Exploring Psychological Well-Being of Nursing Students after Traumatic Experiences in Clinical Area

Exploring Psychological Well-Being of Nursing Students after Traumatic Experiences in Clinical Area

Sergio D. Mahinay, Jr., Rosiely Mostrales-Laco, Joanne Marie Jaramillo, Zaihani Mosanip, Jericho Panigon

College of Nursing, Notre Dame of Midsayap College, Midsayap, Cotabato, Philippines

DOI: https://dx.doi.org/10.47772/IJRISS.2025.903SEDU0322

Received: 21 May 2025; Revised: 05 June 2025; Accepted: 07 June 2025; Published: 12 July 2025

ABSTRACT

This study explored the psychological well-being of nursing students following traumatic experiences in clinical settings. A qualitative phenomenological research design was employed, utilizing in-depth interviews with seven purposively identified and conveniently chosen nursing students as participants. Data analyses had generated eight major themes: Valued Members of Clinical Team, Patient and/or Health-centered Care, Supervised Caring for Patients, Unpleasant Emotional Feelings, Striving to Meet Nursing Work Standards, Reflective Learning, Adaptive Coping, and Gain Worth the Pain. Major findings revealed that the participants were exposed to various clinical situations, had provided patient care, and were assigned with and performed nursing obligations. In the course of their exposures, they were receiving directions from persons on authority, had gone through situational nervousness, and threatened self-esteem for poor performance, and felt to have performed below expected standards. Nonetheless, they accepted the challenges of their experiences, had employed problem and emotion-focused adaptive coping, had seen room for improvement, and recognized the elements of efficient care for patient. Their experiences had posed impacts of various dimensions of their psychological well-being: autonomy, competence, healthy relationship, self-acceptance, personal growth, and purpose of life. It is recommended that nursing programs implement mental health interventions, such as debriefing sessions, resilience training, and offer accessible psychological services, to support students’ well-being.

Keywords: Nursing students, well-being, traumatic experience, coping

INTRODUCTION

Background of the Study

The clinical environment serves as a critical learning platform for nursing students, offering them hands-on experience and the opportunity to apply theoretical knowledge in real-world healthcare settings. However, this exposure also places students in emotionally charged and psychologically demanding situations. These experiences can be traumatic especially for nursing students who are in the early stages of their education. These psychological challenges not only affect their immediate well-being but can also influence their long-term professional development and career satisfaction.

Given the potential severity of these experiences, it is crucial to understand how nursing students cope with trauma. Coping mechanisms can vary widely, ranging from emotional resilience and the ability to adapt positively, to maladaptive strategies such as withdrawal or emotional numbing. The development of effective coping strategies is essential not only for the students’ personal mental health but also for their ability to deliver compassionate and competent patient care throughout their careers.

There were a handful of studies conducted before on the experiences of nursing students in clinical settings. Some studies employed case study (Chachula at al., 2022), literature review (Dhanabhakyam et al., 2023), grounded theory (Hood and Copeland, 2021) and quantitative research designs (Abd-Elhady, 2022 and Fernandez-Feito (2023); others were conducted abroad (Fernandez-Feito et al., 2023; Aryuwat et al., 2024); and finally, others had focused only on their satisfaction level on clinical experience (Abd-Elhady, 2022), the sources of stress (Toqan et al., 2023), and their challenges and resilience (Aryuwat et al., 2024). To the knowledge of the researchers, there were still very limited studies on the topic that dealt with the psychological well-being of nursing students with traumatic experiences and how they dealt with these experiences in the local setting.

Statement of the Problem

This study was guided by the following questions:

1. What are the lived experiences of the participants as third-year nursing students who had undergone traumatic exposures in clinical setting?
2. How did the participants experience such traumatic clinical situations?
3. How do the participants make sense of their experiences?

Significance of the Study

The important contribution that this study could offer are underscored as follows:

For the clinical supervisors, the findings will help them understand the emotional and psychological challenges faced by nursing students. This insight will allow them to provide better guidance, emotional support, and coping strategies, ultimately fostering a healthier learning environment.

For the nursing students, this study will equip them with knowledge on how to manage their emotions and seek help when needed by exploring how traumatic experiences impact psychological well-being. This will contribute to building resilience and maintaining mental health throughout their education and professional careers.

For the healthcare institution, the outcomes of this study can inform this institution in creating or refining mental health support systems, ensuring that nursing students receive adequate psychological support during their clinical training. This, in turn, may improve students’ performance and reduce burnout, leading to more competent and emotionally balanced future nurses.

For future researchers, this study will provide them with valuable data and insights that they can build upon. It will highlight areas in need of further exploration, such as the long-term effects of trauma on nursing students’ well-being and the effectiveness of different interventions, contributing to the advancement of mental health research in the nursing education field.

Delimitations and Limitations of the Study          

This study focused on experience of the nursing students who had undergone traumatic experiences, and the impact of these experiences to their psychological well-being. It included as participants seven third year nursing students who were currently enrolled in the clinical training program at Notre Dame of Midsayap College, and who have encountered traumatic experiences during their clinical placements. Some of the main limitations of this study were that the researchers had recruited small number of participants, spent limited engagement with them, and confined themselves to a particular research site. These flaws were owed to the voluntary nature of participation in the inquiry, the hectic schedule of the participants, and the limited resources of the researchers. These may lead to the possible bias and limited generalizability of the findings of this study. Another limitation of this study was that the researchers themselves are nursing students who are being assigned to clinical settings. To address possible bias on the outcome of the study, the researchers took the stance of Moustakas (1994) by “bracketing” themselves consciously (as cited in Gearing, 2004), to understand the phenomenon in terms of the perspectives of the participants and thereby focused on the “insiders” perspectives (Mouton & Marais, 1990 as cited by Groenewald, 2004).

