The Relationship Between Clinical Practice Anxiety and Self-Efficacy Beliefs of Nursing Students Receiving Hybrid Education During the Pandemic Process: A Cross-Sectional Study
Objective: This study aimed to examine the anxiety and self-efficacy of nursing students who received hybrid education before and after their first clinical experience during the COVID-19 pandemic.
Methods: This study was performed in a cross-sectional design in the state university between November and December 2021. The sample of the study consisted of 106 students who started clinical practice for the first time. The research data were gathered in the first and last week of the clinical practice with the "State-Trait Anxiety Scale" and "General Self-Efficacy Scale" by online survey method. Wilcoxon Signed-ranks Test, Kruskall Wallis Test, Mann Whitney U Test, and Spearman correlation analysis were used to analyze the data.
Results: It was determined that nursing students with hybrid education had moderate anxiety and self-efficacy in the first week of clinical practice and their state anxiety did not decrease at the end of clinical practice (p>0.05); however, their general self-efficacy and the sub-dimension scores of resilience and maintenance decreased (p=.024, p=.002, p=.000, respectively). Self-efficacy and academic achievement were negatively associated with the state of anxiety. Female students had iğler self-efficacy at the beginning of the clinical practice (p=.001).
Conclusion: During COVID-19 pandemic, the anxiety of nursing students in the first clinical practice was moderate, and the perception of self-efficacy decreased. It is recommended that training and practices that reduce anxiety and improve the perception of self-efficacy, especially in nursing students going on their first clinical practice, should be carried out in collaboration with the clinic and university.
Açiksöz S, Uzun Ş, Arslan F. (2016). Hemşirelik öğrencilerinde öz yeterlik algısı ile klinik uygulamaya ilişkin kaygı ve stres durumu arasındaki ilişkinin incelenmesi. Gulhane Medical Journal, 58(2), 129–135. https://doi.org/10.5455/gulhane.
Arseven A. (2016). Öz yeterlilik: Bir kavram analizi. Journal of Turkish Studies, 11(19), 63–63. https://doi.org/10.7827/turkishstudies.10001
Baysan Arabacı L, Tokem Y, Torun R, Korhan EA. (2015). Hemşirelik birinci sınıf öğrencilerinin ilk klinik deneyim öncesi-sırası ve sonrası anksiyete ve stres düzeyleri ve etkileyen faktörler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 2(1), 1–16.
Casafont C, Fabrellas N, Rivera P, Olivé-Ferrer MC, Querol E, Venturas, M ve ark. (2021). Experiences of nursing students as healthcare aid during the COVID-19 pandemic in Spain: A phemonenological research study. Nurse Education Today, 97, 104711. https://doi.org/10.1016/J.NEDT.2020.104711
Chami-Malaeb R. (2022). Relationship of perceived supervisor support, self-efficacy and turnover intention, the mediating role of burnout. Personnel Review, 51(3), 1003–1019. https://doi.org/10.1108/PR-11-2019-0642
Fitzgerald A, Konrad S. (2021). Transition in learning during COVID-19: Student nurse anxiety, stress, and resource support. Nursing Forum, 56(2), 298–304. https://doi.org/10.1111/NUF.12547
García-González J, Ruqiong W, Alarcon-Rodriguez R, Requena-Mullor M, Ding C, Ventura-Miranda MI. (2021). Analysis of anxiety levels of nursing students because of e-learning during the COVID-19 pandemic. In Healthcare, 9(3), 252. https://doi.org/10.3390/healthcare9030252
George TP, DeCristofaro C, Murphy PF. (2020). Self-efficacy and concerns of nursing students regarding clinical experiences. Nurse Education Today, 90, 104401. https://doi.org/10.1016/j.nedt.2020.104401
Göger S, Çevirme A. (2019). Effects on the educational stress of the self-efficacy level of nursing students. Journal of Education and Research in Nursing, 16(4), 306–312. https://doi.org/10.5222/head.2019.306
Han S, Eum K, Kang HS, Karsten K. (2022). Factors influencing academic self-efficacy among nursing students during COVID-19: A path analysis. Journal of Transcultural Nursing, 33(2), 239–245. https://doi.org/10.1177/10436596211061683
Jiao X, Yu X, Wang S, Wang Z, Gong Z. (2021). Are effect sizes in self-efficacy field changing over time? A meta–meta analysis. International Journal of Psychology, 56(5), 801–811. https://doi.org/10.1002/ijop.12736
Kang H, Kim Y, Lee H. (2018). Predictive factors influencing clinical competence in nursing students. Journal of the Korea Academia-Industrial Cooperation Society, 19(3), 389–398. https://doi.org/10.5762/KAIS.2018.19.3.389
Karadağ E, Aksoy D, Ucuzal M. (2011). Sağlık Yüksekokulu öğrencilerinin öz etkililik-yeterlik düzeyleri. Maltepe Üniversitesi Hemşirelik Bilim ve Sanatı Dergisi, 4(1), 13–20.
