qualitative research in nursing articles

Introduction to qualitative nursing research

This type of research can reveal important information that quantitative research can’t.

• Qualitative research is valuable because it approaches a phenomenon, such as a clinical problem, about which little is known by trying to understand its many facets.
• Most qualitative research is emergent, holistic, detailed, and uses many strategies to collect data.
• Qualitative research generates evidence and helps nurses determine patient preferences.

Research 101: Descriptive statistics

Differentiating research, evidence-based practice, and quality improvement

How to appraise quantitative research articles

All nurses are expected to understand and apply evidence to their professional practice. Some of the evidence should be in the form of research, which fills gaps in knowledge, developing and expanding on current understanding. Both quantitative and qualitative research methods inform nursing practice, but quantitative research tends to be more emphasized. In addition, many nurses don’t feel comfortable conducting or evaluating qualitative research. But once you understand qualitative research, you can more easily apply it to your nursing practice.

What is qualitative research?

Defining qualitative research can be challenging. In fact, some authors suggest that providing a simple definition is contrary to the method’s philosophy. Qualitative research approaches a phenomenon, such as a clinical problem, from a place of unknowing and attempts to understand its many facets. This makes qualitative research particularly useful when little is known about a phenomenon because the research helps identify key concepts and constructs. Qualitative research sets the foundation for future quantitative or qualitative research. Qualitative research also can stand alone without quantitative research.

Although qualitative research is diverse, certain characteristics—holism, subjectivity, intersubjectivity, and situated contexts—guide its methodology. This type of research stresses the importance of studying each individual as a holistic system (holism) influenced by surroundings (situated contexts); each person develops his or her own subjective world (subjectivity) that’s influenced by interactions with others (intersubjectivity) and surroundings (situated contexts). Think of it this way: Each person experiences and interprets the world differently based on many factors, including his or her history and interactions. The truth is a composite of realities.

Qualitative research designs

Because qualitative research explores diverse topics and examines phenomena where little is known, designs and methodologies vary. Despite this variation, most qualitative research designs are emergent and holistic. In addition, they require merging data collection strategies and an intensely involved researcher. (See Research design characteristics .)

Although qualitative research designs are emergent, advanced planning and careful consideration should include identifying a phenomenon of interest, selecting a research design, indicating broad data collection strategies and opportunities to enhance study quality, and considering and/or setting aside (bracketing) personal biases, views, and assumptions.

Many qualitative research designs are used in nursing. Most originated in other disciplines, while some claim no link to a particular disciplinary tradition. Designs that aren’t linked to a discipline, such as descriptive designs, may borrow techniques from other methodologies; some authors don’t consider them to be rigorous (high-quality and trustworthy). (See Common qualitative research designs .)

Sampling approaches

Sampling approaches depend on the qualitative research design selected. However, in general, qualitative samples are small, nonrandom, emergently selected, and intensely studied. Qualitative research sampling is concerned with accurately representing and discovering meaning in experience, rather than generalizability. For this reason, researchers tend to look for participants or informants who are considered “information rich” because they maximize understanding by representing varying demographics and/or ranges of experiences. As a study progresses, researchers look for participants who confirm, challenge, modify, or enrich understanding of the phenomenon of interest. Many authors argue that the concepts and constructs discovered in qualitative research transcend a particular study, however, and find applicability to others. For example, consider a qualitative study about the lived experience of minority nursing faculty and the incivility they endure. The concepts learned in this study may transcend nursing or minority faculty members and also apply to other populations, such as foreign-born students, nurses, or faculty.

Qualitative nursing research can take many forms. The design you choose will depend on the question you’re trying to answer.

A sample size is estimated before a qualitative study begins, but the final sample size depends on the study scope, data quality, sensitivity of the research topic or phenomenon of interest, and researchers’ skills. For example, a study with a narrow scope, skilled researchers, and a nonsensitive topic likely will require a smaller sample. Data saturation frequently is a key consideration in final sample size. When no new insights or information are obtained, data saturation is attained and sampling stops, although researchers may analyze one or two more cases to be certain. (See Sampling types .)

Some controversy exists around the concept of saturation in qualitative nursing research. Thorne argues that saturation is a concept appropriate for grounded theory studies and not other study types. She suggests that “information power” is perhaps more appropriate terminology for qualitative nursing research sampling and sample size.

Data collection and analysis

Researchers are guided by their study design when choosing data collection and analysis methods. Common types of data collection include interviews (unstructured, semistructured, focus groups); observations of people, environments, or contexts; documents; records; artifacts; photographs; or journals. When collecting data, researchers must be mindful of gaining participant trust while also guarding against too much emotional involvement, ensuring comprehensive data collection and analysis, conducting appropriate data management, and engaging in reflexivity.

Data usually are recorded in detailed notes, memos, and audio or visual recordings, which frequently are transcribed verbatim and analyzed manually or using software programs, such as ATLAS.ti, HyperRESEARCH, MAXQDA, or NVivo. Analyzing qualitative data is complex work. Researchers act as reductionists, distilling enormous amounts of data into concise yet rich and valuable knowledge. They code or identify themes, translating abstract ideas into meaningful information. The good news is that qualitative research typically is easy to understand because it’s reported in stories told in everyday language.

Evaluating a qualitative study

Evaluating qualitative research studies can be challenging. Many terms—rigor, validity, integrity, and trustworthiness—can describe study quality, but in the end you want to know whether the study’s findings accurately and comprehensively represent the phenomenon of interest. Many researchers identify a quality framework when discussing quality-enhancement strategies. Example frameworks include:

• Trustworthiness criteria framework, which enhances credibility, dependability, confirmability, transferability, and authenticity
• Validity in qualitative research framework, which enhances credibility, authenticity, criticality, integrity, explicitness, vividness, creativity, thoroughness, congruence, and sensitivity.

With all frameworks, many strategies can be used to help meet identified criteria and enhance quality. (See Research quality enhancement ). And considering the study as a whole is important to evaluating its quality and rigor. For example, when looking for evidence of rigor, look for a clear and concise report title that describes the research topic and design and an abstract that summarizes key points (background, purpose, methods, results, conclusions).

Application to nursing practice

Qualitative research not only generates evidence but also can help nurses determine patient preferences. Without qualitative research, we can’t truly understand others, including their interpretations, meanings, needs, and wants. Qualitative research isn’t generalizable in the traditional sense, but it helps nurses open their minds to others’ experiences. For example, nurses can protect patient autonomy by understanding them and not reducing them to universal protocols or plans. As Munhall states, “Each person we encounter help[s] us discover what is best for [him or her]. The other person, not us, is truly the expert knower of [him- or herself].” Qualitative nursing research helps us understand the complexity and many facets of a problem and gives us insights as we encourage others’ voices and searches for meaning.

When paired with clinical judgment and other evidence, qualitative research helps us implement evidence-based practice successfully. For example, a phenomenological inquiry into the lived experience of disaster workers might help expose strengths and weaknesses of individuals, populations, and systems, providing areas of focused intervention. Or a phenomenological study of the lived experience of critical-care patients might expose factors (such dark rooms or no visible clocks) that contribute to delirium.

Successful implementation

Qualitative nursing research guides understanding in practice and sets the foundation for future quantitative and qualitative research. Knowing how to conduct and evaluate qualitative research can help nurses implement evidence-based practice successfully.

When evaluating a qualitative study, you should consider it as a whole. The following questions to consider when examining study quality and evidence of rigor are adapted from the Standards for Reporting Qualitative Research.

Jennifer Chicca is a PhD candidate at the Indiana University of Pennsylvania in Indiana, Pennsylvania, and a part-time faculty member at the University of North Carolina Wilmington.

Amankwaa L. Creating protocols for trustworthiness in qualitative research. J Cult Divers. 2016;23(3):121-7.

Cuthbert CA, Moules N. The application of qualitative research findings to oncology nursing practice. Oncol Nurs Forum . 2014;41(6):683-5.

Guba E, Lincoln Y. Competing paradigms in qualitative research . In: Denzin NK, Lincoln YS, eds. Handbook of Qualitative Research. Thousand Oaks, CA: SAGE Publications, Inc.;1994: 105-17.

Lincoln YS, Guba EG. Naturalistic Inquiry . Thousand Oaks, CA: SAGE Publications, Inc.; 1985.

Munhall PL. Nursing Research: A Qualitative Perspective . 5th ed. Sudbury, MA: Jones & Bartlett Learning; 2012.

Nicholls D. Qualitative research. Part 1: Philosophies. Int J Ther Rehabil . 2017;24(1):26-33.

Nicholls D. Qualitative research. Part 2: Methodology. Int J Ther Rehabil . 2017;24(2):71-7.

Nicholls D. Qualitative research. Part 3: Methods. Int J Ther Rehabil . 2017;24(3):114-21.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: A synthesis of recommendations. Acad Med . 2014;89(9):1245-51.

Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice . 10th ed. Philadelphia, PA: Wolters Kluwer; 2017.

Thorne S. Saturation in qualitative nursing studies: Untangling the misleading message around saturation in qualitative nursing studies. Nurse Auth Ed. 2020;30(1):5. naepub.com/reporting-research/2020-30-1-5

Whittemore R, Chase SK, Mandle CL. Validity in qualitative research. Qual Health Res . 2001;11(4):522-37.

Williams B. Understanding qualitative research. Am Nurse Today . 2015;10(7):40-2.

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• Volume 21, Issue 3
• Data collection in qualitative research
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• David Barrett 1 ,
• http://orcid.org/0000-0003-1130-5603 Alison Twycross 2
• 1 Faculty of Health Sciences , University of Hull , Hull , UK
• 2 School of Health and Social Care , London South Bank University , London , UK
• Correspondence to Dr David Barrett, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, UK; D.I.Barrett{at}hull.ac.uk

https://doi.org/10.1136/eb-2018-102939

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Qualitative research methods allow us to better understand the experiences of patients and carers; they allow us to explore how decisions are made and provide us with a detailed insight into how interventions may alter care. To develop such insights, qualitative research requires data which are holistic, rich and nuanced, allowing themes and findings to emerge through careful analysis. This article provides an overview of the core approaches to data collection in qualitative research, exploring their strengths, weaknesses and challenges.

Collecting data through interviews with participants is a characteristic of many qualitative studies. Interviews give the most direct and straightforward approach to gathering detailed and rich data regarding a particular phenomenon. The type of interview used to collect data can be tailored to the research question, the characteristics of participants and the preferred approach of the researcher. Interviews are most often carried out face-to-face, though the use of telephone interviews to overcome geographical barriers to participant recruitment is becoming more prevalent. 1

A common approach in qualitative research is the semistructured interview, where core elements of the phenomenon being studied are explicitly asked about by the interviewer. A well-designed semistructured interview should ensure data are captured in key areas while still allowing flexibility for participants to bring their own personality and perspective to the discussion. Finally, interviews can be much more rigidly structured to provide greater control for the researcher, essentially becoming questionnaires where responses are verbal rather than written.

Deciding where to place an interview design on this ‘structural spectrum’ will depend on the question to be answered and the skills of the researcher. A very structured approach is easy to administer and analyse but may not allow the participant to express themselves fully. At the other end of the spectrum, an open approach allows for freedom and flexibility, but requires the researcher to walk an investigative tightrope that maintains the focus of an interview without forcing participants into particular areas of discussion.

Example of an interview schedule 3

What do you think is the most effective way of assessing a child’s pain?

Have you come across any issues that make it difficult to assess a child’s pain?

What pain-relieving interventions do you find most useful and why?

When managing pain in children what is your overall aim?

Whose responsibility is pain management?

What involvement do you think parents should have in their child’s pain management?

What involvement do children have in their pain management?

Is there anything that currently stops you managing pain as well as you would like?

What would help you manage pain better?

Interviews present several challenges to researchers. Most interviews are recorded and will need transcribing before analysing. This can be extremely time-consuming, with 1 hour of interview requiring 5–6 hours to transcribe. 4 The analysis itself is also time-consuming, requiring transcriptions to be pored over word-for-word and line-by-line. Interviews also present the problem of bias the researcher needs to take care to avoid leading questions or providing non-verbal signals that might influence the responses of participants.

Focus groups

The focus group is a method of data collection in which a moderator/facilitator (usually a coresearcher) speaks with a group of 6–12 participants about issues related to the research question. As an approach, the focus group offers qualitative researchers an efficient method of gathering the views of many participants at one time. Also, the fact that many people are discussing the same issue together can result in an enhanced level of debate, with the moderator often able to step back and let the focus group enter into a free-flowing discussion. 5 This provides an opportunity to gather rich data from a specific population about a particular area of interest, such as barriers perceived by student nurses when trying to communicate with patients with cancer. 6

From a participant perspective, the focus group may provide a more relaxing environment than a one-to-one interview; they will not need to be involved with every part of the discussion and may feel more comfortable expressing views when they are shared by others in the group. Focus groups also allow participants to ‘bounce’ ideas off each other which sometimes results in different perspectives emerging from the discussion. However, focus groups are not without their difficulties. As with interviews, focus groups provide a vast amount of data to be transcribed and analysed, with discussions often lasting 1–2 hours. Moderators also need to be highly skilled to ensure that the discussion can flow while remaining focused and that all participants are encouraged to speak, while ensuring that no individuals dominate the discussion. 7

Observation

Participant and non-participant observation are powerful tools for collecting qualitative data, as they give nurse researchers an opportunity to capture a wide array of information—such as verbal and non-verbal communication, actions (eg, techniques of providing care) and environmental factors—within a care setting. Another advantage of observation is that the researcher gains a first-hand picture of what actually happens in clinical practice. 8 If the researcher is adopting a qualitative approach to observation they will normally record field notes . Field notes can take many forms, such as a chronological log of what is happening in the setting, a description of what has been observed, a record of conversations with participants or an expanded account of impressions from the fieldwork. 9 10

As with other qualitative data collection techniques, observation provides an enormous amount of data to be captured and analysed—one approach to helping with collection and analysis is to digitally record observations to allow for repeated viewing. 11 Observation also provides the researcher with some unique methodological and ethical challenges. Methodologically, the act of being observed may change the behaviour of the participant (often referred to as the ‘Hawthorne effect’), impacting on the value of findings. However, most researchers report a process of habitation taking place where, after a relatively short period of time, those being observed revert to their normal behaviour. Ethically, the researcher will need to consider when and how they should intervene if they view poor practice that could put patients at risk.

