Abstract

Background: Nursing programs successfully combine theoretical knowledge, real-world

application, and student attitudes. Students are gradually introduced to real-world patient care
through a step-by-step approach in clinical settings. To what extent a student meets learning
objectives depends on how they handle this real-world experience. Good dispositions like joy
and confidence encourage involvement, accelerate the development of therapeutic skills, and
improve the rapport between the patient and the provider. But fear of failing could also make it
hard to pick up practical knowledge and skills, which would eventually result in a worse quality
of care. A supportive clinical teacher, well-designed clinical facilities, and clear expectations all
have a big influence on how students see their experiences.

Methods: The research is cross-sectional and descriptive in nature, and its participants are
nursing students seeking a Bachelor of Science degree in Nursing degree at any of Faisalabad's
approved institutes. A maximum of 24 students had been dropped from the study because their
information was insufficient out of 240 total participants. A modified questionnaire with yes/no
options was utilized to acquire data after validity and reliability testing.
Results: This study explored the experiences of 216 nursing students through a survey. While a
strong foundation in theoretical knowledge was evident (86.1%), and a majority expressed
dedication to patient care (over 50%), the survey revealed opportunities for improvement. Many
students reported anxieties (73.6%) and a sense of under preparedness (64.6%) for clinical
duties. However, the majority still found clinical experiences enjoyable (80.6%) and valued the
chance to apply theoretical knowledge in practice (55.6%). Notably, a significant portion
successfully transferred these skills to real-world settings beyond the clinical environment
(44.4%). It is clear from the results that there is a pressing need to connect academic
understanding with real-world application. (only 38.9% felt a direct connection). Additionally,
ensuring optimal clinical placements (52.8% reported non-ideal hospitals) and addressing student
anxieties are crucial. By fostering student confidence and cultivating a supportive clinical
environment, nursing programs can empower students to achieve successful learning outcomes.

Conclusion: This study explored the experiences of nursing students. While students possessed a
strong foundation in theoretical knowledge and expressed commitment to patient care, the survey
revealed opportunities to enhance clinical preparedness. Students reported anxieties and a sense
of under preparedness for clinical duties. These findings highlight the importance of aligning
theoretical education with practical application and fostering a supportive clinical environment to
empower student learning and successful patient care.

Keywords: Clinical responsibilities, students of nursing, understanding of theory and practice,

