American Journal of Nursing Research
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American Journal of Nursing Research. 2019, 7(6), 1102-1115
DOI: 10.12691/ajnr-7-6-25
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Developing Strategies for Overcoming Challenges Facing Nursing's Clinical Teaching

Magda Atiya Gaber1, , Fatma Gouda Metwally1 and Azza Fathi Ibrahim2

1Nursing Administration Department, Faculty of Nursing, Zagazig University, Egypt

2Nursing Education Department, Faculty of Nursing, Alexandria University, Egypt

Pub. Date: October 29, 2019

Cite this paper:
Magda Atiya Gaber, Fatma Gouda Metwally and Azza Fathi Ibrahim. Developing Strategies for Overcoming Challenges Facing Nursing's Clinical Teaching. American Journal of Nursing Research. 2019; 7(6):1102-1115. doi: 10.12691/ajnr-7-6-25


Vocational students considered young workers who are usually injured at the worksite. Education and awareness are necessitated for them. Background: Clinical teaching is a very important mission of nursing education because the clinical experiences connect theory to practice. Where students who achieve good practice and safety technology in the available health facility and teaching atmosphere would establish nursing competencies through practicing partnerships [1]. Nursing education is the most viable study to continue the education process for practice [2]. Aim: This study aims to develop strategies to overcome the challenges facing nursing's clinical teaching. Method: Current investigation was conducted at Nursing faculty, Zagazig University on 3 studied groups: first; clinical instructors (77), second; faculty students (330) and third, jury (7). Tools: Three tools were utilized for data collection, including challenges assessment questionnaire and two experts' opinionnaires format. Results: The most frequent challenges facing nursing’s clinical teaching are: the clinical instructor was not concerned with the issues that students raised (92.2), the variance between faculty goals for students and clinical site goals (87), students didn't have the required clinical skills in the clinical setting (85.2), and, the clinical instructors enforce students for involvement in practice (82.1). Conclusion: The questionnaire of assessing nursing clinical teaching challenges is reliable, valid and usable. The strategies for overcoming nursing clinical teaching challenges was developed and validated.

clinical teaching challenges students instructors nursing education development strategies