The three core approaches to data collection in qualitative research—interviews, focus groups and observation—provide researchers with rich and deep insights. All methods require skill on the part of the researcher, and all produce a large amount of raw data. However, with careful and systematic analysis 12 the data yielded with these methods will allow researchers to develop a detailed understanding of patient experiences and the work of nurses.

• Twycross AM ,
• Williams AM ,
• Huang MC , et al
• Onwuegbuzie AJ ,
• Dickinson WB ,
• Leech NL , et al
• Twycross A ,
• Emerson RM ,
• Meriläinen M ,
• Ala-Kokko T

Competing interests None declared.

Patient consent Not required.

Provenance and peer review Commissioned; internally peer reviewed.

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Qualitative Methods in Health Care Research

Affiliations.

• 1 School of Nursing and Midwifery, Royal College of Surgeons Ireland - Bahrain (RCSI Bahrain), Al Sayh Muharraq Governorate, Bahrain.
• 2 Department of Mental Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
• 3 Department of OBG Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
• 4 School of Nursing, MGH Institute of Health Professions, Boston, USA.
• 5 Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
• PMID: 34084317
• PMCID: PMC8106287
• DOI: 10.4103/ijpvm.IJPVM_321_19

Healthcare research is a systematic inquiry intended to generate robust evidence about important issues in the fields of medicine and healthcare. Qualitative research has ample possibilities within the arena of healthcare research. This article aims to inform healthcare professionals regarding qualitative research, its significance, and applicability in the field of healthcare. A wide variety of phenomena that cannot be explained using the quantitative approach can be explored and conveyed using a qualitative method. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research. The greatest strength of the qualitative research approach lies in the richness and depth of the healthcare exploration and description it makes. In health research, these methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

Keywords: Ethnography; grounded theory; qualitative research; research design.

Copyright: © 2021 International Journal of Preventive Medicine.

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There are no conflicts of interest.

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Differences between Qualitative & Quantitative Research

" Quantitative research ," also called " empirical research ," refers to any research based on something that can be accurately and precisely measured.  For example, it is possible to discover exactly how many times per second a hummingbird's wings beat and measure the corresponding effects on its physiology (heart rate, temperature, etc.).

" Qualitative research " refers to any research based on something that is impossible to accurately and precisely measure.  For example, although you certainly can conduct a survey on job satisfaction and afterwards say that such-and-such percent of your respondents were very satisfied with their jobs, it is not possible to come up with an accurate, standard numerical scale to measure the level of job satisfaction precisely.

It is so easy to confuse the words "quantitative" and "qualitative," it's best to use "empirical" and "qualitative" instead.

Hint: An excellent clue that a scholarly journal article contains empirical research is the presence of some sort of statistical analysis

See "Examples of Qualitative and Quantitative" page under "Nursing Research" for more information.

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"How does numerical value teach us about a population's problems?" .cls-1{fill:#fff;stroke:#79a13f;stroke-miterlimit:10;stroke-width:5px;}.cls-2{fill:#79a13f;} Numeric data collected from studies can indicate why a health problem exists, such as correlating data between environmental or genetic factors to a condition. This data can help us find appropriate interventions based on a specific cause.

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• Qualitative Research from the SAGE Encyclopedia of Theory in Psychology by Carla Willig Qualitative research is an approach to research that is primarily concerned with studying the nature, quality, and meaning of human experience. It asks questions about how people make sense of their experiences, how people talk about what has happened to them and others, and how people experience, manage, and negotiate situations they find themselves in. Qualitative research is interested both in individual experiences and in the ways in which people experience themselves as part of a group. Qualitative data take the form of accounts or observations, and the findings are presented in the form of a discussion of the themes that emerged from the analysis. Numbers are very rarely used in qualitative research.
• Entanglement and the Relevance of Method in Qualitative Research by Pamela G. Reed "This brief article is an introduction to the feature article on self-reflection in interpretive phenomenology research. Self-reflection is discussed as a method that warrants more explicit description in the practice of qualitative research. Research does not occur in an epistemic vacuum. Despite researchers’ entanglement in the process of research and the fuzziness of the phenomenon under study, scientific methods, including that of self-reflection, enable nurse scientists to persevere in their study of human health experiences" (Reed, 2018, Abstract).
• Papers that go beyond numbers (qualitative research) by Trisha Greenhalgh "Qualitative researchers seek a deeper truth. They aim to study things in their natural setting, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them'[2], and they use a holistic perspective which preserves the complexities of human behaviour" [2]. (Greenhalgh, 2020, Chapter 12).
• Qualitative evidence by Jane Noyes et al. from the Cochrane Handbook for Systematic Reviews of Interventions "A synthesis of qualitative evidence can inform understanding of how interventions work by: increasing understanding of a phenomenon of interest (e.g. women’s conceptualization of what good antenatal care looks like); identifying associations between the broader environment within which people live and the interventions that are implemented; increasing understanding of the values and attitudes toward, and experiences of, health conditions and interventions by those who implement or receive them; and providing a detailed understanding of the complexity of interventions and implementation, and their impacts and effects on different subgroups of people and the influence of individual and contextual characteristics within different contexts" (Noyes et al, 2019, Introduction).
• The value of qualitative research by Liam Clarke "This article describes the dual nature of nursing research. It describes how qualitative research can present the patient's experience in a way that quantitative research cannot, but warns against over-reliance on qualitative methods. The article critically summarises the ideas of the European philosophers on which qualitative research is based" (Clarke, 2004).
• Engaging nursing students in qualitative research through hands-on participation by Hall et al. The article focuses on undergraduate nursing students often view research as challenging and difficult to understand. Topics include student learning the processes of qualitative and quantitative research has compared with learning new clinical skills, active learning uses creative strategies to improve critical thinking, and learning the qualitative research process and has sparked an interest in using the methods for future areas of interest.

Clarke, L. (2004). The value of qualitative research. Nursing Standard , 18 (52), 41+. https://link-gale-com.ezproxy.simmons.edu/apps/doc/A122410070/ITOF?u=mlin_b_simmcol&sid=ITOF&xid=acb3d5a5

Greenhalgh, T. (2019). Papers that go beyond numbers (qualitative research). In How to read a Paper : The basics of evidence-based medicine and healthcare . (Sixth ed., pp. 165-178). Wiley Blackwell.

Hall, K. C., Andries, C., & McNair, M. E. (2020). Engaging nursing students in qualitative research through hands-on participation. Journal of Nursing Education , 59 (3), 177. https://doi-org.ezproxy.simmons.edu/10.3928/01484834-20200220-13

Noyes J, Booth A, Cargo M, Flemming K, Harden A, Harris J, Garside R, Hannes K, Pantoja T, Thomas J. Chapter 21: Qualitative evidence. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from https://training.cochrane.org/handbook/

Reed, P. G. (2018). Entanglement and the relevance of method in qualitative research. Nursing Science Quarterly , 31 (3), 243–244. https://doi-org.ezproxy.simmons.edu/10.1177/0894318418774927

Willig, C. (2016). Qualitative research. In L. H. Miller (Ed.), The Sage encyclopedia of theory in psychology . Sage Publications, Credo Reference.

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Breaking the taboo of using the nursing process: lived experiences of nursing students and faculty members

• Amir Shahzeydi   ORCID: orcid.org/0000-0001-9095-2424 1 , 2 ,
• Parvaneh Abazari   ORCID: orcid.org/0000-0003-4024-2867 3 , 4 ,
• Fatemeh Gorji-varnosfaderani   ORCID: orcid.org/0000-0001-6830-982X 5 ,
• Elaheh Ashouri   ORCID: orcid.org/0000-0002-7566-6566 6 ,
• Shahla Abolhassani   ORCID: orcid.org/0000-0002-5191-7586 6 &
• Fakhri Sabohi   ORCID: orcid.org/0000-0003-1448-6606 6  

BMC Nursing volume  23 , Article number:  621 ( 2024 ) Cite this article

Metrics details

Despite the numerous advantages of the nursing process, nursing students often struggle with utilizing this model. Therefore, studies suggest innovative teaching methods to address this issue. Teaching based on real clinical cases is considered a collaborative learning method that enhances students’ active learning for the development of critical thinking and problem-solving skills. In this method, students can acquire sufficient knowledge about patient care by accessing authentic information.

The aim of the present study was to investigate the experiences of nursing students and faculty members regarding the implementation of nursing process educational workshops, based on real case studies.

A qualitative descriptive study.

Participants

9 Nursing students and 7 faculty members from the Isfahan School of Nursing and Midwifery who attended the workshops.

This qualitative descriptive study was conducted from 2021 to 2023. Data was collected through semi-structured individual and focus group interviews using a qualitative content analysis approach for data analysis.

After analyzing the data, a theme titled “Breaking Taboos in the Nursing Process” was identified. This theme consists of four categories: “Strengthening the Cognitive Infrastructure for Accepting the Nursing Process,” “Enhancing the Applicability of the Nursing Process,” “Assisting in Positive Professional Identity,” and “Facilitating a Self-Directed Learning Platform.” Additionally, thirteen subcategories were obtained.

The data obtained from the present study showed that conducting nursing process educational workshops, where real clinical cases are discussed, analyzed, and criticized, increases critical thinking, learning motivation, and understanding of the necessity and importance of implementing the nursing process. Therefore, it is recommended that instructors utilize this innovative and effective teaching method for instructing the nursing process.

Peer Review reports

Introduction

The nursing process is a systematic and logical method for planning and providing nursing care [ 1 ] that provides an opportunity for nurses to efficiently and dynamically utilize their knowledge and expertise. It also creates a common language, known as nursing diagnosis, which facilitates action, promotes creative solutions, and minimizes errors in patient care [ 2 ]. Clinical education, based on the nursing process, provides an appropriate setting for nursing students to gain clinical experiences and foster professional development [ 3 ].

Despite the numerous advantages, nursing students face difficulties in implementing this model in various countries [ 4 , 5 ], lack of appropriate knowledge, lack of clinical practice, and insufficient learning are among the most significant obstacles to the implementation of the nursing process by students. This can be attributed to the poor quality of education regarding this important nursing care model. Therefore, it is necessary for educators in this field to use innovative and participatory teaching methods [ 3 , 6 ]. According to research conducted in Iran, 72% of nursing faculty members use passive teaching methods. Meanwhile, 92% of nursing students prefer active and innovative learning methods over traditional and passive methods [ 7 ]. Therefore, the use of modern methods, which aim to stimulate students’ thinking and enhance their responsiveness in acquiring and applying knowledge, can be effective [ 6 ].

Case-based learning is a collaborative learning method that aims to develop and enhance critical thinking and problem-solving skills [ 8 ]. Teaching the nursing process based on clinical and real cases can be very important in terms of promoting critical thinking, simulating real experiences, enhancing clinical judgment, and ultimately improving the quality and effectiveness of education [ 8 , 9 ]. In this method, students gain sufficient knowledge about patient care by accessing real information, improving their skills in patient assessment, and gaining personal nursing experience. This leads to a better understanding of comprehensive care and prepares individuals for future professional roles [ 9 ].

Very few studies have been conducted on teaching methods and their impact on the quality of nursing process [ 10 , 11 ]. In Iran, case-based trainings have mostly focused on hypothetical cases [ 1 , 12 ]. In other countries, most studies conducted on the case-based educational method have not focused on the nursing process. The few studies that have been conducted on the nursing process have either not been based on real clinical cases [ 13 ] or, if clinical cases have been researched, the studies have been conducted quantitatively [ 8 , 9 ] While qualitative research provides researchers with more opportunities to discover and explain the realities of the educational environment and gain a better understanding of many challenging aspects related to the nursing education process. Researchers are able to provide a practical model that helps improve and enhance the current process by gaining insight and a deep understanding of what is happening in the field of study [ 14 ]. This study represents the first qualitative research that describes the lived experiences of nursing students and faculty members regarding the teaching of the nursing process through real-based case workshops.

Study design

This qualitative descriptive study was conducted from 2021 to 2023. Qualitative descriptive studies typically align with the naturalistic inquiry paradigm, which emphasizes examining phenomena in their natural settings as much as possible within the context of research. Naturalistic inquiry, rooted in a constructivist viewpoint, enables a deeper understanding of phenomena by observing them within the authentic social world we inhabit [ 15 ]. In this type of study, researchers provide a comprehensive summary of an extraordinary occurrence or circumstance of interest and its related factors, but they do not delve into deep interpretation [ 16 ]. This study was undertaken to explore students and faculty members perceptions of the effect of the educational workshops on knowledge, skills and attitudes of students to the nursing process.

Setting and sample

Participants were selected from nursing students and faculty members who participated in nursing process workshops (Table  1 ). The criteria for entry into the study included volunteering to participate in the study and attending at least 3 sessions of the workshops.

Workshop details

The workshops were held in the conference hall of the Nursing and Midwifery Faculty. They consisted of 9 sessions, each lasting 2 h, from 16:00 to 18:00. Students from terms 2 to 8 and faculty members participated in these workshops. Each session was attended by an average of 60 members. Despite the inconvenience of scheduling the sessions outside of the official class hours, all the members stayed until the end of the meeting, showing a keen interest in the material and actively participating in discussions. Attendance was open to all students and faculty members, and participants in each of the workshop sessions were not the same.

It should be noted that all workshops were accompanied by a specialized instructor in the field of the nursing process, as well as a specialized instructor in the field of the specific disease being discussed. The details of these workshops are summarized in three stages:

First Stage

Step 1 . The researcher visited one of the inpatient clinical wards of the hospital based on the assigned topic for each workshop. They selected a patient, conducted a comprehensive assessment, and recorded the information using Gordon’s assessment form. This included the patient’s current and past medical history, paraclinical tests, physical examinations, medications, and information gathered from credible sources such as interviews with the patient and their family, medical records, and the patient’s treatment and care interventions documented in their medical file and Cardex.

Step 2 . Preparing the presentation file, which includes the following items:

Writing the comprehensive patient assessment based on step one.

Writing actual and at-risk nursing diagnoses according to PES (Problem/ Etiology/ Signs and Symptoms) and PE (Problem/ Etiology) rules, as well as collaborative problems, and then prioritizing them based on Maslow’s Hierarchy of Needs.