attitude, and hands-on experience.
 CHAPTER # 1
INTRODUCTION
1.1 Background:
Clinical duties are seen as a crucial and fundamental component of the nursing curriculum.
Over the past twenty years, nursing education has placed a strong emphasis on the clinical
learning environment in order to produce nurses who are capable, quick to make decisions, and
reasonable in their decision-making. Clinical responsibilities for a nursing student usually
involve patient observation, medication administration, basic care, and procedural assistance.
Over half of the official nursing education in Pakistan and other countries comes from clinical
education. The best way for student nurses to use what they have learnt at the institution is to
provide them the opportunity to perform clinical activities in a range of clinical settings (Atack et
al., 2022).
Nursing students' attitudes regarding clinical work are centered on how they will accomplish
their clinical goals and put their theoretical knowledge into practice. The clinical setting, the
relationship between the institute and hospital, and staff-student interactions may all have an
impact on how nursing students feel about their clinical responsibilities. In order for people to
successfully comprehend complex information, be aware of the repercussions of their actions,
and work toward their goals, attitude is crucial. Indifference to one's work could lead to a decline
in productivity (Jamal & Rafeeque., 2022).
Nursing students' knowledge of clinical responsibilities is centered on how to accomplish
goals and put what they have learned into practice. A certified nursing instructor or an
experienced teacher with a focus on clinical expertise can impart knowledge, which forms the
basis of the practice-based nursing profession. In Pakistan, the field of nursing education is
expanding and getting better. All of the nursing knowledge that is taught to students must be
grounded in real-world practice. At the commencement of the nursing degree, students engage in
theoretical courses before being progressively exposed to the practical environment. Student
teacher interactions, lack of engagement, lack of staff expertise, and the clinical setting can all
have an impact on students' knowledge (Sultan A & Khan S., 2022).
Nursing students practice improving their clinical skills and managing patients' health as
their primary goals when performing clinical activities. Because it allows students to experience
their future occupations in practice while applying their theoretical knowledge in the real world,
nursing practice is an essential component of nursing education. Everything that is related to
nursing work, such as the clinical setting, the personnel, and the patients, is included in the
clinical practice environment. It has been demonstrated that clinical practice directly affects how
nursing students view their field and helps with professional grounding. In the clinical practice,
student nurses work directly with actual patients in actual situations in clinical settings, applying
what they learn in the classroom to their job (Dunn & Hansford., 2020).
The World Health Organization (WHO) suggests that students have access to a variety of
resources for clinical education, such as textbooks, guides, manuals, reading materials,
computers, portable video recorders, brochures, and standard guidelines for nursing. In order to
improve nursing care and clinical education, it is necessary to standardize nursing practices and
equip clinical teachers with a curriculum framework (World Health Organization., 2020).
Many nations throughout the world refer to nursing as a practice-based profession. Clinical
teaching and learning are important components of preregistration nursing education programs in
the United States, Australia, New Zealand, and European countries such as Finland and the
United Kingdom (UK). Clinical learning has significantly enhanced the practices of healthcare
professionals and student nurses in these countries, resulting in better care delivery. In the
clinical context, student nurses can engage with actual patients and situations while under the
supervision of a professional nurse, using what they have learned in the learning environment
(Pasila & Kaariainen., 2017).
Clinical duties are the most stressful components of the nursing program for students,
especially in the early stages when they lack experience and expertise. In clinical practice, the
relationship between nursing staff and student nurses is crucial. A crucial component of student
nurses' education and socialization is their collegial interactions with the staff. The student
nurse's accompanist should devise plans to foster a culture of trust and compassion. The clinical
education of student nurses is improved in such a setting. In order to deliver high-quality nursing
care, student nurses should be assisted in confronting and conquering their anger and fear. In
order for student nurses to recognize and manage conflicts related to patient care, they need also
get support (Porter & Willing., 2021).
Nurses' job expectations and the way they treat and interact with their clients may be influenced
by their views and understanding of aging. Because of the aging population, associated chronic
diseases, declining physical functioning, and increased reliance, there will be an increased
demand for nurses with the proper mindset, information, and competence (Oyetunde et al.,
2018).
A clinical context allows for a meaningful link between theory and practice in education.
Nursing education is built on three learning domains: understanding, perspective, and
experience. According to study, nursing students are more interested in clinical work since it enhances
clinical learning regardless of the attitude positive or negative (Mugoh & Kamau., 2020).
In the context of nursing education programs in Faisalabad, Pakistan, this study intends to
investigate the linkages that exist between these three essential domains of student learning. We
can learn a great deal about how to improve nursing education and clinical training programs by
determining the factors that affect these variables. The ultimate goal of this research is to help
build a more competent and self-assured nursing workforce that is ready to provide patients with
superior care.
1.2 Problem statement
The success of nursing students' transition from the classroom to the clinical setting depends
heavily on their ability to acquire positive attitudes, strong core knowledge, and competent
clinical abilities. However, the complex interconnections among these elements have not
received much attention. Long-term negative patient care, negative student attitudes, and a
decreased motivation to learn in a clinical setting could all be consequences of this
misunderstanding. Investigating the relationships between nursing students' viewpoints,
understanding, and performance of clinical tasks is the aim of this study. Finding the factors that
influence these qualities will be useful in enhancing nursing education and clinical training
programs and, ultimately, creating a more capable and prepared nursing workforce.
1.3 Significance of the study
The research findings have important practical implications for nursing education and
healthcare institutions by identifying the elements that influence these attributes. The
implementation of interactive learning activities, the cultivation of role models, or the resolution
of student concerns regarding clinical practice may be necessary to achieve this. The research
results can direct the creation of more efficient teaching strategies that encourage greater
retention of the material and close the knowledge gap between theory and clinical practice. Case
studies with real-world scenarios, technology-driven learning tools, and simulation exercises
could all be a part of this. Developing a more encouraging learning environment can be aided by
knowledge of the elements impacting student motivation. This could entail establishing
mentorship programs with seasoned nurses, encouraging peer cooperation possibilities, and
cultivating open communication with professors. The results of the study can guide the creation
of clinical training programs that give students regulated chances to put their academic
understanding to use in authentic environments. This could entail patient engagement
experiences, skill laboratories that replicate real-world clinical environments. Training programs
that enable a seamless transfer into the healthcare team can be developed with guidance from an
understanding of the aspects that influence student integration. This could be establishing a
supportive and transparent culture within the clinical setting, giving mentorship opportunities
with seasoned nurses, or encouraging collaborative learning experiences with other healthcare
professionals.
1.4 Objectives of the study:
The objective of this study is:
To investigate undergraduate nursing students' attitudes, practices, and understanding
regarding clinical rotations.
1.5 Hypothesis:

I. Null Hypothesis (Ho):

Clinical duties cannot be attained by knowledge of undergraduate nursing students.

