Republic of the Philippines

Commission on Higher Education Region I

NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City

In Partial Fulfilment
of the Requirements in
NCM 111:
NURSING RESEARCH I
(RELATED LEARNING EXPERIENCE)

"Experiences, Challenges, and Coping Strategies of Level II Nursing Students in their

Clinical Duty"

Presented by:
Agoto, Jenny P.
Belvis, China Joy
Calipjo, Paul Vincent M.
Culasing, Mark Eliezer D.
Flores, Angeline T.
Juan, Jamaila Kaye Q.
Lagmay, Aerol A.
Molina, Mailene
Sagun, Reeza Joy A.
Sulquiano, Allison Pia
BSN – 3C GROUP 1

Presented to:
Dr. Lori Marseli De Castro, Phd
Professor

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TABLE OF CONTENTS

CHAPTER I: THE PROBLEM

Background of the Study .................................................................................................3
Theoretical Framework ....................................................................................................4
Figure 1. The Research Paradigm ....................................................................................6
Statement of the Problem ................................................................................................7
Scope and Limitation .......................................................................................................8
Significance of the Study .................................................................................................8
Definition of Terms .........................................................................................................9

CHAPTER II. REVIEW OF RELATED LITERATURE AND STUDIES

Introduction to Related Learning Experience (RLE) ....................................................11
Experiences of Nursing
Students on their Clinical Duty..................................................................................12
Challenges of Nursing
Students on their Clinical Duty..................................................................................14
Coping Strategies of Nursing.........................................................................................16

CHAPTER III. RESEARCH METHODOLOGY

Research Design ............................................................................................................20
Locale of the Study .......................................................................................................20
Population and Sampling ..............................................................................................21
Research Instruments ....................................................................................................21
Data Gathering Procedure .............................................................................................22
Statistical Treatment of Data .........................................................................................23

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CHAPTER I

THE PROBLEM

Background of the Study

Clinical experience plays a vital role in nursing education. It provides the students

with the chance to integrate theory into practice and prepares student nurses to know and

use the skills in the clinical setting, making them competent and confident to provide

patient care. This is where students learn to connect the 'knowing' with the 'doing' in real-

world clinical situations. These experiences empower nursing students to develop their

clinical capabilities and socialize within the nursing profession. However, these clinical

learning environments, known as clinical settings, are complex and dynamic, influenced

by a network of forces that impact student learning. Clinical environments usually mean

hospital wards, units, and community and health clinics. While clinical experiences offer

numerous benefits, they are also fraught with challenges, unpredictability, stress, and

constant change (Cilingir et al., 2011)

Nursing education is known for being demanding, with patient care at its core.

Students often face challenges during their clinical learning courses, which can leave

them feeling vulnerable. The quality of clinical training provided by nursing educators

and the support students receive from clinical nurses and hospital staff are identified as

the most influential factors in nursing students' learning. Negative attitudes, inadequate

instructor competence, and insufficient student support can detrimentally affect the

learning process (Chan et al., 2009).

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Novice level II Nursing Students are newcomers in the field, lacking experience.

They are beginners who have never had the opportunity to experience the clinical

environment. Their ability to work independently is restricted, and in certain situations,

they rely on instructors and seek specific instructions to complete their duties (Benner,

1984). The direct guidance from instructors to excel in their tasks due to their limited

clinical exposure is important.

Thus, this research aims to explore the various experiences of level II nursing

students, highlighting the coping strategies and how they adapt to these tough demands.

By understanding the experiences of nursing students during their clinical duty, this study

can provide insights into how nursing education can be improved to better support

students. Additionally, this research can contribute to the development of interventions

and strategies that can help nursing students cope with the challenges they face during

their clinical duty. ultimately leading to better learning outcomes and improved patient

care.

Theoretical Framework

The transactional model of stress and coping, as proposed by Lazarus and Folkman

(1987), provides a solid foundation for understanding the experiences of level 2 student

nurses during their clinical duty. Coping, in this model, encompasses both cognitive and

behavioral responses that individuals employ to manage stressors, whether internal or

external, that are perceived to exceed their resources. Stress, according to this model, is

not solely a product of specific events or situations but rather emerges from the dynamic

interaction between an individual and their environment. This interaction entails the

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appraisal of the situation and the assessment of the individual's available resources for

coping. This established model has been widely adopted in various fields, including

psychology, healthcare, and organizational studies, to comprehend how individuals

respond to stress and to develop interventions aimed at enhancing their coping abilities.

