Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr Vicki Schwean

2nd Supervisor

Dr Pam Bishop

Joint Supervisor


The purpose of this study was to examine the affective component of learner engagement (Linnenbrink & Printrich, 2003); more specifically students’ perceptions of learner anxiety and self-efficacy for professional practice in clinical nursing education. This study identified the factors in clinical learning contexts that contribute to learner anxiety, the differences among these factors in real and simulated learning contexts, and finally, the teaching and learning strategies that minimize learner anxiety and positively enhance self-efficacy for professional nursing practice. A convenience sample of 186 students from three university nursing programs in Ontarioparticipated in a two-phased mixed methods study, reflecting a response rate of 72%. In phase one, participants were asked to respond to four self-report instruments: the State-Trait Anxiety Inventory (STAI) (Spielberger, 1983), the Factors Contributing to Anxiety in Clinical Learning (Pierazzo, 2013), the Teaching and Learning Strategies that Enhance Professional Practice Self-Efficacy in Clinical Learning (Pierazzo, 2013) and a demographic questionnaire requesting gender and age. In phase two, a total of 31 participants participated in one of three focus groups.

The results of the study confirm that nursing students do experience feelings of anxiety during clinical learning in both real and simulated contexts, although their state and trait anxiety is similar to the average college student. The participants identified specific factors that contribute to feelings of learner anxiety in both real and simulated learning contexts. Findings reveal that in both contexts, nursing students perceive preparation for patient care as the first subscale of factors most likely to contribute to perceptions of anxiety. Following this, patient acuity in real contexts and learning processes in simulated contexts was the second subscale of factors. In terms of single factor ranking, three of the top five factors for both contexts were the same: feeling unsure about my ability; making a mistake in patient care; and being watched by others as I provide care. Making a mistake while caring for patients was the factor contributing most to anxiety in real clinical contexts, whereas being watched by others contributed most to anxiety in simulated contexts.

In terms of themes describing teaching and learning strategies to enhance professional practice self-efficacy in situations of anxiety, there were both similar and unique differences between the two learning contexts. The teaching strategy identified by students as contributing to their self-efficacy in both contexts was the teachers’ interaction with the student, specifically positive encouragement, constructive feedback and challenges critical thinking. Distinct differences in teaching strategies for both contexts were related to specific elements of the learning process within each context. Learner strategies on the other-hand revealed similar themes in both learning contexts, although being self-directed and looking for new learning opportunities seemed to be more prevalent in real clinical contexts. The findings in this study have implications for nursing educators by contributing to a better understanding of affective learner engagement in clinical education and ensuring safe patient care during the learning process.