Kochuvilayil T, Fernandez RS, Moxham LJ, Lord H, Alomari A, Hunt L ve ark. (2021). COVID-19: Knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing students: A cross-sectional study. Journal of Clinical Nursing, 30(5–6), 882–891. https://doi.org/10.1111/JOCN.15634
Kotaman H. (2008). Özyeterlilik inancı ve öğrenme performansının geliştirilmesine ilişkin yazın taraması. Eğitim Fakültesi Dergisi, 21(1), 111–133.
Köse Tosunöz İ, Güngör S, Öztunç G. (2021). İlk klinik uygulama öncesi yaşanan kaygı: Hemşirelik öğrencileri örneği. YOBÜ Sağlık Bilimleri Fakültesi Dergisi, 2(1), 14-21.
Liu J, Yang Y, Chen J, Zhang Y, Zeng Y, Li J. (2022). Stress and coping styles among nursing students during the initial period of the clinical practicum: A cross-section study. International Journal of Nursing Sciences, 9(2), 222–229. https://doi.org/10.1016/j.ijn ss.2022.02.004
Mazalová L, Gurková E, Štureková L. (2022). Nursing students’ perceived stress and clinical learning experience. Nurse Education in Practice, 64, 103457. https://doi.org/https://doi.org/10.1016/j.nepr.2022.103457
Nordhus GEM, NaNongkhai P, Hofseth Almås S. (2022). Self-efficacy beliefs among baccalaureate nursing students-A cross-sectional, comparative study. International Journal of Nursing Education Scholarship, 19(1), 20210157. https://doi.org/10.1515/ijnes-2021-0157
Oducado RMF, Estoque H. (2021). Online learning in nursing education during the COVID-19 pandemic: Stress, satisfaction, and academic performance. Journal of Nursing Practice, 4(2), 143–153. https://doi.org/10.30994/JNP.V4I2.128
Okçin FA, Gerçeklioğlu G. (2013). Öğrencilerin öz-etkililik-yeterlilik algıları ve sosyal destek düzeylerinin incelenmesi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2(1), 40-51.
Öner N, Le Compte A. (1983). Handbook of state-trait anxiety inventory. Bogaziçi University, İstanbul.
Orkaizagirre-Gómara A, Sánchez De Miguel M, Ortiz de Elguea J, Ortiz de Elguea A. (2020). Testing general self-efficacy, perceived competence, resilience, and stress among nursing students: An integrator evaluation. Nursing and Health Sciences, 22(3), 529–538. https://doi.org/10.1111/nhs.12689
Özsaban A, Bayram A. (2020). Türkiye’de hemşirelik öğrencilerinin klinik uygulama deneyimlerini etkileyen faktörler: sistematik derleme. Ankara Sağlık Bilimleri Dergisi, 9(2), 124-145. https://doi.org/10.46971/AUSBİD.750585
Robb M. (2012). Self-efficacy with application to nursing education: A concept analysis. Nursing Forum, 47(3), 166–172. https://doi.org/10.1111/j.1744-6198.2012. 00267.x
Sakız G. (2013). Başarıda anahtar kelime: Öz-yeterlik. Uludağ Üniversitesi Eğitim Fakültesi Dergisi, 26(1), 185–209.
Sanad HM. (2019). Stress and anxiety among junior nursing students during the initial clinical training: a descriptive study at College of Health Sciences, University of Bahrain. American Journal of Nursing Research, 7(6), 995-999. https://doi.org/10.12691/AJNR-7-6-13
Savitsky B, Findling Y, Ereli A, Hendel T. (2020). Anxiety and coping strategies among nursing students during the COVID-19 pandemic. Nurse Education in Practice, 46, 102809. https://doi.org/10.1016/j.nepr.2020.102809
Sherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. (1982). The self-efficacy scale: Construction and validation. Psychological Reports, 51(2), 663-671.