LITERATURE REVIEW

Psychological Well-being. Psychological well-being is a multifaceted and multidimensional construct that encompasses overall happiness, satisfaction with life, and mental and emotional health of an individual (Dhanabhakyam & Sarath, 2023).  It is also the capacity to realize one’s own abilities, cope with the normal stresses of life, work productively, make a contribution to the community (which may be school and clinical area), and possess the skills to develop and maintain healthy relationships (Race, 2020).

Key Elements of Psychological Well-being. Research on psychological wellbeing has identified six important components (Race, 2020).

Autonomy. It is the ability of one to make his or her own decisions about how to think and behave, rather than over-relying on others’ opinions or approval. Autonomous people resist social pressures that are inconsistent with their inner standards or preferences. They pursue freely chosen goals that they genuinely value.

Competence. It means having knowledge, skills, and abilities and using them to solve problems and accomplish worthwhile tasks. Competent people can manage the responsibilities and demands of daily life and get things done. They make good use of their opportunities and arrange their living environments in ways that suit them.

Healthy relationships. It is the ability to develop caring, trusting, and supportive relationships. Most people need connections with others. Some enjoy large circles of friends, family, and coworkers; others prefer more solitude and independence.

Self-acceptance. It is the act of accepting or embracing oneself, including one’s strengths, weaknesses, and limitations, and feeling satisfied with who they are. They recognize that life has ups and downs; that everyone makes mistakes, misses opportunities, and feels regret, disappointment, and other unpleasant emotions. They are understanding and nonjudgmental of themselves and how their lives have gone so far.

Personal growth. It is a lifelong process of self-discovery and improvement that involves developing new skills, enhancing self-awareness, and improving relationships. People who value personal growth are open to learning and new experiences. They recognize that perspectives change with time and see themselves as maturing and developing. They are interested in broadening their horizons and fulfilling their potential.

Purpose in life. People with purpose have a sense of direction in life. They understand what they value most deeply, such as being a loving parent, supportive friend, productive professional, or contributing member of a community. They find satisfaction in setting goals and working to achieve them and feel that their lives have meaning.

Nature of Traumatic Experiences. Traumatic experience is an incident that can cause emotional distress (National Institute of Mental Health, 2024). These experiences may be caused by acts of nature (earthquakes and floods), by acts of others (abuse, attack, assaults and harm); by accidents (car crashes, burns and collision), and by natural life processes (sickness and death of loved ones).

Traumatic Experiences of Nursing Students. Traumatic experiences of nursing students are adverse or harmful events they encounter in the clinical setting that can affect their psychological well-being (Hood & Copeland, 2021). Nursing students may undergo traumatic experiences by their witnessing of critical situations, by their being subject to physical violence, or by their exposure to psychological harm.

Forms and Sources of Traumatic Experience of Nursing Students. Working with equipment and machinery, incivility among staff and faculty, a gap between theory and practice, fear of making a mistake, fear of unknown incidents, and communication with staff, peers, and patients were all prominent sources of traumatic experiences among nursing students (Ab Latif & Nor as cited by Toqan et al., 2023).

During clinical practice, nursing students encounter numerous challenges that evoke a sense of vulnerability. They are thrust into close encounters with human suffering within the clinical environment, confronting the realities of illness, injury, and mortality. They may grapple with their own limitations and insecurities as they navigate these complex situations. This clinical experience elicits a range of emotions, from apprehension and self-doubt to empathy and resilience. Nursing students may confront uncertainties, struggle with professional responsibility, and face several challenges through these encounters (Aryuwat et al., 2024).

Students may experience emotional labor, such as regulating their emotions while witnessing suffering. They tried regulating their own emotions while witnessing suffering as a student in their program. Many described trying to portray a professional appearance and struggling with not being sure of what to say or engage with family members of the patient. When a patient dies, the majority of them reflected on keeping emotions separate from patients and family members to maintain emotional distance as they wrestled with professional boundaries (Chachula & Varley, 2022).

Traumatic Impact. Numerous studies have explored the effects of clinical exposure on nursing students, highlighting the prevalence of stress, burnout, and trauma. In response to patient safety incidents, students experienced various negative emotions. These emotions were described as anger towards themselves, fear, and confusion (Gradišnik et al., 2024).

Research on psychological well-being, particularly in the context of healthcare workers, indicates that exposure to traumatic events can have long-term implications for mental health. Undergraduate nursing students may experience feelings of hopelessness and anguish in the clinical learning experience, directly impacting their academic performance (Araújo, 2023). Abu Negm (2024) reported on the mild, moderate and severe challenges faced by nursing students during their clinical training in Northern Border University.