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[1]  Weston, W (2017). Clinical Teaching Tips Resources for Royal College Specialists in Community Practices.
[2]  Derya, Y.A. and Pasinlioglu, T. The effect of nursing care based on comfort theory on women's postpartum comfort levels. Int J Nurs Knowl. 2017; 28: 138-144.
[3]  Kettle C, Dowswell T, Ismail KMK. Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database Syst Rev. 2018. p. CD000006.
[4]  Papastavrou E, Dimitriadou M, Tsangari H, Andreou, Ch. (2016). Nursing students’ satisfaction of the clinical learning environment: a research study. BMC Nurs, 15: 44.
[5]  Mutair AA. (2015). Clinical Nursing Teaching in Saudi Arabia Challenges and Suggested Solutions. J Nurs Care S1: 007.
[6]  Petersen, M.R. Review of interventions to relieve postpartum pain from perineal trauma. MCN Am J Matern Child Nurs. 2016; 36: 241-245.
[7]  Pinar, G., Dogan, N., Algier, L., Kaya, N., and Cakmak, F. Factors that affecting mothers' postnatal comfort. (Turkish)Dicle Med J. 2017; 36: 184-190.
[8]  Farzi S, Haghani F, Farzi S. (2016). The challenges of nursing procedures training from the perspective of nursing students: A qualitative study. Strides Dev Med Educ; 12: 645-52.
[9]  Hall, N. and Chichester, M. (2014). How to succeed as an adjunct clinical nurse instructor. Nursing for Women's Health, 18, 341-344.
[10]  Oliveira, S.M., Silva, F.M., Riesco, M.L., Latorre M do, R., and Nobre, M.R. Comparison of application times for ice packs used to relieve perineal pain after normal birth: a randomized clinical trial. J Clin Nurs. 2016; 21: 3382-3391.
[11]  Leventhal, L.C., de Oliveira, S.M., Nobre, M.R., and da Silva, F.M. Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial. J Midwifery Women's Health. 2017; 56: 141-146.
[12]  Yang, Ch and chao, Sh. (2018). Clinical nursing instructors’ perceived challenges in clinical Teaching. Japan Journal of Nursing Science, 15, 50-55.
[13]  Turan S, Nacar M, Akalın AA. (2015). Medical Trainer Handbook. Ed. Iskender Sayek. Ankara: Solar medicine bookstores.
[14]  O’Shea, & Whelan L. (2007). Online ‘Competency Assessment of Nursing Staff’ NCIB, 25(3), 198-202. Retrieved January 24, 2013 from
[15]  East, C.E., Begg, L., Henshall, N.E., Marchant, P., and Wallace, K. Local cooling for relieving pain from perineal trauma sustained during postpartum period. Cochrane Database Syst Rev. 2016; 5: CD006304.
[16]  Sezer, H (2018). How should clinical education be in nursing education?
[17]  Dağ, G; Kılıç, H; Görgülü, R. (2019). Difficulties in Clinical Nursing Education: Views of Nurse Instructors. International Archives of Nursing and Health Care Journal, Volume 5 | Issue 1 PP, 1-9.
[18]  Navvabi, S., Abedian, Z., and Steen-Greaves, M. Effectiveness of cooling gel pads and ice packs on perineal pain. Br J Midwifery. 2017; 17: 724-729.
[19]  Macarthur AJ, Macarthur C. Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. Am J Obstet Gynecol. 2016; 191: 1199-204.
[20]  Peters K, McInnes S, Halcomb E. (2015). Nursing students’ experiences of clinical placement in community settings: A qualitative study. Collegian 22(2): 175-181.
[21]  Farzi, S, Shahriari M, Farzi S (2018). Exploring the challenges of clinical education in nursing and strategies to improve it: A qualitative study Journal of Education and Health Promotion Volume 7 | September 2018.
[22]  Thompson JF, Roberts CL, Currie M, Ellwood DA. Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth. 2017; 29: 83-94.
[23]  Meysamie A., Taee F., Mohammadi-Vajari M., Yoosefi Khanghah S., Emamzadeh-Fard S., & Abbassi M. (2014). Sample size calculation on web, can we rely on the results? Journal of Medical Statistics and Informatics. ISSN 2053-7662. 2014,
[24]  Magnier, K; Wang, R; Dale, V; Pead, M (2014) Challenges and Responsibilities of Clinical Teachers in the Workplace: An Ethnographic Approach. Journal of Veterinary Medical Education 41(2): 1-7.
[25]  Jetha, F., Boschma, G. & Clauson, M. (2016). Professional development needs of novice nursing clinical teachers: A rapid assessment. International Journal of Nursing Education Scholarship, 13, 1-10.
[26]  Berman, S. L., Down, J., & Hill, C. W. (2015). Knowledge Scoring System. Academy of Management Journal, 45(1), 13-31.