Shorey S, Lopez V. (2021). Self-efficacy in a nursing context. Health Promotion in Health Care–Vital Theories and Research, 145–158.
Spielberger CD, Gorsuch RL, Lushene RE. (1970). Manual for the State-Trait Anxiety Inventory. Polo Alto, Consulting Psychologists.
Suliman WA, Abu-Moghli FA, Khalaf I, Zumot AF, Nabolsi M. (2021). Experiences of nursing students under the unprecedented abrupt online learning format forced by the national curfew due to COVID-19: A qualitative research study. Nurse Education Today, 100, 104829. https://doi.org/10.1016/j.nedt.2021.104829
Şanlı D, Uyanık G, Ünsal Avdal E. (2021). COVID-19 pandemi sürecinde dünyada hemşirelik eğitimi. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 6(1), 55–63.
Ulenaers D, Grosemans J, Schrooten W, Bergs J. (2021). Clinical placement experience of nursing students during the COVID-19 pandemic: A cross-sectional study. Nurse Education Today, 99, 104746. https://doi.org/10.1016/J.NEDT.2021.104746
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Strobe Initiative. (2014). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International Journal of Surgery, 12(12), 1495-1499. https://doi.org/10.1016/j.ijsu.2014.07.013
Yıldırım F, İlhan İÖ. (2010). Genel öz yeterlik ölçeği Türkçe formunun geçerlilik ve güvenilirlik çalışması. Türk Psikiyatri Dergisi, 21(4), 301-308.
Amaç: Bu çalışmada hibrit eğitim alan hemşirelik öğrencilerinin COVID-19 pandemisi sırasındaki ilk klinik deneyimleri öncesi ve sonrasında anksiyete ve öz yeterliklerinin incelenmesi amaçlanmıştır.
Yöntem: Bu çalışma Kasım-Aralık 2021 tarihleri arasında bir devlet üniversitesinde kesitsel desende gerçekleştirilmiştir. Çalışmanın örneklemini ilk kez klinik uygulamaya başlayan 106 öğrenci oluşturmuştur. Araştırma verileri, klinik uygulamanın ilk ve son haftasında "Durumluk-Sürekli Kaygı Ölçeği" ve "Genel Öz Yeterlik Ölçeği" ile çevrimiçi anket yöntemiyle toplanmıştır. Verilerin analizinde Wilcoxon İşaretli Sıralar Testi, Kruskall Wallis Testi, Mann Withney U Testi ve Spearman korelasyon analizi kullanılmıştır.
Bulgular: Hibrit eğitim alan hemşirelik öğrencilerinin klinik uygulamanın ilk haftasında anksiyete ve öz yeterliklerinin orta düzeyde olduğu ve klinik uygulama sonunda durumluk anksiyetelerinin azalmadığı (p>0.05); ancak genel öz yeterlikleri ile dayanıklılık ve sürdürme alt boyut puanlarının azaldığı (sırasıyla p=.024, p=.002, p=.000) belirlenmiştir. Bu çalışmada öz yeterlik ve akademik başarı değişkenleri ile durumluk kaygı değişkeni arasında negatif ilişki bulunmuştur. Bununla birlikte kız öğrencilerin klinik uygulamanın başında daha yüksek öz yeterliğe sahip olduğu saptanmıştır (p=.001).
Sonuç: COVID-19 pandemisinde hemşirelik öğrencilerinin ilk klinik uygulamada anksiyeteleri orta düzeydeydi ve öz yeterlik algıları azaldı. Özellikle ilk klinik uygulamasına çıkan hemşirelik öğrencilerinde anksiyeteyi azaltıcı ve öz yeterlik algısını geliştirici eğitim ve uygulamaların klinik ve üniversite iş birliği ile yürütülmesi önerilmektedir.
Açiksöz S, Uzun Ş, Arslan F. (2016). Hemşirelik öğrencilerinde öz yeterlik algısı ile klinik uygulamaya ilişkin kaygı ve stres durumu arasındaki ilişkinin incelenmesi. Gulhane Medical Journal, 58(2), 129–135. https://doi.org/10.5455/gulhane.
