
participants were given tokens as their appreciation for participating and giving data
regarding the study.

Informed and voluntary consent. The researchers will provide the participants
with informed consent as part of the study, ensuring that they clearly understand the
research's objectives, data collection procedures, and voluntary involvement. The
consent forms explicitly outline all aspects of participation and assure that participants
are willingly participating in the study. Coercion of participants to contribute data was
not permitted.

Anonymity and Confidentiality. Researchers ensured that the participant’s

data was secured and kept within the researchers only. According to Hoft
(2021), researchers must observe the principle of anonymity and confidentiality,
whereby participants are protected from any harm that may occur as a result of having
voiced out some views.

CHAPTER III
RESULTS AND DISCUSSIONS
 This chapter presents the key findings obtained from ten in-depth interviews. It
begins with a brief description of the participants to provide context for the study. The
major findings are then discussed and analyzed in detail. This analysis aims to offer a
deeper understanding of the challenges faced by third-year nursing students during
their clinical rotations.

As a phenomenological study, this research aimed to explore the difficulties

encountered by nursing students in clinical settings, focusing on their learning
experiences, coping strategies, and personal insights. By uncovering these aspects, the
study seeks to provide valuable perspectives that may contribute to improving clinical
education and student support systems.

Profile of the Participants

This part introduces the ten nursing students who generously shared their
experiences in this study. Each participant consists of third-year nursing students who
have undergone clinical training in various healthcare settings currently and studying at
Polytechnic College of Davao del Sur Inc.

Table 1. Participant’s Profile

Code Age Sex Address Program Study

ID1 20 F Digos city BSN3 One-on-one Interview

ID2 20 F Digos city BSN3 One-on-one Interview

ID3 21 M Padada, Davao del Sur BSN3 One-on-one Interview

ID4 21 M Digos city BSN3 One-on-one Interview

ID5 21 M Digos city BSN3 One-on-one Interview

ID6 22 F Sta. Cruz, Davao del Sur BSN3 One-on-one Interview

ID7 20 F Digos city BSN3 One-on-one Interview

 ID8 21 F Malalag, Davao del Sur BSN3 One-on-one Interview

ID9 21 F Matti, Davao del BSN3 One-on-one Interview

ID10 20 F Sta. Cruz, Davao del Sur BSN3 One-on-one Interview

This study aims to express the challenges in the learning experience of 10 third-
year nursing students during clinical rotation in various hospital settings in Digos city
which was interviewed in ten in-depth interviews face to face using Colaizzi's (2013)
strategy of descriptive phenomenological data analysis. Further, the criteria of ten
participants who were interviewed one-on-one were third-year nursing students enrolled
in the Bachelor of Science in Nursing at Polytechnic College of Davao del Sur who had
already experienced different hospital exposures during clinical rotation. This study
focuses on understanding the challenges they face during their learning experiences
during clinical rotation. Using a descriptive phenomenological approach, this research
aims to capture and describe their real-life experiences. By doing so, it provides insights
into the challenges they faced, how they coped with them, and how these experiences
shaped their learning and growth as future nurses.

Moreover, descriptive phenomenology offered a holistic perspective, capturing

not only the challenges faced by nursing students but also the benefits they gained from
the experience and their responses to these situations. By applying Colaizzi’s (2013)
seven-step method of descriptive phenomenological analysis, key statements and
thematic clusters were integrated to construct a comprehensive and in-depth portrayal
of the phenomenon. As a result, 44 significant statements were identified from twelve
semi-structured interview transcripts. Following the extraction of significant statements
from all participants' data sources, the researcher assigned meaning to participants'
responses, proving a thorough interpretation of their experiences.

Each formulated meaning was then coded into initial cluster themes
corresponding to its respective significant statement, resulting in 44 formulated
meanings. The number of formulated meanings surpassed the significant statements
since some meanings were categorized under multiple thematic groups. Table 2 below
presents an example of how significant statements were transformed into formulated
meanings.

Table 2. Formulated Meaning from Significant Statements

Significant Statements Formulated Meanings

“I made some errors that upset my CI, Participants felt intense pressure knowing
which significantly affected my that mistakes could impact patient safety
confidence. I've learned that committing
errors isn't entirely wrong. While mistakes
are still mistakes.”

“I tend to learn a few things that need to Participants struggled to bridge the gap
be done in that particular area, For between classroom learning and real-
example, during my OR rotation I learned world clinical situations.
various things that weren't taught during
RD, which were really helpful for me
during my exposure.”

Additionally, after the meanings of the 44 significant statements were

established, similar ideas were grouped to create cluster themes that aligned with the
study’s objectives. This process resulted in ten cluster themes: Anxiety in Facing Real-
World Clinical Responsibilities, Fear of Errors Affecting Patient Care, Sense of
Fulfillment in Hands-On Patient Care, Uncertainty in Applying Theoretical Knowledge to
Practice, Struggles in Establishing Effective Patient and Clinical Instructor Interaction,
Viewing Mistakes as Learning Opportunities, Positive Mindset for Confidence and
Growth, Constructive Feedback as a Tool for Skill Enhancement, Flexibility in
Responding to Clinical Challenges, and Effective Prioritization for Efficiency in Clinical
Tasks.

Table 3 below provides an example of how coded formulated meanings, derived

from related significant statements, were grouped to form the cluster theme "Anxiety in
Facing Real-World Clinical Responsibilities."
 Table 3. Development of Cluster Themes

Significant Statements Formulated Meanings Cluster Themes

“I felt a range of emotions Participants felt nervous Anxiety in Facing Real-

during this experience, due to the pressure of World Clinical
from nervousness to handling real patients and Responsibilities
empathy.” performing procedures

SS8. Lines 119 to 121,

IDI7

From the ten identified cluster themes, four emergent themes were identified
forming the core framework for the findings presented in this study. These key themes
were: Emotional Turmoil in Balancing Fear and Fulfillment, Bridging the Gap Between
Theory and Practical Application, Leveraging Feedback and Reflection for Continuous
Learning, and Adaptability as a Key to Clinical Success. Through thorough data
analysis, these themes provided valuable insights into the challenges faced and the
growth experienced by participants during their clinical rotations. By systematically
extracting significant statements, interpreting their meanings, and structuring them into
cluster and emergent themes, the participants' narratives came together to form a
detailed and comprehensive account of their lived experiences, highlighting both their
struggles and accomplishments in the clinical learning setting.

Nevertheless, the following section presents a detailed discussion of the

emergent themes, drawing from participants' narratives extracted from interview data. It
explores their responses to the research questions: "What are the real-life experiences
of third-year nursing students during their clinical rotations?", "What challenges did the
participants encounter during their clinical rotations?", "How do they transform these
difficulties into opportunities for improving their performance?", and "What valuable
insights can they share with fellow students to enhance overall performance during
clinical rotations?" By examining these research questions through the participants'
stories, this section provides a detailed view of the real-life experiences of third-year
nursing students, highlighting both the difficulties they encountered and the
accomplishments they attained during their clinical training.

Shown below is the thematic map of this study.