[27]  Fuzen, H. K (2014): Applying maternal competency standards in real life situations: Some initial findings from Philippine. British Journal of School Nursing, 2, 74-85.
[28]  AlHaqwi, A and Taha, W (2015). Promoting excellence in teaching and learning in clinical education. Journal of Taibah University Medical Sciences. Volume 10, Issue 1, March 2015, Pages 97-101.
[29]  Shadadi, H; Sheyback, M; Balouchi, A; Shoorvazi, M. (2018). The barriers of clinical education in nursing: A systematic review. Biomedical Research; 29 (19): 3616-3623.
[30]  Melzack, R. The short-form McGill Pain Questionnaire. Pain, 30 (1987). 191-197. Elsevier Science Publishers B.V. (Biomedical Division).
[31]  Karakaplan, S. and Yildiz, H. A study on developing a postpartum comfort questionnaire. (Turkish) Maltepe Üniversitesi Hemşirelik Bilim ve Sanatı Dergisi. 2010; 3: 55-65.
[32]  Salehabadi S, Akbarzadeh M, Nasrollahi S, Golafrozshahri M, Mircholi N. (2015). Clinical education problems and ways of enhancing its quality from the perspective of clinical instructors and students of nursing and midwifery at Sabzevar university medical sciences in 2008. J Sabzevar Uni Med Sci; 20: 539-546.
[33]  Gholami H, Ahmadi chenari H, Chamanzari H, Shakeri M. (2015). Amendable barriers in Clinical education from Viewpoints of students and clinical instructors at faculty of nursing and midwifery of Mashhad. J TorbatHeydariyehUniv Med Sci; 3: 34-39.
[34]  American Nurses Association. Translation Supervisor Kamiizumi K. Nursing: Scope & Standards of Competency Intervention. International Nursing Review. 2016; 29: 12-20. Wan, Postpartum urinary retention: A systematic review of adverse effects and management. IntUrogynecol J. 2016.
[35]  Cheng, C. Y., Tasi, H. M., Chang, C. H., & Liou, S.R. (2018). “Clinical competence, clinical stress, and intention to leave: A longitudinal study in Taiwan, The Scientific World Journal, 3, 122-135.
[36]  Jahromi ZB. (2016). A study of the barriers and facilitators of patient education from the viewpoint of nursing students at Jahromcollege of nursing. Bangladesh J Med Sci; 15: 471-476.
[37]  Asirifi, M; Ogilvie, L; Barton, S; Aniteye, P; Stobart, K; Bilash, O; Eliason, C; Ansong, G; Aziato, L & Kwashie, A. (2017). Assessing challenges of clinical education in a baccalaureate nursing program in Ghana. Journal of Nursing Education and Practice, Vol. 7, No. 10.
[38]  Sherwood, G. & Barnsteiner, J. (2018). Quality and Safety in Nursing: A Competency Approach to Improving Postpartum Nursing Performance. New York: Springer.
[39]  Elshafie, S. S. (2018). Effect of the educational competency program on the level of nurses’ knowledge regarding postpartum perineal pain: a call for educational intervention. Advanced in Medical Education and Practice, 7, 505-510.
[40]  Jamshidi N, Molazem Z, Sharif F, Torabizadeh C, Najafi KM. (2016). The challenges of nursing students in the clinical learning environment: A qualitative study. The Scientific World Journal. Volume 2016, Article ID 1846178, 1-7.
[41]  Dehghani M, Ghanavati S, Soltani B, Aghakhani N, Haghpanah S. (2014). Impact of clinical supervision on field training of nursing students at Urmia University of medical sciences. J Adv Med Educ Prof; 4: 88-92.
[42]  Bifftu, B. B. Dachew, B. A. Tiruneh, B. T. Kelkay, M. M. & Bayu, N. H. (2018): Perceived clinical competence among undergraduate nursing students in the University of Gondar and Bahir Dar University. Northwest Ethiopia: A Cross-Sectional Institution Based Study, Advances in Nursing, 1, 23-36.
[43]  Navvabi, S., Abedian, Z., and Greaves M., (2016). Effectiveness of cooling gel pads and ice packs on perineal pain, British Journal of Midwifery, 17(11): 724-729.
[44]  Rezaei Nik B, Rassuli M, Vaskooi Eshkvari K, Alavi Majd H, Torabi F. (2017). Evaluating the obstacles and facilitators of clinical nurses cooperation in clinical education of nursing students. J Nurs Edu; 6: 56-64.
[45]  Moghimi M, Mohammad Hossini S, Karimi Z, Moghimi M, Naimi E, Mohammadi S. (2014). Obstacles of clinical education and strategies for the improvement of quality of education in Yasuj university of medical sciences. J Res Develop Nurs Midwifery; 11: 95-101.
[46]  Ahmed A. and Mahmed S, (2015). Routine episiotomy for vaginal birth: effectiveness of cold application therapy on episiotomy pain and wound healing. E-ISSN: 2320-1959.p- ISSN: 2320-1940 Volume 4, Issue 5 Ver. I (Sep. - Oct. 2015), PP 70-77