Stressors can be broadly categorized into two primary types: challenging and

threatening. Challenging stressors refer to situations that are perceived as opportunities

for growth, mastery, and gain, such as excelling in clinical duty performance. On the

other hand, threatening stressors encompass situations that are seen as potential sources

of harm or loss, including the fear of underperforming during clinical duties.

The environment in which these student nurses carry out their clinical duties plays a

pivotal role in influencing their stress levels. Factors like noise levels, air quality,

temperature, and overall safety can significantly impact their stress levels. Unfavorable

environmental conditions can lead to distractions, and loss of focus, and, consequently,

hinder the quality of care provided to patients.

Moreover, the social interactions and relationships that student nurses engage in

during their clinical duties can either alleviate or exacerbate their stress levels. For novice

student nurses, the exposure to clinical duties for the first time can be challenging, as they

grapple with a wide array of cases and patient situations, potentially leading to emotional

stress. Additionally, conflicts and strained relationships among peers or mentors can

further intensify stress. These interpersonal challenges may result in persistent worry and

rumination, leading to chronic stress that could ultimately impact the quality of care

provided to patients.

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The interplay of the various variables such as the demographic characteristics of

the respondents, the experiences and challenges, and the coping strategies employed is

shown in

Figure 1. A proposed Stress Management Program will be formulated based on the results

of the study. This will help the nursing students to alleviate the pressures as they do their

clinical duty.

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INPUT PROCESS OUTPUT

Demographic Proposed stress

 Survey on: management
Characteristics of
a. demographic program
Respondents:
characteristics
a) Age
b. experiences
b) Sex
c. challenge
c) Religion
d. coping
d) Civil Status
strategies
Experiences/
Challenges Faced  Data collected
by Respondents in  Data analysis
the Clinical Duty  Data
interpretation
Coping strategies
employed by the
nursing students

Figure 1. The Research Paradigm

Statement of the Problem

The objective of the study is to explore the experiences, challenges, and coping

strategies of Level II nursing students in their Clinical Duty.

Specifically, it sought to answer the following questions;

1. What are the demographic characteristics of the respondents as to:

a) age

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b) sex

c) religion

d) civil status

2. What are the stressors experienced by the respondents in their clinical duty in terms

of:

a) emotional/psychological

b) clinical environment

c) academic workload

d) relationship with others

3. What are the challenges faced by the respondents in their clinical duty?

4. What coping strategies or mechanisms are employed to minimize stress?

5. What stress management program can be formulated for dissemination in the

form of seminars or workshops?

Scope and Limitation

This study focuses on the experiences, challenges, and coping strategies of Level

II nursing students enrolled at Northern Christian College SY 2023-24 and who are

currently undergoing clinical duty at various hospitals in Ilocos Norte.

Significance of the Study

The result of the study will be beneficial to the following:

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Level II Nursing Students. The results of the study will be beneficial since they

will be able to face the challenges they might encounter and coping strategies.

This will help them prepare mentally and emotionally for their clinical duty.

Clinical Instructors. The clinical instructors will be informed of the stressors

their students face, enabling them to provide better guidance and support during

the clinical training period.

Hospital Nurses. The hospital nurses/staff nurses may reflect on their own

experiences and contribute to a supportive environment for nursing students.

Parents/Guardians. They can provide the necessary support to their children by

knowing the stress and demands of their clinical duty.

Future Researchers. The result of the study can serve as a basis for future studies

in nursing education for a more productive clinical experience.

Definition of Terms

For better clarification and understanding of the terms related to this study, the following

terms are defined operationally:

Challenges - These are the difficulties or obstacles that Level II nursing students

face in the context of their clinical duty, hindering their progress or causing stress.

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Coping Strategies - These are the methods, techniques, or mechanisms that Level

II nursing students employ to manage and mitigate the stress and challenges they

encounter during their clinical duty.

Clinical Instructors - A licensed nurse, who provides hands-on training and

supervision to students in a clinical setting, such as a hospital, clinic, or other

healthcare facility.