Coping Mechanisms and Resilience. Coping mechanisms are strategies or behaviors used by individuals to deal with stress, anxiety, difficult situations and traumatic experiences (Smith, 2023). It is usually triggered by situational life changes and stressors, in an effort to maintain mental health and psychological well-being. In Asia, Lee and Park (2021) explored coping mechanisms among nursing students in South Korea, revealing the use of both problem-focused and emotion-focused strategies, including emotional support and religious practices. However, the study emphasized the need for institutional support systems like counseling and stress management programs to bolster student resilience. Globally, Galvin et al. (2021) underscored the importance of integrating mental health interventions and resilience-building into nursing education, citing successful programs in the UK and Canada that have reduced student anxiety. Additionally, Li et al. (2022) explored cross-cultural influences on coping mechanisms, noting that cultural values, such as community support and religious beliefs in China, Japan, and Thailand, play a significant role in fostering resilience. These studies collectively emphasize the need for comprehensive mental health resources, culturally sensitive interventions, and institutional support to promote the psychological well-being of nursing students facing traumatic experiences in clinical areas.

Need for Coping. Stress factors of nursing students highlighted the significance of adequate coping methods in nursing education and practical practicum (Hwang et al., 2021 as cited by Toqan et al., 2023). By analogy, addressing the emotional needs of nurses is vital for their well-being and the delivery of compassionate care (Alodhialah et al., 2024).The psychological well-being of nursing students after traumatic experiences in clinical areas has been the focus of various international studies, highlighting the mental health challenges, stress management, and coping strategies employed by students across the globe.

Types of Coping. The two main types of coping strategies are emotion focused coping strategies that address the emotional needs of an individual and problem focused coping strategies that seek to eliminate the source of the problem (Newell, 2023).

Emotion focused coping addresses the emotional needs of an individual and are centered around comfort or consolation. These strategies are important when changing stressful situations may not be feasible. Rivera and Ramos (2021) found that students often rely on emotional regulation strategies, such as staying calm and managing their feelings, as well as seeking social support from peers, family, and mentors. Many students also turn to religious or spiritual practices, reflecting the strong cultural influence of faith. Additionally, the presence of strong institutional support systems, such as counseling services and mental health resources, is crucial in helping students cope.

Problem focused coping directly addresses the problem in an effort to eliminate the stressor. This type of coping strategy is usually employed when the situation is deemed as changeable by the individual. This type of coping strategy may involve the active removal of stressors or confrontation with others who are liable. Some problem focused coping strategies are making a to-do-list, asking for support, proper time management, and exercising.

Resilience is he ability to overcome such adversity and learn to be stronger from the experience. Resilience and positive coping strategies can resist stress and improve personal well-being (Chow et al., 2018).

Theoretical Lens

This study is seen from the lens of the Cognitive Appraisal Theory by Lazarus and Folkman as cited by Campbell et al. (2013). This theory emphasizes that stress is not merely a direct response to external events but rather a result of how these events are appraised or evaluated by the individual. When faced with a potentially stressful situation, such as a traumatic experience in clinical areas, individuals engage in two types of cognitive appraisal: primary and secondary (Lazarus & Folkman, 1984).

In the primary appraisal, the individual assesses whether the situation is irrelevant, benign-positive, or stressful. If the situation is perceived as stressful, it is further evaluated as a harm/loss, threat, or challenge.

Secondary appraisal involves the evaluation of the individual’s resources and ability to cope with the identified stressor. This process includes an assessment of available internal and external resources, such as emotional support from peers, personal resilience, or coping strategies like problem-solving and emotional regulation.

For nursing students, this framework is particularly relevant as it highlights the importance of both their subjective interpretations of clinical events and their coping mechanisms in shaping their psychological well-being. The theory also suggests that the outcomes of stressful experiences are highly individualized, as each student’s appraisal and coping strategy will differ based on their personal resilience, prior experiences, and support systems.

METHODS

Research Design

This study made use of the qualitative research method to explore and provide deeper insights into real-world problems. Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers such as ‘how’ and ‘why’ (Tenny et al., 2022).

It adopted the phenomenological research design that focuses on the study of an individual’s lived experiences within the world (Neubauer et al., 2019). Phenomenology is defined as interpreting or understanding the experience of an individual through an interview and examining their views about their experience. The researchers recorded and analyzed the beliefs, feelings, and perceptions of the participants as nursing students who have undergone traumatic experiences in clinical settings. Finally, it attempted to understand how participants make sense of their experiences.

Research Environment

The research was conducted at Notre Dame of Midsayap College, Midsayap, Cotabato. It is a private higher educational institution owned and managed by a religious congregation. This school was chosen by the researchers as the research environment of the study for convenience and for the fact that it has been offering nursing programs for more than 15 years.

Research Participants

The participants of this study were the seven (7) third-year nursing students enrolled at Notre Dame of Midsayap College. This study employed purposive sampling in conjunction with convenience sampling. Purposive sampling is one whereby the researchers select participants according to predetermined criteria (Ghosal, 2023). The set criteria for qualified participants were: they are currently enrolled in nursing programs; have experiences in clinical exposure; and willing to participate in this study

The researchers also employed convenience sampling in actually recruiting the participants of the study. Convenience sampling involves selecting participants based on their accessibility and availability to the researchers (Fleetwood, 2024). The combination of these sampling techniques enabled the researchers to strategically choose participants who aligned with their objectives while also considering practical accessibility (Complete Dissertation, 2023).