Writing objectives and outcomes for each nursing diagnosis based on the SMART (Specific/ Measurable/ Attainable/ Realistic/ Time Bound).

Writing nursing interventions (based on objectives and outcomes), along with the rationales according to evidence-based, up-to-date, and reliable sources for each intervention.

Step 3 . Sending the presentation file to an expert professor in the field of nursing process for review and implementing her comments.

Second stage

Step 1 . Announcing the date and time of the workshop session to students and faculty members.

Step 2 . Providing students and faculty members with a comprehensive patient assessment.

Third stage (workshop implementation)

Step 1. Presenting all stages of the nursing process based on the case study:

Providing a comprehensive assessment of the patient’s condition. (Giving time for students, faculty members, and presenters to discuss with each other, express their comments, and summarize)

Presenting diagnoses along with the objectives and expected outcomes. (Giving time for students, faculty members, and presenters to discuss with each other, express their comments, and summarize)

Presentation of nursing interventions. (Giving time for students, faculty members, and presenters to discuss with each other, express their comments, and summarize)

Presentation on assessing the level of achievement of expected outcomes and evaluating interventions. (Giving time for students, faculty members, and presenters to discuss with each other, express their comments, and summarize)

Data Collection Tools

Demographic questionnaire.

It included age, gender, Position, degree and number of sessions attended in the workshop.

Semi-structured interview

It included the following questions:

What was your motivation to attend these meetings?

Before entering the nursing process meetings, what did you expect from the meeting?

How many of your expectations were met by participating in the meetings?

How much did these meetings help you in applying the nursing process in the clinical setting?

What do you think about the continuation of such meetings?

Data collection

After obtaining official permission from the university in 2021, the phone numbers of students and faculty members who participated in more sessions of the workshop were collected in 2023. A specific time and location were subsequently arranged to contact and interview participants who had indicated their willingness to take part in the study. Approximately 40 individuals expressed their consent to participate; however, data saturation was achieved after interviewing 16 participants. It is important to note that interviews were conducted through both individual sessions and focus groups. Individual interviews were carried out with 3 faculty members, while two focus groups were conducted separately with 9 students and 4 faculty members.

Individual Interviews

The interviews were conducted in a semi-structured manner and began with a general question to establish initial and closing communication. These interviews were conducted by one of the researchers who holds a PhD in nursing and has published several qualitative articles in reputable journals. In each of these sessions, the interviewer introduced themselves and welcomed the participants. The goals of the session were discussed, and participants were given complete freedom to express their opinions. The interviewer refrained from interfering or reacting to their opinions, and the information discussed was kept completely confidential under the guise of a code. Participants were subsequently asked to provide consent for voice recording during the interviews. Once consent was obtained from the participants, their voices were recorded. Each individual interview lasted between 30 and 45 min.

Focus Group Interviews

All the conditions of these interviews were similar to individual interviews. However, in focus group sessions, an additional researcher acted as an assistant to the main interviewer. The assistant’s role was to determine the order of speaking based on the participants’ requests, observe their facial expressions while speaking, and take necessary notes. Each of the focus group sessions lasted approximately 5 h. It should be noted that participant selection and sampling continued until data saturation was achieved. Saturation of data refers to the repetition of information and the confirmation of previously collected data.

Data analysis

The qualitative content analysis approach proposed by Graneheim and Lundman was used for data analysis [ 16 ]. The recorded interviews were transcribed verbatim (The transcripts were sent to the participants for feedback and were approved by them), and then each word was carefully examined to identify codes Two independent individuals encoded the data. Words that accurately represented thoughts or concepts within the data were highlighted. Then, the researcher added her own notes about his thoughts, interpretations of the text, and initial analysis of the text. With the progression of this process, appropriate names for the codes emerged, and the codes were organized into subcategories. These subcategories were created to organize and categorize the codes within clusters. The researcher reorganized the subcategories based on their relationships, condensing them into a smaller number of organizational categories. And then the concepts of each category, subcategory, and code were developed.

Trustworthiness

Data was managed using the Lincoln and Guba criteria. These criteria include acceptability, which is equivalent to internal validity; transferability, which is equivalent to external validity; similarity, which is equivalent to reliability; and verifiability, which is equivalent to objectivity [ 17 ]. The use of member checks by participants is considered a technique for exploring the credibility of results. In this regard, the interview text and the primary codes extracted from it were made available to several participants to verify the accuracy with their experiences. External supervision was employed to ensure that the criterion of internal consistency was met. For this purpose, the data was given to a researcher who did not participate in the study. If there was agreement in the interpretation of the data, it confirmed the presence of internal consistency. Finally, an audit or verification inquiry was conducted. The researcher accurately recorded and reported all stages and processes of the research from beginning to end. This allows external supervisors to conduct audits and assess the credibility of the findings.

Data analysis resulted in the emergence of 13 subcategories, 4 categories, and 1 theme (Table  2 ).

Strengthening the intellectual infrastructure of accepting the nursing process

Subcategories such as “improving nursing perception,” “strengthening critical thinking,” “evidence-based nursing practice,” and “filling an educational gap” contributed to the emergence of the category “Strengthening the intellectual infrastructure of accepting the nursing process.”

Improving nursing perception

Participants’ experiences indicate the significant positive impact of the workshop on improving students’ perception of the nursing process. Most nurses in departments do not provide patient care based on the nursing process. As a result, students do not have the opportunity to practically experience the real application of the nursing process in the department. Instead, they only perceive the nursing process as a written task.

For me, it was a question of what the nursing process is, for instance. How difficult is it?” and it really helped me overcome my fear in a way. (P3 student) Usually, they would explain the nursing process to us, but it was not practical or based on real cases, like this. (P1 Student)

Strengthening critical thinking

Critical thinking is a fundamental skill in the nursing process that involves various stages and activities. These include questioning to gather adequate information, validating and analyzing information to comprehend the problem and its underlying factors, evaluating interventions, and making appropriate decisions for effective problem-solving. The experiences of the participating students clearly reflected the formation of these stages during the workshop sessions.

I learned in the workshop about the importance of using critical thinking to successfully connect knowledge and practice. It’s a shame that critical thinking has not been cultivated in the minds of students, and these workshops have laid the foundation for it in our minds. (P6 student) Students often come across hypothetical cases in textbooks, but when they are confronted with real cases, the circumstances are different… This is when critical thinking becomes crucial and the art of nursing is demonstrated… These sessions have made a significant contribution to this subject. (P15 Faculty member)

Evidence-based nursing practice

One of the features of the sessions was that in introducing the case from assessment to evaluation, to justify the rationale and process of collecting and formulating nursing diagnoses, establishing expected outcomes, and providing reasons for each intervention, relied on up-to-date and reliable nursing and medical resources

It had a strong scientific foundation, consistently emphasizing the importance of evidence-based practices and a scientific approach, effectively communicating this perspective to audience. (P2 Student). I became familiar with the book ‘Carpenito,’ and it helped me a lot in understanding my shortcomings. (P3 student). In my opinion, one of the factors that contributed to the effectiveness of the work was consulting the references. They emphasized that as a nurse, I should not solely rely on my personal opinion but should instead base my actions on the reference materials (P14 Faculty member).

Filling an educational gap

From the perspective of workshop participants, the workshop has increased their awareness of their limited knowledge about the application of the nursing process. It has also helped them recognize their shortcomings, and motivated them to pursue additional studies in this field.

Exactly, there was a vacant spot for this educational program in our classes. And there should have been sessions that would prove to us that nursing is not just about the theoretical concepts that faculty members teach in class. (P5 Student) The nursing process has a theoretical aspect that students learn, but when they attempt to apply it in practice, they often encounter difficulties. These sessions helped to fill the gap between theory and practice. (P15 Faculty member)

Practicality of the nursing process

Subcategories of “linking the nursing process with team care,” “demonstrating the role of the nursing process in improving care quality,” “comprehensive view in care,” and “student’s guiding light in the clinic,” Created the category “Practicality of the Nursing Process”.

Linking the nursing process with team care

Participants’ experiences indicated that participating in nursing process sessions helped them realize that the nursing process is a model that will lead to collaborative team care. Prior to attending these sessions, nursing students like nurses considered their duty to be solely executing medical orders under the supervision of clinical faculty members and staff nurses.

I realized that in certain situations, I am able to confidently express my opinion to the doctor. For instance, if I believe that a particular course of action would yield better results, I can easily communicate this and provide reasons to support my viewpoint (P7 Student). Teaching the pathway when it’s categorized with knowing what we’re assessing… Let’s go up to the patient; our confidence can really guide them along with us as we progress step by step and systematically. Often, the patient accompanies us, and sometimes they voice their unspoken concerns, which helps improve their care. It means the patient themselves are partnering with us. (P6 student)

Demonstrating the role of the nursing process in improving care quality

Strengthening the attitude and belief in the role and application of the nursing process in improving the quality of care was another concept that emerged from the experiences of the students. Presenting reports on the implementation of the nursing process on real cases led them to believe that providing care based on the nursing process results in organized care planning and enhances the quality of care.

In these workshops, the needs of patients were prioritized, documented, and then organized systematically. This concept remains ingrained in a person’s mind and enables us to deliver comprehensive care to the patient without overlooking any aspect. This has been very helpful for me, and now it greatly assists me in the clinic. (P4 Student) Another great aspect of these sessions was the emphasis they placed on the nurse-patient relationship. I could see that the students had been following up with patients for a while and implementing the process. This was very helpful to me. For instance, diagnosing based on the patient’s current health status was an ongoing process. In my opinion, the connection between the patient and nurse was more important and practical for me.(P1 Student).

Comprehensive view in care

Attention to the patient’s care needs went beyond focusing solely on physiological aspects. It involved a holistic approach that addressed the patient’s needs related to all aspects of biology, psychology, society, spirituality, and economics. This was clearly reflected in the students’ experiences during the nursing process sessions.

…I paid attention to all aspects of the patient. For example, perhaps I overlooked her anxiety issue and never took it into consideration. However, I eventually came to realize that addressing anxiety is crucial, as it is one of the primary concerns and needs of patients. (P2 Student) …that the students had a holistic view of the patient (they had examined the patient thoroughly, including the patient’s skin, etc.) and had compiled a list of the patient’s issues, paying attention to all aspects of the patient (P14 Faculty member).

Student’s guiding light in the clinic

One of the significant accomplishments of nursing process sessions, as evidenced by the students’ experiences, was the role of these sessions in assisting students in overcoming confusion and uncertainty during their internships. These sessions enabled them to establish a mental connection between the theoretical knowledge learned in the classroom and its application in the real clinical setting, also helped them understand how to effectively utilize their theoretical knowledge in a clinical learning environment.

.I was feeling incredibly lost and confused. I didn’t know what steps to take next. Many of us find ourselves in this situation, unsure of what to do. At least for me, as someone who grasps concepts better through examples, the case-based studies conducted during the workshop had a significant impact. (P6 Student)

Supporting a positive professional identity

Two subcategories, “highlighting the importance of nursing science” and “reforming the perception of nursing nature,” have contributed to the development of the category “supporting a positive professional identity.”

Highlighting the importance of nursing science

Based on students’ experiences, the nursing process sessions have been able to answer an important question. Why should they be bombarded with information and expected to possess extensive knowledge in the field of disease recognition, pathophysiology, diagnosis, treatment, and nursing care during their studies? The students believed that the content of the nursing process sessions clarified the necessity and importance of nursing knowledge for them. In these sessions, they came to believe that providing care based on the nursing process requires extensive nursing knowledge.

. In my opinion, this work showcases a significant strength by highlighting the importance of working scientifically as a nurse. Personally, I feel its impact on myself is profound. (P2 Student) In my opinion, it was very touching and captivating because it accurately portrayed the immense power of a nurse. However, amidst the demanding and difficult nature of the job, what specific details should a nurse pay attention to? and it is precisely these details that shape the work of a nurse. It was very interesting and beneficial for me. (P5 student)

Reforming the perception of nursing nature

The student is seeking ways to comprehend and value the practical aspects of nursing as a genuine science, assuming that nursing is indeed regarded as a science. Participants’ experiences have shown that nursing process sessions have been able to address this identity challenge and modify and enhance students’ understanding of the nature of nursing.

I used to believe that nursing was primarily an art complemented by science until I entered term 2 and participated in these workshops. And now I realize that it has the scientific foundation that I expected from an evidence-based practice. (P5 student). . The important point was that lower-term students, who sometimes lacked motivation and thought nursing had nothing to offer, gained motivation and had a change in perspective by attending these sessions. (P2 faculy members)

Self-directed learning facilitator

Subcategories of “stimulating a thirst for learning,” “creating a stress-free learning atmosphere,” and “teaching fishing,” formed the category of “self-directed learning facilitator.”

Stimulating a thirst for learning

Participants’ experiences indicated that the format of conducting sessions, ranging from step-by-step training to training accompanied by multiple examples, had a significant impact on creating a sense of necessity and stimulating learners’ motivation to learn.

First of all, the challenges that you yourself raised (faculty member) for example, why did you make this diagnosis?” Why did you include this action? Why is this a priority? Really, it shook me and made me think that maybe there is more to this, maybe there is more to the nursing process that I haven’t understood yet…. That’s why it became my motivation. (P3 student) …But these sessions helped me a lot. At least, they sparked my curiosity and motivated me to delve deeper into the subject. I began actively participating in these sessions and found them to be highly effective for my personal growth. (P6 student) In my opinion, one of the things that empowered the work was the act of seeking references. They emphasized that as a nurse, I should not solely rely on my personal opinion but should instead base my actions on credible sources. (P14 Faculty member)

Creating a stress-free learning atmosphere

Students believed that the absence of a legal requirement to attend these workshops, coupled with the understanding that their participation or non-participation would not be evaluated for grading purposes, would enable them to engage in these sessions without concern for their academic performance and in accordance with their own volition.

I was more scared… In my internships, for example, we would sit and talk with the instructor. However, the discussions primarily revolved around grades and other academic matters, which created a stressful environment where students were hesitant to freely express their thoughts. But the sessions here are very relaxed, and students no longer have the fear of grades. (P7 student) The essence of these sessions was that they came from the heart and inevitably touched the heart. The beauty of this program was that it was built on love. (P10 Faculty member)

Teaching fishing

Direct reference to teaching fishing in the participants’ experiences points to one of the very important features that effectively prepares the way for self-guided learning. The term “teaching fishing” was repeatedly mentioned in the participants’ experiences. They believed that these sessions served as a roadmap to easily enhance their knowledge and skills in the field of nursing process application.