II. Alternative Hypothesis (HA/H1):

Undergraduate nursing students' attitudes and behaviors may lead to clinical duties.
 CHAPTER # 2
LITERATURE REVIEW

2.1 Search Strategies:

The literature review focus on suppressing, evaluating, synthesizing & summarizing

information to assess the relevance of examined literature efficiently. The data base searched
include Google scholar, PubMed and Science Direct. Following key term used to initiate the
search: Attitude, knowledge and practice of nursing students towards clinical duties. Thirty five
article is searched on 25 article is relevant with my study.

This review analyzes a cross-sectional descriptive study conducted by Jamal & Rafeeque (2022)
that investigated the attitudes of undergraduate nursing students at an institute of nursing sciences in
Khyber Pakhtunkhwa, Pakistan, towards clinical duties. Data collection involved 309 participants
enrolled in the four-year BSN program. Selection was performed using a random sampling technique. A
modified questionnaire with two sections was employed. Demographic information (gender, age, year of
study, marital status) was collected in the first section. The second section assessed attitudes through a
25-question yes/no format. A sample size of 309 was calculated using the Open-Epi calculator. This
ensured a 95% confidence interval and a 5% margin of error. The researchers assumed a 50% prevalence
of positive attitudes towards clinical duties among nursing students in Khyber Pakhtunkhwa, aligning
with the study's quantitative descriptive design. The findings revealed a generally positive trend. Positive
attitudes were exhibited by 89% of first-year students (11% negative), 84% of second-year students (16%
negative), 81% of third-year students (19% negative), and 83% of fourth-year students (17% negative).
Overall, positive behaviors were observed in 81% of participants (mean: 257.42, standard deviation:
48.91). Conversely, negative behaviors were observed in 19% of participants (mean: 52, standard
deviation: 48.91). The study suggests a positive inclination towards clinical duties among nursing
students. However, a significant portion (around 15-20%) expressed negative attitudes towards potential
changes within the clinical setting. This finding highlights the need for adjustments to be made in clinical
settings to better support student development. Improved interactions with students in these areas could
be fostered, potentially leading to enhanced skill development and equipping them with the confidence
needed to interact with patients (Jamal, H., & Rafeeque, S., 2022).
 This review examines a 2022 cross-sectional study by Ahmad & Sultan that assessed
clinical practice competency and associated factors among graduating Bachelor of Science (BSc)
nursing students in universities located within the Amhara region of Northern Ethiopia. The
study adopted an institutional-based design. A random sample of 307 graduating BSc nursing
students from universities across the Amhara Region participated in the study. Data collection
employed a pre-tested, structured, self-administered questionnaire completed independently by
the participants. Epi Data version 4.2 facilitated data entry, with subsequent export to SPSS
version 24 for statistical analysis. Descriptive statistics, including frequency, percentage, and
standard deviation, were calculated to summarize the data. A binary logistic regression model
was then implemented to identify factors associated with clinical competency. The study's
central finding revealed that a significant proportion, exceeding half, of the graduating nursing
students demonstrated clinical incompetence. This highlights a critical need for targeted
interventions aimed at improving the clinical competency levels of graduating BSc nursing
students in the Amhara region (Bibi et al., 2022).

This review examines a 2022 cross-sectional study by Yezengaw & Animen that
investigated perceived clinical practice competency and associated factors among undergraduate
medical and health science students at Dilla University, Ethiopia. The study employed an
institutional-based design. A random sample of 267 students participated in the research. Data
collection utilized a pre-tested, structured, self-administered questionnaire comprised of three
sections: demographics, a clinical competency checklist, and factors impacting clinical practice
competency. STATA version 12 software facilitated data analysis, generating descriptive
statistics (percentages, frequencies, and mean distributions) to summarize student characteristics.
Bivariate and multivariate logistic regression analyses were conducted to explore the
relationships between independent and dependent variables. Variables with a p-value less than
0.25 in the bivariate analysis were considered candidates for the multivariable analysis, where a
p-value less than 0.05 indicated statistically significant predictors. The study revealed that a
majority of participants (73.8%) were male, with over half (69.7%) falling within the 20-24 year
age range. Notably, only 39.3% (95% CI: 33.3, 44.9) of the students perceived themselves as
clinically competent, signifying that more than half perceived a lack of competence. This finding
highlights a potential need for targeted interventions to enhance students' perceived clinical
competency. The study emphasizes the importance of the learning environment in fostering
clinical competence. It underscores the need for actions to improve interactions between staff
and students, fostering a more supportive and developmentally focused learning environment
(Yezengaw et al., 2022).