Research Instrument

Data were collected through a self-constructed semi-structured interview guide. The instrument thus developed consisted of four main parts: Preliminary Activities, Leveling-off, Interview proper, and Concluding Part. The interview proper would ask initial and general questions: Can you relate to us your experiences in clinical areas during your clinical placement? What challenges did you encounter after having been exposed to traumatic experiences? How do you cope or manage the problems and difficulties you encountered during and after your traumatic experiences? What realization did you have upon exposed to traumatic situation and incident? To deepen the understanding on the experiences of the participants, the initial questions were followed up by more specific and probing questions: Can you elaborate this? Can you tell us more about it? What do you mean by that?

Role of the Researchers

The researcher performed the roles of the interviewer, observer, data analyst and presenter. The researcher facilitated the open sharing of thoughts and feelings by the participants, allowing them to freely express their experiences. They carefully listened to the narratives of the participants, and recorded and transcribed them. Any unclear or confusing data were clarified with the participants to ensure accuracy. They carefully analyzed the data thus gathered and presented them to the thesis defense panelists during their oral defense.

Data Sources

This study made use of both primary and secondary data. The primary source of data of this study were the interviews gathered by the researchers using the self-made interview guide and the queries that were based on the participant’s recorded responses.  The secondary source of information included Websites, papers, documents and journals, peer-reviewed articles, reports, and case studies that explored psychological trauma, coping mechanisms, and mental health in healthcare education.

Data Gathering Procedure

This study made use of the one-on-one and face-to-face interviews with the participants. Prior to data gathering, the researchers sought the approval to conduct the study from the Dean of the College of Nursing at Notre Dame of Midsayap College. Coordination would be established with the Chief of the College of Nursing and relevant faculty members. A formal communication letter was sent to the administration, requesting permission to interview third-year nursing students. The interviews were scheduled at a time convenient for both the researchers and the participants to ensure a smooth and respectful process. The researcher personally conducted interviews with the participants after securing proper consent. Ethical considerations were thoroughly addressed, with participants given ample time to respond to the interview questions. The researchers adapted the process of data saturation whereby they continued gathering data until they reached a point wherein new information no longer brings fresh insights to the research questions (Webster & Oliveros, 2025).

Data Analysis

This study made use of reflexive thematic analysis (RTA). In generating and writing the themes, the researchers followed the steps suggested by Braun and Clarke (as cited by Caulfield, 2023). This method of analysis was used in similar studies (Panda et al., 2021; Chachula & Varley, 2022; Camara et al., 2024; Aryuwat et al., 2024).

Phase 1: Familiarization with the Data. Step 1: Transcription. This involved converting the recorded audio into words or texts and placing them in the interview transcripts. Step 2: Familiarization. The researchers got a thorough overview of all the data collected by reading the text, taking initial notes, and looking through the data to be familiar with them.

Phase 2: Coding the Data. Step 3: Identifying Significant Texts. This involved identifying and highlighting texts from the narrative of the participants that provided an insight into what and how they experienced the phenomenon. Step 4: Identifying Core Ideas and Labelling them with Codes. This involved collecting core ideas from significant texts to describe their content by using codes. Codes were either words or phrases that represent significant concepts identified within the significant statements.

Phase 3: Development of Themes. Step 5: Generating Themes. This involved identifying patterns in the codes created, followed by coming up with preliminary or potential themes. Themes were identified through constant comparison whereby codes which were similar to each other but different from another were clustered into themes (Glazer and Strauss,1967, as cited in Ryan & Bernard, 2003). Step 6: Seeking Relationships and Clustering Themes. This involved compiling themes for the whole transcripts before looking for connections. Some of the themes were clustered into major themes.

Phase 4: Review and Refinement of Themes. Step 7: Reviewing Themes. This involved re-reading the coded, transcribed, and collected data and ensuring the themes were useful and accurate representations of the data. Whenever necessary, the researchers would refer the results back to the participants for validation. Step 8: Refinement of Themes. The researchers returned to the transcripts and compared the themes against them. When they encounter problems with their themes, they split them up, combined them, discard them, or created new ones.

Phase 5: Defining and Naming of Themes. Step 9: Defining and Naming of Themes. These involved formulating exactly what the researchers meant by each theme and figuring out how it helped to understand the data, and coming up with a succinct and easily understandable name for each theme.

Phase 6: Generating the Report. Step 10: Writing up the findings and discussion. This involved taking the final themes and writing up the analysis of the data. It considered what they mean, including examples from the data as evidence from the results or finding section.

Trustworthiness of the Study

Credibility. To assure that the findings accurately reflected the realities that the participants experienced as nursing students, the researchers used the techniques of triangulation by adopting multiple data sources approach; reflexivity by acknowledging their own biases to avoid influencing the study especially so that the researchers themselves are nursing students; and prolonged engagement in the research field to build rapport with the participants and to understand more deeply their perspectives.

Confirmability. To guarantee that the findings of the study were shaped by the participants and the data rather than the preferences of the researchers, they will use the techniques of peer debriefing by engaging with colleagues and advisers to review the findings and their interpretation; member checking by involving the participants in the validation process; and reflexive journaling by documenting their biases.

Transferability. To assure that the findings of this study would be applicable to other settings or contexts, the researchers used the techniques of thick descriptions by providing rich, detailed accounts of the context, location, and population to be studied; and sampling strategies by clearly setting the inclusion and exclusion criteria for the identification of the participants and by explicitly describing the process of their actual recruitment.