.And actually, teaching fishing, as mentioned by other students, is important. In my opinion, it has a positive impact both professionally and in terms of the effectiveness of the nursing process. (P2 student) The important aspect was the involvement and full participation of the students, who prepared the materials themselves… The meaning and concept of being a student were more evident, and the talents of the students flourished. They actively participated in discussions about learning and education. (P15 Faculty member)

Planners, in their efforts to help students gain a better understanding of the nature and application of the nursing process, are constantly striving to innovate in teaching this model. The aim of the present study was to describe and explain the experiences of nursing students and faculty during clinical-based nursing process workshops involving real cases.

Hanisch et al. (2020) recommend using data from actual patients [ 18 ], and Yilmaz et al. (2015) suggest providing nursing students with opportunities to apply the nursing process in diverse patient populations during clinical training [ 19 ]. The study conducted by Karimi et al. (2011) demonstrated that organizing nursing process classes as workshops stimulated a sense of competition and superiority both among and within groups. This approach also enhanced participants’ concentration on learning the content of each session. In addition, the workshop fostered a sense of cooperation and cohesion among the students, which was evident in their increased interest and excitement [ 1 ]. The importance of utilizing workshop-based training with real clinical cases is clearly evident. When students receive data related to a real patient, they directly experience the clinical environment. This, in turn, leads to an improvement in their critical thinking and decision-making skills when they encounter similar cases. For this purpose, nursing educators can present the rich clinical cases they encounter during their internships in theory classes based on the stages of the nursing process. They can also ask students to present these cases for their peers to comment on and critique the care provided, in order to stimulate discussion.

The category of " Strengthening the intellectual infrastructure of accepting the nursing process " indicates that the teaching method used in this study has been able to help students better understand and recognize the nature and improvement of insight into the nursing process. In the study by Thuvaraka et al. (2018), 52% of participants strongly agreed on the necessity of having a positive attitude and insight towards the nursing process for its proper implementation [ 20 ]. According to the study by Mert et al. (2020), a lack of insight into the nursing profession and process can even lead students to consider dropping out of their studies [ 21 ]. The importance of reviewing the nursing education process to enhance this perception has been emphasized in various studies. Zamanzadeh et al. (2015) discuss several challenges in the implementation of the nursing process. These challenges include a lack of clarity regarding its meaning, differences in perspectives, and insufficient training leading to a lack of awareness on how to properly implement it [ 22 ]. More than 90% of students (93.5%) in the study conducted by Rajabpoor et al. (2018) [ 4 ] and over two-thirds (75.6%) of students in the study conducted by Sharghi et al. (2015) identified lack of proper training and insufficient time allocated for teaching as the most significant barriers to implementing the nursing process. They attributed this to traditional and routine teaching methods [ 23 ]. This causes students to undervalue the nursing process, perceiving it only at a theoretical level rather than practical. As a result, they become overwhelmed by the routine when working as clinical nurses [ 7 ]. Therefore, by teaching the case method based on real clinical cases, nursing instructors can strengthen students’ positive outlook and ability to apply the nursing process. This increases the percentage of students implementing the nursing process in clinical wards.

Strengthening critical thinking is one of the concepts derived from analyzing the experiences of the students and faculty who participated in the present study. Based on a review study by Carvalho et al. (2017), the utilization of the nursing process, particularly the stage of nursing diagnosis formulation, enables nurses to employ critical thinking in making judgments and providing clinical care [ 24 ]. This process also helps ensure the delivery of high-quality care [ 25 ]. But if the nursing process is presented in an undesirable manner, it suppresses critical thinking. According to Heidari et al. (2016), the nursing process resulted in students relying on copying from books, which led to a decline in creativity and an increase in their dissatisfaction [ 26 ]. According to the study conducted by Ghanbari et al. (2017), the implementation of collaborative workshops focused on the nursing process resulted in an improvement in critical thinking skills among nursing students [ 3 ]. Therefore, nursing instructors can teach theoretical classes based on the clinical cases they have experienced in the hospital. By doing so, students can immerse themselves in the clinical environment during theoretical classes, which significantly enhances their critical thinking skills.

The evidence-based nursing display was one of the achievements of nursing process educational workshops, which were based on real cases. Mackey et al. (2017) consider evidence-based practice as a means to bridge the gap between theory and practice in nursing education for undergraduate and graduate students [ 27 ]. And likewise, Sin et al. (2017) believe that nursing faculties are obligated to enhance the competence and knowledge of students for evidence-based practice by employing innovative methods [ 28 ]. Therefore, it is recommended that nursing instructors use up-to-date scientific references for nursing interventions when teaching about the nursing process of diseases. This practice helps students feel that the care they provide is supported by scientific evidence and motivating them to carry out nursing care more effectively.

One of the emerging concepts in this study was the focus on the practicality of the nursing process. In the study conducted by Agyeman-Yeboah et al. (2017), participants reported that new students and nurses tend to neglect the implementation of the nursing process when they observe experienced nurses failing to apply it in a scientific and systematic manner [ 5 ]. The lack of implementation of the nursing process by nurses is due to a lack of knowledge and a negative attitude towards it. Zerihun Adraro and Adugna Cherkos (2021) conducted a study in Ethiopia and found that the majority of nurses had inadequate knowledge, and half of them lacked a positive attitude towards the implementation of the nursing process [ 29 ]. In the study by Thuvaraka et al. (2018), only 17% of nurses had sufficient knowledge about the nursing process and implemented it [ 20 ]. One of the important experiences for students in the “Practicality of the Nursing Process” category is the development of their participatory and interprofessional spirit. They are encouraged to express their opinions about the care and treatment process of patients, rather than blindly following the doctor’s orders. According to a systematic review study, the level of physicians’ proficiency in their management systems is a significant issue for the healthcare system [ 22 ]. According to the study conducted by Nakhaee et al. (2017), doctors are the ones responsible for making decisions regarding all patient matters, while the efforts of nurses often go unappreciated. This lack of recognition can result in a decline in their self-esteem [ 30 ]. While according to Adamy et al. (2019), the implementation of the nursing process at a professional level is highly effective in creating an independent nursing role, rather than just serving as assistants to physicians. This implementation also enhances the credibility of the nursing profession [ 31 ]. The recommendation of the present researchers to nursing instructors is to take a significant step in enhancing the knowledge and independent spirit of nursing students by basing their teaching on real clinical cases. When students perceive that they have independence and are not merely following doctors’ orders, their engagement in operationalizing the nursing process and evidence-based care will increase.

Strengthening the holistic perspective was one of the positive experiences for students and faculty members who attended these workshops. According to the study by Hackett et al. (2017), physical problems can result in mental stress among patients. Therefore, it is essential to consider all dimensions of care [ 32 ]. According to Ericsson (1995), humans should be considered as a whole, and nursing care should be tailored to address biological, psychological, social, and spiritual aspects [ 33 ]. The importance of holistic care has been emphasized by Florence Nightingale, who encouraged caregivers to practice it [ 34 ]. Holistic care emphasizes partnership and dialogue between nurse and patient about health care needs [ 35 ]. Adequate training is crucial in ensuring that nurses and nursing students are well-prepared to meet the diverse needs of patients and deliver comprehensive care [ 36 ]. It is recommended for nursing instructors to focus on the mental aspect in addition to the physical aspect when teaching the nursing process and encourage students to apply this approach during clinical internships.

Another advantage of these sessions was the successful implementation of the nursing process in apprenticeship. Work disorder and confusion in implementing the nursing process are significant challenges. According to the study by Korkut et al. (2021), students were unable to collect appropriate data from their patients and were confused when formulating and prioritizing nursing diagnoses, determining goals, and planning care. However, due to the fear of receiving a low grade, they were compelled to present fabricated data [ 37 ]. Therefore, nursing instructors should incorporate real clinical cases encountered during internships into their theoretical classes. This simulation helps students perform better in implementing the nursing process in the hospital environment later on.

During these workshop sessions, the students’ awareness of the professional identity of nursing was heightened. They came to understand that this professional identity is a crucial principle that underpins their comprehension of nursing and scientific care. As a result, they recognized the significance of studying pathophysiology and the fundamental principles of scientific care for different diseases. Professional identity is described as a person’s perception of themselves within a profession or the collective identity of the profession [ 38 ]. In nursing, professional identity plays a crucial role in delivering high-quality services to patients [ 39 ] because it effectively enhances clinical competence, self-assurance, self-esteem, and interpersonal communication skills [ 40 , 41 ]. In this regard, the study by Sun et al. (2016) found that professional identity and education level had the greatest impact on the stress levels of nursing students. The results of that study showed that developing and enhancing professional identity could be beneficial for nursing students in managing stress [ 42 ]. Similarly, according to the study by Sabanciogullari et al. (2015), there was a positive and significant correlation between nurses’ job satisfaction and professional identity. This study found that 15.5% of nurses who intended to leave their profession had insufficient professional identity and lower job satisfaction. Professional identity is a significant factor in job satisfaction [ 41 ]. According to the study by Van der Cingel et al. (2021), a lack of attention to the professional identity of nursing contributes to the departure of nursing students and young nurses from the nursing profession [ 43 ]. Therefore, focusing on professional identity in nursing education is crucial and should be a primary objective [ 38 ], despite findings from Haghighat et al. (2019) indicating that nursing education programs in Iran have not effectively nurtured nursing students [ 44 ]. This highlights a greater focus on teaching based on real clinical cases, which enhances the professional identity of nursing and facilitates the implementation of the nursing process.

“Self-directed learning facilitator” is one of the important categories identified in the present study. It encompasses three crucial concepts: “stimulating a thirst for learning”, “creating a stress-free learning atmosphere”, and “teaching fishing”. The students’ experiences indicated that engaging in discussions, asking questions, and providing answers had a significant impact on motivating them to study and enhancing their motivation for learning. This learning took place in a calm and stress-free environment. Participants were able to analyze the content calmly, as grades were not involved. As a result, they were able to diagnose what to prioritize in a clinical setting, even without the assistance of a clinical instructor. In fact, during these sessions, the instructors focused on teaching the students how to fish instead of simply giving them fish. As a result, the students’ spirit of independent learning increased. Kholmuratovich et al. (2020) stated in their study that independent learning helps students to learn effectively and efficiently [ 45 ]. It increases their independence and critical thinking skills, while also effectively enhancing their self-esteem and motivation [ 46 ]. For this reason, Lau et al. (2017) recommend promoting this teaching method in their study [ 47 ]. Based on the aforementioned studies, independent and self-directed learning leads to improved comprehension and learning, increased motivation, enhanced self-confidence, and critical thinking among students. Consequently, it can be argued that teaching based on clinical cases and workshop-based approaches, beyond aiding students in better understanding and applying the nursing process, has the potential to transform students’ overall learning approach.

Teaching the nursing process through workshops based on clinical cases has broken the taboo surrounding the application of the nursing process. The organization of these workshops in a friendly and stress-free environment, where real clinical cases were discussed, analyzed, and criticized, motivated the students to apply the nursing process in clinical setting. This approach led to a correction in their perception that they considered the implementation of the nursing process as time-consuming and unnecessary, and it also increased the students’ critical thinking abilities. The nature and process of conducting the workshops proved to be beneficial in implementing the theoretical standards in practical settings. The nursing interventions program was evidence based. This approach not only fostered students’ motivation for self-directed learning but also heightened their curiosity for acquiring knowledge. In these sessions, the approach involved teaching students how to fish rather than simply giving them fish. On the other hand, one of the significant challenges in the application of the nursing process in clinical practice by students is the lack of knowledge and skills among nurses to provide care based on the nursing process, it is recommended that these workshops also be conducted for nurses. Furthermore, action research should be employed to evaluate the role of this educational approach in enhancing the knowledge and skills of clinical nurses.

Limitations

Considering that the workshops had to be held outside of the regular class hours of the faculty, which is at 16:00, and taking into account the transportation issues of the students, the workshops could only continue until 18:00. The limitations of this study include the restricted hours and duration of these workshops. Another limitation of this study is the lack of implementation of nursing interventions by the researchers for the patient and subsequently the real evaluation of the interventions performed, due to ethical considerations. In fact, considering that the biggest problem for students is the application of the nursing process related to assessment, diagnosis, and planning, the focus of the workshops was on these stages. However, it seems that by covering all stages of the nursing process in educational workshops, the challenges faced by students in the implementation and evaluation stages can also be addressed.

Data availability

The data that support the findings of this study are available from the cor - responding author upon reasonable request.

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Acknowledgements

The researchers would like to express their gratitude to the students and professors who participated in the workshops and Student Research Committee of Isfahan University of Medical Sciences.

This study was financed by the Student Vice Chancellor for Research of Isfahan University of Medical Sciences (Project number 1400254).

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Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran

Fatemeh Gorji-varnosfaderani

Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

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ASH, PA, FG designed the study. ASH, PA, FG, EA, SHA, FS helded the Workshops. PA interviewed the participants. ASH and FG wrote the interviews. PA, EA and SHA analyzed the interviews. ASH, PA and FS prepared the manuscript, and all authors read and approved the final manuscript.

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This study has been approved by the ethics committee of Isfahan University of Medical Sciences (IR.MUI.NUREMA.REC.1400.139) in 2021. Initially, the research purpose was explained to the patients and their caregivers. They were informed that participation in the research is entirely voluntary and free of charge. Not participating in the research would not affect their care and treatment interventions. They were assured that they could withdraw from the research at any time. Furthermore, it was emphasized that their information would be presented in the workshop in a strictly confidential manner, without disclosing their names, photos, file numbers, etc. Subsequently, both oral and written consent were obtained from them. After that, the study’s purpose was also explained to nursing students and faculty members, and informed oral and written consent was obtained from them. Numeric codes were used instead of personal names to ensure the confidentiality of the interviews. The participants were free to withdraw from the study at any time. All methods were conducted following the applicable guidelines and regulations.

