Daily Positive Reaffirmation from the Lenses of Student Nurses in a Higher Education Institution in Cebu City

Daily Positive Reaffirmation from the Lenses of Student Nurses in a Higher Education Institution in Cebu City

Maria Jocelyn C. Gimenez¹, Jose Mari Louis G. Alforque^1,2

¹University of the Visayas – Graduate School of Allied Health Sciences

²Cebu Normal University – College of Nursing and Allied Health Sciences

DOI: https://doi.org/10.51244/IJRSI.2025.12030028

Received: 16 February 2025; Accepted: 03 March 2025; Published: 02 April 2025

ABSTRACT

This study explores the impact of daily positive reaffirmation on the academic and personal development of student nurses in a higher education institution in Cebu City. Grounded in the context of rigorous nursing education, the research investigates how consistent reaffirmation influences students’ mental well-being, motivation, and overall performance. Descriptive phenomenology was utilized as research design. Data was collected through in-depth interview of eight participants who were involved in the study. Emerged are five major themes: (1) Apprehending: Acknowledging feelings of uncertainty; (2) Becoming: Building a positive mindset and outlook; (3) Conforming: Developing a purposeful self-confidence; (4) Deepening: Embracing a more motivated sense of self, and (5) Engaging: Building string relations and effective management. The findings highlight the critical role of daily positive reaffirmation in fostering resilience, enhancing self-esteem, and promoting a supportive learning environment.  The practice of positive affirmation plays a critical role in shaping the personal and academic development of student nurses.  By promoting emotional resilience, enhancing self-confidence, fostering motivation, and supporting strong interpersonal relationships, affirmations empower students to navigate the demands of nursing education successfully. The impact of positive affirmation extends to all stages of their learning journey, making it a valuable tool for enhancing mental well-being and academic success.

Keywords: descriptive phenomenology, experiential, positive affirmation, resilience, student nurses

INTRODUCTION

Good mental health and wellbeing is essential for students. It helps them to learn effectively, cope with day-to-day challenges, and develop into resilient young adults. There are several things that schools can do to support the mental health and well-being of their students.

Nursing students have been recognized as a group of health workers that may not be able to manage stress well, experiencing health problems connected to stress that are comparable to those experienced by registered nurses. Nursing students should take into account the excellent employment rates that are often guaranteed to them, since they often choose their major based more on parental and other recommendations than on their own abilities or interests (Jo, 2020). Research has shown how important it is for higher education institutions to provide resilience programs to nursing students. It is important to ascertain tactics that enhance resilience in order to guarantee that forthcoming initiatives are efficacious and adhere to an evidence-based methodology.

Thus, nursing is seen as a practical career decision rather than a passion. Due to their intense workloads after being admitted to college, student nurses have little chances for introspection. This makes it difficult for them to make judgments about their future occupations based on an objective knowledge of who they are and on researching suitable jobs and relevant information. Furthermore, due to the demands of their curriculum, the need for clinical experience in addition to normal coursework, and the stress of passing the national licensing test, nursing students report lower levels of satisfaction than other undergraduates (Park, 2019). These variables are linked to early turnover among new nurses and may worsen the quality of life for nursing students.

The most significant issue facing nurses in the Philippines is frequent turnover, which has a negative impact on their ability to provide patients with consistent, high-quality treatment. As a result, certain actions are required to boost nursing students’ satisfaction and possibilities for self-exploration. In order to preserve self-integrity—that is, the belief that one is moral, adaptable, and in charge of significant events—positive affirmation entails thinking back on qualities like one’s strengths and values (Cohen & Sherman, 2020). This helps in many areas and is especially helpful when someone feels mentally threatened. For instance, when individuals are taught to affirm their own worth, they are more likely to practice healthy habits, do better in school, volunteer more, and report feeling happier (Nelson, Fuller, Choi, Lyubomirsky, 2020).

This study relates to Sustainable Development Goal 3, regarding “Good Health and Well-being”, (SDG 3).  SDG 3 aims to ensure healthy lives and promote well-being for all at all ages, encompassing both physical and mental health (United Nations, 2023). Positive affirmations, which involve consciously using positive, self-empowering statements, can play a significant role in improving mental well-being, self-esteem, and overall health outcomes (Smith & Johnson, 2022).  One of the key focuses of SDG 3 is improving mental health, recognizing that mental well-being is integral to overall health (World Health Organization, 2021). Positive affirmations help individuals reframe negative thoughts and reduce stress, directly benefiting mental health. Research has shown that regular affirmation practice can lower anxiety and promote feelings of calm (Williams et al., 2022).  Affirmations can assist individuals in cultivating healthy habits, a cornerstone of SDG 3’s goal to reduce non-communicable diseases (United Nations, 2023). For example, affirmations like “I am capable of maintaining a healthy lifestyle” encourage individuals to engage in behaviors such as exercise and proper nutrition. Studies suggest that individuals who engage in positive self-talk are more likely to set and meet health-related goals (Brown & Adams, 2021).

Evidence suggests that when people focus on valued aspects of their identity, they view information as less threatening to the self. This allows cognitive resources to be redirected from worrying about a threat or protecting their image to the task at hand or to helping others. The mechanisms underlying the benefits of positive affirmation are still being fully understood.

By encouraging positive self-evaluations and developing self-schemas that serve as genuine emotional and affective support in the face of unfavorable experiences like learning challenges or academic failure, positive affirmation is an intervention technique that attempts to safeguard students’ self-esteem (Aronson, Fried, & Good, 2022). Discrimination or segregation (stereotype threat) for being a member of a minority group is another experience that can undermine students’ sense of self. In this case, they are compelled to adopt defensive mechanisms that cause them to hide their own values and start identifying with those that others want them to (Bratter et al., 2019). The danger of stereotypes is a genuine barrier to students’ identity development, particularly during pivotal life phases like adolescence. It results in socio affective responses focused on the initiation of defense mechanisms that compel a person to rethink who they are and how they fit into a world that they feel is dangerous. In this case, student nurses are protected from the dangers of stereotyping by the true positive self-definitions that self-affirmation helps to foster (Soler et al., 2024).

In positive affirmation, one’s self-worth is confirmed via contemplation of fundamental ideas, which results in a more thorough knowledge of oneself. Positive comments will boost people’s self-esteem and self-worth while also encouraging them. When confronted with troubling facts, this strategy helps individuals recognize their strengths across a wide range of domains without evoking negative emotions. Nonetheless, there hasn’t been much focus on this sort of research in the nursing studies sector. In order to get insight into real-world situations, the present study aimed to explore on the influence of positive affirmation on the academic performance of nursing students from a Private Higher Education Institution. By using a qualitative technique through the use of Husserlian Phenomenology to improve its validity, this study expands on earlier findings. Carrying out the research in an authentic learning environment, namely inside a university setting including nursing students, guarantees that the findings are more indicative of actual circumstances and may be broadly applicable.

The results of this study contribute to the body of information about the use of positive affirmation as an intervention to improve academic achievement in students. Moreover, the study findings contribute as a starting point by policymakers and academic institutions to enhance current practices and policies. The outcome of the study provides the institution useful information for developing initiatives or programs that strengthen the use of positive affirmation as a tool for encouraging students to improve their academic performance.

Purpose of the Study

This study aims to explore on the phenomenon of positive affirmation among nursing students.  It sought to answer the following queries:

1. How is the positive reaffirmation experienced by the nursing students?
2. What is the essence or meaning of the experienced?
3. What implications can be provided based on the findings of the study?