Dependability. To make the findings consistent and reliable and that the study can be repeated by other researchers under similar conditions, the researchers used the techniques of methodological documentations by providing details of the procedure made during the study; audit trails by keeping a transparent and organized documentation of the research process and by being open about their analysis.

Authenticity. To ensure that the study captured the true voices of the participants and their diverse perspectives and experiences, the researchers applied the suitable sampling techniques to select the appropriate participants, considered their original narratives, and presented the discrepant information that might run counter with the common pattern.

Ethical Considerations

Autonomy. The researchers respected the rights of the participants to autonomy or voluntariness by giving them the right to choose between accepting or not accepting the invitation to participate in the study. They abided by the informed consent process during which they provide necessary information to the participants in a comprehensible manner necessary for them to make an informed decision to participate in the study. They informed the participants that the activity is for academic purposes.

Beneficence. The researchers strived to assess the possible risks to the projected benefits. The participants were made to appreciate such risks that may be brought about by the research process. The participants were likewise made to understand that no direct benefit will be provided to them by participating in the research except that their participation would likely help in coping with their challenges.

Anonymity, Confidentiality, and Privacy. The researchers safeguarded the anonymity of the participants by assigning them with pseudonyms instead of their true names. The researchers would preserve the confidentiality of the information attributable to the participants by not sharing the same with anyone outside of the research group and the defense panel. The participants would not be required to share with the researchers personal information and would not be made to answer questions that might make them feel uncomfortable to deal with.

Justice. The researchers treated the participants with decency and respect, taking into account their needs, values, and beliefs. They exhibited sensitivity towards cultural and linguistic variations of the participants in order to facilitate meaningful communication. The researchers gave additional considerations due their schedules and studying conditions, suitable time and place of the conduct of the interviews. The information that might be generated by this study would be shared to them as the same may be useful to further improving their conditions.

RESULTS AND DISCUSSION

Data bares that there were seven participants in the study. They were all third-year nursing students, mostly females and were 20 to 21 years of age. This implies that the participants were transitioning from adolescence to full adulthood period in their lives as individuals; were establishing more independence; and were close to completing their nursing education (Higley, 2019).

Lived Experiences of the Participants

Table 1 Thematic Outline on the Lived Experiences of the Participants

Theme 1: Valued member of clinical team. Clinical team is a group of people who work together to provide medical care and treatment to patients. It encompasses general practitioners and advanced nurse practitioners to practice nurses and healthcare assistants (Understanding your clinical team, 2024). The participants experienced being valued members of the clinical care team as they were assigned to various clinical situations that necessitate nursing care and support. As narrated by the participants:

“I was assigned to a delivery room” – P1

“We had our regular drills.” – P3

“Our duty was in the ward.” – P4

“We were assigned in a station where some patients had bad illnesses.” – P5

“That (clinical) experience took place during my first duty in the ward.” – P6

“That (clinical) experience was during my first exposure to the operating room.’ – P7

Amimaruddin and RuditaIdris (2022) observed that nursing students were treated as workforce and performing routine tasks. They further explained that this could be partly because nurses perceived the students’ presence, e.g., in the wards, as a time when they can have some rest and thus, they only delegate the work to the students. These findings substantiate the contention of Mercer University (2024) that student nurses are an important part of the clinical team. In fact, Fernandez-Feito et al (2023) found out that nursing students were perceived by nurses to favorably contribute to clinical setting mainly because the nursing students are future professionals who know the center, support the development of the nurses’ teaching role and constitute a link between the health center and the university.

This experience of the participants contributes to their psychological well-being especially in the purpose of life dimension. By seeing their purpose as nursing students and as future nurses, the participants would have a sense of direction in life (Race, 2020).

Theme 2: Patient or health-centered care. Patient or health-centered care is a model of healthcare that focuses on the patient’s and other individuals with health conditions, needs and values. It is based on the idea that patients and healthcare providers are partners in the patient’s care (Tulane University, 2024). The participants provided the so-called patient or health centered care. As revealed by the participants:

“I had pregnant patient that I need to administer oxytocin through intramuscular.” – P1

“I was entrusted to give my classmates their own tasks on what things to bring to carry out the program, and also the activities that we were about to do especially the feeding that we are about to give to the residents…” – P2

“I managed to give her (patient) bedside care.” – P4

“I am careful on my observations about the conditions of the patients especially on their breathing and overall conditions. I do not ignore even small signs of problems.” P5

“There is really a need to closely monitor and provide for care to patients with worse conditions.” – P6

“I also manage to provide bedside care for my patient and focused on the giving of assistance to the doctor for her safety.” – P7

These findings highlight the roles of student-nurse in the clinical setting and in the community – to attend to patients and the vulnerable population while they are learning. According to the American Nurse Today (2018), a student nurse’s role in a clinical setting is to help patients maintain, restore, and promote their health. Nuuyoma et al. (2022) believed that student nurses play a role in the community by providing care, educating the public, and volunteering to improve health. Taking care of patients in a clinical setting provides nursing students important insight that can help improve patient care (American Nurse Today, 2018) while community immersion like food feeding expands nursing students’ understanding of community health problems (Nuuyoma et al., (2022). Meanwhile, return demonstrations are important because they help learners practice and master new skills in a low-pressure environment and build confidence needed to provide competent care (Medline Plus, 2024).