This review examines a 2020 cross-sectional study by Mugoh & Kamau that explored the
perceptions and practices of Bachelor of Science in Nursing (BScN) students regarding clinical
duties at Mathare Teaching and Referral Hospital in Kenya. The study employed a stratified
sampling technique to select a sample of 54 students currently enrolled in clinical placements at
the hospital. The strata were formed by the five different learning institutions the students
originated from. Data collection utilized self-administered, structured questionnaires with
established quality control measures, including pre-testing, validity, and reliability checks. SPSS
Version 20 software facilitated data coding, entry, and analysis. Descriptive statistics, including
frequencies and percentages, were used to summarize the findings. The study revealed that a
majority of participants (64.4%) held a favorable attitude towards clinical duties. Conversely,
35.6% expressed negative attitudes. Notably, a significant proportion (64.8%) reported pursuing
nursing as a personal choice, viewing it as a calling. This finding contrasts with the 18.5% who
followed their parents' wishes and the combined 25.9% and 9.3% who indicated a potential shift
in career path or uncertainty about their interest in nursing, given the opportunity. The study
suggests a need for adjustments within clinical settings to better support student development.
Improved interaction with students in these areas could be instrumental in fostering skill
development and equipping them with the confidence needed to effectively interact with patients
(Mugoh, E. K. N., & Kamau, M. W. N., 2020).

This review examines a 2019 cross-sectional study by Aragaw, Sinishaw, & Mekie that
investigated the attitudes, knowledge, and practices of undergraduate nursing students towards
clinical duties at the University of Gondar in Northwest Ethiopia. A random sampling technique
was employed to select 345 participants enrolled in the four-year BSc Nursing program who met
the inclusion criteria. Data collection utilized a self-administered questionnaire, adapted from
previous literature and translated into English for clarity. Participants were oriented to the
questionnaire before completion. Epi Data version 3.1 facilitated data entry, and SPSS version 20
was used for analysis, employing descriptive statistics (mean and standard deviation) to
summarize the data. Bi-variable and multivariable logistic regression analyses were conducted to
identify the significance, strength, and direction of associations at a 95% confidence interval.
The study revealed that 42.9% of participants exhibited a favorable attitude towards clinical
practice, while 57.1% displayed an unfavorable attitude. Furthermore, 60.9% demonstrated
inadequate knowledge regarding clinical education, potentially impacting their ability to perform
well in clinical settings. Based on these findings, the study underscores a critical need for
interventions to enhance both the knowledge and practice skills of nursing students with respect
to clinical duties (Aragaw et al., 2019).

This review examines a 2019 cross-sectional descriptive study by Devi & Scori that
investigated the knowledge and attitudes of nursing students towards the nursing profession at
Manipal College of Medical Sciences (Nursing Programme) in Pokhara, Nepal. The study
employed a survey design, involving 183 nursing students enrolled in the program. Data
collection utilized a modified, two-part questionnaire assessing both knowledge and attitudes.
SPSS version 20 software facilitated data analysis, with descriptive statistics (frequencies and
percentages) employed to summarize the findings. The study's key findings centered on student
attitudes towards various aspects of the nursing profession. Notably, a significant majority of
participants (over 92.9%) disagreed with statements suggesting that nursing is an easy profession
requiring no specific skills or that nurses simply follow physician orders without independent
judgment. Additionally, over 55.7% expressed a positive attitude regarding nurses' autonomy in
decision-making. Interestingly, while a large proportion (97.3%) rejected the notion that nursing
solely involves administering injections and basic patient care, a substantial number (68.3%)
held a negative view on the career advancement opportunities within the profession. Overall, the
study revealed that while the majority of students (91.8%) demonstrated a fair level of
knowledge about the nursing profession, a small percentage (2.2%) exhibited poor knowledge
(Devi & Scori, 2019).

This review examines a 2018 descriptive-correlational study by Hatamleh & Sorio that
investigated knowledge, attitudes, and intentions towards nursing among pre-clinical nursing
students in Riyadh, Saudi Arabia. The study involved a convenience sample of 128 male and
female students enrolled in the fourth year of a BScN program at a government nursing college.
Data collection utilized three questionnaires: one for sociodemographic information, another
assessing knowledge, and a third measuring attitude and intention. SPSS version 20 software
facilitated data analysis. Sociodemographic data were analyzed using descriptive statistics
(mean, frequency, percentages, and standard deviations). Bivariate statistical tests (chi-square)
explored correlations between intention and knowledge, attitude and intention, and intention and
perceived reasons for discouragement from pursuing nursing. A significance level of p < 0.05
was set. The study revealed that while 60% of participants demonstrated a baseline level of
knowledge and 77% displayed positive attitudes towards nursing, a significant portion (around
60%) expressed a lack of interest in pursuing the profession. Additionally, over half (slightly
more than 50%) indicated a lack of encouragement from their families regarding a nursing
career. Concerns about working with the opposite sex and a perceived lack of respect for the
nursing profession were reported as the most prominent factors deterring students from pursuing
nursing careers (Hatamleh & Sorio, 2018).