Arseven A. (2016). Öz yeterlilik: Bir kavram analizi. Journal of Turkish Studies, 11(19), 63–63. https://doi.org/10.7827/turkishstudies.10001
Baysan Arabacı L, Tokem Y, Torun R, Korhan EA. (2015). Hemşirelik birinci sınıf öğrencilerinin ilk klinik deneyim öncesi-sırası ve sonrası anksiyete ve stres düzeyleri ve etkileyen faktörler. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 2(1), 1–16.
Casafont C, Fabrellas N, Rivera P, Olivé-Ferrer MC, Querol E, Venturas, M ve ark. (2021). Experiences of nursing students as healthcare aid during the COVID-19 pandemic in Spain: A phemonenological research study. Nurse Education Today, 97, 104711. https://doi.org/10.1016/J.NEDT.2020.104711
Chami-Malaeb R. (2022). Relationship of perceived supervisor support, self-efficacy and turnover intention, the mediating role of burnout. Personnel Review, 51(3), 1003–1019. https://doi.org/10.1108/PR-11-2019-0642
Fitzgerald A, Konrad S. (2021). Transition in learning during COVID-19: Student nurse anxiety, stress, and resource support. Nursing Forum, 56(2), 298–304. https://doi.org/10.1111/NUF.12547
García-González J, Ruqiong W, Alarcon-Rodriguez R, Requena-Mullor M, Ding C, Ventura-Miranda MI. (2021). Analysis of anxiety levels of nursing students because of e-learning during the COVID-19 pandemic. In Healthcare, 9(3), 252. https://doi.org/10.3390/healthcare9030252
George TP, DeCristofaro C, Murphy PF. (2020). Self-efficacy and concerns of nursing students regarding clinical experiences. Nurse Education Today, 90, 104401. https://doi.org/10.1016/j.nedt.2020.104401
Göger S, Çevirme A. (2019). Effects on the educational stress of the self-efficacy level of nursing students. Journal of Education and Research in Nursing, 16(4), 306–312. https://doi.org/10.5222/head.2019.306
Han S, Eum K, Kang HS, Karsten K. (2022). Factors influencing academic self-efficacy among nursing students during COVID-19: A path analysis. Journal of Transcultural Nursing, 33(2), 239–245. https://doi.org/10.1177/10436596211061683
Jiao X, Yu X, Wang S, Wang Z, Gong Z. (2021). Are effect sizes in self-efficacy field changing over time? A meta–meta analysis. International Journal of Psychology, 56(5), 801–811. https://doi.org/10.1002/ijop.12736
Kang H, Kim Y, Lee H. (2018). Predictive factors influencing clinical competence in nursing students. Journal of the Korea Academia-Industrial Cooperation Society, 19(3), 389–398. https://doi.org/10.5762/KAIS.2018.19.3.389
Karadağ E, Aksoy D, Ucuzal M. (2011). Sağlık Yüksekokulu öğrencilerinin öz etkililik-yeterlik düzeyleri. Maltepe Üniversitesi Hemşirelik Bilim ve Sanatı Dergisi, 4(1), 13–20.
Kochuvilayil T, Fernandez RS, Moxham LJ, Lord H, Alomari A, Hunt L ve ark. (2021). COVID-19: Knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing students: A cross-sectional study. Journal of Clinical Nursing, 30(5–6), 882–891. https://doi.org/10.1111/JOCN.15634
Kotaman H. (2008). Özyeterlilik inancı ve öğrenme performansının geliştirilmesine ilişkin yazın taraması. Eğitim Fakültesi Dergisi, 21(1), 111–133.
Köse Tosunöz İ, Güngör S, Öztunç G. (2021). İlk klinik uygulama öncesi yaşanan kaygı: Hemşirelik öğrencileri örneği. YOBÜ Sağlık Bilimleri Fakültesi Dergisi, 2(1), 14-21.