RESEARCH METHODOLOGY

This chapter provides an overview of the methodology that will be used to conduct the study. This paper aims to provide a comprehensive overview of the research design, key informants, sampling technique, research instrument, data gathering procedure, data analysis, criteria for trustworthiness, and ethical considerations employed in the current investigation.

Design

This study employed the descriptive phenomenological research design. A descriptive phenomenological study design was considered the most suitable for this study because it provided a clear process for setting aside my own preconceptions about the phenomenon of the lived experiences of nursing students with regards to receiving daily positive affirmation in academic setting. The goal of the phenomenological study was to explore the phenomenon of receiving positive affirmation as experienced by nursing students of a Private Higher Education Institution in Cebu City.

In this research, the use of descriptive phenomenology focuses on revealing the essential structure of the lived experiences of nursing students in pursuing their degree and how positive affirmation affects their academic performance. I focused on a method proposed by Colaizzi (1978) since its process provides a rigorous analysis, with each step staying close to the data. The end result is a concise yet all-encompassing description of the phenomenon under study, validated by the participants that created it.

The experiences of the undergraduate nursing student informants with regard to receiving daily positive affirmation as well as their own opinions as a result of reflection, will be crucial in understanding the true phenomenon in this study. This research used descriptive phenomenology to describe the events as fresh and unique as they were perceived by those who lived them, due to a limited data base and lack of focus. My aim as the researcher was to capture meaningful understanding of the events of participants by employing an interpretive perspective and a reflective interpretation.

Environment

This research employed a qualitative approach using phenomenology to understand the daily positive affirmation received among nursing students and will be conducted in a Private Higher Education Institution which is situated in the vicinity of N. Bacalso Ave., Bulacao Pardo, Cebu City, which is in close proximity to the boundary between Cebu City and Talisay.

The identified Private Higher Education Institution has been granted a Deregulated status by the Commission on Higher Education (CHED) after providing quality education for forty-two (42) years. Additionally, it has been acknowledged by the Philippine Association of Colleges and Universities Commission on Accreditation (PACUCOA) as an educational institution with the highest number of accredited programs. At present, UC is nurturing over 42,000 talented young individuals while generating exceptional board members through its four campuses strategically located in various areas of Cebu.

Participants

The participants of this study include eight (8) selected level one nursing students currently enrolled at a Private Higher Education Institution (HEI) and have been routinely experienced positive affirmations for three (3) months.  The participants were selected based on their availability and willingness to participate in the study, who voluntarily consented to participate in the research study. Participants who did not complete the interview sessions were excluded. Finally, participants had the opportunity to exclude themselves by not agreeing to participate in the study.

This study utilized the non-probability purposive sampling procedure to select the participants in the locale of the study. Purposive sampling concentrates on specific features of a population that are of interest in order to better address research questions, and it is designed to meet a very specific need or intent. The primary goal of a purposive sample was to generate a representative sample. This was achieved by tailoring a random sample of the population according to certain data elements in order to achieve (Lavrakas, 2008).

Instrument

The main instrument of the study was the researcher and used of a semi-structured interview guide that aided in facilitating the essential information from the participants. When performing qualitative research, independent interviews were a common tool used by researchers undertaking phenomenology investigations. Researchers and participants participated in talks that vary in structural degree to obtain information regarding life experiences, thoughts, emotions, and views about a certain topic. Qualitative interviews are the term for these discussions (Creswell & Creswell, 2018; Creswell & Poth, 2018).

As the name suggests, individual interviews record information from a single subject at a particular moment (Creswell & Guetterman, 2019). Building rapport between the researcher and the participants was further facilitated via interviews, which are often conversational in nature. Participants are more relaxed and forthright with the researcher as a consequence of the enhanced trust that arises from this rapport, which should make it simpler for the researcher to collect meaningful data since participants will be less hesitant to be honest and open throughout the interview.

The researcher provided a series of open-ended questions to the participants, who responded by sharing specifics about their own experiences in receiving daily positive affirmations as nursing students. The researcher’s objective was to comprehend the phenomena from the perspective of the participant. The researcher conducts interviews via the phone, using a video chat application, or in person, to name a few methods (Creswell & Guetterman, 2019). The study’s scientists would want to speak with each participant face-to-face.

The researcher records each interview so that, after the interview, the data may be reviewed and taken into consideration. Additionally, each interview has its accuracy confirmed by transcription. One important method for gathering data for phenomenological research was the independent interview technique. By employing the interview approach, researchers got a deeper understanding of participants’ previous experiences and their emotional reactions to the phenomena, since it is difficult for researchers to quantify emotions, ideas, and views or to witness events that occurred before the study. Furthermore, the individual interview method allows a researcher to pay close attention to the words and experiences that participants recount, producing rich and detailed descriptions of the phenomenon. This is because qualitative research in general and phenomenological studies in particular aim to reveal the true essence of a phenomenon by examining its structural and textural meanings (Merriam & Tisdell, 2016).

In order to get information from participants that may contribute to addressing the research goals that underpin this project, the researcher developed interview questions especially for one-on-one sessions. Each interview question developed in accordance with the investigation’s previously stated research questions. The open-ended grand tour questions seek to answer the primary research topic and build a connection with the participant. The following questions focused on the three sub questions; a denotation was used to identify the associated sub-question for each question, and several interview questions were constructed specifically for each sub-question. Participants were invited to submit any additional information they believed may assist to enhance the present research in a final question after the interview.

Before any participant data was collected, subject-matter experts will carefully review each interview question to ensure its acceptability and validity. The validation of the research instrument includes experts in the field such as ‘Enabler’, Guidance Counselors, Faculty, Life Coach, or Formators. Before the data-collecting portion of the research began, permission was granted, and the previously specified interview methodology was examined. The study began as soon as authorization was granted and the interview methodology was approved. Interview questions will be reviewed and adjusted as needed to better represent the manner in which the first individual interview in the series was conducted.

Data Gathering

A formal letter was sent to the selected participants who were student nurses of the identified Private Higher Education Institution (HEI) to conduct the study and administer the questionnaire to the respective participants, following acceptance of the submission, the researcher was able to conduct the in-depth interview.

In-depth interviews with student nurses were conducted to learn more about their experiences receiving daily positive affirmations in an academic setting. According to Seidman (2013), the curiosity in knowing people’s lived experiences and the sense they make of those experiences is at the heart of in-depth interviewing. In-depth, phenomenologically oriented interviews, according to Seidman (2013), combine personal experience with concentrated, in-depth interviewing that mainly uses open-ended questions. Nondirectional, emerging, unrestrictive, open-ended, and changing qualitative phenomenological research questions, the interviewer’s main goal when using open-ended questions is to discuss and draw on the answers of the participants (Seidman, 2013).

When interviewing participants, the interviewer aimed to strike a balance. Questions were designed to prompt the learning process, not to restrict or limit the participants’ exploration of their experiences. Questioning mechanisms can be used to aid in the discovery process if an open-ended discussion does not disclose the participants’ experiences.

The phenomenological design encouraged participants to explore their experiences as student nurses receiving daily positive affirmation, as well as the perceptions they formed during their lives affecting their academic performances, in order to gather more information on this demographic group.

Interviews took place at a mutually convenient moment. Time was spent at the start of the interview building a small rapport and creating a nonjudgmental environment. To make the participants feel more at ease, I spent time talking to them before beginning the semi-structured interview. Afterwards, I began the interview after collecting demographic information. In a semi-structured interview, the participants were asked a series of questions. The interview was captured using a digital recorder. The study needs a high level of confidentiality. To maintain confidentiality, no names will be used explicitly or implicitly, and each participant’s name will be coded. The names of the participants will only be revealed to me, the researcher.