EXPLORING THE CHALLENGES ON THE LEARNING EXPEREINCES OF THE THIRD

YEAR NURSING STUDENTS DURING CLINICAL ROTATIONS

Emotional Turmoil in Bridging the Gap Leveraging Feedback Adaptability as a Key

Balancing Fear and Between Theory and and Reflection for to Clinical Success
Fulfillment Practical Application Continuous Learning

1. Anxiety in Facing 4. Uncertainty in 6. Viewing Mistakes as 9. Flexibility in

Real-World Clinical Applying Theoretical Learning Responding to Clinical
Responsibilities Knowledge to Practice Opportunities Challenges

2. Fear of Errors
5. Struggles in 10. Effective
Affecting Patient Care
Establishing Effective 7. Positive Mindset for Prioritization for
Patient and Clinical Confidence and Efficiency in Clinical
3. Sense of Fulfillment
Instructors Interaction Growth Tasks
in Hands-On Patient
Care
8. Constructive
Feedback as a Tool for
Skill Enhancement

Figure 2. Thematic Map

Emergent Theme 1: Emotional Turmoil in Balancing Fear and Fulfillment

This theme explores the emotional challenges nursing students encounter as

they balance feelings of anxiety and achievement during clinical rotations. Fear often
stems from worries about making errors, handling critical situations, or adjusting to
unfamiliar settings. Such anxiety can lead to self-doubt and heightened stress,
particularly when students face pressure to meet expectations. Conversely, fulfillment
arises when students effectively apply their skills, deliver quality patient care, and
receive positive recognition. These moments of success boost their confidence and
encourage further growth. Managing this emotional contrast demands resilience, self-
regulation, and support from mentors or peers. Nursing students often face a wide
range of emotional challenges as they experience the ups and downs of clinical
rotations. Shifting from theoretical studies to practical patient care can be both fulfilling
and overwhelming, frequently triggering a combination of anxiety and achievement.

One of the biggest stressors for nursing students is the fear of making mistakes.
Since clinical environments require accuracy and quick thinking, the potential for errors
—especially those that could affect patient well-being—can be intimidating. Additionally,
students may feel immense pressure to meet expectations while being observed by
instructors, healthcare professionals, and patients. Despite these challenges, clinical
training is not solely a source of stress. Many students experience profound satisfaction
when they successfully apply their skills in real patient care scenarios. Delivering quality
treatment, witnessing positive patient outcomes, and receiving encouraging feedback
from mentors and patients can be highly rewarding.

To manage these emotional ups and downs, nursing students need to build
emotional resilience. Engaging in self-care practices—such as mindfulness, stress
management techniques, and maintaining a balanced lifestyle—can help mitigate
anxiety. Additionally, a strong support network of mentors, peers, and educators plays a
crucial role in creating a positive learning environment. Ali et al. (2021) emphasized that
guidance from experienced professionals and the use of structured coping mechanisms
can significantly assist students in handling stress and adapting to the demands of
clinical practice. By fostering a supportive atmosphere and equipping students with
effective coping strategies, nursing programs can help future nurses develop confidence
and resilience, ultimately preparing them for success in their careers.

Cluster Theme 1.1 Anxiety in Facing Real-World Clinical Responsibilities

The first cluster theme, Anxiety in Facing Real-World Clinical Responsibilities,

highlights the emotional strain nursing students experience as they move from
classroom learning to practical clinical duties. This transition can be overwhelming as
students face the pressure of applying theoretical knowledge in real patient care
settings. Several factors contribute to this anxiety. One major cause is the fear of
making mistakes, particularly when students are responsible for administering
medications, performing medical procedures, or handling life-threatening situations. The
pressure of knowing that errors can potentially harm patients creates intense worry,
especially among students who are still developing their clinical skills. Further, this
cluster theme describes the shared narratives of both individual interviews which
showed that some of the participants shared a common view as they shared their
experiences. Besides, the informant says:

I was nervous because you never really knew what would

happen, even though I had already gone through the return
demonstration and was confident (SS1, Lines 3 to 5, IDI1)

During the interview, one informant mentioned that she is nervous about facing the
challenges during her clinical rotation. She shared:

Of course, it was very nerve-wracking at first, but since I

truly wanted this course and understood its challenges,
SS7, Lines 97 to 100, IDI6

Also, participant 7 shared common views, as I remember she is very confident while
saying:

I felt a range of emotions during this experience, from

nervousness to empathy. SS8. Lines 119 to 121, IDI7

The implication of anxiety in facing real-world clinical responsibilities emphasizes

the need for nursing institutions to implement targeted interventions that address
students' emotional struggles. Since anxiety is linked to fear of making mistakes,
handling unfamiliar procedures, and meeting professional expectations can hinder
students' confidence and performance, educational strategies should focus on
improving students' preparedness and emotional resilience. Incorporating simulation-
based training allows students to practice clinical skills in a controlled setting, helping
them build confidence and reduce anxiety before handling real patient care.
Establishing mentorship programs that connect third-year students with experienced
peers or instructors can provide both emotional support and practical guidance.
Additionally, promoting stress management techniques like mindfulness exercises and
reflective practices can help students develop effective coping strategies, improving
their ability to manage anxiety during clinical rotations.

A study conducted by Reverté-Villarroya et al. (2020) explored how nursing

students experience anxiety and stress during their clinical training, as well as the
coping mechanisms they employ to manage these emotional challenges. The study
emphasized that stress and anxiety levels are not static but fluctuate throughout
students’ educational journey, influenced by various internal and external factors. One
of the key findings was that students who effectively adopt coping strategies tend to
experience lower levels of stress and anxiety. Moreover, the study suggested that
different students respond to stress in diverse ways, depending on their prior
experiences, personal resilience, and the availability of supportive resources. Some
students might resort to maladaptive coping mechanisms, such as avoidance or self-
doubt, which can exacerbate anxiety and impact their clinical learning experience
negatively. On the other hand, those who develop constructive coping behaviors, such
as time management, relaxation techniques, and positive self-talk, are more likely to
adapt successfully to the pressures of clinical practice.

Cluster Theme 1.2 Fear of Errors Affecting Patient Care

The fear of errors affecting patient care emerged as a significant concern. This
fear stems from students’ anxiety about making mistakes that could compromise patient
safety, harm their professional reputation, or result in disciplinary action. Third-year
nursing students, in particular, experience heightened pressure as they shift from
classroom-based learning to hands-on clinical practice. During this period, they are
required to apply their theoretical knowledge in real-life scenarios, such as
administering medications, monitoring patients’ vital signs, and managing emergencies.
The worry of making errors while performing these tasks can cause overwhelming
stress, especially for students who feel uncertain about their abilities or lack confidence
in handling complex medical situations. This was evident in the informants during
individual interviews, as one of the informants stated:
 I keep thinking about what I’ve learned and what mistakes
I’ve made so I can turn them into lessons. SS5, Lines 56 to
58, IDI4

On the same line, other informants also shared narratives parallel to the responses of
another informant as she said:

I made some errors that upset my CI, which significantly

affected my confidence. I've learned that committing errors
Isn’t entirely wrong. While mistakes are still mistakes. SS6,
Lines 78 to 81, IDI5

Also, participant 9 shared common views, as I remember she is very confident while
saying:

During my clinical rotations, there were times when I felt

unsure about certain procedures. SS10, Lines 142 to 144,
IDI9

Emphasizing the need for nursing institutions to address this anxiety, targeted
interventions are crucial in helping students manage their fear of making mistakes. This
fear can significantly affect their confidence, decision-making skills, and overall clinical
performance; thus, educational strategies should prioritize reducing anxiety while
enhancing students' competence in practical settings. Integrating simulation-based
training can offer students a controlled environment where they can practice key skills,
allowing them to build confidence before handling real patients. Additionally, introducing
error management training can equip students with strategies to respond to mistakes
positively, turning errors into valuable learning experiences. Providing close supervision
and mentorship from clinical instructors further ensures that students receive guidance,
support, and immediate feedback, helping them feel more confident and secure in their
clinical duties.