This experience of the participants also contributes to their psychological well-being especially in the purpose of life dimension. They are made to understand what they should value most deeply as a student nurse such as being a productive professional under training and a contributing member of a community (Race, 2020).

Theme 3: Supervised caring for patients. Supervision is a process of professional learning and development that enables individuals to reflect on and develop their knowledge, skills, and competence, through agreed and regular support with another professional (Health & Care Professions Council, 2022).  Likewise, the participants as nursing students were to take care of the patients assigned to them under the supervision of the more expert individuals. They received directions from persons on authority. The subjection of the participants in performing their assigned tasks under the supervision of their superiors are manifested by them through performing in the presence of clinical instructor, asking clinical instructor for instructions, and even receiving admonition from the more expert persons in authority:

“I was called by ma’am / sir at the side of the hospital room and was aptly told not to make such uncertain remarks in the presence of the patient… Since I committed some kind of lapses, I was reprimanded by my clinical instructor.” – P1

“I encountered a significant challenge with one of my clinical instructors due to a lack of clear guidance and communication, which led to scheduling and program mishaps.” – P2

“My clinical instructor at the time was overseeing my training.” – P3

“I always think to recheck everything first especially when my clinical instructor is around.” – P4

“We were given guidance by our clinical instructor especially in dealing with critical situations.”  – P5

“Whenever I could not understand the instruction, I would always ask my clinical instruction…” – P6

“While I was assisting the doctor, I felt pressured as my clinical instructor was standing beside me. – P7

These findings are aligned with the assertion of Mercer University (2024) that student nurses work under the supervision of more experienced nurses and other healthcare professionals. According to the American Nurse Today (2018), student nurses practice what they learned in class by joining clinical rotations under the supervision of a nursing instructor.

This experience of the participants inhibits, for the time being at most, their psychological well-being by limiting their autonomy through their reliance on the opinions or approval of the persons in authority. On the other hand, it may pose a challenge on how to build healthy relationships with the health care team. Just like any other people, student nurses need connections with others like coworkers (Race, 2020).

Theme 4: Unpleasant emotional feelings. Unpleasant emotions can be described as any feeling which causes one to be miserable and sad (Better Health, 2022). The participants had experienced unpleasant emotional feelings. These feelings were manifested by their situational nervousness, threatened self-esteem, and being emotionally affected by their poor performance. Their situational nervousness was expressed by them through induced trembling and anxious reaction; their threatened self-esteem was expressed by them through lowered self-confidence, self-doubt, loss of self-confidence, and feeling being pulled down; and their being emotionally affected was expressed by them through feeling sad about poor performance. As expressed by the participants:

“It was my first time administering through IM (Intramuscular), and I felt nervous and was trembling. “When my performance was not desirable, I felt embarrassed and had lowered self-confidence. – P1

“I started to doubt the things that I normally do after what happened. It really affected me in a negative way.” – P2

“Having that fear of receiving criticism and reprimands from my CI (clinical instructor), I became hesitant to interact with patients” – P3

“Because the clinical instructor had a comment about me during our duty, I feel sad and frustrated by my performance.” – P4

“I felt nervous and afraid, and anxious that I might experience the same emergency situation, and I may not be able to do the right thing.” – P5

“That experience had caused me to overthink, I doubt myself and felt nervous if we had our duty and I would be assigned to patient with critical condition.” – P6

“I felt so nervous that my hands were trembling while handing over the instruments, although I am very much familiar with them. The CI (clinical instructor) put pressure on me that aggravated those feelings.” – P7

These findings coincide with the study of Aryuwat et al., (2024) that during clinical practice, nursing students encounter numerous challenges that evoke a sense of vulnerability. These unpleasant emotions could be induced by external factors such as navigating complex situations, confronting uncertainties, struggling with professional responsibility, and thrusting into close encounters with human suffering within the clinical and social environment; or could emanate from the nursing students themselves such as grappling with their own limitations and insecurities, apprehension and self-doubt, and lapse in knowledge and competencies (Aryuwat et al., 2024).

These experiences of the participants may hinder their psychological well-being by questioning their self-acceptance. They may not be feeling satisfied and not embrace themselves (Race, 2020).

Theme 5: Striving to meet nursing work standards. Work standards are a set of instructions that outline how to perform a task or process. In a clinical sense, they include ensuring that patients receive high-quality care that is safe and meets their needs (World Health Organization, 2023). The participants strived to meet the nursing work standards as they might work below the expected ones. These struggles over their performance were evident in terms of their unsatisfactory nursing performance, hesitance to approach patients, and their performance as adversely affected. As stated by the participants:

“That resulted to my unsatisfactory performance in a hospital. I could not properly approach my patient because of fear. I could not also approach my CI (clinical instructor) because of the feeling that I might be put to shame.” – P1

“I had a problem with the scheduling of the program and the activities that we are about to do as they were not clearly communicated to me.” – P2

“I believe I can be a competitive nurse in the future, so no one could ever tell discriminating remarks against me.” – P4

“I had one patient whose vital signs needed to be monitored every 30 minutes because they were dropping. In the morning, the patient was stable, but as the shift ended, the blood pressure suddenly dropped so low, and the patient started having difficulty breathing.” – P5

“That traumatic experience affected my academic performance, and I questioned myself if nursing is the right path for me.” – P6

“I was really thinking, ‘Can I still handle this program? Is this really for me?’ Those thoughts were constantly in my head.” – P7

These findings support the observations of Panda et al. (2021) that not meeting the standards for nursing care is one the challenges faced by student nurses. The World Health Organization (2023) had cautioned the commission of preventable and unnecessary harm associated with errors in health care. These experiences of the student nurses were explained by Panda et al. (2021) as caused by lack of resources, lack of preparedness, lack of support from clinical instructors and staff, lack of confidence of clinical instructors and the gap between theory and practice.