This review examines a 2018 cross-sectional descriptive study by Teferra & Mengistu that
investigated the knowledge and attitudes of Ethiopian nurse educators in Addis Ababa towards nursing
clinical preceptorship. A random sampling technique was employed to select 384 nurse educators who
met the inclusion criteria. Data collection utilized a semi-structured questionnaire developed in English to
align with the study objectives. The questionnaire comprised three sections: demographics (gender, work
experience, educational status), knowledge assessment of clinical preceptorship, and attitude assessment
towards clinical preceptorship. SPSS version 20 software facilitated data analysis. Bivariate and
multivariate regression analyses were conducted to explore statistical associations between variables,
using odds ratios and a 95% confidence interval with a p-value of less than 0.05 to determine
significance. The study revealed that while 90 (82.6%) of the 109 respondents claimed familiarity with
the concept of clinical preceptorship, only 47 (43.1%) demonstrated adequate knowledge on the subject.
However, regarding attitudes, a positive trend emerged, with 96.3% of respondents classified as having a
favorable attitude towards clinical preceptorship. The study suggests a need for institutions to focus on
implementing a comprehensive clinical preceptorship approach. This could involve fostering a deeper
understanding of the concept among nurse educators, potentially by positioning clinical preceptorship as a
core component of student clinical learning. Enhancing awareness and knowledge could be a crucial first
step (Teferra & Mengistu, 2018).

While a significant body of research explores nursing students' attitudes towards clinical
duties (Jamal & Rafeeque, 2022; Mugoh & Kamau, 2020), knowledge acquisition (Aragaw &
Sinishaw, 2019; Devi & Scori, 2019), and clinical practice competency (Ahmad & Sultan, 2022;
Yezengaw et al., 2022), a critical gap exists in understanding the interrelationships between these
factors. Existing studies primarily investigate these aspects in isolation, hindering our
comprehension of how they influence each other.
 CHAPTER # 03
METHODOLOGY
3.1 Study design:
Cross sectional descriptive study design will be used to get information on Attitude,
Knowledge and Practice of Under-graduate Nursing Students towards Clinical Duties.
3.2 Study Variable:
 Dependent variables:
Nursing student knowledge regarding the clinical duties was dependent variable.
 Independent variables:
Nursing student attitude and practice regarding the clinical were independent variable.
3.3 Operational Definitions:
1. Attitude
Definition: Attitude is conceptualized as a student's relatively stable evaluation of clinical duties.
It encompasses a constellation of beliefs, ideas, and perceptions that influence the student's
response (positive or negative) towards these tasks.
Measurement: The Nursing Attitude Scale (NAS) developed by Coban & Kasikci (2011) will
be employed to assess student attitudes. This psychometrically robust scale utilizes a Likert-type
response format, with items ranging from 1 ("Strongly Disagree") to 3 ("Strongly Agree").
Higher scores will indicate a more positive attitude towards clinical duties.
2. Knowledge
Definition: Knowledge is operationalized as a student's comprehension of theoretical
information and practical skills relevant to clinical practice. This encompasses the ability to
translate theoretical understanding into competent performance within a clinical setting.
Measurement: A standardized, multiple-choice examination specifically designed to assess
knowledge of key clinical procedures, protocols, and fundamental physiological concepts will be
utilized. This format allows for objective scoring (correct = 1, incorrect = 0). The total score will
represent the student's overall level of knowledge.
3. Practice
Definition: Practice is operationalized as the observable behaviors and demonstrated capabilities
of a student while performing clinical tasks. It encompasses the application of both knowledge
and skills in a real-world clinical setting.
Measurement: A validated observational tool developed by Gerber et al. (1990) will be
employed by qualified clinical instructors to assess student performance during clinical
assignments. The tool will utilize a pre-defined scoring system based on specific criteria,
generating a numerical score that reflects the student's competence in performing the assigned
tasks.
3.4 Study setting:
Data were collected from the Participants from several Faisalabad nursing colleges who
are engaged in a 4-year BSN program.
3.5 Study population:
Students enrolled in 4-year BSN Programme at different college of nursing in Faisalabad.
3.6 Sampling technique:

Convenience sampling was used in this study.