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Shahzeydi, A., Abazari, P., Gorji-varnosfaderani, F. et al. Breaking the taboo of using the nursing process: lived experiences of nursing students and faculty members. BMC Nurs 23 , 621 (2024). https://doi.org/10.1186/s12912-024-02233-z

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Exploring mindfulness interventions for stress resilience in newly graduated nurses: A qualitative study

Wang, Shu-Chen a,* ; Shih, Shih-Ming b ; Kuo, Li-Chuan c

a Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan

b Xin-Ming Psychological Clinic, Chiayi, Taiwan

c Department of Medical Humanities, Tzu Chi University, Hualien, Taiwan

* Address for correspondence: Prof. Shu-Chen Wang, Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung-Yang Road, Hualien, Taiwan. E-mail: [email protected]

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives: 

In an aging society coping with workforce challenges, successful hospital management hinges on the recruitment and retention of nurses. It is of utmost priority to address job stress and fortify mental resilience. While quantitative research supports investigating the stress-alleviating effects of mindfulness for nursing staff, obtaining a direct perspective from nurses is essential to comprehend how they navigate burnout and apply mindfulness for stress management. This qualitative study aimed to explore newly graduated nurses’ experiences who participated in a mindfulness course and evaluate the practical application of acquired strategies in their work and daily lives, providing insights for retention strategies in health-care institutions.

Materials and Methods: 

Thirty-one recently graduated nurses participated in an 8-session weekly in the mindfulness program. Qualitative data were obtained through focus group discussions during each session and subjected to thematic analysis.

Results: 

Five key themes were generated to show how nurses experience mindfulness training: (1) shedding light on workplace stress and adaptation; (2) stress upon entering the workforce; (3) reactions to the vicious cycle of anxiety responses to stress through mindfulness practices; (4) discovery of daily life pleasures and obstacles encountered during the mindfulness course; (5) obstacles encountered during the mindfulness course. Through participation in the program, the subjects’ levels of mindfulness of stress responses were enhanced.

Conclusion: 

This study underscores the advantages of mindfulness courses for newly graduated nurses and emphasizes the crucial role of workplace support. Practical recommendations for nursing administrators and educators include fostering familiarity with the health-care environment, promoting teamwork, and addressing anxiety related to handovers. Mindfulness breathing training has proven effective in alleviating pressure during shift transitions. Nursing managers can enhance staff well-being by creating moments of happiness, encouraging positive experience sharing, and organizing outdoor activities. Suggestions for future research involve refining the implementation of the Mindfulness-Based Stress Reduction course for accessibility and effectiveness, extending courses to other health-care professionals to promote team harmony, and positively impacting nursing staff’s well-being and performance.

I NTRODUCTION

In an aging society coping with workforce challenges, successful hospital management requires the recruitment and retention of nurses. Particularly, newly graduated nurses encounter a myriad of stressors and challenges as they navigate the transition to professional clinical practice. The management of patient interactions and collaboration with colleagues in a new and unfamiliar environment can contribute to heightened work anxiety, particularly in the absence of adequate support [ 1 ] . Workplace stress and job satisfaction play pivotal roles in influencing nurse retention rates, with those experiencing elevated work-related stress expressing a greater inclination to resign [ 2 , 3 ] .

The phenomenon known as “reality shock” is evident among novice nurses who grapple with dissonance between the experiences during their academic training and those encountered in the practical work setting [ 4 ] . Research indicates that during the initial month of duty, newly graduated nurses experience the highest levels of work-related stress, with a heavy workload and a perceived lack of clinical competence identified as primary stressors [ 5 ] .

To address these challenges, hospital administrators could provide essential support and training for newly graduated nurses, facilitating a smoother transition into their roles as professional health-care practitioners [ 6 ] . Nurse resilience training is designed to address stress, depression, anxiety, and fatigue by employing strategies such as mindfulness, self-efficacy, and social support. However, the effectiveness of these interventions varies, as indicated by diverse outcomes in measurement assessments [ 7 ] .

In this context, mindfulness refers to a continuous learning cycle and applying new insights to work and daily life [ 8 ] . One specific approach, Mindfulness-Based Stress Reduction (MBSR), promotes a nonjudgmental and open-minded attitude, emphasizing meditation to enhance personal resilience and alleviate stress [ 9 ] . Mindfulness embodies a purposeful and comprehensive behavior involving acknowledging stress sources and managing and controlling reactions to current situations [ 10 ] . Rather than altering stressful circumstances, mindfulness programs empower individuals to be aware of stress and develop strategies to respond to it. MBSR incorporates psychological self-regulation and encourages the development of individual and interpersonal skills [ 11 ] .

Numerous studies have demonstrated the positive impact of mindfulness interventions on nurses [ 12-14 ] . In quantitative systematic research, interventions utilizing mindfulness-based interventions (MBI) have proven effective for nursing professionals in mitigating stress, depression, anxiety, and burnout. These interventions enhance resilience, improve the quality of life, foster self-compassion, boost happiness, and increase mindfulness levels [ 13 , 15 ] .

Nurses who engaged in mindfulness interventions demonstrated heightened self-awareness and an increased awareness of others. The enhanced ability for stress management proved instrumental in mitigating the distress caused by nursing errors and reducing overall stress levels [ 16 , 17 ] . Building on these insights, seven qualitative systematic studies revealed that MBI contribute significantly to alleviating work-related stress, positively influencing both professional and personal domains. These studies offer valuable perspectives on how nursing professionals perceive the impact of mindfulness training, emphasizing (1) the conceptualization and management of stress, (2) nurses’ appreciation of mindfulness training strategies, (3) self-care awareness and strategies, and (4) challenges associated with mindfulness training [ 13 ] .

The accumulated evidence strongly supports the efficacy of MBI in reducing stress and fatigue among novice nursing professionals. This, in turn, has a positive ripple effect on the work environment and patient treatment outcomes [ 15 ] . Recognizing that the stresses of newly recruited nurses entering the workforce may differ from those experienced by seasoned nurses and understanding the variability in stress adaptation skills, mindfulness interventions emerge as effective tools for stress and anxiety relief among newly graduated nurses [ 18 , 19 ] .

Stress is a subjective experience, and exploring nursing professionals’ perceptions of workplace stress and applying mindfulness courses through qualitative methods hold considerable value. This approach can potentially enhance our understanding of the transitional period from the student role to becoming a nurse and illuminate the experiences and applications of MBSR among nursing professionals. Notably, previous studies have predominantly focused on the outcomes following mindfulness interventions, with participants primarily comprising experienced nurses [ 20 ] .

There is a dearth of research delving into the real-time experiences of participants during the weekly sessions of mindfulness programs. Addressing this gap, our study employed a qualitative methodology to investigate the mindfulness learning experiences of recently graduated nurses. In addition, we assessed the practical application of mindfulness strategies in their professional and personal lives. This approach provides a nuanced exploration of the immediate and tangible impacts of mindfulness training, offering valuable insights into the unique challenges faced by newly graduated nurses in their journey toward professional competence and well-being.

M ATERIALS AND METHODS

Study design.

A qualitative study was conducted. Participants were newly graduated nurses who had enrolled in an MBSR course comprising eight sessions conducted at weekly intervals. The course was developed by Jon Kabat-Zinn [ 21 ] . The course curriculum encompassed various components, such as an introduction to MBSR, body scanning, mindful movement, the raisin meditation, managing challenging emotions, the STOP technique, the 3-min breathing exercise, loving-kindness meditation, mindful communication, and embracing mindfulness in daily life. Each week, participants were tasked with practicing these acquired skills in homework assignments, accompanied by journaling their reflections. In addition, focus group discussion was held in every session.

Participants were explicitly informed of their right to decline participation or withdraw from the study at any point for any reason. Before their involvement, written informed consent was acquired from all participants, accompanied by a comprehensive explanation of the study’s objectives and assurances regarding the anonymity and confidentiality of their responses.

Participants

Newly graduated nurses without any prior professional work experience were recruited from a medical center in eastern Taiwan. Recruitment advertisements were disseminated to all newly hired nursing staff members following their 5-day induction course. A total of 31 newly graduated nurses initially enrolled in the MBSR course, out of which 25 participants completed half of the total sessions and 14 participants successfully completed all sessions. The focus groups for this research are scheduled following each weekly MBSR session. Consequently, nonparticipation by nurses every week may lead to subject attrition, resulting from reasons such as taking leave, resigning, or scheduling conflicts. Participation in this study is voluntary and is extended to newly recruited nursing staff. The hospital supports the study, facilitating participation by granting 4 h of paid leave for the coursework and subsequent focus group sessions, followed by group interviews.

The MBSR course occurs weekly, spanning 2.5–3 h per session. After each session, group interviews are conducted, lasting approximately 40–50 min. While the recommended number of participants for a focus group typically ranges from 8 to 12, this study adopts an approach centered on collecting insights into participants’ experiences and reflections immediately after the class without a predefined limit on the number of attendees.

During each session, a 1-h focus group discussion was facilitated. The discussion was moderated by SMS (the second author), a certified MBSR trainer, who guided participants in sharing their work experiences and reactions to work-related stress. In addition, participants discussed their personal experiences with mindfulness practices at home and the integration of mindfulness techniques into their daily lives and work routines. In total, eight of these focus group discussions were recorded for analysis.

Data analysis

Two research assistants transcribed the audio recordings of the focus group discussions, and subsequently, the accuracy of the transcripts in correspondence with the recorded files was verified. The data were then analyzed using the thematic analysis method as outlined by Nowell et al . [ 22 ] . This data analysis process comprises six steps. The initial step involves immersing in the data, wherein the researchers compiled the findings by extensively listening to the audio recordings, reading the transcripts, and documented reflections repeatedly. Notably, interactions between the participants and the moderator were meticulously recorded. The subsequent step involves generating initial codes. Here, the transcripts were imported into NVivo-12, and preliminary codes were assigned based on key elements within the original data. Moving to the third step, the researchers identified overarching themes by discerning critical aspects of the data, including the emotions and behavioral responses of the nurses toward specific individuals and situations, as well as the underlying causes. In the fourth step, the researchers conducted a thorough review of these emerging themes. Following this, individual files were created for each identified theme, and these files underwent a comprehensive review. Moving on to the fifth step, the process involved defining and assigning names to these themes. During this phase, the researchers reorganized the text files and specified keywords, such as body reactions, thoughts, and emotions associated with self-awareness. The analysis of the transcripts centered on discerning and contrasting participants’ reactions to stress. It specifically sought to identify and compare their habitual responses in the workplace with those developed after undergoing mindfulness training. Finally, in the sixth and final step, a comprehensive report was generated based on the identified themes.

Rigor of the research

To enhance the authenticity and credibility of the research, the first author (SCW), who serves as a nursing supervisor, refrained from participating in the course. Furthermore, all participants were briefed on the group principles, which emphasized noncriticism and confidentiality. The course sessions were conducted in a secluded classroom, ensuring an environment free from disturbances. The research protocol was meticulously explained to participants, fostering an atmosphere where they felt comfortable sharing their thoughts openly. For data dependability, both the first author (SCW) and the third author (LCK) conducted initial checks of the audio recordings and notes from the focus group discussions.

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Tzu Chi General Hospital (IRB103-11-B). Participants were provided with a detailed informed consent form explaining the purpose of the research, their role, the potential risks, and the rights of the participants. It was made explicit that participation was voluntary, and they had the right to withdraw from the study at any time without penalty.

All participants in this study were female nurses with bachelor’s degrees. Their average age was 23 years, with ages ranging from 20 to 24. In addition, all participants were newcomers to the workforce. The analysis yielded a total of five distinct themes.

Theme 1: Stress experienced on entering the workforce

The stress experienced at the outset of their careers stemmed from both the unfamiliarity with colleagues and the demanding workload. As this marked the participants’ inaugural job experience, they grappled with stress while communicating with physicians and senior nurses. Conversations among participants often revolved around their negative work encounters during their 1 st month on the job. Participants also mentioned their challenges in comprehending the treatment processes followed by doctors. Moreover, immediate “stat” orders disrupted their preestablished treatment routines and extended their work hours. In addition, the participants were unfamiliar with the senior nurses and their working habits. They also lacked a clear understanding of the specific key points to address during duty handovers, particularly on their 1 st day of work. For example:

• “I was afraid of the process of handing over duties… I tended to look disorganized and did not know where the focal points were.”

One participant stated: “I was anxious whenever I handed over my duty to a senior nurse that I had never met.”

The participants found themselves in an unfamiliar work environment, grappling with unfamiliar nursing techniques, and uncertain about the operation of medical equipment. The newly acquired skills they had learned were at risk of fading due to a lack of opportunities for independent practice. Moreover, they were burdened with an excessive workload, caring for double the number of patients compared to their school experiences. This heightened workload led to significant stress levels and hindered their ability to provide optimal patient care. Their inability to meet job demands to their satisfaction even extended to their ability to maintain proper eating habits, exacerbating their overall stress levels.

Beyond their regular working hours, participants frequently found themselves dedicating additional time to refresh their nursing skills, often at the expense of the rest they needed. Concerns about their subpar work performance also took a toll on the quality of their sleep. For example:

• “There are many machines in the intensive care unit . We have to investigate and respond immediately . We cannot just focus on our duties; we must be mindful of all types of situations at once.”
• “The burden at work was so large that I could not eat or sleep well.”

Theme 2: Reactions of participants caught in the vicious cycle of anxiety

The experience of work-related stress served as a catalyst for the participants’ ingrained responses, ensnaring them in a cycle of anxiety, self-criticism, and uncertainty. This, in turn, had adverse effects on their cognitive abilities, impeding their execution of the clinical techniques they had acquired. Both external environmental factors and internal doubts acted as triggers for anxiety, perpetuating this detrimental cycle.

Figure 1 illustrates a paradigmatic representation of an anxiety-driven vicious cycle initiated by a nurse’s medication error, which sets off a cascade of psychologically distressing situations. The cycle commences with an initial sense of sadness, followed by self-blame and a profound questioning of how the medication error transpired. As the aftermath unfolds, the nurse experiences physical manifestations of stiffness and tension, coupled with internal thoughts suggesting that the head nurse may perceive them as incompetent.

Doubts regarding suitability for the nursing profession begin to emerge, giving rise to persistent inner turmoil that extends day and night. Sleep becomes elusive during nighttime hours, fostering a pervasive sense of failure and gradually nurturing contemplations of resigning from the position. Notably, minor events or stressors can trigger ongoing negative feelings and thoughts among nurses. In this context, the term “thought” underscores participants’ inclination to engage in introspection and generate responses to their cognitive processes.