Liu J, Yang Y, Chen J, Zhang Y, Zeng Y, Li J. (2022). Stress and coping styles among nursing students during the initial period of the clinical practicum: A cross-section study. International Journal of Nursing Sciences, 9(2), 222–229. https://doi.org/10.1016/j.ijn ss.2022.02.004
Mazalová L, Gurková E, Štureková L. (2022). Nursing students’ perceived stress and clinical learning experience. Nurse Education in Practice, 64, 103457. https://doi.org/https://doi.org/10.1016/j.nepr.2022.103457
Nordhus GEM, NaNongkhai P, Hofseth Almås S. (2022). Self-efficacy beliefs among baccalaureate nursing students-A cross-sectional, comparative study. International Journal of Nursing Education Scholarship, 19(1), 20210157. https://doi.org/10.1515/ijnes-2021-0157
Oducado RMF, Estoque H. (2021). Online learning in nursing education during the COVID-19 pandemic: Stress, satisfaction, and academic performance. Journal of Nursing Practice, 4(2), 143–153. https://doi.org/10.30994/JNP.V4I2.128
Okçin FA, Gerçeklioğlu G. (2013). Öğrencilerin öz-etkililik-yeterlilik algıları ve sosyal destek düzeylerinin incelenmesi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2(1), 40-51.
Öner N, Le Compte A. (1983). Handbook of state-trait anxiety inventory. Bogaziçi University, İstanbul.
Orkaizagirre-Gómara A, Sánchez De Miguel M, Ortiz de Elguea J, Ortiz de Elguea A. (2020). Testing general self-efficacy, perceived competence, resilience, and stress among nursing students: An integrator evaluation. Nursing and Health Sciences, 22(3), 529–538. https://doi.org/10.1111/nhs.12689
Özsaban A, Bayram A. (2020). Türkiye’de hemşirelik öğrencilerinin klinik uygulama deneyimlerini etkileyen faktörler: sistematik derleme. Ankara Sağlık Bilimleri Dergisi, 9(2), 124-145. https://doi.org/10.46971/AUSBİD.750585
Robb M. (2012). Self-efficacy with application to nursing education: A concept analysis. Nursing Forum, 47(3), 166–172. https://doi.org/10.1111/j.1744-6198.2012. 00267.x
Sakız G. (2013). Başarıda anahtar kelime: Öz-yeterlik. Uludağ Üniversitesi Eğitim Fakültesi Dergisi, 26(1), 185–209.
Sanad HM. (2019). Stress and anxiety among junior nursing students during the initial clinical training: a descriptive study at College of Health Sciences, University of Bahrain. American Journal of Nursing Research, 7(6), 995-999. https://doi.org/10.12691/AJNR-7-6-13
Savitsky B, Findling Y, Ereli A, Hendel T. (2020). Anxiety and coping strategies among nursing students during the COVID-19 pandemic. Nurse Education in Practice, 46, 102809. https://doi.org/10.1016/j.nepr.2020.102809
Sherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. (1982). The self-efficacy scale: Construction and validation. Psychological Reports, 51(2), 663-671.
Shorey S, Lopez V. (2021). Self-efficacy in a nursing context. Health Promotion in Health Care–Vital Theories and Research, 145–158.
Spielberger CD, Gorsuch RL, Lushene RE. (1970). Manual for the State-Trait Anxiety Inventory. Polo Alto, Consulting Psychologists.
Suliman WA, Abu-Moghli FA, Khalaf I, Zumot AF, Nabolsi M. (2021). Experiences of nursing students under the unprecedented abrupt online learning format forced by the national curfew due to COVID-19: A qualitative research study. Nurse Education Today, 100, 104829. https://doi.org/10.1016/j.nedt.2021.104829
Şanlı D, Uyanık G, Ünsal Avdal E. (2021). COVID-19 pandemi sürecinde dünyada hemşirelik eğitimi. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 6(1), 55–63.
Ulenaers D, Grosemans J, Schrooten W, Bergs J. (2021). Clinical placement experience of nursing students during the COVID-19 pandemic: A cross-sectional study. Nurse Education Today, 99, 104746. https://doi.org/10.1016/J.NEDT.2021.104746
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, Strobe Initiative. (2014). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International Journal of Surgery, 12(12), 1495-1499. https://doi.org/10.1016/j.ijsu.2014.07.013
Yıldırım F, İlhan İÖ. (2010). Genel öz yeterlik ölçeği Türkçe formunun geçerlilik ve güvenilirlik çalışması. Türk Psikiyatri Dergisi, 21(4), 301-308.
Takmak, Ş., & Karaçar, Y. (2024). Hibrit Eğitim Alan Hemşirelik Öğrencilerinin Pandemi Sürecinde Klinik Uygulama Kaygısı ve Özyeterlik İnançlarıyla İlişkisi: Kesitsel Bir Çalışma. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 7(1), 226-235. https://doi.org/10.38108/ouhcd.1246710