Clinical environments - Usually mean hospital wards, units, and community and

health clinics.

Clinical Duty - The practical, hands-on experience and responsibilities that Level

II nursing students undertake in healthcare settings, such as hospitals, as part of

their nursing experiences

Experiences - These refer to the encounters, situations, and events that Level II

nursing students undergo during their clinical duty, encompassing both positive

and negative occurrences.

Stress - Generated by pressure and strenuous activities which may have physical

and psychological effects on Level II nursing students’ well-being.

Stressor – Refers to someone or something that causes stress.

Emotional/psychological - Terms that are often used in the context of human

experiences and mental well-being.

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Clinical environmental stress – These refer to the psychological and emotional

strain experienced by Level II nursing students working in a clinical or healthcare

setting.

Academic workload - Refers to the amount of work and tasks that Level II

nursing students are required to complete within a given time.

Relationship with others - The interpersonal connections and associations of

Level II nursing students that they have with people around them.

CHAPTER II

Review of Related Literature and Studies

This chapter presents various literature and studies on the experiences, challenges,

and coping strategies related to the study

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Introduction

Stepping into the realm of clinical duty as a Level II nursing student marks a

transformative yet challenging phase in one's academic journey. The nursing profession

demands a unique blend of skills, knowledge, and resilience, particularly during the

crucial period of clinical education. Clinical experience has been a fundamental

component of nursing education. It equips nursing students to be capable of both

"knowing" and "doing" clinical principles in real-world settings. Students are encouraged

to apply their critical thinking abilities to solve problems through clinical experience.

Since nursing is a performance-based profession, clinical learning environments play an

important role in the acquisition of professional abilities and training the nursing students

to enter the nursing profession and become registered nurses. Moreover, the clinical area

of nursing education is of great importance for nursing students in the selection or

rejection of nursing as a profession. (Sharif F. et al, 2016).

Related Learning Experience (RLE)

The Related Learning Experience (RLE) is a component of the nursing

curriculum focused on the development of the nursing competencies of students as future

nurses. In RLE, nursing students are exposed to various clinical and community settings

under the supervision of clinical instructors.

The exploration of the clinical learning environment is firmly rooted in the

recognition that nursing education extends far beyond the confines of the classroom. It

necessitates a profound understanding of the challenges and opportunities presented

during clinical duty. Previous research has illuminated the multifaceted nature of the

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clinical environment, encompassing the stressors faced by nursing students (Admi, 1997;

Lasiter et al., 2012) and the profound impact of clinical supervision on their well-being

(Begat & Severinsson, 2005). Additionally, the existing literature sheds light on the

coping strategies employed by nursing students to navigate the complexities of their

clinical experiences (Pourafzal et al., 2013; Scully, 2011).

Experiences of Nursing Students on their Clinical Duty

Clinical experience has consistently been a vital component of nursing education,

fostering the learning journey for student nurses (Sharif & Masoumi, 2005). This facet

equips them not only with theoretical knowledge but also the practical application of

clinical principles, engaging their critical thinking skills for effective problem-solving

(Dunn & Burnett, 1995).

According to a white paper published by the American Association of Colleges of

Nursing (AACN, date), hands-on job experience prepares nursing students for a diverse

patient-care environment in a variety of settings. This is due to the broad field of nursing

as a whole – there are many specialties, care settings, positions, and more – and no two

days are alike. Clinical experience before entering the professional world in full provides

a vast wealth of knowledge to nursing students. Furthermore, clinical experience helps

nursing students become accustomed to high-stress moments. This experience will enable

them to hone their preparation skills and reflexes to ensure that they’re ready for

anything. (Duquesne University,2020).

Sharif and Masoumi's study in 2005 found heightened anxiety among nursing

students during their second-year clinical practice. Exploring students' perspectives on

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their clinical experience becomes crucial, as it may pave the way for the development of

effective clinical teaching strategies in nursing education. In the initial clinical

experience, students express anxiety about factors such as lack of experience, unfamiliar

settings, challenging patients, fear of making mistakes, and faculty evaluation (Hart &

Rotem, 1994). The exploration of factors associated with students' experiences highlights

the need to address the emotional well-being of nursing students during their clinical

rotations and the importance of creating a supportive and engaging clinical learning

environment to foster student retention (Beck, 1991; Lindop, 1987).