Data Analysis

In the data analysis stage of a phenomenological study, Creswell (2007) claimed that the participants’ personal experiences are in the form of a description. This stage entails a methodical quest for significance. Hatch (2002) described data analysis as the process of organizing and interrogating data in such a way that researchers can see trends, recognize themes, discover associations, create hypotheses, generate theories, and make interpretations. As noted previously, this research employs Colaizzi’s (1978) seven-step strategy for the analysis of phenomenological data. A brief description of data collection and transcript formation will be summarized and reviewed in order to describe the proposed analysis of this study.

Semi-structured interviews were conducted using a prepared interview guide. Participants were encouraged to talk freely and to tell stories using their own words. Each interview lasted for 30 to 40 minutes in which I conducted. At the end of each interview, I reviewed the requirement for a second contact to discuss the analysis of findings and to ensure an accurate representation of the reported experiences of the participants.

The first step of the data analysis of this study involved transcription and familiarization. Colaizzi (1978) suggests collecting, reading, and/or replaying each transcript numerous times until a level of comprehension and understanding of the participants’ experience is achieved. The researcher would read and listen to the data that were collected until the researcher was certain that a complete comprehension of the experiences has been reached. Thoughts, feelings, and notions that may have developed as a result of the researchers’ prior experience with group participation and facilitation will be recorded in the researchers’ journal. This will assist in accounting for any researcher bias and in fully exploring the phenomenon as experienced by participants.

The second step of analysis is extracting significant statements from the participants. Significant statements related to the group process and feelings experienced within the group will be extracted from each transcript. In this stage of analysis, significant statements and phrases pertaining to their experiences in receiving daily positive affirmations and how this affects their academic performances These statements will be written in separate sheets and coded based on their transcript, page, and line numbers.

The third step is formulating meanings from the gathered significant statements. Each underlying meaning will be coded in one category as they reflect an exhaustive description. Coding will be the technique to identify specific details and notations that may be relevant in answering identified research questions of this study. Similarly, I will compare the formulated meanings with the original meanings maintaining the consistency of descriptions.

The fourth step will be clustering themes in which the researcher will group all the formulated meanings into categories that reflect a unique structure of clusters of themes. Each cluster of themes will be coded to include all formulated meanings related to that group of meanings. Following that, I will combine the groupings of clusters of themes that reflect a certain vision issue to create a unique theme construct. Indeed, all of these themes are internally convergent and externally divergent; each formulated meaning belongs to a distinct topic cluster that is conceptually distinct from other structures.

The fifth step aims to create an exhaustive description. During this stage of analysis, all emergent themes will be integrated into an exhaustive description. Peer debriefers that will be utilized in this study will assist in the development of this description by providing feedback of the analysis. Through the process of analysis and merging of themes, the complete structure of the phenomenon of the lived experiences of level 1 nursing students. The sixth step is producing fundamental structure. At this stage, a reduction of findings will be executed, and any descriptions found to be misused or overgeneralized will be eliminated from the overall structure. A fundamental statement of structure will be formulated at this stage to fully describe the phenomenon in question.

Lastly, the seventh step is the validation of the findings of the researcher. This step will employ member checks to assist in validating the data analysis. I will distribute the research findings to the participants and will have a discussion with them about the findings. Participants’ perspectives on the study’s findings will be elicited through e-mail correspondence. All participants are requested to indicate satisfaction with the results and to express their agreement or disagreement with the data conclusions on their feelings and experiences.

Trustworthiness of the Study

In qualitative research, “trustworthiness” refers to results quality, truthfulness, and correctness. Readers’ trust in results matters as stated by Schmidt & Brown et al., (2015). Researchers should establish protocols and methods for each work to be considered by readers Amankwaa et al., (2016). Thus credibility, dependability, confirmability, and transferability criteria will be employed to verify this study’s reliability.

Credibility. The credibility of the research findings in this study is essential to their plausibility and reliability. Credibility was crucial because the researcher’s goal was to fully understand the perspectives and experiences of first year nursing students as they transition into college life. The researcher will treat every statement from the informants as equally important and relevant (Creswell, Poth et al., 2017). In this phase, the researcher immersed in the raw data, the unfiltered narratives of the student nurses. As the researcher reads through the transcripts, the researcher must remember that each word, each sentence, bears significance. The researcher should refrain from making premature judgments or prioritizing certain statements over others, ensuring that the data collection process is rigorous, thorough, and free from undue influence or prioritization of certain statements, thus bolstering the credibility of the research.

Transferability. One of the fundamental strategies that the researcher use was to provide a comprehensive and detailed description of the research context. This encompasses providing ample information about the participants, the setting, and the methods used for data collection (Yin et al., 2018). The researcher offered detailed participant descriptions and research methodology to aid future evaluation of result generalization. The researcher utilized purposive sampling to ensure homogeneous participants sharing the same phenomenon studied.

Dependability. Dependability relates to the consistency and stability of the research findings over time. It involves ensuring that the research process and the interpretation of results were reliable and consistent. In the context of clustering and organizing data, this step contributes to dependability by providing a structured and systematic approach to data analysis. Clustering guides the researcher in organizing the data by grouping similar statements into themes or categories. Clustering similar statements into themes or categories is a systematic approach that helps ensure dependability (Creswell, Poth et al., 2017). It allows the researcher to organize and categorize data in a consistent and replicable manner. As the researcher identifies patterns and themes within the narratives, the researcher discerns the common threads that weave through the students’ experiences.

Confirmability. The concept of neutrality refers to the degree to which the outcomes of a study are influenced by the participants rather than by the biases, motivations, or interests of the researcher. Further investigators must be able to replicate the results to prove that they were obtained through independent research methods rather than intentional or unconscious bias (Devault et al., 2019). In this research, the researcher is committed to ensuring the reliability of the study. The researcher will maintain a detailed record of the methods and documents used, such as the questionnaire and the research paper itself, to prevent bias and guarantee fairness. The researcher had her research advisor review the study itself. Additionally, the researcher used analytic memoing to record important information throughout the research process, ensuring that the generated codes and themes are rooted in the participants’ information (reflexivity). Lastly, triangulation was then applied by supporting the results by three (3) related theories.

Ethical Considerations

In this study, several ethical considerations were taken into account. The researcher ensured that informed consent was obtained from the participants. Personal information and responses will be handled with strict confidentiality and in accordance with the existing provisions of the Data Privacy Act of 2012. The protection of privacy and anonymity of the participants is of utmost importance. Any identifying information was protected from unauthorized disclosure and will be removed from the data and reports. Moreover, respect for the dignity of participants will be prioritized in the study. The entire data collection procedure were done with honesty and transparency which includes the prevention of any sort of misleading information and misrepresentation of findings. Ethical considerations were constantly maintained throughout the data collection and analysis to ensure the participant’s privacy and confidentiality of data. The procedures outlined for the research encompassed a meticulous approach to data collection, concentrating on daily positive reaffirmation experienced among student nurses of a Private Higher Education Institution (HEI). A clear description of the expected length and structure of the participation was provided, and participants were asked to participate at their own decision.  The researcher and her background was introduced, ensuring transparency regarding the individuals involved in the study. With a paramount focus on confidentiality, the researcher pledged to maintain the privacy of participants.

In order to obtain consent for the paper, the researcher used the UVIRB informed consent form to ask student informants to participate in the study. All of the information that were collected were kept private and securely stored, and it was used for research purposes only.