A study conducted by Dehvan et al. (2021) and Stolic et al. (2022) revealed that
medical errors among nursing students occur more frequently than what is typically
acknowledged. This finding underscores the challenges faced by students as they
transition from theoretical learning to real-world clinical practice. The study highlighted
that approximately half of these errors go unreported, which poses significant risks to
both patient safety and the student's learning process. Several factors contribute to this
lack of reporting. Fear of consequences is a major concern, as students worry about
potential disciplinary actions, negative feedback, or damaged academic standing. This
anxiety often discourages them from openly admitting their mistakes, even when doing
so could provide valuable learning opportunities.

Cluster Theme 1.3 Sense of Fulfillment in Hands-On Patient Care

As a valuable emotional experience, fulfillment significantly contributes to nursing

students' growth and motivation. Despite the stress and challenges that come with
clinical rotations, many students discover purpose and satisfaction through meaningful
patient interactions and the successful application of their skills. This sense of
achievement not only improves their emotional well-being but also strengthens their
resilience, allowing them to manage anxiety and difficulties in clinical practice more
effectively. By creating supportive learning environments, offering mentorship, and
promoting reflection on positive experiences, nursing institutions can help students find
deeper meaning and fulfillment in their patient care roles. For instance, during the
interview one of the participants shared a narrative as she said:

I was really amazed by that area because of the process of

childbirth- it has such a huge impact. SS11 Lines 167 to
169, IDI10

Also, another informant expresses almost the same sentiment. This was evident when
he shared:

Amazing and incredible- this experience really inspired my

ability to care, SS6, Lines 59 to 61, IDI4

This sense of fulfillment plays a vital role in enhancing students' confidence,

strengthening their competence, and deepening their dedication to the nursing
profession. When students observe the positive effects of their care—such as patient
recovery, appreciation from patients and families, or recognition from mentors—their
motivation and belief in their abilities grow. This heightened confidence enables them to
overcome self-doubt and improves their capacity to manage complex clinical situations
more effectively. Moreover, fulfillment in patient care fosters emotional resilience.
Nursing students who derive meaning from their work are more likely to develop
effective coping mechanisms to handle stress and prevent burnout. This resilience is
crucial for maintaining a sustainable career in healthcare, where demanding situations
are common. Additionally, finding satisfaction in patient interactions inspires students to
pursue lifelong learning, continually refining their skills and expanding their knowledge
to enhance the quality of care they provide.

A study conducted by Mlek (2011), investigated nursing students' experiences

during clinical rotations, focusing on their stress levels, anxiety, and coping strategies.
The research emphasized that while clinical training is crucial for developing practical
skills, it often triggers strong emotional reactions due to the demanding nature of real-
world healthcare environments. To manage these challenges, many students adopted
coping mechanisms such as seeking support from mentors, engaging in self-reflection,
and using stress management techniques to handle the pressures of clinical practice.
As they advanced in their training, they became more adept at managing complex
patient cases, which enhanced their confidence and independence. The satisfaction
gained from actively contributing to patient care, along with positive reinforcement from
instructors and patients, further solidified their commitment to pursuing a career in
nursing.

Emergent Theme 2. Bridging the Gap Between Theory and Practical

Application

Bridging the gap between theoretical knowledge and practical application is a

common challenge for third-year nursing students during their clinical rotations.
Although these students gain substantial knowledge in the classroom, putting it into
practice in real clinical settings can be challenging. One reason for this struggle is the
limited hands-on experience they receive before starting their clinical duties. Even with
a solid understanding of procedures in theory, students may feel anxious and unsure
when performing them in real-life scenarios. Moreover, clinical environments are often
more unpredictable and demanding than classroom simulations, requiring students to
adapt quickly and make sound decisions. Emotional pressure also plays a role, as the
fear of making mistakes can affect their confidence and ability to apply what they have
learned.

To help students overcome these challenges, nursing programs can incorporate

advanced simulation exercises. These simulations offer a risk-free setting where
students can develop their clinical skills without endangering patient safety. Reflective
activities are also valuable in allowing students to process their experiences and
enhance their critical thinking abilities. Encouraging self-reflection helps students
assess their actions, leading to greater self-awareness and ongoing development.
Engaging in supervised clinical procedures further strengthens their confidence and
sharpens their practical skills. Hands-on learning under expert supervision ensures
students gain real-world competence. Implementing these strategies facilitates a
seamless transition from academic knowledge to clinical application. Nursing programs
that adopt these methods foster a more supportive and effective educational
environment. Well-trained students are better equipped to provide exceptional patient
care. Ultimately, improving nursing education benefits both future healthcare
professionals and the broader medical community.

The study by Shoghi et al. (2019) examines the challenges associated with
bridging the gap between theoretical knowledge and practical application in nursing
education, specifically from the perspective of Iranian nursing experts. The authors
emphasize that while nursing students gain substantial theoretical knowledge in the
classroom, they often struggle to effectively translate these concepts into clinical
practice. This disconnect can lead to difficulties in decision-making, reduced confidence,
and a lack of preparedness when transitioning into real-world healthcare settings.
Additionally, the study underscores the importance of simulation-based training as a
vital educational tool. High-fidelity simulations create realistic clinical scenarios where
students can practice skills, make decisions, and manage patient care without the risk
of causing harm. These exercises help reinforce theoretical concepts, enhance critical
thinking, and build students' competence in handling complex medical situations.

Cluster Theme 1.4 Uncertainty in Applying Theoretical Knowledge to Practice

 The transition from theoretical learning to practical application during clinical
rotations remains a significant challenge for third-year nursing students, with many
experiencing uncertainty and anxiety when faced with real-world patient care. Nursing
students often struggle to translate classroom knowledge into practice, especially when
confronted with complex clinical situations that require immediate and accurate
decision-making. This uncertainty can affect their confidence and decision-making
abilities, as they may feel ill-prepared to handle the unpredictable nature of clinical
settings (Jones et al., 2022). These difficulties highlight the importance of effective
mentorship and structured reflection opportunities to help students bridge the gap
between theory and practice, ultimately fostering greater self-confidence and
competence in their clinical roles. Moreover, this cluster theme highlights the common
narratives found in both individual interviews, revealing that some participants had
similar perspectives as they recounted their experiences. Additionally, the informant
states:

It made me more cautious in the part that it’s scary that your
handling the life of another person is under your
responsibility. I’m cautious in giving the right medicine, the
right patient, right procedure, I’m cautious when I'm not
wearing a uniform if there is no duty and by chance there is
an accident I’m the one who can help (SS12, Lines 184 to
187, IDI1)

Another informant stated that she does not feel confident when it comes to major
operations:

No, because you know… my self-confidence is not that high,

unlike my classmates, like Lucile. Anyway, I don’t have high
self-esteem, especially when it comes to major subjects or
major operations—I still get nervous (SS16, Lines 221 to
223, IDI4)
Further, one of the informants also feels unsure if she was really prepared to face
hospital challenges since her experiences in class were different than what she
expected, she stated that:

At first, I didn’t feel adequately prepared for these

challenges because the pace and demands were much
higher than what I had experienced in class (SS19, Lines
275 to 276, IDI7)

The persistent uncertainty and anxiety experienced by students underscore the

need for modifications in nursing education and training programs to better prepare
them for real-world patient care. The transition from classroom knowledge into practice,
particularly under the pressure of complex clinical situations, suggests the necessity for
a curriculum that emphasizes experiential learning. Integrating simulation-based training
and real-life scenarios into nursing programs could provide students with opportunities
to practice decision-making and critical thinking in a controlled environment. The
narratives shared by informants highlight a shared experience of apprehension
regarding patient safety and self-efficacy in clinical roles. This indicates a need for
educational frameworks that not only teach technical skills but also address the
emotional and psychological dimensions of patient care. Incorporating training on self-
awareness, stress management, and resilience could empower nursing students to
navigate the complexities of clinical settings with greater confidence.