These experiences of the participants put a challenge on their psychological well-being by casting doubts on their competence. On the other hand, they make good use of these experiences as opportunities and arrange their living environments in ways that suit them (Race, 2020).

Theme 6: Reflective Learning. Reflective learning is a method of learning that involves analyzing past experiences to improve future performance. According to Carroll and Gray (2023), it is a type of active learning that helps students become more aware of their learning process and develop critical thinking skills. The participants have undergone reflective learning after their traumatic experiences. This learning took place after seeing room for improvement, and recognizing the elements of efficient care for patients. As affirmed by the participants:

“At that time, I realized that I am not that good yet.” P1

“Despite the adversity, I learned the importance of readiness and preparedness in both leadership and clinical duties.” – P2

“During the duty, you can really learn a lot. With that experience, I thought about the limits of my capacity and I realized what areas I have to do much better.” – P3

“There is always room for improvement. That really helped me as a nursing student and as a person to grow and to be the best version of me.” – P4

I became more aware that I need to do better to meet the needs of my patients.” – P5

“I realized that the duty was unforgettable not because of the traumatic experience, but because it was a great learning opportunity. It helped us learn how to handle patients at that level and become more advanced since we were exposed to serious illnesses early on.” – P6

“Because of that, I practice myself not to be overwhelmed by pressures because not all CI’s (clinical instructors) are that calm. All the more that I embrace my course.” – P7

The findings of this study parallel with those of Abd-Elhady (2022) which show that student nurses were highly satisfied with the educational atmosphere of the clinical setting though the study indicates a need to improve the clinical learning environment. However, the findings of this study contradict the results of the study of Amimaruddin et al., (2022) that the students have their own learning objectives to achieve from their clinical placement but they were unable to achieve the goals and are confused on what they are really supposed to learn in the clinical area.

These experiences of the participants promote their psychological well-being in terms of personal growth. Personal growth is a lifelong process of self-discovery and improvement that involves developing new skills, enhancing self-awareness, and improving relationships. People who value personal growth are open to learning and new experiences (Race, 2020).

Theme 7: Adaptive coping. Adaptive coping is a protective factor that decreases the adverse effects of life stressors when they occur and that can also reduce the likelihood of stressor occurrence (Holahan et al., 2017). The participants employed adaptive coping in dealing with their traumatic experiences and their effects in terms of problem-focused coping through enhancing academic skill, realization of the uniqueness of nursing skills, and seeing opportunity for improvement; and emotion-focused coping through self-enhancement and regaining lost self-confidence. As claimed by the participants:

“I took my undesirable performance in positive way. I improved my performance in the academics and in the hospital setting. By improving myself, I rebuild my self-confidence.” – P1

“I find solace in articulating my emotions through writing or journaling, as it alleviates the burden that would otherwise weigh heavily on me. Additionally, music serves as a therapeutic outlet for me, offering respite from stress and turmoil in any environment.” – P2

“I just focus on improving my academics and practical skills. I used that feedback as motivation and opportunity for me to become better. I rant to my family and parents and then I felt alright.” – P3

“I keep myself busy, and distract myself by doing something else so that my attention will be diverted. I don’t overthink.” – P4

“After that incident, I nurture deeper respect to staff nurses and clinical instructors for I saw how they were performing their duties amidst difficult situations. It became my inspiration their dedication and ability to stay calm and alertness despite pressure.” – P5

“I open up with my friends, especially to God. It might sound corny, but yes, sharing my traumatic experience with my friends or classmates boosts my confidence because I realize I’m not the only one feeling this way. With my family, when I feel down, I just hug them without saying what I really feel inside because I don’t want them to worry. Somehow it gives me calmness and peace of mind.” – P6

“I vent out with my close friends. I read books, and watched videos so that I could perform rightly next time even if not being reminded by my CI (clinical instructor) – P7

According to Bailey (2025), adaptive coping mechanisms empower you to change a stressful situation or adjust your emotional response to stress. According to Aryuwat et al. (2024), engaging in open communication with family, seeking encouragement from nursing instructors and patients, actively participating in the healthcare team, and fostering relationships with peers all contribute to restoring the strength that supports nursing students’ resilience during clinical practice.

These experiences of the participants promote their psychological well-being through self-acceptance and personal growth. Self-accepting people understand that, like everyone else, they have strengths and weaknesses and people who value personal growth are open to learning and new experiences (Race, 2020).

Theme 8: Gain worth the pain. The participants adhered to the mantra “gain worth the pain” by accepting the challenges of traumatic experiences. Moreover, they viewed their experiences as sources of motivation. As admitted by the participants:

“My advice (to our fellow nursing students) is that they should accept setbacks as motivation and use them as springboard to bounce and get stronger as they go back to their clinical duties.” – P1

“That event really widened my eyes into the situation that among seniors, or clinical instructors, or other nurses would not always be that kind towards you. – P2

“All the more that I learn how to handle those things especially when you committed a mistake. You know how to take those words from your CI (clinical instructor) in a positive way, and can improve you instead. – P3

“Trauma is something that makes you very sad, or very depress; or triggers your anxiety, but as a nursing student we know that we can cope up it immediately because we believe that everything is really temporary and it will serve as lesson to us. Let’s take it as a challenge to be better nursing students, and to be competitive nurse in the future.” – P4

“Nervousness and fear are normal, but we should not be afraid to ask help, or share what we feel to our classmates, CI (clinical instructors), or staff nurses.” – P5

“My advice (to our fellow nursing students) is for them to look for the positive side of every traumatic experience. But is it’s okay to express your feelings first – cry if you must – so that when you feel okay, you’re truly okay.” – P6

“I advised other nursing students who might be exposed to traumatic experiences not to be overwhelmed if ever there will be setbacks. That is for them, to be molded as student nurses. They entered into this course, so there would be no retreat. – P7

In analogous terms, Haririan et al. (2024) encapsulated the gains and pains by nursing students in clinical exposure: the pains are facing reality, shock, stress, and mislearning, and the gains are improving the nursing students’ clinical and communication skills, increasing their self-confidence, learning and practicing discipline and nursing responsibilities. Along this line, Hood and Copeland (2021) had emphasized that after traumatic experiences, debriefing positively affected students’ post-event stress response.

Functional Implications and Insights

Functional Implications

To the Theory. The findings of this study substantiate the Cognitive Appraisal Theory by Lazarus and Folkman as cited by Campbell et al. (2013) that emphasizes that stress like traumatic experience is not merely a direct response to external events but rather a result of how these events are appraised or evaluated by the individual. When faced with a potentially stressful situation, such as a traumatic experience in clinical areas, the participants engaged in two types of cognitive appraisal: primary and secondary. In the primary appraisal, they assess that the situation is stressful and further evaluate it as a challenge. In secondary appraisal, the participants evaluated their resources and ability to cope with the identified stressor. This process includes an assessment of available internal and external resources, such as emotional support from peers, personal resilience, or coping strategies like problem-solving and emotional regulation.

To the Nursing Profession. This study shines a light on the often-overlooked psychological toll that traumatic experiences in clinical settings can take on nursing students. It compels the nursing profession to acknowledge the prevalence of these experiences and to prioritize the mental health of future nurses. This increased awareness can foster a more empathetic and supportive environment for students, encouraging them to seek help when needed and reducing the stigma associated with mental health issues.  By understanding the unique challenges faced by nursing students, the profession can better address their needs, potentially leading to improved retention rates and a more resilient nursing workforce.

To the Clinical Practice. The study’s findings have direct implications for clinical practice. It emphasizes the importance of incorporating trauma-informed care principles into clinical training programs. This means creating a learning environment that recognizes the potential for trauma exposure and equips students with the skills and resources to cope with these experiences. The study also highlights the need for effective interventions to address the psychological needs of students who have experienced trauma.

Insights

First Researcher. Nursing students face considerable emotional challenges. It underscores the urgent need for better support systems and resources to help these students cope with the emotional toll of their demanding work, fostering resilience and ensuring their mental health.  The findings emphasize that prioritizing the mental health of future nurses is not just compassionate, but crucial for the quality of patient care they will provide.

Second Researcher. Nursing students are frequently exposed to many fields of nursing areas during their duties and they will observe various scenarios such as patient suffering, medical emergencies, and ethical quandaries, which can result in emotional depletion, anxiety, or even trauma in their clinical instructor/s. This study will probably look into how these events affect students’ psychological well-being, coping mechanisms, and overall professional development.

Third Researcher. Not all impacts are negative in clinical traumas of psychological well-being of nursing students but have a positive impact too. Each nursing student has different clinical trauma experiences and unique coping mechanisms. It also depends how they manage the effects of clinical traumas they encounter. This study will help the College of Nursing in Notre Dame and also other schools on how they will incorporate this kind of experiences their students encounter during clinical trauma and its effect in the long run.

RECOMMENDATIONS

It is recommended that nursing programs implement mental health interventions, such as debriefing sessions, resilience training, and accessible psychological services, to support students’ well-being. Future research should explore the long-term impact of clinical trauma and evaluate the effectiveness of institutional support programs in fostering psychological well-being among nursing students.

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ABOUT AUTHORS

Sergio D. Mahinay, Jr. is a faculty member of the College of Arts and Sciences of Notre Dame of Midsayap College, Midsayap, Cotabato, Philippines. https://orcid.org/0000-0002-7125-250X

Rosiely M. Laco is a faculty member of the College of Nursing of Notre Dame of Midsayap College, Midsayap, Cotabato, Philippines,

Joanne Marie B. Jaramillo is a 3^rd year nursing student of the College of Nursing of Notre Dame of Midsayap College, Midsayap, Cotabato, Philippines.

Zaihani K. Mosanip is a 3rd year nursing student of the College of Nursing of Notre Dame of Midsayap College, Midsayap, Cotabato, Philippines.

Jericho N. Panigon is a 3rd year nursing student of the College of Nursing of Notre Dame of Midsayap College, Midsayap, Cotabato, Philippines.