In the lesson concerning responses and habitual reactions to stress, the participants recounted the stressful situations they had encountered, along with their typical reactions, as follows:

Emergencies involving patients and other challenging situations disrupted their workflow, compelling them to navigate multiple demands simultaneously. These stressors initiated an entry level of anxiety, characterized by feelings of frustration, physical exhaustion, apprehension about delayed duty relief, concerns about potential reprimands, and frustration stemming from insufficient control over their time.

Subsequently, participants advanced to a second stage of anxiety, characterized by an increasing sense of isolation and heightened frustration and anger. Physical symptoms, including abnormal gastric acid secretion and headaches, became more pronounced, accompanied by an overwhelming impulse to consider resigning.

This inclination to quit only intensified their exhaustion, propelling them into a third and even more severe level of anxiety.

• “Medical orders would be issued by two doctors simultaneously and changed one after the other , and I would run around without knowing what was going on . The whole situation had fallen apart , and I could feel the secretion of gastric acid.”
• “I was forced to deal with a mountain of tasks suddenly without a clear priority , and I was depressed and tired. I wanted to resign.”

Due to their lack of familiarity with the work environment and the procedures in use, these participants found themselves unable to respond to their preceptors’ queries and lagging behind their colleagues in terms of assignment progress. Their ability to care for patients was limited to just half the number managed by their more experienced peers. Consequently, these circumstances engendered the following emotions: a sense of burden, the weight of additional responsibilities on their shoulders, a feeling of forgetfulness, and a sense of shame when seeking assistance from senior colleagues after spending a considerable amount of time in the workplace. This feeling of shame was compounded by the awareness that asking for help would only increase the workload for their senior colleagues.

• “After I finished my tasks , the preceptor would ask if there were other tasks that I should do. I would then become doubtful about whether I had forgotten any tasks…. I wonder if this situation would persist forever.”
• “Whenever I was extracting drugs , I would think about what to do next , what questions seniors would ask me , and what the drugs are for. I would then become distracted and nervous.”

Participants’ nursing performance did not consistently meet their expectations during stressful moments. The handover process was often chaotic, giving rise to the following feelings: providing imprecise descriptions of the patient’s condition, even though they were fully aware of the circumstances; experiencing discomfort when facing dissatisfied senior colleagues who were taking over their duties; and struggling with clear thinking while feeling embarrassed in the presence of preceptors.

• “I handed over my duty at 12 o’clock , and I would feel extremely nervous whenever the clock struck 11: 30. ”
• “I would feel nervous when handing over my duty to my senior . Whenever she asked me questions , I would freeze and be unable to think properly. ”

Theme 3: Responses to stress through mindfulness practices

As a result of participating in weekly course sessions and gaining more experience in their roles, the participants began to develop strategies for coping with stress. They incorporated techniques such as the S-T-O-P process (stop, take a breath, observe what’s going on, and proceed) and the 3-min breathing exercise into their routines. Through these practices, participants came to realize that they had previously spent a significant amount of time feeling guilty about inconveniencing their senior colleagues when experiencing stress. They also recognized the importance of focusing on their immediate tasks to prevent issues from spilling over into their subsequent responsibilities.

The participants often faced extended working hours due to increased workload and patient complications. These circumstances left them feeling drained and fatigued. To cope, they temporarily redirected their focus away from the stress-inducing situations to alleviate their anger and frustration, resulting in a sense of relief.

Initially, the participants struggled to meet work demands promptly and occasionally forgot essential tasks and information. In response, they adopted a strategy of completing tasks efficiently without dwelling on potential negative outcomes. In addition, they made efforts to self-assess and address their weaknesses, sought assistance from senior colleagues when necessary, and worked on enhancing their skills.

• “I was only able to perform one task at a time when I entered my job , but now I can think about the content of the words while listening. ”

Utilizing mindfulness strategies can effectively mitigate spontaneous reactions. Themes 1–3 illustrate the connection between these reactions and stress responses [ Figure 2 ].

Theme 4: Discovering small daily life pleasures

Amid these challenges at work, small pleasures had the power to elicit temporary positive emotions in the participants. Discussing positive experiences allowed them to momentarily divert their thoughts from immediate work-related stress. Through mindfulness, they learned to savor their meals at a more deliberate pace, engaging all five senses and heightening their awareness of their actions. In the concluding session, participants discovered the capacity to fully appreciate life through all their senses. Regular sights such as the sea outside their window, the moon, or the breeze during a bicycle ride evoked feelings of awe and comfort. Engaging with patients and experiencing a sense of accomplishment during their work also brought moments of happiness, despite the challenging nature of their profession. The following quotes encapsulate the transformative experiences that participants underwent through mindfulness practice.

• “The pear was rough in appearance but juicy and sweet in taste . My father cultivated it . It reminded me of my hard-working parents and was given to me by my mother . It provided me with a special memory. ”
• “Because my roommate woke up early to prepare it (breakfast) for me…. I chewed on the plain toast , which became sweeter the more I ate it , providing me with a sense of happiness…. I felt that today would be a good day.”
• “Because I’m too tired , sometimes too busy to have a meal or drink water at work . For now , I got a chance to rest for a bit . It’s quite nice. ”

Theme 5: Obstacles encountered during the mindfulness course

Overall, the participants expressed satisfaction with the MBSR program. They recommended that the course be integrated into nursing school curricula. However, some participants voiced concerns about the potential impact of the MBSR program on their clinical learning hours. Despite these challenges, several participants overcame these obstacles through their determination to learn, and some even extended their newfound knowledge to their families.

• “Although the course was beneficial to me and allowed me to talk to other newly graduated colleagues , it was stressful and consumed our learning time. ”
• “To me , when numerous tasks must be completed , we should focus our time on them rather than on this MBSR course. ”

The participants faced challenges in finding time to practice mindfulness techniques. Nevertheless, the majority of participants were able to incorporate mindfulness exercises into their routines, practicing 2–6 times per week and reporting a sense of relaxation. For some, the only available time was a few minutes before bedtime. However, a few participants found it difficult to engage in the practice due to negative moods or the necessity to dedicate time to research literature relevant to their work.

• “When you are tired , you remain tired even after practicing the course content. ” “I was in a bad mood and wanted the class to end.”
• “I have no time to practice what I learned in the course because my workload increased. ”

D ISCUSSION

This study delves into the experiences of newly graduated nurses who participated in the MBSR course. These nurses encountered a transition shock when faced with workplace stressors encompassing knowledge and skills, interpersonal relationships, and professional responsibilities during their initial job placements. In addition to external stressors, their internal anxieties regarding how they would respond to them played a significant role. The MBSR intervention emerged as a valuable tool, fostering self-awareness and equipping participants with essential self-care skills to effectively navigate the demands of workplace stressors.

Given the unfamiliarity of newly graduated nurses with their team members, work environment, and necessary skills, they consistently found themselves grappling with a reality shock, experiencing both physical and psychological discomfort. These challenges detrimentally impacted their job performance, eroded their confidence, heightened self-blame tendencies, and, at times, even triggered contemplations of resignation. Consequently, they became entangled in a vortex of negative emotions. The findings highlight the importance of targeted interventions, like MBSR, in supporting newly graduated nurses during their transitional phase, promoting resilience, and enhancing their ability to cope with the multifaceted challenges encountered in their professional roles.

Scholars Im and Kim discovered a correlation between a higher level of psychological burnout among nurses and an increased incidence of medication errors and adverse events during adverse events [ 23 ] . Our study reveals that nurses, following medication-related incidents, experience a series of vicious cycles leading to heightened anxiety, ultimately culminating in thoughts of resigning from their positions. Research by Wu et al . suggested that assisting newly graduated nurses in adapting to the demanding work environment could alleviate their anxiety and enhance their self-efficacy at work [ 13 ] .

Self-awareness involves the skillful comprehension of stressful events in an organized manner, encompassing the capacity to analyze one’s own emotions, thoughts, and reactions to stress, ultimately leading to the formulation of effective stress responses. Individuals immersed in mindfulness exhibit the ability to gain clarity on their immediate circumstances and interpret situations from various perspectives [ 24 ] . In our study, participants applied the techniques they acquired during the course to manage stress stemming from senior colleagues and their own internal challenges. Our findings align with Lehto et al .’s research results, which underscored the role of self-awareness in enhancing participants’ self-management capabilities in the face of workplace stress. Furthermore, in our investigation, participants frequently turned to mindfulness breathing as a coping mechanism within their high-stress work environment [ 25 ] .

Figure 2 illustrates that nurses, postmindfulness training, exhibit the ability to self-regulate negative emotions and make alternative choices in their responses. This corroborates the observations of Yang et al. , who determined that mindfulness augments self-regulated learning abilities in nursing master’s students by elevating their self-efficacy and psychological flexibility [ 26 ] . In addition, Lee and Park identified a mediating effect of sociocognitive mindfulness and emotion regulation, particularly reappraisal, on empathy [ 27 ] .

Self-awareness involves the skillful comprehension of stressful events in an organized manner, encompassing the capacity to analyze one’s own emotions, thoughts, and reactions to stress, ultimately leading to the formulation of effective stress responses. Individuals immersed in mindfulness exhibit the ability to gain clarity on their immediate circumstances and interpret situations from various perspectives [ 24 ] . In our study, participants adeptly applied the techniques they acquired during the course to manage stress stemming from both senior colleagues and their own internal challenges. Our findings align with the results of Lehto et al .’s research, which underscored the role of self-awareness in enhancing participants’ self-management capabilities in the face of workplace stress. Furthermore, in our investigation, participants frequently turned to mindfulness breathing as a coping mechanism within their high-stress work environment [ 25 ] .

Nurses encounter interference, distractions, anxiety, time pressure, as well as acute and chronic fatigue during handovers, contributing to a decline in handover quality [ 28 ] . Our study reveals that nurses who undergo mindfulness training exhibit an ability to recognize the impact of handover stress on themselves. Consequently, these nurses employ deep breathing techniques to regulate their emotions before handovers. As a result, they experience reduced fear during handovers, allowing them to concentrate more effectively and facilitate a smoother completion of the handover process.

Mindfulness training heightens an individual’s awareness of their immediate environment [ 29 ] . In a prior quantitative study, participation in the MBSR course positively influenced participants’ stress responses [ 19 ] . Embracing small pleasures can elevate nurses’ moods and enhance their ability to unwind, both in their daily lives and at work. Yeganeh and Kolb propose that automatic categorization often underlies both positive and negative work experiences, where emotions are naturally triggered by environmental stimuli [ 30 ] . However, mindfulness empowers individuals with greater control over their emotions.

In the MBSR course, the exchange of experiences plays a crucial role in participants’ learning journeys. Participants provide various forms of support to one another, with some acquiring effective stress management methods, while others remain entangled in the cycle of anxiety. Many participants face challenges practicing MBSR at home due to exhaustion or time constraints. Therefore, this study suggests introducing MBSR training to nurses before they commence hospital inductions.

Moreover, the demanding workload and work schedules pose significant challenges for nurses attending mindfulness courses and engaging in mindfulness activities [ 31 ] . Lehto et al . reported that health-care providers found it challenging to learn mindfulness, citing time constraints and emotional factors, even with the availability of a mobile application designed to facilitate mindfulness practice [ 25 ] . Thus, future MBSR courses should encourage students to integrate MBSR into their routines through shorter, more frequent sessions (both on and off duty) and assess the outcomes accordingly.

Limitations

While interpreting the results, it is important to acknowledge certain limitations of this study. The transcripts utilized were derived from focus group discussions, involving an initial enrollment of 31 participants, but ultimately, only 14 nurses completed the program. A predominant reason cited by most participants for noncompletion was their perceived lack of adequate time for mindfulness practice at home. Consequently, this study suggests offering MBSR training to newly graduated nurses 1 week before their entry into the workforce or before graduation. This approach would enable them to incorporate mindfulness into their daily routines and apply it seamlessly on entering the workforce, mitigating potential scheduling conflicts associated with formal MBSR courses. In addition, we did not comprehensively trace the experiential context of individuals throughout the entire course. We relied on home assignments to gauge participants’ engagement with mindfulness practice; however, many participants reported exhaustion after work, making it challenging to accurately document the time they spent awake in bed before falling asleep and their feelings during practice. This limitation affected the effectiveness of the assignments.

C ONCLUSION

In this study, we utilized qualitative data analysis to explore the perceptions of newly graduated nurses regarding the impact of stress and the effectiveness of the MBSR program on their professional practice. The qualitative findings of this research identified five key themes that offer valuable insights for nursing administrators and educators.

First, the training of new nurses should prioritize their familiarity with the work environment and colleagues, emphasizing the significance of teamwork and addressing anxiety related to the pressure of handovers. Mindfulness breathing training has emerged as a promising approach to alleviate nervous pressure, assisting nurses in maintaining performance standards during shift transitions.

In addition, nursing managers can play a pivotal role in enhancing the well-being of their staff. Creating small moments of happiness within the work environment and fostering a culture of sharing positive experiences among the team can contribute to a more positive and supportive workplace atmosphere. Furthermore, organizing outdoor activities can be instrumental in guiding nurses to engage their five senses, bolstering self-awareness and overall job satisfaction.

Recommendations for future research involve refining the implementation of MBSR courses. It is suggested that the timing of these courses be made more flexible or the class duration be shortened with an extended overall period. These adjustments could enhance the accessibility and effectiveness of MBSR, potentially leading to improved stress management and well-being among nursing professionals. Overall, the findings of this study provide actionable insights for nursing education and administration, with the potential to positively impact the well-being and performance of nursing staff.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author (Shu-Chen Wang) on reasonable request.

Financial support and sponsorship

The authors thank Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, for its support (Grant no. TCRD103-32).

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

We would like to thank all the nurses who participated in the study.

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Nursing Research Priorities

Research priorities.

The ANA Enterprise Research Priorities are strategically designed to address critical challenges and opportunities in nursing and healthcare. These priorities focus on enhancing healthcare access, improving safety and quality of care, and promoting the health and well-being of nurses. They also emphasize the importance of diversity, equity, and inclusion, the development of professional identity, and environmental sustainability. Together, these research priorities aim to drive impactful changes that will shape the future of nursing and healthcare on a global scale. Download the full document to learn more about how these priorities are guiding innovative research and advancing the profession.