According to Shdaifat (2019), nursing students encounter a moderate degree of

stress due to the rigorous demands of both academics and clinical training. The main
contributors to this stress include heavy coursework, interactions with faculty and
nursing staff, peer relationships, daily responsibilities, and patient care obligations.
These pressures can have a notable impact on students' academic success, emotional
stability, and overall mental well-being. To help students manage these challenges,
nursing programs should incorporate stress management strategies into their
curriculum. Offering counseling services, peer support networks, and mindfulness
activities can significantly improve students' ability to handle academic and clinical
pressures. Additionally, workshops on time management, self-care techniques, and
resilience-building can further equip them with coping mechanisms.
Cluster Theme 1.5 Struggles in Establishing Effective Patient and Clinical
Instructor Interaction

Third-year nursing students often face significant challenges in establishing

effective interactions with both patients and clinical instructors during clinical rotations,
which can hinder their learning experiences. A study by Garcia et al. (2021) highlights
that communication difficulties with patients, especially in complex clinical settings, can
contribute to increased anxiety and a lack of confidence in students. This challenge is
compounded by the dynamic and sometimes strained relationships with clinical
instructors, as noted by Kim et al. (2022), who found that inconsistent feedback and
limited availability of instructors hindered the development of essential clinical skills.
Moreover, the quality of interaction with both patients and instructors has a direct impact
on students' ability to apply theoretical knowledge in practice, as ineffective
communication can create a barrier to learning and patient care (Jones & Hill, 2020).
Furthermore, this cluster theme illustrates the shared narratives across individual
interviews, indicating that some participants expressed similar viewpoints while sharing
their experiences. Moreover, the informant mentions:

Miscommunication and pressure in specialized fields like the

OR and DR are real challenges. Sometimes, students
struggle to focus, especially with strict CIs and the fact that
they’re still learning. (SS15, Lines 215 to 217, IDI4)

Another informant also shared his struggles with one of the clinical instructors that he
encountered, he stated that:

In clinical rotations, we can’t always expect clinical

instructors to guide us like mothers, treat us like their own
children, or spoon-feed us information and skills. The
biggest challenge I faced was initially thinking that our
clinical instructor was kind and supportive, only to be startled
when she started screaming at us during a procedure in the
DR. It was a tough experience, especially since it was our
 first time encountering such a situation. (SS18, Lines 251 to
256, IDI6)

Further, managing a heavy patient load during clinical rotation was one of the struggles
of the informants, she stated that:

One of the biggest challenges I encountered during my

clinical rotation was managing a heavy patient load,
especially during busy shifts. I struggled to balance
providing individualized care while meeting the demands of
the unit (SS19 Lines 269 to 271, IDI7)

Similarly, an informant also shared the difficulties in handling

uncooperative family members and patients, she stated that:

During my clinical rotations, one of the challenges I faced

was dealing with difficult patients or family members who
were uncooperative. It was a tough situation (SS21, lines
295 to 296, IDI9)

The pressing need to enhance communication strategies and mentorship

programs within clinical settings to address the challenges faced by third-year nursing
students in establishing effective interactions with both patients and clinical instructors.
The documented struggles, ranging from miscommunication in high-pressure
environments to inconsistent guidance from clinical instructors, suggest that nursing
education programs should prioritize interventions aimed at improving student support
systems. Moreover, the narratives shared by informants highlight the emotional and
psychological challenges faced in clinical settings, including managing heavy patient
loads and dealing with difficult patients or family members.

Stress is widely recognized as a significant psychosocial factor within the clinical

learning environment, with the potential to adversely affect the overall well-being,
academic performance, and professional development of nursing students. In light of its
profound implications, it is imperative to prioritize student mental health by fostering a
supportive, empathetic, and psychologically safe learning atmosphere that promotes
resilience and holistic growth. Moreover, research conducted by Li et al. (2022) and
Velando-Soriano et al. (2020) highlights the pivotal role of social support in mitigating
stress-induced depression and burnout among nursing students. Their findings
underscore the significance of cultivating strong interpersonal and institutional support
networks to promote psychological well-being, enhance resilience, and ensure
academic and clinical success in high-pressure healthcare settings.

Emergent Theme 3. Leveraging Feedback and Reflection for Continuous Learning

This theme is about the use of feedback and reflection plays a crucial role in
enhancing the learning experiences of third-year nursing students during clinical
rotations, though it is not without challenges. Utilizing feedback and reflection as tools
for continuous learning is essential in enhancing the educational journey of nursing
students, especially during their clinical rotations. These strategies play a significant role
in professional growth and skill development, allowing students to refine their
competencies. Feedback from clinical instructors, peers, and patients enables students
to recognize their strengths and areas for improvement, promoting a culture of ongoing
learning. Constructive feedback aids in honing clinical skills, critical thinking, and
decision-making, which are crucial in bridging the gap between theoretical knowledge
and practical application.

Additionally, reflection encourages nursing students to critically evaluate their

experiences, emotions, and responses in clinical environments, promoting deeper
learning and self-awareness. Participating in structured reflective practices, such as
journaling and debriefing sessions, enables students to manage challenging situations,
gain insights from their mistakes, and develop effective problem-solving strategies for
future practice. Incorporating feedback and reflection into clinical education fosters
confidence, adaptability, and a patient-centered mindset among students, equipping
them for the challenges of professional nursing. This continuous learning approach
enhances critical thinking, decision-making, and overall competency, ensuring that
nursing students evolve into skilled, resilient, and compassionate healthcare
professionals ready to navigate the complexities of patient care.
 Furthermore, Jones and Smith (2020) emphasize the significance of fostering a
supportive learning environment where students can actively participate in feedback
sessions and reflective exercises. They highlight that the absence of structured
reflection frameworks in clinical placements may limit students' ability to effectively
integrate feedback, thereby reducing the overall impact on their learning and skill
development. Without clear guidelines for reflection, students may struggle to process
constructive criticism, refine their clinical skills, and develop critical thinking
abilities.These findings collectively stress the necessity of intentional strategies and
well-structured support systems that empower students to maximize the benefits of
feedback and reflection. By implementing formalized reflection models, mentorship
programs, and guided debriefing sessions, nursing education can better equip students
for continuous learning, self-improvement, and professional growth throughout their
clinical rotations and beyond.