RESULTS AND DISCUSSION

There were 10 participants who were involved in the study in relation to the inclusion criteria set.  After the extraction of significant statements and analyzing it, five themes emerged from the experiences of the participants, as discussed in the succeeding sections.

Theme 1. Apprehending: Acknowledging feelings of uncertainty

The first theme encapsulates how the participants were feeling apprehensive and uncertain in doing positive affirmation.  Because this was something that is not what they usually do, some of the participants were feeling some awkwardness when starting to these positive affirmation activities.

Subtheme 1. The Feeling of being Awkward

One significant theme that emerged from the student nurses’ experiences with daily positive reaffirmation is the feeling of being awkward. While many participants reported that positive self-affirmation practices contributed to improved emotional well-being, a notable number expressed initial discomfort or awkwardness when engaging in the practice. This sense of awkwardness can be understood through a combination of psychological and social factors that influence the adoption of self-affirmation techniques in students within healthcare fields.

As some of the participants said:

“Pag sa una mam kay hesitant ko and I feel awkward jud.  Labi na ig ignon mi nga “okay close your eyes and take a deep breath” kay kiwaw kayo magpiyong sa mata.” (I was hesitant back then.  Most especially when we are told that “Okay close your eyes and take a deep breath” because it feels so awkward when closing our eyes while doing the activity. (Shiela, L3)

Several participants noted that verbalizing affirmations or focusing on positive self-talk felt unnatural at first. This discomfort can be attributed to a phenomenon known as self-objectification, where individuals are more likely to view themselves through the critical lenses of others rather than internalizing positive affirmations (Fredrickson & Roberts, 1997). In the context of nursing students, who often navigate high-pressure environments, this external focus can exacerbate feelings of awkwardness, as self-reaffirmation may feel disconnected from the reality of their professional roles.

“It was awkward at first but then I get used to it na and I feel something missing if di ko ka-execute ani nga morning routine.” (It was awkward at first but then I get used to it and I feel something is missing if I am not able to execute this morning routine.) (Alexa, L3)

Interestingly, the feeling of awkwardness also suggests an area for further development in nursing education programs. Educators and mentors could potentially support students by creating a more open and supportive environment for exploring self-affirmation practices, emphasizing their potential for fostering emotional resilience. Chang et al. (2022) emphasized that positive psychological interventions, when normalized within educational settings, can reduce feelings of alienation and awkwardness, allowing students to experience greater benefits from affirmations.

Subtheme 2. Having Doubts and Being Unsure

There were some participants who shared that their life was different before they started doing positive affirmation.  There is that feeling of being skeptical and feeling low about oneself.

“I was skeptical at first and find it funny.” (Gretchen, L3)

“I used to feel so low about myself and kept comparing myself to others. Wa nako nakita ang akong value, it is always “unsay ikasulti ni mam, basin masuko si mam if sayop akong tubag.” (I used to feel so low about myself and kept comparing myself to others.  I did not see my value, it is always “What will Mam say about me, maybe she will reprimand me is I give a wrong answer.) (Rose, L13)

Positive affirmation enables nursing students to reframe their problems as chances for growth rather than proof of failure, which is critical for developing emotional resilience and coping techniques in high-stress workplaces.  In the context of student nurses, admitting uncertainty can foster emotional growth and a more open approach to learning.

Theme 2. Becoming: Building a Positive Mindset and Outlook

This theme of the study reveals how the participants were able to initiate doing the positive affirmations.  The more they practice in doing this, the more they are being accustomed to this.  These positive affirmation activities were becoming a routine for the participants as they are doing this in their everyday activities.

Subtheme 1. Initiating the Act

The process of beginning to engage in self-affirmation practices was characterized by a sense of intention and, for many, an initial challenge. The act of consciously starting the process of affirming oneself daily was not automatic, and the students often described the first steps as requiring considerable mental effort and motivation.

As revealed by some of the participants:

“Nindot jud siya kay ako na gi-practice every day naa jud siyay unique nga effect.” (It really is good since I practice this every day, there really is a unique effect.) (Claire, L3)

Despite the initial discomfort, the research participants also expressed that once they initiated the practice of affirming themselves daily, the experience became progressively easier and more natural. Creswell (2023) highlighted that self-affirmation interventions are more effective when participants allow themselves to ease into the practice at their own pace, which could explain why the students in this study reported improved comfort and consistency over time. The positive effects of self-affirmation are often cumulative, and as students continued to practice affirming themselves, they began to internalize the experience, making the act feel less like an obligation and more like an integral part of their routine.

“Nagkadaghan ang tunanan pero ang time nako nga ma-stress kay nidaghan. So, when I tried doing this everyday kanang igmata jud nako, the whole day nako kay ma-manage ra jud nako akong school assignments and activity nga smooth ra. (There are so many things to study but my time to be stress is also increased.  So, when I tried doing this everyday whenever I wake up, the whole day I am able to manage my school assignments and the activities goes smoothly.) “(Claire, L7)

The process of initiating the act of daily positive reaffirmation for nursing students can be both challenging and empowering. The initial barriers to starting the practice—ranging from resistance to cultural factors—require a significant amount of motivation, self-awareness, and sometimes social support. As students continue to engage in self-affirmation, they are more likely to internalize the practice and experience its benefits in fostering emotional resilience and reducing stress.

Subtheme 2. Feeling Positive

A central theme that emerged from the participants’ experiences with daily positive reaffirmation was the profound sense of feeling positive that developed over time. As the students incorporated self-affirmation practices into their daily routines, many reported an increased sense of optimism, confidence, and overall emotional well-being. This positive shift aligns with previous research on the psychological benefits of self-affirmation, particularly in high-stress contexts like nursing education.  There is one participant who shared that with doing positive affirmation, she was able to think positively despite the encountered challenges:

“Thinking positively despite the challenges.” (Gretchen, L4)

Several participants noted that after engaging in daily affirmations, they began to notice improvements in their mood and outlook on both their academic and personal lives. This change can be attributed to the psychological mechanisms underlying self-affirmation. Cohen and Sherman (2014) proposed that self-affirmation works by reducing defensiveness and increasing openness to new experiences, leading to improved emotional regulation. For nursing students, who often experience high levels of stress, this increased emotional regulation can significantly enhance their ability to cope with daily challenges and maintain a positive mindset.

Subtheme 3. Being Grateful and Mindful

An essential theme that emerged in the study was being grateful and mindful—a practice that many student nurses reported cultivating through their engagement with daily positive reaffirmation. As participants reflected on their experiences, it became evident that self-affirmation not only facilitated an emotional shift but also encouraged an enhanced sense of gratitude and mindfulness. The incorporation of gratitude and mindfulness into their daily lives created a holistic approach to self-care, fostering deeper self-awareness and emotional balance.

Some participants were able to become more calm and grateful for what has happened to them in every day, considering that there are instances in which it will not be favorable for them:

“Naa na jud ko daghan lista, kay mas kalmado man ang akong approach basta I will start my day thinking only positive things.” (I have a few things on my list, because when my approach is calm, I will start my day thinking only positive things.) (Gretchen, L5)

Gratitude, defined as the recognition and appreciation of the positive aspects of life, plays a crucial role in improving mental health and well-being (Emmons & McCullough, 2003). For the nursing students in this study, expressing gratitude through affirmations helped them to focus on their strengths, their personal growth, and their ability to overcome challenges.  Being grateful and mindful also appears to facilitate emotional regulation, a key component of emotional intelligence (Goleman, 2006). Many participants expressed that practicing gratitude allowed them to frame their academic and clinical challenges in a more positive light.

