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Person‐Centred Learning: Enabling Development of Clinical Competence in Nursing Students Following Initial Failure During Clinical Education—A Grounded Theory Study
Luleå University of Technology, Department of Health, Education and Technology, Nursing and Medical Technology.ORCID iD: 0000-0003-1522-275X
Luleå University of Technology, Department of Health, Education and Technology, Nursing and Medical Technology.ORCID iD: 0000-0002-3400-323X
Luleå University of Technology, Department of Health, Education and Technology, Nursing and Medical Technology.ORCID iD: 0000-0002-8842-7759
Luleå University of Technology, Department of Health, Education and Technology, Nursing and Medical Technology.ORCID iD: 0000-0001-7140-625X
2025 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: To explore the learning processes and prerequisites for nursing students to develop and achieve passing clinical competence, following an initial failing grade in their clinical education.

Design: A constructivist grounded theory study was employed.

Methods: Data were collected between January 2022 and June 2024 through individual interviews with seven undergraduate nursing students retaking their clinical education in the final semester at a university in Sweden. In addition, individual interviews were conducted with four teachers in higher education and two focus group discussions, one with four teachers in higher education and another with a clinical teacher and a supervisor. The data analysis was conducted using an iterative process of constant comparison of data in different phases.

Results: The analysis resulted in a theoretical model of person-centred learning which illustrates nursing students' learning processes and the prerequisites for them to develop and achieve clinical competence in clinical education. The model's core learning processes involve tailoring clinical education to students' needs: acknowledging one's own learning needs, receiving supervision which addresses their specific needs and having an educational institution which meets these needs are the three main learning processes that define student development. Students' acknowledgement of their personal learning needs itself entails three learning processes: trusting one's own knowledge, reflecting on and applying the nursing process, and reflecting on one's own learning. For students to progress in the learning process, prerequisites related to supervision and an educational institution meeting the students' needs must be in place.

Conclusion: The study provides evidence for a person-centred model which promotes nursing students' learning and development of clinical competence during clinical practice at the end of their nursing education.

Implications for the Profession: This model can provide support to coordinators and supervisors in nursing education with regard to planning and implementing clinical education.

Impact: This grounded theory study provides a theoretical model for nursing students' learning and development of clinical competence during their clinical education in their final year of nursing education.A person-centred learning approach in clinical education can provide learning prerequisites for students to successfully achieve learning objectives and develop safe competences for the profession.The findings of the study can offer valuable support and direction to nursing students, educators, and clinical practice supervisors in the planning and implementation of clinical education.

Reporting Method: The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and the Guideline for Reporting and Evaluating Grounded Theory Research Studies (GUREGT).

No Patient or Public Involvement: This study did not include patient or public involvement.

Place, publisher, year, edition, pages
John Wiley & Sons, 2025.
Keywords [en]
clinical competence, clinical education, constructivist grounded theory, failure, nursing, nursing education, nursing process, nursing students, person-centred learning
National Category
Nursing
Research subject
Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-114216DOI: 10.1111/jan.70080ISI: 001528920800001PubMedID: 40664358Scopus ID: 2-s2.0-105010680148OAI: oai:DiVA.org:ltu-114216DiVA, id: diva2:1987657
Note

Full text license: CC BY-NC-ND 4.0;

Available from: 2025-08-07 Created: 2025-08-07 Last updated: 2025-12-15
In thesis
1. The nursing process – A core structure for nursing students’ development of clinical competence: From the perspective of nursing students, supervisors and teachers
Open this publication in new window or tab >>The nursing process – A core structure for nursing students’ development of clinical competence: From the perspective of nursing students, supervisors and teachers
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Clinical education is the part of the nursing education wherein students gain experiential and practical knowledge in real clinical settings. It is essential because it allows nursing students to develop clinical competence by applying and integrating theoretical knowledge through patient encounters. The nursing process is a component of clinical competence and a systematic approach to providing care which involves critical thinking. The overall aim of this thesis was to explore how the nursing process can support nursing students’ learning and development of clinical competence during clinical education. The thesis takes a qualitative research approach and consists of four interrelated studies, each designed to correspond to different aspects of the overall aim: qualitative descriptive design (I), focus group methodology (II), grounded theory (III) and qualitative longitudinal intervention study (IV). Data were collected through individual interviews (I, III, IV) and focus group discussions (II, III). The included participants were nursing students in their final year (I, III, IV), supervisors in clinical settings (II, III), clinical teacher (III) and teachers in nursing education from higher education (III). Data were analysed using qualitative content analysis (I), focus group methodology (II), constant comparative analysis (III) and pattern-oriented analysis (IV). For addressing the overall aim, an interpretative synthesis was conducted to form a comprehensive understanding of the findings from all the sub-studies. 

The overall findings show that the nursing process can provide a core structure for nursing students’ learning and development of clinical competence during their clinical education. The nursing process can serve as a framework for reflection and help students give meaning to theory in practice. Through reflection and a deeper understanding of the nursing process in practice, students can adopt a more structured approach to their clinical work, which strengthens their clinical competence. However, for learning based on the nursing process to be meaningful, students must receive sufficient support and experience the necessary prerequisites. A reciprocal relationship between the student and the supervisor is significant, as both have the responsibility to create conditions for learning and development. In addition, students’ understanding and holistic view of the patient were enhanced when they were given the opportunity to consider the entire nursing process. A clinical education grounded in person-centred learning and reciprocal supervisory relationship offers a conducive environment for students to grow and enhance their clinical competence in becoming a nurse. 

In conclusion, the nursing process appears to be a valuable structure in nursing students’ learning during clinical education. Nursing students need support from supervisors and teachers to make the process meaningful in practice. These findings have implications for educators in nursing programmes and supervisors in clinical practice with regard to structuring and improving clinical education. 

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2026
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Keywords
clinical competence, clinical education, nursing, nursing education, nursing student, nursing process, supervision, qualitative research
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-115809 (URN)978-91-8048-970-6 (ISBN)978-91-8048-971-3 (ISBN)
Public defence
2026-02-27, A117, Luleå University of Technology, Luleå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Luleå University of Technology, 622940
Available from: 2025-12-15 Created: 2025-12-15 Last updated: 2026-02-06Bibliographically approved

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Löfgren, UlrikaWälivaara, Britt-MarieStrömbäck, UlricaLindberg, Birgitta

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