Cluster Theme 3.6 Viewing Mistakes as Learning Opportunities

During clinical rotations, third-year nursing students often face challenges in

dealing with mistakes, yet the ability to view these mistakes as learning opportunities is
crucial for their development. However, many students experience initial frustration and
self-doubt when they make errors, which can hinder their growth and confidence.
According to Zhang et al. (2022), clinical instructors who create a supportive
environment, where mistakes are viewed as opportunities for learning rather than
failures, significantly enhance students' capacity to reflect on their actions and learn
from them. This shift in mindset is essential for fostering a culture of continuous
improvement, where students feel empowered to take risks, ask questions, and
ultimately become more competent in their clinical practice. Additionally, this cluster
theme reflects the common narratives present in individual interviews, showing that
some participants had aligned perspectives as they recounted their experiences.
Furthermore, the informant states:

Acceptance is a must, especially when we are being

corrected or given feedback by our Clinical Instructors (CIs)
or even doctors for the mistakes we make during clinical
 rotations. We should take it as a lesson learned and then
move on (SS13, Lines 194 to 196, IDI2)

Similarly, another informant stated that the errors that she encountered helped her to be
better and lessen her future mistakes. She uttered:

It shapes me… well, how do I explain it? If I make mistakes

—because, honestly, every student nurse makes mistakes
(except maybe those who are "perfect")—I have errors. And
through these errors, I have built a foundation that helps me
prevent or at least lessen future mistakes. So, through these
experiences, I have grown both as a student nurse and in
my curiosity about the profession (SS16, Lines 226 to 230,
IDI4)

Furthermore, an informant also stated that accepting her mistakes and challenges is a
lesson, not a failure. She claimed that:

Accepting that challenges will happen allows me to focus on

learning instead of feeling down. Mistakes are not failures—
they are lessons. Instead of being upset about them, I use
them to improve. By understanding what went wrong and
asking for help, I can do better next time ( SS23, Lines 313-
318, IDI10)

This research implication emphasizes the need for educational strategies that
cultivate a supportive environment where mistakes are not stigmatized but rather
embraced as integral to the learning process. The ability to reframe mistakes as
valuable learning experiences is essential for fostering resilience and enhancing clinical
competence. Nursing education programs should emphasize the development of
pedagogical strategies that help instructors create such an environment. Incorporating
structured reflection sessions, debriefings, and mentorship programs can facilitate
students’ ability to critically analyze their errors and develop corrective measures,
ultimately leading to better clinical decision-making skills. Furthermore, the narratives
provided by informants emphasize the role of personal agency in learning from
mistakes. The insights from student nurses reveal that self-acceptance and a
constructive approach to errors contribute to their professional development.

Moreover, in the study of (Subke et al,2020), the nursing students’ world, the
clinical learning environment is required to be an environment that is caring and
supportive. The clinical learning environment should provide nursing students with
individual and professional development. The clinical learning environment has a direct
effect on the nursing students’ performance and their learning. It is thus imperative to
consider the clinical learning environment in which care is given. Caring in the clinical
learning environment by stating that in caring cultures, nursing students feel
accomplished, purposeful, grateful, and satisfied with their work. When nursing students
feel physically and emotionally safe as part of the health care team, they experience a
sense of belonging. Additionally, it is noted that when a clinical learning environment is
experienced in a positive way, learning is enriched.

Cluster Theme 3.7 Positive Mindset for Confidence and Growth

A positive mindset plays a crucial role in fostering confidence and supporting

growth among third-year nursing students during clinical rotations, particularly when
faced with the challenges of transitioning from theory to practice. Students with a
positive mindset are more likely to view challenges as opportunities for growth, which
enhances their self-efficacy and clinical performance. This perspective helps them
overcome the initial anxiety and uncertainty often encountered in clinical settings.
Additionally, clinical instructors who encourage a positive approach and provide
constructive feedback help students develop resilience and self-assurance, key
components in navigating the complexities of patient care (Williams & Lee, 2022). As
such, fostering a positive mindset not only aids in the development of clinical skills but
also contributes to the emotional well-being of nursing students, ultimately preparing
them for the demands of the profession. This cluster theme also highlights the shared
narratives within individual interviews, demonstrating that some participants held similar
viewpoints as they shared their experiences. Moreover, the informant stated:

It’s influential in a good way that I can see myself that I can
do it, If I am eager to learn, I can do it. It boosted my
 confidence to never stop learning and never be scared to be
scolded, it is more okay to be scolded than to make an error
to the patient that can lead to a complication (SS12 Lines
187 to 190, IDI1)

Also, another participant stated that he was confident to face challenges, especially
when he stepped out of his comfort zone, he uttered:

That’s why I can confidently say that I felt prepared to face

this challenge. But I noticed that my confidence improved
because I faced my challenges; I even stepped out of my
comfort zone (SS14, Lines 212 to 214, IDI3)

Similarly, an informant also stated that her challenges made her confident in her skills,
she claimed that:

Facing these challenges has definitely increased my

confidence and skills. It has taught me the importance of
time management, prioritization, and teamwork in providing
quality care. These experiences have helped me develop as
a nurse and will continue to influence my practice in the
future. (SS19, Lines 278 to 281, IDI7)

Further, an informant shared that using effective stress management helped her
improve and strengthen her ability to work under pressure, she stated that:

I became more resilient, learning to manage the stress that

comes with the responsibility. I also developed effective
techniques for stress management, which allowed me to
stay calm and focused while administering medication. This
experience not only improved my technical skills but also
strengthened my ability to work under pressure (SS20, Lines
291 to 294, IDI8)

This research implication emphasizes the essential role that a constructive

attitude plays in enhancing students' self-efficacy, resilience, and overall clinical
performance. Given the challenges inherent in transitioning from theoretical knowledge
to practical application, fostering this mindset should be a priority for nursing education.
Additionally, the shared narratives among informants highlight the transformative impact
of facing challenges and stepping out of comfort zones. These experiences not only
enhance clinical skills but also foster essential competencies such as time
management, prioritization, and teamwork. Nursing curriculum should integrate
opportunities for students to engage in diverse clinical experiences that challenge them
and encourage collaboration. Such exposure can further solidify their confidence and
prepare them for the multifaceted demands of the nursing profession.

Additionally, Carter (2024) emphasizes that nursing education requires students

to be open to the possibility of growth in their knowledge, skills, and attitudes, which are
crucial for their professional nursing development. This openness is particularly
essential as students adapt to new learning and clinical settings. To promote a growth
mindset, faculty should design intentional learning strategies that are aligned with
course goals, program outcomes, learning domains, and the learners’ developmental
stage. Moreover, skilled educators consider the necessary entrustable professional
competencies, which play a key role in supporting role transformation and easing the
transition into professional practice. This strategy helps cultivate nurses who are skilled,
flexible, and ready to meet the challenges of their profession.

Cluster 3.8 Constructive Feedback as a Tool for Sill Enhancement

Constructive feedback is a critical component in the education and professional

development of nursing students during their clinical rotations. As third-year nursing
students move from theoretical classroom learning to practical clinical experience,
guidance from clinical instructors, mentors, and healthcare professionals becomes
essential for improving their skills, boosting confidence, and supporting ongoing growth.
Feedback helps students pinpoint errors, enhance their techniques, and deepen their
understanding of clinical procedures. In the absence of constructive feedback, students
may struggle to identify and address their mistakes, which can lead to a decline in
confidence and a reduction in their clinical effectiveness. Furthermore, the informant
emphasizes that:
 Reflecting on feedback from peers, instructors, and patients
has contributed greatly to my growth. Constructive criticism
has helped me understand what I could improve, and
positive feedback has reinforced my strengths. These
interactions motivated me to work harder and focus on areas
that needed improvement. (SS32, Lines 430 to 433, IDI7)

Besides, another informant express that feedback from their instructors helped them
improve their mistakes, as she stated:

Feedback from my instructors helped me fix my mistakes

and improve my techniques. (SS34, Lines 456 to 458, IDI9)

Another participant shares common views, as researchers remember she

says:

Getting good feedback helps boost confidence, while

constructive criticism encourages improvement. (SS33,
Lines 444 to 446, IDI8)

This cluster emphasis the importance of receiving timely and well-structured

feedback from their clinical instructors. They expressed that constructive feedback
helped them recognize their strengths and identify areas for improvement, allowing
them to develop critical thinking skills and enhance their clinical competencies. For
instance, students who initially struggled with procedures such as administering
medications or performing patient assessments reported that consistent feedback
enabled them to correct mistakes, refine their techniques, and gain confidence in their
abilities. Moreover, participants highlighted that feedback delivered in a supportive and
encouraging manner was more effective in facilitating learning than criticism without
guidance. Positive reinforcement, combined with specific suggestions for improvement,
motivated students to engage in self-reflection and actively work on their weaknesses.