“Simple ra kaayo, just tell myself the things that I am grateful for that is my way of positive affirmation.” (Just simple, just tell myself the things that I am grateful for that is my way of positive affirmation) (Alexa, L5)

The combination of gratitude and mindfulness also has a synergistic effect. Bohlmeijer et al. (2011) noted that integrating both practices into daily routines can enhance subjective well-being by fostering positive emotions and reducing negative affect. This is particularly important for nursing students, who often face emotional and physical exhaustion. By integrating mindfulness with gratitude, students can anchor themselves in the present moment and appreciate their progress, rather than becoming overwhelmed by the pressure of future responsibilities.

Subtheme 4. Having an Open Mind

Having an open mind is crucial for students in embracing and sustaining the practice of daily positive reaffirmation.  or many participants, the act of engaging in self-affirmation required them to remain receptive to new perspectives and ways of thinking, particularly regarding their own strengths and abilities. This openness allowed students to challenge their internalized doubts and negative self-talk, ultimately contributing to a more positive and resilient mindset.

For some of the participant, they were able to overcome criticisms and became less affected about what others have to say about them:

“I won’t get affected with criticism, I don’t really mind them, I take it constructively now. Unlike before when I usually get affected and sulk.” (Nerlinda, L8)

A positive outlook is critical for nursing students’ personal and academic success. The concept of “Becoming” symbolizes the cultivation of a positive mindset, which is critical in battling stress and maintaining motivation in demanding nursing programs.  The importance of having an open mind aligns with self-determination theory, which emphasizes the role of autonomy and psychological flexibility in fostering personal growth (Ryan & Deci, 2000). Nursing students, often immersed in rigorous academic demands, must navigate complex emotional and professional challenges. In this context, an open mind enables students to approach difficult situations with curiosity and adaptability, rather than defensiveness or rigidity. By accepting the idea of self-affirmation, students could explore the potential benefits of this practice, even when it initially felt unfamiliar or uncomfortable.

Theme 3. Conforming: Developing a purposeful self-confidence

This theme reveals how the participants were able to build self-confidence through doing and be engaged with daily positive affirmations.  Looking back when they were not aware of positive affirmation activities, these individuals are full of doubts about themselves and there is the least amount of self-confidence within them.

Subtheme 1. Building up Self-confidence

Many of the student nurses reported that engaging in daily positive reaffirmation played a critical role in enhancing their self-esteem and belief in their abilities. Through consistent affirmations, students were able to challenge self-doubt and internalized feelings of inadequacy, which are common in nursing education due to the high-pressure and emotionally demanding nature of the profession.

The process of self-affirmation is closely tied to the psychological construct of self-efficacy, a concept developed by Bandura (1997), which refers to an individual’s belief in their ability to succeed in specific situations or accomplish particular tasks. Self-affirmations helped students reframe their self-perceptions and focus on their strengths, thus boosting their sense of competence and ability to succeed both academically and in clinical practice.

As shared by some of the participants:

“Ma-develop jud ang self-confidence especially as a nursing student, Miss kay lain pud kayo ug mauwaw ko moatubang sa pasyente.” (Self- confidence is developed especially when you are a nursing student, Miss because it will be awkward if you are embarrassed to face the patients.)  (Shiela, L8)

For nursing students, regular affirmation practices can serve as a buffer against the stress and self-doubt that often accompany the intense demands of their studies. By consciously affirming their worth, students could enhance their confidence and resilience, which in turn supported their academic and professional growth.

“With positive affirmation it helped us build confidence. It helped me build my confidence and if student nurses will also have this attitude, it will have a good impact in dealing with our patients.” (Claire, L8)

Building self-confidence through self-affirmation also has significant implications for emotional well-being. Cohen and Sherman (2014) found that self-affirmation exercises are particularly effective in reducing anxiety and defensive reactions to stress. Many nursing students in this study expressed how their self-confidence improved not only in their academic tasks but also in their ability to handle emotionally charged clinical situations.  the theme of building self-confidence highlights the transformative power of daily positive reaffirmation in enhancing the self-efficacy, emotional well-being, and interpersonal skills of nursing students. By affirming their strengths and capabilities, students not only cultivated a stronger sense of self-belief but also improved their ability to handle the challenges of nursing education and practice. Self-affirmation thus serves as a powerful tool for fostering personal growth and professional competence in the demanding field of nursing.

Subtheme 2. Appreciating the Self More

The theme of appreciating the self more emerged as a significant outcome of daily positive reaffirmation among student nurses in this study. Many participants reported that engaging in self-affirmation not only enhanced their self-confidence but also deepened their sense of self-appreciation. This practice allowed students to develop a more compassionate and positive relationship with themselves, which was particularly important given the challenges and emotional demands of nursing education.  There was a participant who shared that with positive affirmation, she refrained from comparing herself with others.  Instead, she has herself to compete with as she gradually builds the self-confidence with a purpose:

“I have myself to compete di na ko mag-mind kung kinsa ang bright sa amoang klase, I just make sure that I do my best because I know that I can do it as well.” (I have myself to compete, I don’t mind who is bright in our class.  I just make sure that I do my best because I know that I can it as well.) (Rose, L8)

The theme of appreciating the self more underscores the transformative impact of daily positive reaffirmation on nursing students’ emotional well-being and personal growth. By affirming their worth and recognizing their accomplishments, students were able to cultivate a deeper sense of self-compassion, self-awareness, and appreciation. These qualities not only enhanced their resilience in the face of academic and clinical challenges but also contributed to their overall sense of satisfaction and fulfillment in their nursing journey.

Subtheme 3. Always being Prepared

The theme of always being prepared emerged as an important outcome of engaging in daily positive reaffirmation. Many nursing students in the study expressed that daily affirmations helped them build a mindset of readiness and proactive thinking. By reaffirming their strengths and capabilities, students felt more confident in their ability to meet the demands of their rigorous academic and clinical responsibilities. This theme reflects the importance of preparedness in nursing, not only in technical skills but also in emotional and psychological resilience.  For one of the participants, she was able to prepare herself for class, that is she is called to answer during recitation, she will be able to answer.

“Confidence mao jud na ako notice karon. Di na kaayo ko mahadlok ug tawgon bisan akong answer di kaayo sakto.” (Confidence that is what I notice now.  I am not scared if I will be called in class even if my answer is not sure.) (Beatrice, L8)

Additionally, when students engage in positive affirmation, they are less likely to internalize criticism or failure, which helps to build more sustainable and resilient self-confidence.  Positive affirmation plays a crucial role in developing self-confidence, which is a key theme in nursing education.  Fostering emotional preparedness, the theme of always being prepared also highlighted the importance of self-regulation, a key aspect of emotional intelligence. Goleman (2006) defines self-regulation as the ability to manage one’s emotions, behaviors, and reactions in the face of difficult situations. Nursing students who engaged in self-affirmation were better able to regulate their emotions and remain calm and composed, especially in high-stress clinical environments.

Theme 4. Deepening: embracing a more motivated sense of self

This theme speaks about how positive affirmations influence the lives of the participants by keeping them more motivated with their everyday life.  Because they were able to build a purposeful self-confidence, they are able to continually motivate themselves amidst the challenges and adversities that they encounter.

Subtheme 1. Motivations and a Positive Outlook

In the context of nursing education, maintaining motivation and a positive outlook is crucial.  The theme of motivations and a positive outlook emerged as a significant result of daily positive reaffirmation among student nurses in this study. Many participants reported that the practice of affirmations played a vital role in helping them maintain a positive mindset, even in the face of challenges and setbacks. By affirming their strengths and capabilities, nursing students were able to foster an optimistic perspective that drove them to keep pursuing their goals, regardless of the obstacles they encountered in their academic and clinical training.