Available evidence indicates that stress among nursing students stems

predominantly from two main sources: academic and clinical stressors. Notably, nursing

students perceive clinical stressors more intensely across all levels (Jimenez et al., 2010;

Pulido-Martos et al., 2012). Academic stressors encompass elements such as the

academic process (Tully, 2004), substantial assignments, and workloads (Al-Zayyat &

Al-Gamal, 2014b; Labrague, 2014; Suresh et al., 2012), as well as examinations (Burnard

et al., 2008; Gibbons, 2010; Nolan & Ryan, 2008; Pulido-Martos et al., 2012). Consistent

findings across studies indicate that nursing students endure moderate to severe stress

levels during clinical practice (Blomberg et al., 2014; Burnard et al., 2008; Labrague,

2014; Tully, 2004).

Challenges of Nursing Students on their Clinical Duty

The role of clinical practice in nursing has long been the focus of research. A

systematic review by Williams and Palmer (2014) was compiled from various sources to

provide a literature review of the benefits and challenges the Clinical Learning

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Experience (CLE) brings to nursing students as well as their experiences and awareness

of the CLE. The results of the review found clinical practice was an important factor in

improving the nursing student's practical ability and brings great benefits to nursing

students in the development of their confidence in a multi-professional environment.

At times, students may struggle to seize available opportunities due to various

barriers. The anxiety experienced by nursing students in intensive care settings can

impede knowledge acquisition. Additionally, disparities between theoretical knowledge

and practical application pose challenges for nursing students. Researchers suggest that

addressing these issues requires collaborative efforts between academic and clinical

institutions to enhance the clinical training system (Williams & Palmer, 2014).

Another facet of the difficulties encountered by nursing students in CLE pertained

to interactions with clinical stakeholders, including those directly involved in the

department such as head nurses, nurses, physicians, and patients or their families. A

systematic review conducted in Iran, drawing from various studies, highlighted that the

relationship between students and these stakeholders represented a primary consideration

for stressors in the CLE (Changiz, Malekpour, & Zargham-Boroujeni, 2012).

Successful completion of learning in nursing often requires frequent connections and

interactions with these key groups. Challenges faced by nursing students in the CLE often

originated from interactions with clinical staff and patients, with factors from clinical

stakeholders being both positive and negative (Neal, 2016). Truong (2015) echoed this

issue in her study, revealing that some students expressed discomfort with clinical

nursing staff and desired more kindness. However, the study also reported instances

where students felt supported by nursing staff in the ward offering guidance and

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answering queries while performing nursing procedures for patient care. This support

contributed significantly to the sense of security among nursing students in the

challenging clinical environment.

Undoubtedly, the attitude of clinical nurses significantly influences the mindset of

nursing students. Mamaghani et al. (2018) highlighted an insufficient interaction between

staff in the CLE and nursing students, attributing this issue to the negative attitude of the

nurses involved. In his study on the phenomenon of a "bully culture", he observed this

behavior across various participants, including physicians, head nurses, and ward nurses.

Nursing students reported restrictions on performing tasks as intern nurse practitioners,

being relegated to menial jobs, and essentially serving as "servants" to these nurses.

Furthermore, there was noted segregation between nursing students and medical students

in the CLE, affecting basic needs such as access to dressing rooms, restrooms, and the

library, which were exclusively designated for medical students.

Collaborations between nursing staff and students play a crucial role in the

reciprocal exchange of knowledge. Consequently, when this interaction is lacking, it puts

students at a disadvantage. This concern became prominent, particularly when students

expressed predominantly negative comments about the clinical staff (Alraja, 2011).

Recent studies, both in Vietnam and internationally, echo these concerns. Terms

like "inadequate," "lack of respect," and even "bullying" were commonly used in these

research studies (Smith, Gillespie, Brown, & Grubb, 2016). Learning environments

have become more intricate, and students are no longer self-reliant in what should be

their central space. One of the challenges nursing students face in the CLE stems from

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unsuccessful interactions between clinical nurses, other stakeholders, and the students

themselves. Ghodsbin and Shafakhah (2008) emphasized that non-cooperation from

nursing staff constitutes a significant barrier to effective clinical education.

On the other hand, the presence and involvement of nursing students in clinical

tasks were occasionally perceived negatively by clinical nursing staff leading to an

increased workload. Rather than instructing students, some clinical nurses preferred to

perform tasks themselves for safety and efficiency, and, correcting any mistakes made by

students could lead to work delays for the clinicians (Neal, 2016).

Coping Strategies of Nursing Students

Nursing students experience a lot of stressful situations. It is an inevitable part of

their life. In the study of Sharif and Masoumi (2005), they found that nursing students

experienced much more stress during their second, third, and fourth years of nursing

training. The effects of stress on individuals depend on the sufficiency of their coping

behaviors (Findik, U. Y., Ozbas, A., Cavdar, I., Topcu, S. Y., & Onler, E., 2015).

Students in nursing who undergo stress may face challenges in academic

performance, and mental well-being, and even at risk of suicide (Yamashita et al., 2012).

The inherent stress in nursing is attributed to the profession's focus on managing clients

within intricate and dynamic clinical environments (Hamaideh & Ammouri, 2011).

Clinical stressors encompass a range of challenges, including the apprehension of

the unknown (Pulido-Martos et al., 2012), adapting to new clinical environments (Kim,

2003), participating in diverse clinical activities (Yamashita et al., 2012), attending to

patients' needs (Jimenez et al., 2010; Khater et al., 2014; Sheu et al., 2002), insufficient
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professional knowledge or nursing skills (Gorostidi et al., 2007; Jimenez et al., 2010;

Labrague, 2014; Sheu et al., 2002), fear of failure and clinical incompetence (Labrague,

2014), encountering death and dying experiences (Burnard et al., 2008; Suresh et al.,

2012; Timmins & Kaliszer, 2002), unfamiliarity with patients' medical history (Sheu et

al., 2002), unfamiliar diagnoses and treatments (Sheu et al., 2002), fear of making

mistakes (Kim, 2003; Pulido-Martos et al., 2012), administering medication to children

(Oermann & Lukomski, 2001), and a lack of control in patient relationships (Gorostidi et

al., 2007). Additionally, stressors include interactions with peers, daily life, and the

environment (Shaban et al., 2012), relationships with nursing staff and educators (Khater

et al., 2014), forming new connections and assuming new responsibilities (Seyedfatemi et

al., 2007), facing unfamiliar situations and working with strangers, financial strain (Tully,

2004), relationships with friends, tutors, and companions (Gorostidi et al., 2007),

negative interactions with instructors (Timmins & Kaliszer, 2002), being observed by

instructors, arriving late (Kim, 2003), and having challenging relationships with clinical

staff (Nolan & Ryan, 2008).

Given the heightened stress levels experienced by nursing students from various

sources, they employ diverse coping strategies, which can is classified into two

categories. As outlined by Clark, Nguyen, and Barbosa-Leiker (2014), the first category

involves positive approaches, such as seeking emotional support, organizing workloads,

sharing experiences with faculty, engaging in exercise, and seeking spiritual guidance.

The second category encompasses avoidance strategies or attempting to alleviate stress

effects through alcohol and drug use, overeating or undereating, disengagement, apathy,

procrastination, and even dropping out. Notably, an avoidance coping style emerges as a

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robust predictor of adverse psychological well-being. Some students manifest stress

through arguments with family and friends, resorting to cheating in nursing courses and

exams, and adopting a "survival mode" to navigate through the program.

The most effective means of reducing stress involve cognitive-behavioral coping

strategies (Kaviani et al.,2007) . While students cannot evade stressors, the key lies in

their ability to adapt to demands and employ effective coping mechanisms, with the

nature of stress being less crucial. Zhao et al. (2015) suggest that employing appropriate

coping methods is paramount, as they mitigate the damage caused by stress.

Concerning coping behaviors, nursing students with relatives in the nursing field

exhibit more coping behaviors than those without, potentially influenced by supportive

relatives, particularly mothers, guiding them toward adaptive coping. Those living

independently away from family employ more coping strategies, possibly because they

face stress without familial assistance. During the teaching and learning process, students

navigate theoretical and practical stressors, prompting the use of coping strategies to

mitigate stress effects. However, when these strategies prove ineffective, stress persists,

leading to potential burnout.

Moreover, nursing students' stress coping levels are influenced by self-esteem and

social support, impacting overall health. Numerous studies spanning decades highlight

high stress and anxiety levels in nursing undergraduate programs (Moscaritolo, 2009).

The duration of stress exposure and stress levels affect anxiety, influencing coping

mechanisms, academic performance, and retention (Katrina Turner, 2017).

Synthesis

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This comprehensive examination of literature on experiences, challenges, and

coping mechanisms illuminates the journey of Level II nursing students in their clinical

duty, providing valuable insights into their experiences, challenges, and coping strategies.

By understanding the experiences of nursing students during their clinical duty, our study

can contribute to the development of interventions and strategies that can help nursing

students cope with the challenges they face during their clinical duty, ultimately leading

to better learning outcomes and improved patient care.

CHAPTER III

RESEARCH METHODOLOGY

This chapter describes the research design, local of the study, population and

sample, sampling procedure, research instrument, data gathering procedure, and

statistical treatment of data for analysis.

Research design

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The researchers will use descriptive research design and semi-structured

interviews. A survey will be conducted using a questionnaire to collect data on the socio-

demographic profile, the experiences and challenges and coping strategies of Level II

nursing students in their clinical duties. The semi-structured interview will be done by

asking questions that will probe further their clinical experiences. This method is

particularly useful for investigating complex social phenomena during their clinical

duties. Using both methods, researchers may develop in-depth information material that

can be formulated for dissemination, seminars, workshops, etc. for the incoming level II

nursing students who will be having their first clinical experience.

Locale of the Study

The research will be conducted at Northern Christian College (NCC), a private

educational institution offering various courses including a Bachelor of Science in

Nursing situated at Brgy. 5 Mabini St., Laoag City. The Bachelor of Science in Nursing is

under the School of Nursing.

Population and Sampling

As per the record from the Registrar's Office, there are 307 nursing students

enrolled in Level II for the SY 2023-2024. The researchers will use a convenience-quota

sampling technique to determine the number of participants in this study. According to

Nikolopoulou (2022), convenience and quota sampling are non-probability sampling

methods that rely on the non-random selection of a predetermined number of

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respondents. Each of the researchers will have a quota of ten (10) respondents making a

total sample size of 100 respondents which is about 33% of the total population.

Research Instruments

The questionnaire is the primary tool for gathering the data. It consists of five parts:

Part I deals with the profile of the respondents such as age, sex, religion, and civil

status.

Part II includes the experiences of the respondents in their clinical duty

Part III deals with the challenges faced by the respondents in their clinical duties,

Part IV is the coping strategies or mechanisms that are employed to minimize

stress.

Open-ended questions will also be used in conjunction with Likert scales to gain a

deeper understanding of participants’ perspectives of their experiences.

Data gathering Procedure

First, a letter will be submitted to the Dean of the School of Nursing and the

AVPAA for permission to conduct the study indicating its objectives and how it will

contribute to enhancing the coping strategies to mitigate stress. Once approved, the

questionnaire will be pilot-tested to ten (10) Level II nursing students on the clarity of

questions. These ten nursing students will be discarded as sample. The researchers will

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explain the objectives of the study, and participation is voluntary. If they have any queries

unclear to them, they are allowed to ask questions from the researcher, and the

researchers will clarify any questions that may confuse them.

After the retrieval of the questionnaires, the researchers will thank the respondents

for their participation and cooperation during the conduct of the study. Furthermore,

respondents will be assured that the information acquired will be kept confidential and

used purely for academic reasons.

Statistical Treatment of Data

To analyze the collected data, the researchers will make use of the following

statistical treatment.:

For problem 1 - Frequencies and percentages will be computed.

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For problems 2, 3, and 4 – A 4-point Likert scale will be used to analyze the
responses of the respondents

Scale Interval Verbal Description

1 1.00 -1.75 Strongly Disagree
2 1.76 -2.50 Disagree
3 2.51 -3.25 Agree
4 3.26 -4.00 Strongly Agree

The responses will be tabulated and the weighted means will be computed and
interpreted.

INSTRUCTIONS: READ EACH STATEMENT BELOW AND INDICATE

FOLLOWING THE RATING SCALE OF YOUR AGREEMENT ON THE
EXPERIENCES, CHALLENGES, AND COPING STRATEGIES.

EXPERIENCES Strongly Disagree Agre Strongly

Disagre (2) e (3) Agree
e (1) (4)

1. Clinical duty experiences are

valuable for my learning and skill
development
2. I often encounter positive
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interactions and collaboration with
healthcare professionals during
clinical duty
3. The long hours and physically
demanding nature of clinical
rotations left me feeling exhausted.
4. I felt adequately supported by
clinical instructors during clinical
duty
5. Feedback provided by clinical
instructors helps improve my
clinical skills and knowledge
6. Clinical duties provide adequate
opportunities to practice my critical
thinking and problem-solving skills
7. I am satisfied with the level of
exposure to various nursing
specialties and procedures during
clinical duty
8. I struggled to keep up with the pace
of the clinical setting.
9. I felt physically exhausted from the
demanding workload, often
experiencing fatigue and a lack of
energy due to long study hours.
10. I felt constantly rushed due to poor
time management, struggling to
balance assignments and personal
responsibilities.
11. I found it difficult to maintain a
healthy sleep schedule while on
clinical rotations.
12. 4. I felt the physical impact of stress
on my sleep patterns, often
experiencing insomnia or disrupted
sleep due to academic worries.
13. I felt a deep fear of failing
academically, which often affected
my motivation and increased my
stress levels.
14. I experienced physical discomfort
due to prolonged standing or
uncomfortable positions during
patient care.
15. I felt the toll on my body from
prolonged sitting and studying,

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Republic of the Philippines
Commission on Higher Education Region I
NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City
leading to backaches and posture-
related discomfort.

A. CHALLENGES
1. I felt overwhelmed by the amount of
new information I needed to learn
during clinical rotations.
2. I am well-prepared and confident in
applying theoretical knowledge to
practical situations during clinical
duty
3. Clinical duties provide adequate
opportunities to practice my critical
thinking and problem-solving skills
4. My clinical assignments were often
challenging and required me to
apply complex concepts.
5. I felt anxious about making mistakes
during patient care.
6. I found it difficult to balance my
clinical workload with my other
academic commitments.
7. I felt the lack of adequate mental
health support available on campus,
which added to the challenges of
coping with academic stress.
8. I felt the challenge of maintaining
good health habits amid a hectic
schedule, struggling with irregular
eating patterns, and limited time for
self-care.
9. I felt pressure to perform at a high
level, which led to physical tension
and fatigue.
10. I was concerned about the risk of
exposure to infectious diseases
during clinical rotations.
11. I worried about making a negative
impression on my clinical
instructors and peers.
12. I experienced feelings of self-doubt
and uncertainty about my abilities as
a nurse.

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Republic of the Philippines
Commission on Higher Education Region I
NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City
13. I felt overwhelmed by the emotional
demands of caring for patients in
difficult situations.
14. I found it challenging to cope with
the death or suffering of patients.
15. The noise and activity level in the
clinical setting was distracting and
made it difficult to focus.
16. I felt uncomfortable or unsafe in
certain areas of the clinical setting.
17. I felt that the hospital staff was not
always welcoming or supportive of
nursing students.
18. The lack of clear instructions or
expectations from clinical
instructors added to my stress.
19. I felt pressure to conform to the
existing culture or hierarchy of the
clinical setting.
20. I felt that my financial concerns
affected my ability to focus on my
clinical education.
21. I felt stressed trying to balance my
academic workload with personal
responsibilities, causing challenges
in managing both effectively.
22. I felt isolated when I struggled to
connect with peers or felt excluded
from social circles, which affected
my overall experience at school.
23. I felt challenged in maintaining a
healthy work-life balance,
struggling to allocate time for self-
care amidst academic demands.
24. I felt stressed when trying to balance
rigorous coursework with clinical
rotations, leaving little time for
personal life or rest.
25. I felt the weight of responsibility
during practical sessions, fearing
mistakes that could impact patients'
well-being.

B. COPING STRATEGIES
1. I prioritize and manage my tasks
during clinical duties efficiently

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Republic of the Philippines
Commission on Higher Education Region I
NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City
2. I communicate and collaborate well
with my fellow nursing students to
share responsibilities.
3. I take short breaks during clinical
duties to prevent feeling
overwhelmed.
4. I seek guidance and support from
clinical instructors or mentors when
facing challenges.
5. I engage in reflective practices to
process and learn from challenging
clinical experiences.
6. I maintain a positive and
professional attitude even in
stressful clinical situations.
7. I utilize effective time management
strategies to balance clinical duties
and study requirements.
8. I practice self-care routines to
ensure my well-being during
demanding clinical rotations.
9. I actively seek feedback to improve
my clinical skills and performance.
10. I am comfortable expressing
concerns or seeking help from peers
or faculty when needed.
11. I use effective communication skills
to interact with patients and their
families during clinical duties.
12. I engage in peer support networks to
share experiences and coping
strategies with fellow nursing
students.
13. I set realistic expectations for myself
regarding my performance during
clinical rotations.
14. I proactively plan and prepare for
clinical duties to reduce last-minute
stress.
15. I go to church to ask God to calm
the storms of my life.
16. I engage in debriefing sessions with
classmates or instructors after
challenging clinical experiences.
17. I try new stress-reducing techniques
or activities recommended by

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Republic of the Philippines
Commission on Higher Education Region I
NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City
instructors or peers.
18. I maintain a healthy work-life
balance, ensuring time for relaxation
and activities outside of nursing
duties.
19. I actively engage in self-reflection to
identify areas for personal and
professional growth during clinical
experiences.
20. I felt calmer after engaging in
relaxation exercises such as deep
breathing or meditation to reduce
my exam-related stress.
21. I felt more in control when I learned
effective study habits, like breaking
tasks into smaller parts, which
helped with time management.
22. I felt empowered by setting realistic
goals and not comparing myself to
others, which reduced my stress
levels.
23. I felt more connected when I joined
study groups or engaged in campus
activities, reducing feelings of
isolation and stress.
24. I felt better equipped to handle
stress after accessing mental health
resources like counseling or support
groups
25. I felt more resilient when I learned
to accept setbacks and failures as
part of my learning journey,
reducing my fear of academic
failure.

Experiences:

1. Can you describe a specific clinical experience that had a significant impact on
your learning as a nursing student? What did you find most valuable about it?
__________________________________________________________________
__________________________________________________________________
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Republic of the Philippines
Commission on Higher Education Region I
NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City
__________________________________________________________________
____________________________________
2. How do you feel your clinical experiences have contributed to your overall
development as a nursing student?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________
3. How have your perceptions of the nursing profession evolved during your clinical
rotations, and what factors have influenced these changes?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

4. What feedback or guidance from clinical instructors or preceptors has been most
valuable to you in enhancing your nursing skills?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

5. What is the worst experience you find most difficult to deal with in your clinical
duties? Can you share a specific instance and how you handled it?

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

Challenges:

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Republic of the Philippines
Commission on Higher Education Region I
NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City
1. Describe a moment when you felt particularly challenged or outside of your
comfort zone during a clinical assignment. How did you navigate that situation?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

2. How do you handle unexpected challenges that may arise during patient care or in
the overall clinical setting?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

3. What aspects of your clinical duties are the most demanding or stressful situations
for you?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

4. What aspects of the clinical environment do you find most challenging?

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

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Republic of the Philippines
Commission on Higher Education Region I
NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City
5. Could you share an example of a particularly challenging patient interaction or
clinical scenario you've encountered recently? How did you handle it?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

Coping Strategies

1. What coping strategies do you use to deal with the pressures and expectations of
your clinical responsibilities?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

2. How do you cope with the emotional and psychological challenges often
associated with clinical practice?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

3. What approaches or strategies do you find most effective in managing stress and
workload during your nursing studies?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

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Republic of the Philippines
Commission on Higher Education Region I
NORTHERN CHRISTIAN COLLEGE, INC.
Laoag City
4. What advice or tips would you give to fellow student nurses who might be
struggling to find effective coping mechanisms for the demands of nursing
education and clinical practice?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________
5. In your opinion, how can the nursing education curriculum be improved to better
prepare students for the realities of clinical practice?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
____________________________________

THANK YOU FOR YOUR COOPERATION. GOD BLESS!!!

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