Additionally, one of the key strategies for enhancing students' practical skills is
providing feedback on their performance. Effective feedback is a fundamental
component of any well-structured clinical training program, playing a crucial role in
developing clinical competencies and refining techniques. Just as observing oneself in a
mirror helps in mastering sports movements, feedback in clinical education allows
students to assess their performance and bridge the gap between theoretical
knowledge and hands-on practice. Additionally, students perceived written feedback as
more impactful than verbal feedback, as it provided a lasting reference for improvement.
However, research suggests that the quality of feedback is more important than its
delivery method, with different types of feedback influencing learning and skill
development in various ways (Imanipour et al., 2023).

The implication of constructive feedback extends beyond the academic growth

and skill development of nursing students, significantly influencing patient care
outcomes. By receiving clear, structured, and supportive feedback, students build the
confidence and proficiency required to carry out clinical tasks with greater precision and
efficiency. Teamwork and collaboration among nursing students and healthcare
professionals are strengthened when constructive feedback is encouraged, leading to a
more cohesive and efficient clinical environment. This contributes to improved patient
safety, as well-prepared students are less likely to make serious mistakes in medication
administration, patient assessments, and other critical nursing duties. Furthermore,
constructive feedback helps enhance communication skills—an essential component of
patient-centered care—enabling students to engage more effectively with patients, their
families, and healthcare professionals.

Emergent 4. Adaptability as a Key to Clinical Success

Adaptability is an essential quality for nursing students as they face the

challenges of clinical rotations, allowing them to effectively respond to the constantly
changing and unpredictable nature of healthcare settings. Third-year nursing students
often encounter situations that require quick thinking, adherence to new protocols, and
the ability to handle unforeseen patient conditions, making adaptability a key factor in
their success. Students who remain flexible and open to learning are better prepared to
meet the demands of clinical practice while enhancing their overall performance. A
critical aspect where adaptability is particularly important is the application of theoretical
knowledge to real-world patient care. While nursing students acquire fundamental
concepts in the classroom, clinical environments frequently present complex patient
cases that do not always align perfectly with textbook examples.

Aryuwat et al. (2024) conducted a study emphasizing the critical role of

adaptability in the clinical success of nursing students. The research found that
adaptability allows students to effectively manage unpredictable situations, such as
varying patient conditions, complex medical procedures, and diverse healthcare team
dynamics. Nursing students who demonstrated adaptability were more confident in
applying theoretical knowledge to real-world clinical settings, enabling them to make
informed decisions under pressure. Furthermore, the study highlighted that students
who embraced adaptability were better equipped to handle stress and anxiety
commonly experienced during clinical rotations. By being flexible in their approach to
learning and problem-solving, these students could quickly adjust to new protocols,
integrate constructive feedback, and improve their critical thinking skills.

One key implication is the need for nursing education programs to actively
cultivate adaptability among students by incorporating flexible learning strategies,
simulation-based training, and exposure to varied clinical scenarios. By preparing
students to think critically and adjust their approaches in real time, educators can
enhance their problem-solving skills and overall clinical performance. Moreover,
adaptability plays a crucial role in ensuring patient safety and delivering high-quality
care, as nurses must constantly respond to changing patient conditions, updated
medical protocols, and unforeseen clinical challenges. Nursing students who can
quickly evaluate situations and adjust their actions accordingly are better prepared to
provide prompt, precise, and patient-centered care.

Cluster 4.9 Flexibility in Responding to Clinical Challenges

Clinical rotations expose nursing students to dynamic and often unpredictable

healthcare environments, requiring them to adapt quickly and respond effectively to
emerging challenges. Flexibility in clinical practice is a crucial skill that enables students
to adjust to varying patient conditions, unforeseen emergencies, and evolving
healthcare protocols while maintaining professionalism and delivering high-quality
patient care. Moreover, flexibility is essential when interacting with multidisciplinary
teams and adapting to different leadership and communication styles among healthcare
professionals. Nursing students often rotate through various hospital units, each with its
own workflow, policies, and expectations. The ability to quickly acclimate to new clinical
settings and work collaboratively with different healthcare teams enhances students'
confidence and helps them develop strong interpersonal and problem-solving skills.
During the individual interview with the participants, she shared that:

For me, being flexible and able to quickly adapt to any

situation is the most important quality a student nurse should
have. (SS36, Lines 493 to 496, IDI1)

Also, another informant expresses almost the same sentiment. She says that:

Adaptability is important because every clinical setting is

different. Each hospital, department, and patient situation is
unique, so I need to be flexible and open to changes. (SS43,
Lines 597 to 600, IDI9)

On the same token, one of the informants also shared common narratives. She
stated that:

The most important quality a student should develop to

succeed in clinical rotations is adaptability. (SS39, Lines 558
to 560, IDI6)

Ultimately, the implication of flexibility in responding to clinical challenges is

closely linked to stress management and emotional resilience. Clinical rotations can be
overwhelming due to time constraints, patient emergencies, and heavy workloads, but
students who develop flexibility are better able to prioritize tasks, stay composed under
pressure, and make quick yet informed decisions. This adaptability not only improves
their performance but also contributes to their overall well-being and professional
growth. Flexibility should be a core focus in nursing education and training. By fostering
adaptability, nursing programs can prepare students to excel in diverse clinical
environments, transition smoothly into professional practice, and provide high-quality
patient care despite the challenges they may face.
 The study found that rigid, pre-set schedules often led to increased stress,
burnout, and difficulty balancing academic responsibilities with hands-on clinical
training. In contrast, flexible rostering allowed students to adapt their schedules based
on their learning needs, personal commitments, and varying clinical demands, ultimately
reducing stress and enhancing engagement. One of the key findings was that flexible
scheduling provided students with greater opportunities for meaningful learning
experiences. Instead of being confined to fixed shift patterns, students could rotate
through diverse clinical settings, gaining exposure to different patient cases, medical
procedures, and healthcare teams. This exposure helped them develop a more
comprehensive understanding of patient care, while also improving their adaptability
and problem-solving skills in real-time clinical environments (Brook & Kemp, 2021).

Cluster 4.10 Effective Prioritization for Efficiency in Clinical Tasks

In the high-pressure and dynamic environment of clinical rotations, effective

prioritization is a critical competency that empowers nursing students to navigate
complex responsibilities while maintaining efficiency, accuracy, and patient safety. This
skill requires the ability to analyze patient conditions, assess the urgency of
interventions, and strategically allocate time and resources to ensure the delivery of
timely and high-quality care. Without proper prioritization, students may struggle with
task overload, delays in critical care, and increased stress levels, all of which can
negatively impact both their learning experience and patient outcomes. During the
interview, researchers observed that the participant was cooperative as she expressed
the narratives based on her experiences. This was manifested by the informant as she
shared a statement says that:

For me, time management and presence of mind are very

important, especially in special areas. (SS37, Lines 503 to
505, IDI2)

Also, another informant revealed that time management can help them improve
their performance as she stated:

You need to be open-minded and willing to learn from every

clinical exposure. Self-care and time management are
important to avoid burnout. (SS41, Lines 581 to 583, IDI8)
Also, another informant imparted the same narrative, according to her patience and time
management are very important. As her response was:

Of course, we always need patience, and time management

is also very important. (SS38, Lines 521 to 523, IDI3)

A study explores the impact of time management education on critical care

nurses, emphasizing how structured training in task prioritization and activity planning
significantly improved their ability to manage their workload efficiently. The study found
that when student nurses were equipped with effective time management strategies,
they were better able to assess the urgency of patient needs, delegate non-essential
tasks, and allocate their efforts to high-priority clinical responsibilities. Moreover, the
study highlighted that patients also experienced increased satisfaction when nurses
practiced effective prioritization. With better time management, nurses were able to
spend more time engaging with patients, addressing their concerns, and providing
individualized care, rather than constantly rushing between tasks. This improved
communication and responsiveness led to greater trust and confidence in the care
provided (Vizeshfar et al., 2022).