ANA Enterprise Research Council

The ANA Enterprise Research Advisory Council provides expert guidance and recommendations to the Institute for Nursing Research & Quality Management on matters of global importance, aimed at shaping the future of nursing and healthcare. By fostering a culture of inquiry and advancing interprofessional, practice-based research, the Council drives transformative initiatives that align with the ANA Enterprise's mission to lead the profession forward.

Composed of volunteer experts, the Council unites diverse nursing voices to steer research efforts that strengthen the global impact of nursing. It ensures that frontline nurses' perspectives are central to advancing healthcare innovations. Historically focused on building research capacity, fostering collaboration, and enhancing data governance, the Council's priorities now emphasize workforce development, nurse well-being, diversity and inclusion (DEIB), expanding the scope of practice, and demonstrating the value of nursing.

Research Advisory Council

Jen bonamer.

PhD, RN, AHN-BC, NPD-BC

Nursing Professional Development – Research Specialist Education, Professional Development & Research Department Sarasota Memorial Health Care System

Jen Bonamer works as a Nursing Professional Development – Research Specialist at Sarasota Memorial Hospital in Sarasota Florida. She leads the nursing research and evidence-based practice programs and is actively focused on supporting healthy work environments and clinician well-being. Jen received her BSN from the University of Florida (Gainesville) and practiced for ten years in pediatrics (general practice and hematology/oncology/bone marrow transplant). She completed the University of South Florida’s (Tampa) Nursing BS to PhD program with her master’s of science degree (nursing education) and PhD (nursing). She is certified in both nursing professional development and advanced holistic nursing. Jen is an active member in the American Nurses Association – Enterprise (ANAE) Research Advisory Council and an independent contractor of peer review services for the Magnet program.

Catherine H. Ivory

PhD, RN-BC, NEA-BC, FAAN

Associate Nurse Executive, Nursing Excellence Vanderbilt University Medical Center

Cathy Ivory, PhD, RN-BC, NEA-BC, FAAN, Associate Nurse Executive, oversees the Office of Nursing Excellence for the Vanderbilt Health System. Through collaboration across all VUMC and Vanderbilt University entities, The Office of Nursing Excellence is responsible for professional, evidence-based nursing practice, VUMC’s shared governance and Magnet activities, and all aspects of inquiry that translates evidence into practice and improves quality, safety, patient experience, and the delivery of cost effective care across settings. Dr. Ivory facilitates nursing research activities and connects nurse investigators with collaborators across the broader research enterprise at Vanderbilt.

Dr. Ivory has more than 25 years of experience as a staff nurse, clinical specialist, system-level nursing administrator, educator, and health services researcher. Dr. Ivory’s clinical focus is perinatal nursing and she served as the 2014 President of the Association of Women’s Health, OB and Neonatal Nurses (AWHONN), representing more than 300,000 nurses who care for women and newborns. She also holds two ANCC board certifications, one as an informatics nurse (RN-BC) and one as an advanced nurse executive (NEA-BC). She was inducted as a fellow in the American Academy of Nursing in 2017.

Dr. Ivory holds a BSN, an MSN in nursing administration/healthcare informatics, and a PhD in nursing science. Her research interests include implementation science and using data generated by nurses to quantify their role in patient care, patient safety, and patient outcomes. She is passionate about the nursing profession, nursing informatics, evidence-based nursing practice, and research.

David W. Price

MD, FAAFP, FACEHP, FSACME

Professor, Family Medicine, University of Colorado Anschutz School of Medicine Senior Advisor to the President and CEO, American Board of Family Medicine Medical Education and Quality Improvement Consultant and Coach Associate, Wentz/Miller Global Services

Dr. Price is Senior Advisor to the President, American Board of Family Medicine. He is also Professor of Family Medicine at the University of Colorado School of Medicine.

Dr. Price spent 29 years in the Kaiser Permanente (KP) system in several roles, including Director of Medical Education for the Colorado Region and the (national) Permanente Federation; physician investigator with the KP Colorado Institute of Health Research; Co-director of the Kaiser Colorado Center for Health Education, Dissemination and Implementation research; Clinical Lead for Kaiser National Mental Health Guidelines; member of the Kaiser National Guideline Directors Group, and Chair of Family Medicine for the Colorado Permanente Medical Group. He served on the ABFM Board of Directors from 2003 – 2008, where he chaired the R&D and Maintenance of Certification committees and was Board Chair from 2007-2008. He is a former Senior Vice-President at the American Board of Medical Specialties. He is a past Director of the Accreditation Council for Continuing Medical Education, a past-president of the Colorado Academy of Family Physicians, past chair of the AAMC Group on Educational Affairs section on Continuing Education and Improvement, and currently serves on the AAMC Integrating Quality Initiative steering committee. He is widely published and has spoken nationally and internationally and published in areas ranging from continuing medical education/professional development, quality and practice improvement, mental health, and evidence-based medicine.

Dr. Price received his M.D. degree from Rutgers Medical School in 1985 and completed his Family Medicine Residency and chief residency at JFK Medical Center, Edison, NJ, in 1988. He is a fellow of the American Academy of Family Physicians, the Alliance for Continuing Education in the Health Professions, and the Society of Continuing Medical Education (SACME) and the recipient of the 2018 SACME Distinguished Service in CME Award.

Marianne Weiss

Professor Emerita of Nursing Marquette University College of Nursing

Dr. Weiss is Professor Emerita of Nursing at Marquette University in Milwaukee, WI. She holds a Bachelor of Science in Nursing degree from McGill University in Montreal, Canada, and Master of Science in Nursing and Doctor of Nursing Science degrees from the University of San Diego. Prior to joining the faculty of Marquette University, she held positions as clinical nurse specialist and nurse researcher in women’s services for a large healthcare system.

Dr. Weiss continues to be an active nurse researcher and research consultant. Her program of research focuses on the contribution acute care nurses make to patient outcomes. Much of her work has focused on discharge preparation, assessment of discharge readiness, and post-discharge outcomes across the range of patients discharged from acute care hospitals. Her funded research studied the impact of nurse staffing on quality and cost measures of the discharge transition from hospital to home. Dr. Weiss was the Principal Investigator for the READI multi-site study, commissioned by ANCC and conducted at 33 Magnet hospitals, that investigated implementation of discharge readiness assessment as a standard nursing practice for hospital discharge. Other related research focuses on nurse staffing, continuity of care, and nurse characteristics such as education and certification that contribute to nurse performance in achieving patient outcomes. Her goal is to document the critical role and value hospital nurses bring to patient care and outcomes during and after hospitalization.

Instrument development has been an important aspect of her work on discharge readiness. Dr. Weiss has developed and tested research scales to measure quality of discharge teaching, discharge readiness, and post-discharge coping difficulty. She has conducted tool validation studies in adult-medical surgical patients, parents of hospitalized children, and postpartum mothers. These scales have been translated into more than 15 languages and are being used extensively in clinical practice and research. Dr. Weiss collaborates frequently with researchers worldwide on the science of discharge preparation. She has published extensively with US and international colleagues.

Olga Yakusheva

Professor of Nursing and Public Health Department of Systems, Populations and Leadership Department of Health Management and Policy University of Michigan School of Nursing and School of Public Health

Dr. Yakusheva is an economist with research interests in health economics and health services research. Yakusheva's area of expertise is econometric methods for causal inference, data architecture, and secondary analyses of big data. The primary focus of Yakusheva’s research is the study of economic value of nursing/nurses. Yakusheva pioneered the development of a new method for outcomes-based clinician value-added measurement using the electronic medical records. With this work, Yakusheva was able to measure, for the first time, the value-added contributions of individual nurses to patient outcomes. This work has won her national recognition earning her the Best of AcademyHealth Research Meeting Award in 2014 and a Nomination in 2018. Yakusheva is currently a PI on a AHRQ funded R01 measuring the continuity of interprofessional ICU care and an ANF/ANCC funded research grant measuring the value-added contribution of specialty nurse certifications to nurse performance and patient outcomes.

Yakusheva is a team scientist who has contributed methodological expertise to many interdisciplinary projects including hospital readmissions, primary care providers, obesity, pregnancy and birth, and peer effects on health behaviors and outcomes

Yakusheva holds a PhD in economics, an MS in economic policy, and a BS in applied mathematics.

Colleen K Snydeman

Executive Director, Office of Quality, Safety, Informatics, & Practice and the Inaugural MGH Endowed Scholar in Nursing Practice, Nursing & Patient Care Services, Massachusetts General Hospital

Dr. Snydeman’s expertise and leadership are dedicated to delivering safe, evidenced-based, high quality patient care through the continuous improvement of practice and positive outcomes with a focused commitment to the safety and well-being of the workforce. As the executive director of Massachusetts General Hospital’s Patient Care Services Office of Quality, Safety, Informatics, & Practice I provide oversight for quality and safety programs, improvement initiatives and outcomes associated with quality nursing care (falls, pressure injuries, central line blood stream infections, catheter associated urinary tract infections, and assaults on nursing personnel). I oversee a team of nine quality and informatics specialists and have a formal, non-direct reporting relationship with 75 unit based clinical nurse specialist and nurse practice specialists.

During the unprecedented COVID-19 era I led and supported a full implementation of Circle Up Huddles in all PCS inpatient areas, implementation of hospital-wide Proning Teams (recognized by Johnson & Johnson as a top ten innovation), pressure injury research, qualitative research on the experiences of bedside nurses and respiratory therapists, and implementation of resiliency and wellbeing strategies. In collaboration with RGI analytics, we have developed an algorithm using live streaming electronic health record data to alert nurses on their iphones to changes in patient’s fall risk and the associated interventions needed to prevent falls. Preliminary statistical findings are promising.

I have over forty years of progressive nursing leadership experience. My background in nursing leadership and critical care nursing led to my dissertation work using a quasi-experimental pre/post-test design with intervention and control groups to measure the impact of a theory based adverse event nurse peer review program on safety culture and the recovery of medical errors in the critical care setting. A linear mixed model analysis suggested that critical care nurses who participated in the program had a more critical view of safety culture and work environment, along with increased accountability and responsibility for their role in using strategies to keep patients safe. Further interdisciplinary safety research is underway.

Johana Rocio, Fajardo (Almansa)

Advanced Heart Failure & Transplant Nurse Practitioner, Duke University Hospital

As a doctor of nursing practice with a specialty in heart failure, transplant and mechanical support, my research is focused on improving patient outcomes through the development and implementation of best practices for the care of advanced heart failure patients. My clinical activities are centered on reducing healthcare inequities and improving Health Related Quality of Life (HRQoL) throughout the disease trajectory by optimizing interdisciplinary management and transitional care. Additionally, I have worked on database creation for both clinical and academic purposes as well as leveraging information technology to promote clinical practice standardization, minimize medical errors, and reduce cost of care.

Lastly, I have assisted in the establishment of centers of excellence by building the organizational, clinical, and educational infrastructures to deliver integrative, efficient, and specialized care to the Amyloidosis and Sarcoidosis populations. Furthermore, I have participated as a keynote speaker at national and international medical symposiums and have served as editor in chief and writer of textbooks. During my tenure as an Assistant Professor at Georgetown University School of Medicine, my research focused on the implementation of translational and organizational research to address specific issues in clinical practice and patient care delivery. Additionally, my work in the utilization of Inotropic support in rare cardiomyopathies was recognized as innovative in the field. By providing evidence and simple clinical approaches, this body of work has changed the standards of care for rare cardiomyopathy patients and will continue to provide assistance in relevant medical settings well into the future. I have served in the capacity of Principal Investigator, Co-Investigator, task leader, and technical consultant on projects supported by the government, industry and internal funding sources. In addition, I have successfully collaborated in randomized clinical trial conduction (e.g. patient screening, enrollment, and monitoring), and produced peer-reviewed publications.

Kathy Casey

PhD, RN, NPD-BC

Professional Development Specialist, Denver Health Adjunct Professor, University of Colorado, College of Nursing Adjunct Faculty, Colorado Christian University

Kathy Casey, PhD, RN, NPD-BC, is nationally and internationally known for her Casey-Fink Survey design work supporting graduate nurse role transition, nurse retention, and readiness for professional practice.

Kathy is certified in Nursing Professional Development, and currently serves as a Professional Development Specialist at Denver Health, in Denver, Colorado. She is an Adjunct Professor at the University of Colorado College of Nursing and Adjunct Faculty teaching EBP and Research at Colorado Christian University. Kathy is a lead appraiser for the American Nurses Credentialing Center Practice Transition Accreditation Program (PTAP).

In March 2023, Kathy received the Association for Nursing Professional Development's Marlene Kramer Lifetime Achievement Award for her contributions and research on survey development for use in education and practice programs. In October 2023, Kathy will be inducted as a fellow in the American Academy of Nursing.

Kathy received her Bachelor of Science in Nursing from Pacific Lutheran University, her Master's Degree in Nursing Administration from the University of Colorado, College of Nursing, and her Doctorate in Nursing Education from the University of Northern Colorado, School of Nursing.

Kortney James

PhD, RN, PNP-C

Dr. Kortney James is a PhD prepared nurse and Associate Health Policy Researcher at RAND Corporation. Her research focuses on improving access to quality reproductive health services to minoritized populations. Dr. James is also the Associate Editor of the Nursing for Women's Health Journal, a role in which she is committed to recruiting and supporting manuscripts and research that reflect diverse perspectives and identities. Dr. James recently completed a postdoctoral fellowship in the National Clinician Scholars Program, a continuation of the Robert Wood Johnson Foundation, in the School of Medicine at the University of California, Los Angeles. During her postdoctoral fellowship Dr. James has published several manuscripts in high impact journals. Select publications include "NIH funding: Hone efforts to tackle structural racism" featured in Nature and "Factors associated with postpartum maternal functioning in Black women," featured in Journal of Clinical Medicine. Thus far, Dr. James has been awarded $230,000 to support her research related to Black perinatal mental health. She received $30,000 from the Iris Cantor UCLA Women's Health Center to support her mixed methods study that aims to identify and understand culturally and racially relevant influences on their journey to healing from perinatal mood and anxiety disorders. Dr. James also received $200,000 from the American Nurses Foundation to implement an educational intervention to support ambulatory care nurses and other healthcare staff to care for Black pregnant and postpartum people’s mental health needs with culturally relevant resources. Dr. James has a wide range of clinical experience in acute inpatient care, primary care, and public health. Dr. James is a pediatric nurse practitioner with over a decade of experience in acute newborn care and pediatric primary care. Dr. James has extensive experience in perinatal care due to her time as a registered nurse in the highest volume birthing hospital in the country with an average of around 25,000 births a year (and counting). Dr. James has also held an executive leadership position in the Office of Nursing, Maternal Child Health, and Infectious Disease divisions at the Georgia Department of Public Health in Atlanta, GA.