3.7 Sample Size:
 Sample size as calculated by formula.
 Sample size was 216 as determined by using solving formula.

2∗¿ P ( 1−P )
N∗z
n= 2
P (1− P)
¿
E 2∗¿(N−1)+z ¿
 N=population
 n=sample size
 E=Margin of error 0.5% (If we take confidence interval 95%)
 P=Proportion of the population
 Z=Z score
2∗¿0.5 ( 1−0.5 )
2300∗1.96
 n= 2 ¿
0.052∗¿(2300−1)+1.96 0.5 (1−0.5) ¿

2208.92
n= =215.3013
6.7079
 n=216
3.8 Study Duration:

After approval of the synopsis study duration was 6 month November 2023 to April 2024
3.9 Inclusion criteria:
 Student Nurses
 Enrolled in BSN Generic (1st to 4th year student)
 Age limitation:18 to 25 years
 Voluntary participate and give consent
3.10 Exclusion criteria:
 Staff Nurses
 Excluded the other nursing student who’s not registered in BSN Generic.
 Age limitation: more than 25 years
3.11 Research tool:
 Demographic information
 Nursing Attitude Scale (NAS)
 Nursing knowledge Scale (NKS)
 Practice of Nursing Scale (PNS)

Data collection utilized a researcher-designed questionnaire with four sections. The first section
captured demographic information like gender, age, year of study (if applicable), and marital
status. The following sections assessed participants' attitudes, knowledge, and practices related to
a specific topic (to be replaced with your topic). Each section employed an eight-point Likert
scale ranging from "Strongly Disagree" to "Strongly Agree" for a total of 23 questions. This
format ensured a well-rounded data collection process, gathering information on participant
backgrounds, viewpoints, knowledge level, and reported behaviors concerning the research topic.
3.12 Validity and reliability

To ensure the instrument effectively measured the intended constructs, this study
addressed both content and faces validity. Content validity was established through a review
process by a panel of seven content experts, including Advanced Practice Nurses (APNs), a
nursing academic, and an intensivist. These experts assessed the questionnaire's clarity,
relevance, comprehensiveness, understandability, applicability, and ease of implementation.
Based on their feedback, minor modifications were made to enhance the instrument's
effectiveness.
Internal consistency, a key aspect of reliability, was assessed using Cronbach's Alpha
coefficient. This coefficient measures the extent to which items within a scale consistently reflect
the underlying construct. An acceptable Cronbach's Alpha value typically falls between 0.70 and
0.95. In this study, Cronbach's Alpha for the Nurses' Attitudes section was 0.96, for the Nurses'
Knowledge section was 0.86, and for the Nurses' Practices section was 0.89. These values
indicate a high degree of internal consistency within each section of the questionnaire,
supporting the reliability of the data collected.

3.13 Data collection procedure:

Following the acquisition of permission letters from the university principal and the principals of
the chosen nursing colleges in Faisalabad, data collection will commence. A convenience
sampling method will be utilized to recruit participants currently enrolled in the 4-Year BSN
program at these institutions. The primary instrument for data collection will be a self-
administered questionnaire developed based on relevant guidelines and scholarly articles
pertaining to nursing clinical duties. The questionnaire is divided into four distinct sections:
demographics, attitudes towards clinical duties, knowledge of clinical duties, and self-reported
practice of clinical duties within the clinical setting. To ensure the instrument's effectiveness, a
pilot study was conducted with a sample of 25 nursing students who met the established
inclusion criteria. During designated breaks or free time, these students were selected through
convenience sampling and independently completed the questionnaire. Their responses were
meticulously analyzed to identify any instances of ambiguous language, unclear instructions, or
issues with the overall length. The pilot study also played a crucial role in determining the
estimated time required for questionnaire completion. During breaks or free time, potential
participants will be approached and provided with a comprehensive explanation of the study.
They will be explicitly informed of the voluntary nature of their participation and their right to
withdraw at any point. Informed consent documents will accompany the questionnaires,
guaranteeing the privacy and anonymity of all responses. To further ensure confidentiality, any
personal information will be redacted before data analysis commences . Participants were
guaranteed the privacy and anonymity of their responses by the informed consent papers that
were accompanied the questionnaires. Any personal information was deleted prior to data
analysis starting.
3.14 Data Analysis Plan:

Data analysis was conducted using the IBM SPSS Statistics software package, version
26.0. Sociodemographic data were described using frequencies (percentages) for categorical
variables, means (standard deviations) for normally distributed continuous data, and medians
(interquartile ranges) for non-normally distributed continuous data.