The implication of effective prioritization for efficiency in clinical tasks is highly

significant, as it empowers nursing students to manage their time effectively, ensuring
that urgent and essential tasks are completed promptly. This not only optimizes
workflow efficiency but also enhances patient outcomes by preventing delays in critical
care. Moreover, strong prioritization skills reduce the likelihood of errors, minimize
stress levels, and boost students' confidence, enabling them to navigate the
complexities of clinical rotations with greater competence. By honing these skills,
students cultivate critical thinking, sharp decision-making, and strong teamwork abilities
—foundational competencies essential for thriving in real-world nursing practice.
Ultimately, mastering prioritization not only enhances the learning experience during
clinical rotations but also prepares students for the fast-paced, high-pressure demands
of professional nursing.‌
 CHAPTER IV

IMPLICATIONS

This study can benefit many people in the field of nursing, especially nursing
educators, clinical instructors, and nursing students. By understanding the real-life
challenges that third-year nursing students face during their clinical rotations, such as
anxiety, fear of making mistakes, difficulty applying theoretical knowledge, and
communication problems, nursing programs can make important improvements.

Nursing Practice. Nursing schools can use the findings to improve their
programs by adding more hands-on training and mentorship for students. This will
prepare students better for real-life situations and help them feel more confident.
Moreover, Nursing instructors can learn how to give feedback that encourages students
to see mistakes as chances to learn, creating a more supportive environment. This will
help students grow, feel more confident, and be open to improving their skills.
Furthermore, Hospitals and healthcare facilities can use this research to create safer
and more positive learning environments for students, where they are treated with
respect and feel safe to ask questions or admit mistakes. In the long run, this leads to
better-trained nurses who are more capable, emotionally strong, and ready to provide
high-quality care to patients. When students are well-supported during their training,
they are more likely to become skilled, confident, and compassionate professionals,
something that benefits the entire healthcare system.

Nursing Education. This study emphasizes the urgent need for nursing schools
to reevaluate the structure and approach of clinical education. While academic
knowledge is necessary, it is just as important for students to be mentally and
emotionally prepared for the real-life challenges of working in healthcare settings. To
support this, nursing programs should go beyond teaching technical skills and theories.
They should include training in stress management—such as relaxation techniques,
coping strategies, and time management—to help students build emotional strength.
Activities like journaling, group discussions, and guided reflections should be
encouraged so students can better understand and learn from their clinical experiences.
Pre-clinical orientation is also crucial, as it helps students become familiar with hospital
rules, routines, and common situations before they enter the actual workplace. This kind
of preparation can ease their worries and improve their confidence. In addition, soft
skills like communication, teamwork, empathy, and emotional control are very important
in clinical environments. These skills help students connect with patients, work
effectively with healthcare teams, and handle stressful situations. Nursing schools can
develop these skills through hands-on methods such as role-playing, group tasks,
simulations, and timely feedback during clinical training.

Clinical Practice. Clinical areas should focus on the mental and emotional well-
being of nursing students because it greatly affects how well they perform and learn
during their clinical duties. When students are in a safe, supportive, and welcoming
environment, they feel more comfortable getting involved in their learning. They are
more likely to ask questions, admit when they don’t understand something, and reflect
on their experiences—all of which help them learn better. If students are allowed to
make small mistakes and are guided kindly through them, they gain confidence, learn
responsibility, and are not afraid to try. Giving feedback respectfully and encouragingly
also helps students stay motivated and become stronger emotionally. Nurses and
clinical instructors who are kind, patient, and professional create a positive learning
environment.

Future Researchers. This study lays the groundwork for future research by
pointing out important areas where specific programs or strategies could help improve
the clinical learning experience of nursing students. For example, more research can be
done to test how helpful support systems or training methods are in reducing stress and
improving learning. It would also be useful to do long-term studies that follow nursing
students even after they graduate. These studies can show how the challenges
students face during training affect their ability to handle real jobs, their confidence, how
they manage stress, and how well they care for patients. Ultimately, these insights can
guide nursing educators and healthcare institutions in designing more supportive and
effective clinical training programs that not only address immediate challenges but also
prepare students for long-term success in the nursing profession.

RECOMMENDATIONS

Based on the results of the study, the following recommendations are proposed
to address the challenges faced by nursing students and to enhance their clinical
learning experiences:

Integrate Mental Health and Stress Management Programs. Nursing schools

should focus on supporting students’ mental and emotional health by providing regular
workshops, counseling, and wellness programs that help manage stress and build
resilience. Clinical rotations are often intense and demanding, exposing students to
real-life patient care, time pressure, and high expectations. Without proper support,
these experiences can lead to anxiety, exhaustion, or poor academic and clinical
performance. By including mental health support in the academic calendar, schools can
offer a safe environment where students feel comfortable seeking help. Sessions on
time management, self-care, and coping skills can give students effective strategies to
handle stress. Additionally, wellness activities like meditation, fitness classes, and peer
support groups can encourage healthier routines and a stronger sense of community.
These efforts not only help students manage the stress of clinical work but also
strengthen their emotional well-being, which is essential for their growth as future
nurses.

Enhance Pre-Clinical Orientation and Simulation Training. Before nursing

students begin their clinical rotations, it is important for schools to provide them with
thorough orientation and simulation-based training. These activities help connect what
students learn in the classroom with what they will experience in real clinical settings. A
well-designed orientation introduces students to hospital procedures, safety rules,
expectations, and how daily operations work. This early preparation helps reduce
confusion, builds familiarity with the clinical environment, and makes students feel more
confident and at ease when they begin working with patients. Simulation training is also
a valuable part of this process. These simulations recreate common clinical situations—
like taking vital signs, giving medications, or responding to emergencies—without
putting real patients at risk. Students also receive helpful feedback from instructors,
which supports their learning and skill development.

Promote a Supportive Clinical Learning Environment. This study highlights

that the clinical learning experiences of third-year nursing students are greatly
influenced by their level of clinical exposure. However, to make clinical education more
effective, several improvements are necessary. Stronger collaboration between nursing
schools and healthcare institutions is recommended to create more structured and
meaningful clinical placements. Ensuring that students have enough hands-on
opportunities to practice essential nursing skills under the guidance of qualified clinical
instructors can help bridge existing learning gaps. One key issue identified is the limited
practical experience caused by overcrowded clinical environments, passive observation
roles, and unequal chances to engage in patient care. To address this, future initiatives
could include developing clinical rotation schedules that reduce the student-to-patient
ratio and adopting preceptorship models, where students receive personalized
supervision and regular feedback. Allowing students to rotate through a variety of
clinical departments—including specialized areas—can further enrich their learning.
Combining real-life clinical exposure with simulation-based training can also help
students gain the confidence and competence needed for critical nursing tasks.
Moreover, encouraging students to engage in regular reflection and debriefing activities
can support deeper learning and self-awareness.