Nursing students often face high academic demands, emotionally taxing clinical experiences, and the pressure to meet the expectations of instructors, patients, and themselves. Self-determination theory (Deci & Ryan, 2000) emphasizes the importance of intrinsic motivation, which is driven by an internal desire to achieve personal goals and develop competence. Daily affirmations reinforced the students’ intrinsic motivations by helping them connect with their deeper purpose in nursing.

“Motivations every day.  I will always feel motivated bisan usahay if nay retdem unya grabe manutana ang CI, okay ra gyud siya, kaya ra gyud nako dawaton” (Motivations every day.  I will always feel motivated even if sometimes there is retdem and then the CI will ask many things, it is really fine for me.) (Andrea, L11)

Moreover, the practice of affirmations also helped students manage stress and anxiety, which can often undermine motivation and hinder a positive outlook. Cohen and Sherman (2014) highlight the role of self-affirmation in reducing stress by allowing individuals to affirm their values and strengths, thereby buffering against the negative impact of external challenges. Nursing students who used affirmations reported feeling less overwhelmed by stress and more capable of navigating the pressures of their coursework and clinical responsibilities.

“It is easier for me to accept failure, that it is a part of my journey as a student nurse. Di pwede mo give up with one mistake. I always have to move on and move forward.” (It is easier for me to accept failure, that is a part of my journey as a student nurse.  You do not give up with one mistake.  I always have to move on and move forward.) (Claire, L12)

The theme of motivations and a positive outlook underscores the role of daily positive reaffirmation in maintaining intrinsic motivation, cultivating a growth mindset, and fostering a resilient, optimistic perspective. By affirming their strengths and capabilities, nursing students were able to stay focused on their goals and persist through the challenges of their training. The ability to maintain a positive outlook and motivation through affirmations is an essential factor in nursing students’ academic and professional success.

Subtheme 2. A Strong Sense of Self

The theme of a strong sense of self emerged as a significant outcome of engaging in daily positive reaffirmation among nursing students in this study. Students frequently described how daily affirmations helped them establish and maintain a firm sense of identity, grounding them in their personal values, strengths, and aspirations. A strong sense of self is critical for nursing students, as it allows them to navigate the complexities of both their educational journey and their eventual professional roles with confidence and clarity.

Some of the participants shared that with positive affirmation, they were able to accept themselves and appreciate all they have as an individual.  This becomes their way to self-love:

“It boosts my self-esteem.  With daily affirmation, slowly I accept myself, my limitations and the things that i can do. I love myself now. and with that I can face my patients with confidence.” (Rose, L12)

This finding aligns with self-determination theory (Deci & Ryan, 2000), which suggests that a strong sense of self is essential for intrinsic motivation and overall well-being. Nursing students who practiced self-affirmation reported that the affirmations not only strengthened their self-concept but also fueled their intrinsic motivation to pursue their goals.  Moreover, a strong sense of self is intimately connected to self-efficacy, the belief in one’s ability to successfully perform tasks and overcome obstacles (Bandura, 1997). Nursing students who engaged in positive reaffirmations consistently reported an increase in their self-efficacy.

“Never give up, never surrender jud siya mam, mindset lang na siya Ms. Di nako i-compare akong kaugalingon kay I have my own skills and strength man Ms. Kay if ako i-compare man gud akong kaugalingon like mas bright sila, maguol na man nuun ko. Slowly I changed the way i look at things jud Miss.” (Never give up, never surrender, it is all about the mindset Miss.  I will not compare myself because I have my own skills and strength Miss, because if I compare myself to others, I feel worried.  Slowly I changed the way I look at things, Miss.) (Beatrice, L12)

The theme of a strong sense of self highlights the profound impact of daily positive reaffirmation on nursing students’ personal development. Through the practice of self-affirmation, students were able to develop a clearer understanding of their identity, reinforce their self-worth, and build confidence in their abilities. This sense of self provided a foundation for their success in both their academic and clinical experiences, as it allowed them to approach challenges with resilience, self-compassion, and authenticity. Ultimately, nurturing a strong sense of self through affirmations is a powerful tool for fostering personal and professional growth in nursing students.

Subtheme 3. Making it a Daily Habit

This theme emerged as a crucial factor in the success of daily positive reaffirmation among nursing students in this study. Many participants reported that turning affirmations into a consistent daily routine significantly enhanced their overall effectiveness. Once affirmations became a habit, students noted that the practice became an automatic and integral part of their daily lives, leading to a more consistent and sustained impact on their mindset, confidence, and overall well-being.

For some of the participants, doing positive affirmation activities becomes a part of their everyday life.  If they are not able to do this, it seems that something is lacking with their day:

“Kulang ang adlaw Miss if wala koy affirmation. It always reminded me man gud nga I can do it if I believe nga I can. Who else will believe me kung ako mismo dili motoo di ba Ms. (smile).” (My day is not complete if there is no affirmation. It always reminded me that I can do it if I believe that I can.  Who else will believe me if I, myself will not believe in me, right Miss?) (Beatrice, L7)

“Yes Miss, kay lahi ra jud ang impact if we start our day with loving ourselves and being grateful.  Even the smallest thing we can appreciate their existence jud.” (Yes Miss, the impact is different if we start our day with loving ourselves and being grateful.  Even the smallest thing we can appreciate their existence. (May, Line 12)

As nursing students continue their education, their intrinsic motivation can be enhanced through the regular practice of positive affirmation.  Affirmations also help to reinforce nursing students’ sense of professional identity, which is vital for maintaining motivation over the long term.  The theme of making it a habit emphasizes the importance of consistency in the practice of positive affirmations. For nursing students, turning affirmations into a daily routine allowed them to experience sustained benefits, including greater self-confidence, emotional resilience, and a positive outlook. By making affirmations a habit, students were able to seamlessly integrate them into their lives, which led to long-term positive changes in their mindset, motivation, and ability to cope with the challenges of nursing education. Ultimately, developing the habit of positive affirmation became a powerful tool for personal growth and success in both academic and clinical settings.

Theme 5. Engaging: Building strong relations and effective time management

This theme describes how the participants engage more fully on building strong relations and establishes effective time management.  The positive affirmation experience of the participants has greatly influenced their relationship with families and gives them a sense of value for time.

Subtheme 1. Effective Time Management

The theme of effective time management emerged as a pivotal benefit for nursing students who engaged in daily positive reaffirmation. Time management is an essential skill for nursing students, who often juggle demanding academic schedules, clinical rotations, and personal commitments. Students in this study reported that affirmations helped them stay focused, organized, and better equipped to manage their time effectively, which is crucial for their success in nursing education and future careers.

Effective time management is closely related to self-regulation, which involves planning, monitoring, and adjusting behaviors to achieve desired goals (Zimmerman, 2000). By incorporating positive affirmations into their daily routines, nursing students were able to reinforce their ability to manage their time and tasks more efficiently. Students who practiced daily affirmations felt more empowered to prioritize their responsibilities and stay on track with their academic and clinical duties.

“Oras, importante jud na for both kay kasagaran man gud mag-panic dayon kung wala pa mahuman ang assignments due for the following day.” (Time, it is very important for both because usually there is panic mode when assignments are not yet done which is due for the following day.) (Andrea, L8)

Affirmations also helped students enhance their self-discipline, which is an essential component of effective time management (Duckworth et al., 2007). By reinforcing their commitment to their goals and responsibilities, students were better able to resist distractions and stay focused on their priorities.