[47]  Petersen, M.R. Review of interventions to relieve postpartum pain from perineal trauma. MCN Am J Matern Child Nurs. 2018; 36: 241-245.
[48]  Pardue KT, Morgan P. (2008). Millennials considered: a new generation, new approaches, and implications for nursing education. NursEducPerspect; 29(2): 74-79.
[49]  Bvumbwe, T (2016) Enhancing nursing education via academic clinical partnership: An integrative review. International journal of nursing sciences, 3, 314-322.
[50]  Derya, Y.A. and Pasinlioglu, T. The effect of nursing care based on comfort theory on women's postpartum comfort levels after vaginal delivery. Int J Nurs Knowl. 2017; 28: 138-144.
[51]  Oliveira, S.M.J.V., Silva, F.M.B., Riesco, M.L.G., Do Latorre, M.R., and Nobre, M.R.C. Pain management. Comparison of application times for ice packs used to relieve perineal pain after normal birth: a randomized clinical trial. J Clin Nurs. 2019; 21: 3382-3391.
[52]  Thomas, L; Asselin, M(2018) Promoting resilience among nursing students in clinical education. Nurse Education in Practice 28.
[53]  Foronda, C. L., Baptiste, D., Pfaff, T., Velez, R., Reinholdt, M. M., Sanchez, M., & Hudson, K. W. (2018). Cultural Competency and Cultural Humility in Simulation-Based Education: An Integrative Review. Clinical Simulation in Nursing, 15, 42-60.
[54]  Shirvani MA, Ganji Z. The influence of cold pack on perineal pain relief: a randomised controlled trial. J Clin Nurs. 2018; 23 (17-18): 2473-9.
[55]  Leventhal LC, de Oliveira SMJV, Nobre MRC, da Silva FMB. Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial. J Midwifery Womens Health [Internet]. 2018 [cited 2016 Oct 18]; 56(2): 141-6.
[56]  Mackey A, Bassendowski, S. (2017). The History of Evidence-Based Practice in Nursing Education and Practice. J Prof Nurs. 33(1): 51-55.
[57]  Gaber, M. (2011). Development of Clinical Teaching Skills Standards. Journal of American Science; 7(11).
[58]  Irby DM, Bowen JL. (2004). Time efficient strategies for learning and performance. The Clinical Teacher. 2004; 1(1): 23-28.
[59]  Cambridge Dictionary 2013. Available at:
[60]  Eta, V; Atanga, M; Atashili, J; D’Cruz, G. (2011). Nurses and challenges faced as clinical educators: a survey of a group of nurses in Cameroon. Pan African medical journal, Research, Volume 8, Number 28, 2011.
[61]  Joolaee, S. Jafarian S. R. Amiri, M. A. Farahani, and varaei S. (2015). Iranian nursing students' preparedness for clinical training: A qualitative study. Nurse Education Today, vol. 35, no. 10, pp. e13-e17, 2015.
[62]  Jahanpour F, Zarei A, Ravanipour M, Razazan N, Hoseini S. (2014). Nursing students views on problems in clinical education in the pediatric ward in Bushehr University of Medical Sciences. J Nurs Edu; 2: 72-79.
[63]  Gaberson, K; Oermann, M; Shellenbarger, T. (2015). Clinical Teaching Strategies in Nursing. Fourth edition, New York, Springer Publishing Company, LLC.ISBN 978-0-8261-1961-2—ISBN 978-0-8261-1962-9 (e-book).
[64]  Heidari MR, Norouzadeh R. (2015). Nursing students perspectives on clinical education. J Adv Med Educ Professional 2015; 3: 39-43.
[65]  Melrose, SH; Park, C; Perry,B (2015) CREATIVE CLINICAL TEACHING IN THE HEALTH PROFESSIONS , ch 3 PP 12-88 Retrieved from
[66]  Jasemi M, Whitehead B, Habibzadeh H, Zabihi RE, Rezaie SA (2018) Challenges in the clinical education of the nursing profession in Iran: A qualitative study. Nurse Educ Today 67: 21-26.
[67]  Johanpour F, Azodi P, Azodi F, Khansir AA. (2016). Barriers to practical learning in the field: A qualitative study of Iranian nursing students’ experiences. Nurs Midwifery Stud 5: 1-3.
[68]  Gardner S.S. (2014). From learning to teach to teaching effectiveness: Nurse educators describe their experiences. Nurs Educ Perspect 35: 106-111
[69]  Van Graan AC, Williams MJ, Koen MP. (2016). Professional nurses’ understanding of clinical judgement: A contextual inquiry. Health SA Gesondheid 21: 280-293
[70]  Kim EK, Shin S. (2017). Teaching efficacy of nurses in clinical practice education: A cross-sectional study. Nurse Educ Today 54: 64-68.
[71]  Jokar F, Haghani F. (2011). Nursing clinical education, the challenges facing: A Review Article. Iran J Med Educ 10: 1153-1160.
[72]  Xu Jie-hui. (2016). Toolbox of teaching strategies in nurse education. Chinese Nursing Research 3: 54-57.