Future Researchers. Further research is necessary to address existing gaps

and uncover deeper dimensions of this topic. It is recommended that future researchers
investigate a broader range of student experiences across different academic
institutions and clinical settings to enhance the generalizability of findings. Studies
should also consider including perspectives from clinical instructors, preceptors, and
hospital staff to gain a more holistic view of the clinical learning environment. An
identified gap in the current literature is the limited data on the influence of institutional
support, mental health, and coping mechanisms in shaping students’ clinical
experiences. Future research could focus on these aspects to develop more targeted
strategies that support student well-being and academic performance. Additionally,
there is a need to evaluate interventions that aim to improve the clinical learning
experience—such as mentorship programs, stress management workshops, or
simulation-based learning—using measurable outcomes like improved skill acquisition,
confidence levels, or academic performance. Researchers may also explore the role of
digital learning platforms and mobile applications in supplementing hands-on clinical
training. Finally, policy recommendations could be strengthened by examining barriers
faced by clinical instructors and students alike—such as inadequate supervision, limited
patient exposure, or communication gaps between schools and clinical sites.
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‌
 APPENDIX A
Letter To The Dean of Nursing

MORSID K. TULAO, CHA, PHD

Dean, College of Nursing

Dear Sir,

Greetings!

In Partial Fulfilment of our requirement for the subject Nursing Research

1, we, the third-year nursing students of section F would like to ask for
permission to conduct a research study entitled “ EXPLORING THE
CHALLENGES IN THE LEARNING EXPERIENCES OF THIRD YEAR NURSING
STUDENTS DURING CLINICAL PRACTICE”.

Rest assured that the data gathered will remain absolutely confidential and
to be used for academic purposes only.

Respectfully yours,

JUSTINE HOPE J. AMORGANDA

CHRISTIAN HURVEY D. CALLE

LUCILE ANN B. BELLONID

Noted by:
MARILOU DIANA, MAED
Research Adviser

Approved by:
MORSID K. TULAO, CHA, PHD
Dean, College of Nursing
 APPENDIX B
Letter To The School Registrar

Myrtel R. Solatorio
CollegeRegistrar

Dear Ma'am,

We, the bona-fide students of Bachelor of Science in Nursing from

Polytechnic College of Davao del Sur, Inc., are conducting a research
entitled “EXPLORING THE CHALLENGES IN THE LEARNING EXPERIENCES OF
THIRD YEAR NURSING STUDENTS DURING CLINICAL PRACTICE”.

In connection with the development of the research, we are cordially

asking your good office for the master list of second-year nursing
students of Polytechnic College of Davao del Sur, Inc., enrolled in the first
semester for the school year 2024-2025.

Respectfully yours,

JUSTINE HOPE J. AMORGANDA

CHRISTIAN HURVEY D. CALLE

LUCILE ANN B. BELLONID

Noted by:
MARILOU DIANA, MAED
Research Adviser

Approved by:
MYRTEL R. SOLATORIO
College Registrar
 APPENDIX C
Letter To The Participants

Dear Participants,

We, the third-year nursing students of Polytechnic College of Davao del

Sur, Inc., are enrolled in Nursing Research 1. Presently, we are
conducting a research entitled “EXPLORING THE CHALLENGES IN THE
LEARNING EXPERIENCES OF THIRD YEAR NURSING STUDENTS DURING
CLINICAL PRACTICE”.

With your relevant knowledge and experience, we humbly ask for your
precious time and effort to honestly answer all the questions in the
questionnaire that are important and helpful to the study. Rest assured
that all the data gathered from you will be treated with respect and will be
kept in utmost confidentiality.

We appreciate your support and cooperation.

Respectfully yours,

JUSTINE HOPE J. AMORGANDA

CHRISTIAN HURVEY D. CALLE

LUCILE ANN B. BELLONID

 APPENDIX D
Survey Questionnaire

1. What are the real-life experiences of third-year nursing students during their
clinical rotations?

Probe Question:
1.1. What are your real-life experiences during your clinical rotation as a third-year
nursing student that had a significant impact on you?

Follow-up Questions:
1.1.1. How did you handle the situations you encountered during that experience?
1.1.2. What did you feel in these experiences, and how did this inspire your ability to
provide care?
1.1.3. What lessons did you learn from that situation, and how will they shape your
future practice as a nurse?

2. What are the challenges that the participants encountered during their clinical
rotations?

Probe Question:
2.1. What were some of the biggest challenges you encountered during your clinical
rotation as a third-year nursing student?

Follow-up Questions:
2.1.1. How did you approach these challenges?
2.1.2. Did you feel adequately prepared to face these challenges?
2.1.3. How have these challenges influenced your confidence and skills as a nursing
student moving forward?

3. How do they turn these difficulties into ways on how to improve their performance
during clinical rotations?

Probe Question:
3.1. What are the strategies to turn difficulties that you encountered during your clinical
rotation into opportunities to improve your performance as a nursing student?

Follow-up Questions:
3.1.1. What specific changes did you make to address the challenges you encountered?
3.1.2. How did feedback from your instructors, peers, or patients contribute to your
growth and improvement?
3.1.3. How have these experiences shaped your approach to learning and providing
care in future clinical settings?
 4. What valuable insight can they share with their fellow students to help them
improve their overall performance during clinical rotations?

Probe Question:
4.1. What valuable insights have you gained during your clinical rotations that could
help your fellow students improve their overall performance?

Follow-up Questions:
4.1.1. What tips do you have for effectively communicating with patients, nurses, and
physicians?
4.1.2. What do you think is the most important quality a student should develop to
succeed in clinical rotations?
4.1.3. What lessons have you learned from your own experiences that you think others
should know?
 CURRICULUM VITAE

JUSTINE HOPE J. AMORGANDA

Prk5, Largo St. Almendras District
09553577036
amorgandajustinehope@gmail.com

PERSONAL DATA
Sex: Female
Age: 21 years old
Date of Birth: April 14, 2003
Place of Birth: Digos City
Civil Status: Single
Religion: Roman Catholic
Father: Tommy S. Amorganda
Mother: Joanel J. Amorganda

EDUCATIONAL BACKGROUND

College: Polytechnic College of Davao del Sur Inc.

(2021 - Present)

High School: Southern Davao National High School

(2020-2021)

Elementary: Padada Central Elementary School

(2009 - 2010)
 CHRISTIAN HURVEY D. CALLE
Curvada, Bansalan, Davao Del Sur
09915709241
mostvaluableperson13@gmail.com

PERSONAL DATA
Sex: Male
Age: 20 years old
Date of Birth: December 21, 2003
Place of Birth: Bansalan Dava del Sur
Civil Status: Single
Religion: Roman Catholic
Father: Jervien Calle
Mother: Queen Joimee D. Calle

EDUCATIONAL BACKGROUND

College: Polytechnic College of Davao del Sur Inc.

(2021 - Present)

High School: St. Therese School of Bansalan Inc

(2020-2021)

Elementary: St. Therese School of Bansalan Inc.

(2009 - 2010)
 LUCILE ANN B BELLONID
Purok 4, Sinayawan, Hagonoy,
Davao del Sur
09061132400
padillolucile@gmail.com

PERSONAL DATA
Sex: Female
Age: 20 years old
Date of Birth: March 15, 2004
Place of Birth: Quezon City
Civil Status: Single
Religion: Roman Catholic
Father: Lucio R. Padillo Jr.
Mother: Baby Ann B. Padillo

EDUCATIONAL BACKGROUND

College: Polytechnic College of Davao del Sur Inc.

Bachelor of Science in Nursing
(2021 - Present)

High School: South East - Asia Institue of Trade and Technology

(2019-2021)

Elementary: Royal Kids Academy of Arts

(2009 - 2010)