“Balance in school and home time management.” (Rose, L9)

The theme of effective time management highlights the role of daily positive reaffirmation in improving students’ ability to manage their time and tasks efficiently. By affirming their strengths and abilities, nursing students were able to reduce mental clutter, enhance their self-discipline, and approach their schedules with greater focus and confidence. Affirmations provided a sense of purpose and motivation, enabling students to balance their academic, clinical, and personal commitments more effectively. Ultimately, the practice of affirmations helped nursing students cultivate the time management skills necessary for success in their rigorous academic and professional journey.

Subtheme 2. Strengthened Familial Relations

Strengthened familial relations is an important outcome of practicing daily positive reaffirmation among nursing students.  Students in this study reported that engaging in self-affirmation not only contributed to their personal well-being and academic success but also positively impacted their relationships with family members. Many nursing students shared that their affirmed sense of self, increased emotional resilience, and enhanced stress management skills helped them foster more supportive, understanding, and meaningful connections with their families.

“I understand the value of family support especially if kulang ka sa time. Kay nay usahay di kasabot imong siblings nga sige ra ka naa sa kwarto nagtoon instead of helping them with house chores pero I was able to communicate with them of my situation, open communication is the key.” (I understand the value of family support especially if there is lack of time.  There are times when my siblings will not understand why I always stay in my room studying instead of helping with the household chores, but I was able to communicate with them of my situation, open communication is the key.) (SS6, P6)

“A better bond with my family.” (Amelia, L8)

The theme of strengthened familial relations is also connected to the concept of social support, which plays a vital role in coping with stress and maintaining mental health. Research has demonstrated that individuals with strong social support systems tend to experience better emotional well-being and resilience (Cohen & Wills, 1985). Affirmations helped nursing students build their internal sense of worth and self-confidence, which enabled them to seek and provide support more effectively within their families.

Subtheme 3. Doing what is being Learned

The affirmations provided them with the motivation, confidence, and clarity necessary to apply the knowledge and skills they acquired in both academic and clinical settings.  Affirmations helped students reinforce their belief in their abilities and enabled them to take proactive steps in translating theoretical knowledge into practical, real-world actions.  The practice of daily affirmations also supports the concept of active learning, where students engage in processes that involve applying knowledge and reflecting on their experiences (Kolb, 1984). Affirmations helped nursing students reinforce a mindset that encouraged them to take initiative and apply their knowledge in practical settings.

With this experience, there was effective learning among the participants that influenced their day-to-day life activities.  The learning they obtained on positive affirmation also influenced their family members.

“Aside from studies man gud ms kay ako ni gi-apply sa amoa, like kung naay isugo akong mama, rather than sige siya yawyaw, kalmado na siya. Ako gani gitudluan ako mama pud unson na siya, hihihi.” (Aside from studies I was able to apply it at home, like if I am to do errand for my mother, rather than making a big deal out of it, I just remain calm.  I also taught my mother about this.) (Amelia, L7)

“It felt good Ms. Kay hasta akong mama karon bitaw kay mag-practice na pud siya ug positive affirmation especially kung wa siyay kwarta…hahahaa matinood man sab Ms. So para nako effective jud siya basta you feel it in your heart lang jud. Di ra man gud siya about sa school performance, it is my personal experience.” (It felt good, Miss, because even my mother now practices positive affirmation most especially when she lacks money.  It also becomes real, Miss.  So, for me it is effective as long as you feel it in your heart.) (Amelia, L9)

Additionally, the theme highlights the importance of mindfulness in applying learned knowledge. Practicing affirmations encouraged students to remain present and focused on the tasks at hand, which is essential when performing clinical procedures or interacting with patients. Mindfulness not only enhances the quality of care provided but also allows students to remain calm and collected in high-pressure situations.

“Sa panahon karon, nindot jud siya i-incorporate sa time sa class especially before mag start ang discussion. Bisan di kaayo ta makasabot sa lesson, at least di kaayo ta ma discourage ba.” (At times like this, it is good to incorporate in class especially before the start of a discussion. Even if we don’t understand the lesson fully, at least we will not be that discouraged.) (Rose, L13)

By affirming their ability to manage both personal and academic demands, students are better equipped to maintain healthy relationships and balance multiple responsibilities, which are key to their overall success. Positive affirmation thus contributes to both emotional well-being and academic achievement, creating a foundation for effective engagement.

DISCUSSION

The study delved into the lived experiences of student nurses, focusing on the multifaceted experiences that shape their journey with positive affirmation. Drawing on the core themes identified in the findings, these serves as the phases in which the participants were able to go thorough from the phase of Apprehending until the phase of Engaging.

Apprehension and uncertainty are common emotional responses experienced by student nurses as they navigate the challenges of their academic and clinical environments (López-González et al., 2023). The transition from theoretical knowledge to practical application can create feelings of doubt and confusion, often leading to self-questioning and anxiety (Santos et al., 2022). Recognizing and acknowledging these feelings is a critical first step in developing coping mechanisms. According to Carver and Connor-Smith (2010), acceptance and acknowledgment of uncertainty are essential for stress reduction, as it allows students to build resilience.  Positive affirmation is a psychological practice that involves consciously focusing on positive thoughts, beliefs, and self-statements. It is a form of cognitive restructuring aimed at challenging and replacing negative or self-limiting thoughts with more empowering ones (Mayo et al., 2022). In the context of student nurses, positive affirmation has significant implications for their emotional well-being, academic performance, and professional development. As explored through the emergent themes of your study—apprehending uncertainty, building a positive mindset, developing purposeful self-confidence, deepening motivation, and engaging in relationships and time management—positive affirmation can profoundly influence each aspect of their journey.

The transition from theoretical knowledge to practical application can create feelings of doubt and confusion, often leading to self-questioning and anxiety (Santos et al., 2022). According to Carver and Connor-Smith (2010), acceptance and acknowledgment of uncertainty are essential for stress reduction, as it allows students to build resilience. In the context of student nurses, admitting uncertainty can foster emotional growth and a more open approach to learning. Positive affirmation can help student nurses manage and mitigate the feelings of uncertainty that often accompany the transition into clinical practice and higher education. As students face new challenges and unfamiliar situations, affirmations such as “I am capable of learning and growing through this experience” can combat self-doubt and anxiety (Carver & Connor-Smith, 2010). By affirming their ability to handle challenges, students can shift their focus from fear to a more constructive mindset. Research by Lopez-González et al. (2023) highlights that positive self-affirmation promotes emotional regulation and resilience, helping individuals better cope with stress and uncertainty.

A growth mindset, as described by Dweck (2006), helps students embrace challenges as opportunities for growth rather than obstacles. Studies have shown that cultivating optimism and a sense of self-efficacy can reduce feelings of burnout and increase engagement in both academic and clinical learning environments (Johnson et al., 2021). Nursing students who maintain a positive outlook are more likely to persevere through difficult situations, as optimism acts as a buffer against the emotional toll of their studies (Tuckey et al., 2022).  Affirmations are directly linked to the cultivation of a positive mindset, especially in students who are working toward a challenging goal such as becoming a nurse. Studies have shown that engaging in positive self-talk can enhance students’ self-esteem and academic motivation (Dweck, 2006). Affirming one’s strengths and potential helps foster a growth mindset, which is critical for embracing learning opportunities rather than being discouraged by setbacks. For nursing students, affirmations like “I am growing each day, and every challenge is a chance to improve” can strengthen their outlook on both academic and clinical challenges.