Ultimately, Dr. James' mission is to co-create solutions with Black women and people capable of pregnancy to achieve health equity.

For questions or inquiries please contact the ANCC Research Council members at [email protected] .

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Qualitative Research Findings as Evidence: Utility in Nursing Practice

Wendy r. miller.

1311 N Street, Bedford, IN 47421, ude.iupui@lbeurtrw , Indiana University School of Nursing

The use of qualitative research methods in nursing research is common. There is a need for Clinical Nurse Specialists (CNSs) to become informed regarding how such qualitative findings can serve as evidence for nursing practice changes.

To inform CNSs of the meaning and utility of qualitative research findings. Implications for qualitative research findings as evidence in nursing practice are particularly discussed.

Introduction

As the use of qualitative research methods proliferates throughout health care, and specifically nursing research studies, there is a need for Clinical Nurse Specialists (CNSs) to become informed regarding the potential utility of qualitative research findings in practice. In this column, the questions of what qualitative findings mean , how the ever-increasing amounts of qualitative research evidence can be used, and how such findings can contribute to evidence-based nursing practice, are considered. First, to provide readers with a context for the discussion, a brief overview of qualitative research and its theoretical underpinnings is included.

What is Qualitative Research?

Qualitative research refers to a method of inquiry in which the researcher, acting as data collection instrument, seeks to answer questions about how or why a particular phenomenon occurs. Questions regarding of what a phenomenon is comprised may also guide qualitative research 1 . The most fundamental assumption underlying qualitative research is that reality is something socially constructed on an individual basis 2 . Varied methods of qualitative research exist. Examples of qualitative methods employed in nursing research include grounded theory, phenomenology, ethnography, and qualitative description. Each method has its own assumptions and purposes and an appropriate method is chosen based on the research question. For example, a researcher investigating the process involved in the occurrence of a phenomenon would likely choose grounded theory, while a researcher interested in the meaning of the phenomenon would utilize phenomenology. Regardless of method, participants are purposefully enrolled based on their familiarity with the phenomenon. Data are generally collected via one or a combination of three mechanisms: interviews, observation, or document/photograph review. Data are analyzed inductively via specific, rigorous techniques and then organized in a manner which best answers the research question 3 . Importantly, the objective of qualitative research is not the accumulation of information, but the growth of understanding about phenomena of concern to nursing 4 .

The Nature of Qualitative Research Findings and their Use as Evidence

The way in which qualitative findings appear in research reports varies depending on the method utilized. Experts (Sandelowski and Kearney) in the field recommend categorizing qualitative findings in terms of the knowledge they generate, regardless of methodological origin. Sandelowski and Barroso 5 have developed a typology of qualitative research findings. In this typology, findings exist on a continuum. Categories on the far left side of the continuum (“no finding,” consisting of a report of raw data, and “topical survey,” consisting of an organization of the data in a table of contents format) are considered to be not research and not qualitative research, respectively. The remaining three categories on the right side of the continuum (“thematic survey,” consisting of patterns found in the data, “conceptual/thematic description,” in which concepts and themes are used to link and illuminate concepts in new ways, and “interpretive explanation,” the defining feature of which is a transformation of data into theories or full explanations of a phenomenon) are considered exploratory, descriptive, and explanatory, respectively. While the authors note that the goal of the typology is not to judge the quality of findings, the typology can assist readers in determining which types of findings should be omitted from evidence influencing practice (no finding and topical survey) and those which may be more sophisticated, furthest from the data, and potentially applicable to practice.

Kearney 6 , too, has put forth a categorization mechanism for qualitative findings based on their degree of complexity and discovery and asserts that their application as evidence in practice is based on the category in which they fall. Findings “bound by a priori frameworks” are produced via the application of existing sets of ideas to data without identifying new insights. These findings cannot serve as evidence. Findings comprised of “descriptive categories” are similar to those in the “topical survey” 5 and serve as a type of evidence that provides a map for previously unstudied experiences. “Shared pathway or meaning” findings portray linked themes or concepts, as well as an analyst’s ideas for practice implications. Findings that situate under the category of “depiction of experiential variation” not only describe the essence of an experience but portray how that experience varies depending on context. Finally, findings characterized as a “dense explanatory description” are considered the gold standard and explain human behavior and choice-making. 6 Findings in this category are most readily applied to clinical practice.

Now that the types of qualitative findings have been described, it is possible to discuss how such findings are used in nursing practice. A common misconception is that qualitative research findings are, by default, preliminary to quantitative studies, cannot stand alone, and lack generalizability 4 . Qualitative findings, however, can be complete by themselves. Sandelowski 4 differentiates between the generalizability of quantitative findings versus that of qualitative findings. Regarding quantitative findings, generalization is characterized by establishing universal laws for populations based on information from samples deemed to be similar to those populations, which cannot, nor is it meant to, be achieved with qualitative findings. Qualitative findings are not generalizable in the prevalent sense of the word—they do not provide laws or relationships that can be taken from a single sample and applied to entire populations. Rather, they are generalizable in a way that is particularly pertinent to nursing practice, in which there is an expectation that scientific findings, and nursing care itself, be tailored to unique individuals in their distinct contexts. That is, qualitative findings provide idiographic knowledge about human experiences to readers , who can apply qualitative findings to the care of individuals who are in situations similar to that of those in the sample from which findings came 4 . A prime example of the generalizability of qualitative findings is seen in Conrad’s 7 study, which reframed the problem of “non-compliance” to “self-regulation” whereby patients with epilepsy changed medication practices in order to exert control over their disease. The findings from this study have been generalizable in that they have, in the form of a self-regulation theory, helped in understanding the origins of seemingly self-destructive behavior associated with a wide range of “noncompliant” behavior related to childhood immunizations, safe sex practices, and self-management of asthma and diabetes 8 . As the above example demonstrates, a CNS who reads qualitative research can potentially gain insight into the behaviors, needs, and experiences of his or her patient population, informing CNS practice. For example, an obstetrics/neonatal CNS who learns about the etiologies of prenatal “non-compliance” behavior via reviewing qualitative research findings is armed with information to help him or her develop etiology-specific nursing interventions for mothers living this experience, rather than relying on more general interventions to improve treatment adherence.

Sandelowski 9 notes that qualitative findings can demonstrate instrumental, symbolic, and conceptual utility. Instrumental utilization refers to the concrete application of findings that have been made into new forms such as clinical guidelines, standards of care, appraisal tools, algorithms, and intervention protocols. Symbolic utilization is less concrete and does not result in a true practice change, but rather findings are used to legitimate a position or practice. Symbolic utilization of findings is often a precursor to instrumental utilization. Conceptual utilization is very intangible, and leads to the way in which a user thinks about providing care.

Qualitative findings have demonstrated independent instrumental utility in leading to key changes in clinical communication practices. The results of one study eventually led to the recommendation that active listening, appraisal, teaching, and social support be included in patient-family-provider communication. These findings were executed into practice directly and have led to improved outcomes 10 . A CNS could similarly directly apply qualitative findings to practice. For example, an oncology CNS who learned, via reading qualitative research, that oncology patients prefer a certain type of communication style at the end of life could work in the nursing sphere to educate nurses and develop with them a communication guide for these particular patients. The CNS could then measure pertinent outcomes associated with the intervention (patient satisfaction, for example). Qualitative findings also demonstrate instrumental utility by refining quantitative research. Qualitative findings often underlie the concepts measured in quantitative instruments. 9 Further, qualitative findings provide knowledge about how individual and contextual factors affect the impact of an intervention 11 and can explain subject variation on targeted outcomes of an intervention 12 . That is, qualitative methods can be used to investigate unexpected quantitative results or to explain why the effectiveness (success of an intervention in a research study) is not equal to its efficacy (success of an intervention in practice). For example, qualitative findings might inform a CNS of potential reasons a particular evidence-based intervention has not been effective in his or her patient population or for a specific patient. Conceptually and symbolically, qualitative findings are useful by increasing nurses’ understanding of patients’ experiences, thereby allowing for more tailored interventions in care, as well as the anticipation of problems that might be encountered by a particular patient in a particular context 9 . Qualitative findings inform a CNS’ understanding of patients’ experiences, improving his or her ability to develop specific, tailored interventions, particularly in the patient and nursing spheres, that will improve patient outcomes. For instance, a CNS who learned, via reading qualitative research, that ventilated patients’ chief concern is their inability to communicate while intubated could devise and implement nursing interventions that would allow for the use of alternative communication strategies for these patients. In effect, the experiences of patients in a certain situation (as captured via qualitative methods) have informed, and potentially improved, the care provided to other patients in that situation.

Kearney 6 has made explicit statements regarding the ways in which qualitative findings can directly impact nursing practice. First, findings can lead to clinical insight or empathy . In this simplest mode of application, nurses can learn “what it feels like” to be in a given illness situation, common factors encountered by patients in that situation, and different ways patients view an illness. Armed with this understanding, the nurse pays attention to new cues from the patient, can make sense of certain presumably aberrant behaviors, and provide support in a more informed way. Qualitative findings can also contribute to assessment of patient status or progress . Findings which portray a trajectory of illness can inform the development of clinical assessment tools for individual patients or, with further testing, a particular patient population. For example, if a nurse reads that there are five reactions from teenage mothers immediately following birth, he or she can monitor for specific cues and form questions to determine the patient’s reaction and possible needs. Qualitative findings can also be applied via anticipatory guidance . This type of application is somewhat interventionist, as nurses share qualitative findings directly with clients, offering a research-based perspective on what patients might be experiencing and how others have described that experience. Findings at the “shared pathway” level are needed for this application. Coaching is achieved when the nurse shares qualitative findings with clients and further advises regarding steps they should consider taking to reduce stress/symptoms and improve adaptation. This application requires higher-complexity findings.

Evaluating the Validity of Qualitative Research

How does one know if he or she can trust the results of a qualitative study? Unlike in quantitative research, in which there are checklists and p values available to guide such a decision, the evaluation of qualitative research is less clear-cut. While researchers have created checklists to ease the process by which the validity of qualitative findings is assessed 13 , experts in the field struggle to come to a consensus regarding the appropriate criteria for evaluating qualitative studies because, according to Sandelowski 14 and others 15 – 16 , no criteria can uniformly address quality in the many various methods used in qualitative research. That is, quality “looks different” from one qualitative method to the next. Sandelowski and Barroso 16 prefer that the quality of qualitative studies be judged based on criteria specific to the method being used. These authors offer a reading guide , to which readers of this journal are referred, which guides readers through evaluating the features of any qualitative report most relevant to its quality and use 16 .

Undeniably, qualitative methods have become a standard way in which researchers generate knowledge pertinent to nursing practice. Thus, CNSs are surrounded by much qualitative evidence with which they might lack familiarity in utilizing. Here, the discussion, though admittedly non-exhaustive, has hopefully illuminated to readers the value and potential utility of qualitative findings as evidence in nursing, including ways in which such findings can be immediately applied to practice. Further, readers have been exposed to the evaluation of qualitative studies and it is hoped that they will seek out the suggested sources in helping them to learn to read and critique qualitative studies so that data generated from such studies can be added to the CNS’s repertoire of evidence.

Acknowledgments

This column was made possible by Grant Number 2T32 NR007066 from the National Institute of Nursing Research

Wendy Miller is an Adult Health Clinical Nurse Specialist and a PhD in Nursing Science student at the Indiana University School of Nursing. She is studying the self-management of older adults with epilepsy and is supported by a T32 pre-doctoral training grant.

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Exploring perspectives: a scoping review of the challenges facing doctoral training in Africa

• Open access
• Published: 06 September 2024

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• Oluwatomilayo Omoya   ORCID: orcid.org/0000-0002-0545-5341 1 ,
• Udeme Samuel Jacob   ORCID: orcid.org/0000-0002-3234-8226 2 ,
• Olumide A. Odeyemi   ORCID: orcid.org/0000-0002-6041-5027 3 &
• Omowale A. Odeyemi 4  

Given the growing demand to produce PhD holders in Africa, it is crucial to grasp the intricacies faced by PhD candidates. This review aimed to synthesise the existing studies that explore the perspectives of candidates pursuing or completing a PhD in Africa. In conjunction with the Joanna Briggs Institute (JBI) methodology for scoping reviews, a scoping review guide developed by Arksey and O’Malley ( 2005 ) was used. Multiple databases were searched, including EBSCO Host, Scopus, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline (Ovid), and Google Scholar. Of the 51 articles that were retrieved, 12 were included in the review from various African countries. All articles were screened for quality before inclusion. The studies explored the types and characteristics of the included articles. The studies were descriptively mapped using qualitative content analysis, which revealed five themes: the sociodemographic profile of the PhD candidates, funding, resources and training, supervision experiences, and coping mechanisms. There is evidence on sociodemographic characteristics, challenges posed by funding, inadequate resources, and supervisor–candidate relationships, the research addressing why African candidates are studying at a later age, gender-specific environmental and cultural barriers, and coping strategies used during candidature is comparatively limited. Consequently, further investigations in these areas are crucial to better support PhD candidates in Africa.

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Introduction

Doctor of Philosophy (PhD) degrees are considered to be a high priority in many continents, including Africa because they contribute to research output, innovation, economic and scientific growth (Alabi & Mohammed, 2018 ; Akudolu & Adeyemo, 2018 ; Tsephe & Potgieter, 2022 ; Molla & Cuthbert, 2016 ; ASSF, 2010 ). Furthermore, doctoral education is viewed as a driver for the strengthening of economic knowledge, and the development of capital driven by academia has been described as pivotal for the continent of Africa (ASSF, 2010 ; Bitzer & