From defiance to struggle to adapt: ​​nursing students’ experiences of attending a clinical learning environment during the Covid-19 pandemic | BMC Psychiatry

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From defiance to struggle to adapt: ​​nursing students’ experiences of attending a clinical learning environment during the Covid-19 pandemic | BMC Psychiatry

A total of 15 nursing students were included in the study. Demographic characteristics of the participants are presented in Table 1.

Table 1 Demographic characteristics of the participants

Data analysis led to the emergence of two main themes “Defiance” and “struggle to adapt” and four categories “objection to CLE” (three subcategories), “patient marginalization” (three subcategories), “Use of sources of support” ( three subcategories ) and “Use of problem-oriented strategies” (three subcategories) (Table 2). “”.

Table 2 Themes, categories and subcategories derived from the study


During the covid-19 pandemic, one of the challenges for nursing students in t CLE was reluctance to attend CLE. Participants, although opposed to attending the CLE due to the conditions of Covid-19, always marginalize the patient in the clinical environment. Disobedience consisted of two categories of objection to staying in the CLE and marginalization of the patient.

Objection to CLE

The majority of students resisted CLE, especially at the beginning of the Covid-19 pandemic. These students showed their opposition to the CLE by getting angry, bargaining not to do an internship, and expressing their fear of becoming infected and infecting others.

Being mad about being in CLE

Some of the participants were angry when they learned that they were forced to attend the CLE due to reasons such as the unknown measures to control Covid-19, the immediate decision of the authorities to conduct an internship, ignoring the conditions of the students and concern of the authorities and their families.

“… when they told me I had to go to the internship, I got angry and started shouting…” (P.5).

“… when we found out that the internships were face-to-face, we were all angry, we quickly wrote a letter to the Vice Chancellor of Education on behalf of all students and objected to attending CLE during this pandemic situation…” (p. 9).

Fear of infecting others

According to the participants’ statements, being forced to attend the CLE caused them to feel anger, rage, and strong reactions.

Most of the participants were apprehensive when they were invited to attend the CLE. They were afraid of getting infected and then infecting others, especially their family members.

“… Why did we have to take an internship? You know, I was afraid of coronavirus, how can I say, the truth is that I was afraid of getting infected, of infecting my family, especially my father who had a heart problem…”(p. 12).

Shopping for not doing an internship

After knowing that it was mandatory to attend the CLE, most of the participants gathered at the university to discuss and convince the authorities to avoid holding internships until they have more information on how to control the pandemic, as well as find vaccines and effective medicines. They submitted their request to the authorities orally and in writing.

“…we all got together at the university, talked to the staff and tried to convince them that now is not the right time to start an internship, but…” (p. 8).

Marginalization of the patient

Most of the participants felt that the clinical staff did not cooperate with them due to the stressful conditions of the CLE; also ward overcrowding was a factor that caused students to worry and neglect caring for their patients or providing optimal care.

Non-cooperation by CLE staff due to ward overcrowding

Due to the overcrowded and stressful conditions in the wards during the Covid-19 pandemic, most nurses did not assist students, answer their questions or inform them whether patients were Covid-19 positive or not, which in turn led to an increase of students’ lack of motivation to provide patient care.

“…Some days when the ward was overcrowded, the staff didn’t take the time or I don’t know, maybe they didn’t care at all to tell us that a certain patient had the coronavirus or that we were going to do a Covid -19 test and that made the use reluctant to care for the patient under these circumstances” (p. 7).

Patient absconding due to ward overcrowding

Majority of the students did not approach the patients for fear of contracting Covid-19 and tried to run away from the patients.

“… On days when the ward was overcrowded, I didn’t even do TPR on the patients because I was afraid to go near the patients and if I did, I would stress myself out more…” (P.9).

“…I went to take the patient’s vitals. The patient said: I tested positive and I have a crown! I jumped back like you do when you touch something hot. The first warning that came to my mind was to run away from him…” (p. 6).

Poor patient care

According to participants, overcrowded/stressful ward conditions during the pandemic resulted in poor patient care.

“… When the ward was crowded, I became more stressed, my self-esteem could decrease. One day the ER was crowded, the professor told me to find this patient’s vein, I was always good at finding veins, but that day I tore the poor patient’s vein…” (P.3).

“… I couldn’t communicate with the patient like I did when the ward was quiet and there was no coronavirus, or I couldn’t even support or care for patients emotionally anymore when they were crying and upset. I just took a general history and asked about his symptoms while keeping the doctor’s distance, and I went…” (p. 6).

The struggle for adaptation

After being forced to attend CLE during the covid-19 pandemic, students struggled to adapt to the existing conditions by using sources of support as well as problem-oriented strategies. Indeed, the adjustment struggle involved two categories of using sources of support and using problem-oriented strategies.

Use of Support Sources

All participants used different sources of support, including help and trust in spirituality, effective interaction and experiences of other students, to adapt to the Covid-19 conditions in the hospital.

Effective interaction

All participants talked and shared their experiences with peers, received support from educators, as well as video contact with family members as sources of support for adapting to existing conditions.

“… I called my faculty advisor and talked about my concerns and concerns in this situation. He listened to me patiently, gave me hope and said: Don’t worry. It made me feel a little better…” (p. 2).

Sharing students’ experiences with each other

Drawing on the experiences of other students was another source of support for adapting to CLE during the Covid-19 pandemic.

“… I sat and talked with the students from other areas or departments who had already gone to the hospital. They were at the Covid-19 center and told me not to worry at all. For two or three months we have been following the health protocols and visiting the patient with Covid-19. We haven’t had any problems and these words put my mind at ease…” (P.6).

Relying on spirituality

Relying on spirituality, students were able to overcome their fear, adapt to new conditions and care for patients.

“…I prayed a lot and said, ‘God, when I follow the health protocols, you will definitely not let me get infected. God was my hope, that is, the only thing I could do was to trust in God and there was nothing I could do…” (P.3).

Using problem-oriented strategies

The participants coped with the covid-19 pandemic using strategies such as seeking information about covid-19, strictly following health protocols and finally accepting the reality and existing situation by attending CLE.

Acceptance of the existing situation

All participants tried to justify and accept the existing conditions to attend the clinical environment, considering the uncertainty regarding the end of the pandemic, the possibility of similar pandemics in the future and the choice of a nurse out of interest and voluntarily.

Acceptance of the existing situation of the Covid-19 pandemic and its consequences was one of the strategies used by all participants in the present study to adapt to the critical conditions.

“…I said to myself, I’m a nursing student, I’ve already chosen this path, what can I run from? Is this the last pandemic in our lifetime! There will definitely be a virus more dangerous than corona in the future and I have to deal with this problem…” (P.7).

Search for information

Given the unknown nature of the Covid-19 pandemic and the lack of information about it, most of the participants sought to obtain information from up-to-date scientific sources and articles.

One participant stated:

“… I have been trying to access and read the latest articles and scientific material on Covid-19. I looked to see what recent articles had to say about how and how long to wash hands and used their recommendations…” (p. 11).

Attention to compliance with protocols

All participants, entering the clinical environment, made maximum efforts to follow health protocols as a strategy to reduce the fear of infection and cope with the conditions of Covid-19.

One participant stated:

“…I tried to be very careful because the only thing I could do was to wear at least two masks in this situation. I used five-layer masks, changed them every 5-6 hours, washed my hands regularly…” (p. 1).

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