For nursing students, confidence is built through competence in clinical skills, a solid understanding of nursing knowledge, and the ability to adapt to various clinical settings (Williams et al., 2020). As students’ progress through their education, they often encounter moments of self-doubt, which can challenge their confidence. However, self-confidence becomes purposeful when students understand the importance of their role in patient care and develop an intrinsic sense of value in their professional identity (Swanson et al., 2023). This purposeful confidence, according to Bandura’s social cognitive theory (1997), is rooted in mastery experiences, vicarious learning, and verbal persuasion, which collectively build a strong sense of self-efficacy.  Positive affirmation plays a crucial role in developing self-confidence, which is a key theme in nursing education. Nursing students often encounter moments of self-doubt, particularly in high-stakes clinical settings where they are responsible for patient care. By affirming their own abilities, such as saying “I trust my training, and I am prepared to handle this situation,” students can increase their self-efficacy and reduce anxiety (Bandura, 1997). Research has shown that positive self-affirmation significantly enhances nursing students’ self-confidence by promoting feelings of competence and worthiness (Swanson et al., 2023).

Intrinsic motivation is fueled by a sense of purpose, passion for patient care, and the internal satisfaction derived from helping others. When nursing students develop a more motivated sense of self, they tend to experience higher levels of academic engagement, professional identity formation, and overall well-being (Smith et al., 2021). This process of deepening motivation is also influenced by the support they receive from peers, faculty, and mentors (Tait et al., 2022).  As nursing students continue their education, their intrinsic motivation can be enhanced through the regular practice of positive affirmation. Affirmations help deepen the student’s sense of purpose and passion for nursing by reminding them of their intrinsic motivations, such as their desire to help others and make a positive impact on healthcare (Deci & Ryan, 2008). Statements like “I am dedicated to my patients and my learning, and every day brings new growth” encourage students to internalize their goals and aspirations.  Research by Smith et al. (2021) found that positive affirmation can enhance motivation by fostering a sense of personal competence and autonomy, which are key factors in increasing students’ engagement and persistence in their studies. Affirmations also help to reinforce nursing students’ sense of professional identity, which is vital for maintaining motivation over the long term.

Positive affirmation also influences the theme of “Engaging,” particularly in relation to building strong relationships and managing time effectively. In nursing education, the ability to collaborate with peers, faculty, and patients is essential. Affirmations such as “I value the relationships I am building with my peers and mentors” can help foster a sense of belonging and trust in these relationships (Miller et al., 2020). In addition, affirmations related to time management, like “I am in control of my time and can balance my responsibilities,” can reduce stress and improve academic performance by helping students prioritize and manage their workload (Jones et al., 2021).  According to Jones et al. (2021), time management is a learned skill that helps nursing students navigate the demands of their studies while maintaining their well-being. Furthermore, peer relationships provide opportunities for collaborative learning and mutual support, which can reduce feelings of isolation and enhance academic success (Miller et al., 2020).  By affirming their ability to manage both personal and academic demands, students are better equipped to maintain healthy relationships and balance multiple responsibilities, which are key to their overall success. Positive affirmation thus contributes to both emotional well-being and academic achievement, creating a foundation for effective engagement.

SUMMARY OF FINDINGS AND IMPLICATIONS

Summary of Findings

The theme of “Apprehending” reveals the common emotional responses experienced by student nurses as they navigate the challenges of their academic and clinical environments (López-González et al., 2023).  Recognizing and acknowledging these feelings is a critical first step in developing coping mechanisms.

The theme of “Becoming” reflects the development of a positive outlook, which is vital in combating stress and maintaining motivation in challenging nursing programs.  A positive mindset is central to nursing students’ personal and academic success.

The theme of “Conforming” highlights the process of developing self-confidence in a purposeful manner.  Self-confidence is crucial for student nurses as it directly impacts their academic and clinical performance.

This theme, “Deepening,” reflects a transformation from external motivation (e.g., grades or approval) to intrinsic motivation, which is essential for long-term success in nursing (Deci & Ryan, 2008).  As student nurses progress in their studies, they experience a deepening sense of motivation, which is key to sustaining their professional journey.

The theme of “Engaging” underscores the importance of interpersonal relationships and time management skills in the success of nursing students. Building strong relationships with peers, faculty, and patients can provide emotional and academic support, fostering a sense of belonging and collaboration. Effective time management is also crucial, as it enables students to balance their academic, clinical, and personal responsibilities.

Implications of the Study

The practice of positive affirmation plays a critical role in shaping the personal and academic development of student nurses. By promoting emotional resilience, enhancing self-confidence, fostering motivation, and supporting strong interpersonal relationships, affirmations empower students to navigate the demands of nursing education successfully. The impact of positive affirmation extends to all stages of their learning journey, making it a valuable tool for enhancing mental well-being and academic success. By incorporating positive affirmations into their daily routines, student nurses can build the confidence, motivation, and emotional resilience required to thrive in both their studies and professional practice.

Policy.  The findings of this study could influence policy at both institutional and healthcare system levels. For example, nursing schools may consider integrating daily positive reaffirmations into their institutional policies, promoting a supportive and positive learning environment. Policies that prioritize mental health and well-being can be shaped by evidence of the benefits of positive reinforcement, such as enhanced student resilience and decreased stress levels. Policymakers may also be encouraged to advocate for the inclusion of mental health initiatives as a fundamental part of nursing curricula. It is essential to recognize that fostering positive self-affirmation in nursing students could mitigate burnout and improve overall mental health, making a compelling case for supportive policies in academic settings.

Nursing Practice.  From a nursing practice perspective, this study highlights the importance of positive affirmation not only for student nurses but also for practitioners in clinical settings. Positive reinforcement can contribute to improved self-efficacy and emotional resilience in nurses, ultimately enhancing patient care. Nurses equipped with better emotional well-being are likely to exhibit more empathetic behaviors, thereby improving the quality of patient-nurse interactions. Implementing similar affirmations in daily practice could be beneficial in helping nurses navigate the emotional challenges of the profession, especially in high-pressure environments like hospitals and care units. Integrating these strategies could foster a more compassionate and well-rounded healthcare workforce.

Nursing Education.  This study’s implications for nursing education underscore the significance of incorporating positive affirmation techniques into teaching practices. Educators in nursing programs can use daily positive affirmations to enhance the learning experience and promote student confidence. Such practices are particularly beneficial in reducing anxiety, which can otherwise impair academic performance and clinical skills development. The findings suggest that nursing education should prioritize not only clinical competence but also the mental and emotional development of students, creating a more holistic approach to training future nurses. By fostering a culture of positive reinforcement, educational institutions can contribute to the well-being of students, increasing retention rates and graduation success.

Research.  For nursing research, this study provides a foundation for further investigation into the impact of positive affirmations on the academic and emotional development of nursing students. It opens avenues for exploring how different forms of positive feedback can influence not only academic performance but also long-term career satisfaction and retention in the nursing profession. Future studies can focus on comparing the effectiveness of various affirmation techniques across diverse educational settings and nursing specialties. Furthermore, research could extend beyond students to investigate how these interventions could be applied to practicing nurses dealing with high levels of stress and burnout.

Future Researchers.  For future researchers, this study highlights the need to explore further the role of emotional well-being in the education and practice of nurses. Research can be expanded to investigate the long-term effects of daily affirmations on career outcomes and professional well-being. Additionally, researchers can explore the intersection of positive reaffirmation with other factors such as mentorship, peer support, and institutional culture, to determine a more comprehensive approach to fostering a positive learning environment for nursing students. Future studies could also explore the impact of cultural differences on the reception and effectiveness of affirmations in diverse nursing student populations.

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