3.15 Ethical Consideration:

Data collection procedures were initiated upon obtaining permission letters from the
principals of designated colleges of nursing in Faisalabad. The target population comprised
students enrolled in the four-year Bachelor of Science in Nursing (BSN) program across these
institutions. Recruitment efforts encompassed a variety of colleges within Faisalabad to ensure a
broader representation of the city's nursing student population. Participation was strictly
voluntary. Following approval from the Principal of the College of Nursing in Faisalabad,
researchers approached potential participants and provided a comprehensive explanation of the
study. Informed consent documents were presented, detailing the voluntary nature of
participation, the right to withdraw at any point, and the unwavering commitment to maintaining
participant confidentiality. Students who opted to participate then signed the consent forms and
proceeded to complete the self-administered questionnaires independently.
3.16 GANTT Chart:

MONTHS
Novembe Decembe Januar Februar Marc Apri
r r y y h l
Activity
(Introductio
n)

Background

Literature
Review

Methodolog
y

Final
Synopsis
submission

Evaluation
 CHAPTER # 4
RESULTS

Demographic Results:
The study recruited 216 nursing students, with females comprising the larger portion at 68.1%.
The age distribution skewed towards younger participants, with 80.2% falling within the 21-25
year old range. Marital status reflected a predominantly single population (86.1%). Regarding
academic year, the 3rd year of the BSN program had the highest representation (27.8%),
followed by 4th year (26.4%), 2nd year (25.0%), and 1st year (20.8%).
Attitude of nursing students towards clinical duties:
The majority of participants (80.6%) indicated that they like clinical duties. A smaller yet
significant portion (40.3%) reported enjoying their clinical duties when assigned by their
institute. However, the data also suggests some anxieties associated with clinical duties: Over
three-quarters of participants (73.6%) admitted feeling scared when interacting with patients and
duty staff. A considerable number (64.6%) stated they don't always feel prepared for clinical
duties. These findings highlight the importance of addressing student anxieties and ensuring they
feel adequately prepared to handle clinical interactions.
Knowledge of nursing students towards clinical duties:
The survey revealed mixed experiences regarding instructor feedback and student preparedness. While a
significant portion (62.5%) reported receiving positive feedback when asking questions, a substantial
number (64.6% from previous section) indicated they don't always feel fully prepared. Similarly, while
the majority (86.1%) acknowledged possessing some clinical knowledge, a smaller yet noteworthy group
(38.9%) felt they directly learned clinical skills through theoretical knowledge. This suggests potential
areas for improvement in aligning theoretical education with practical application. On a positive note, a
majority of students expressed a strong commitment to patient care. Over half (52.8%) found theoretical
knowledge necessary for clinical practice, and a similar proportion (61.1%) reported satisfaction in
fulfilling patient needs (61.1%) and maintaining patient dignity (66.7%). Additionally, most students
(65.3%) felt adequately supervised by assigned staff during clinical rotations.

Practice of nursing students towards clinical duties:

The survey data suggests that while a majority of students (84.7%) felt staff communication was
positive, there were areas where the clinical environment could be improved. Over half (55.6%)
reported difficulty learning clinical skills, and a similar number (52.8%) indicated their assigned
hospital wasn't ideal. This highlights the need to ensure clinical placements align well with
student needs and learning objectives. Despite these challenges, the survey also revealed positive
aspects. A majority of students (55.6%) found applying theoretical knowledge to clinical skills
interesting, and a significant portion (44.4%) reported successfully applying these skills in their
communities and homes. This demonstrates the value of clinical experiences in solidifying
theoretical learning.
Overall, the survey results paint a complex picture of student experiences in clinical settings.
While there are areas for improvement, particularly regarding preparedness and clinical
environment suitability, the survey also highlights the positive aspects of clinical duties and their
role in solidifying theoretical knowledge and fostering a commitment to patient care.
 CHAPTER # 5
DISCUSSION

Discussion of the result:

While the majority of participants expressed a general liking for clinical work and the
opportunities it provides for hands-on learning, the survey results also highlight areas where
improvements can be made to improve student preparedness and optimize the clinical learning
environment. These insights into student attitudes and experiences with clinical duties are
invaluable. The response to the study highlights the importance of clinical sessions for
prospective nurses. They seemed to be well-liked by a large majority (80.6%), and many valued
the opportunity to put theoretical knowledge to use in a real-world situation (56.9%).This is
consistent with other research that highlights the value of clinical experiences in enhancing
theoretical knowledge and igniting a desire for the nursing field.
Furthermore, the results of the survey conclusions indicate students have a high dedication to
patient care. More than half of the participants (52.8%) acknowledged that theoretical knowledge
was essential for clinical practice, and more than 60% expressed satisfaction with meeting
patients' needs and preserving their dignity. These results imply that nursing students have a
solid basis in patient-centered care principles when they reach clinical settings. The evaluation
also identifies areas in which student support needs to be improved. Even though most (86.1%)
admitted to having some clinical expertise, a sizable portion (64.6%) said they don't always feel
completely equipped. Furthermore, a sizable percentage (38.9%) believed that the theoretical
knowledge they had acquired had no bearing on the clinical abilities they were expected to
acquire. This draws attention to a possible gap between theoretical learning and real-world
application. Institutions can deal with this by making sure that the curriculum's content reflects
the particular abilities needed in clinical settings. In addition, a significant amount of students
(73.6%) said they experienced anxiety when interacting with staff and patients. Targeted support,
such as role-playing games and workshops on patient contact and communication techniques,
could help reduce this fear.
According to survey results, students' experiences might be greatly impacted by the clinical
setting. Although the majority of students (84.7%) thought that staff members communicated
well, more than half (55.6%) said they had trouble picking up clinical skills, and a comparable
amount (52.8%) said their designated hospital wasn't the best fit for their educational needs. This
emphasizes how crucial it is to make sure clinical placements correspond effectively with
students' skill levels and learning goals. In order to create placements that give students the
chance to hone their clinical skills and confidence, collaboration between educational institutions
and clinical facilities is essential. The survey also emphasizes the possible advantages of
carefully planned clinical rotations. The majority of students (55.6%) thought it was intriguing to
apply theoretical knowledge to practical abilities, and a sizable percentage (44.4%) said they had
done so successfully.
Conclusion:
The current research offers insightful information about how students feel about clinical duties in
the profession of nursing. The results emphasize the benefits of clinical learning, such as
students' dedication to patient care and their ability to apply theory in a real-world situation. But
the report also points out areas that need to be improved, such improving student readiness and
making the clinical setting more efficient. Together, educators and healthcare organizations may
address these areas through focused support, modified curriculum, and carefully chosen clinical
placements to guarantee that prospective nurses graduate with the expertise and confidence
needed to offer outstanding patient care.

The strength of the study:

The study focuses on the experiences and attitudes of nursing students in clinical settings, with a
particular emphasis on their experiences. Enhancing clinical education programs can benefit
instructors and healthcare facilities by gaining useful information about their needs and
viewpoints.
The study does not only focus on pleasant encounters; it also identifies negative aspects.
Additionally, it pinpoints opportunities to improve student support and optimize the clinical
learning setting. The holistic view of student needs is provided by this well-rounded approach.
Practical Advice: The discussion section provides specific suggestions for enhancing student
readiness, communication skills instruction, and clinical placement choices based on the results.
You may immediately put these useful recommendations into practice. Stress on Patient-
Centered Care: The findings show that students have a solid understanding of patient-centered
care concepts when they join clinical settings. This demonstrates the beneficial effects of nursing
education programs and reaffirms the significance of this fundamental principle in the field.
Limitations:
It's critical to recognize the study's limitations. It's possible that not all nursing student
populations can be represented by the sample size and participant demographics. Furthermore,
the poll used self-reported data, which is prone to bias.

Future Research Directions

Future studies could examine the precise elements that cause anxiety in students in clinical
settings and look at the best ways to deal with them. Furthermore, research might look into how
various clinical placement models affect students' skill development and career readiness over
the long run.

Implication of this Study

This study's findings on student experiences with clinical duties in nursing education hold
significant implications for both nursing education programs and healthcare institutions involved
in clinical placements. The finding that some students struggle to connect theoretical knowledge
to clinical skills suggests a potential gap between curriculum content and practical application.
Nursing programs can address this by reviewing and revising curricula to ensure it aligns with
the specific clinical skills students are expected to develop during placements. Study results
highlight the need for increased focus on preparing students for the realities of clinical settings.
Programs can introduce workshops or simulations to address student anxieties about interacting
with patients and staff. Additionally, strengthening practical skills training can enhance student
confidence before entering clinical rotations. The study underscores the importance of effective
communication and feedback between instructors and students. Faculty development programs
can equip educators with strategies to provide targeted support and ensure students feel prepared
for clinical challenges.
Recommendations for Healthcare Institutions:

The finding that some students find their assigned hospitals not ideal for their learning needs
emphasizes the importance of thoughtful clinical placement selection. Collaboration between
educational institutions and healthcare facilities is crucial. Considerations should include
alignment with student skill levels, learning objectives, and the availability of qualified
mentors to supervise and guide students.
 Creating a positive and supportive learning environment is essential. Healthcare
institutions can provide orientation sessions for students to familiarize them with the
facility and staff. Additionally, fostering open communication between students, nurses,
and other healthcare professionals can help alleviate student anxieties and facilitate a
smooth learning experience.
 Implementing mentorship programs can provide students with valuable guidance and
support during their clinical rotations. Experienced nurses can help students bridge the
gap between theoretical knowledge and practical application, fostering confidence and a
sense of professional identity.

By implementing these recommendations, both nursing education programs and healthcare

institutions can work together to create a more comprehensive and supportive learning
environment for student nurses. This will ultimately lead to better-prepared graduates who are
confident and equipped to provide high-quality patient care.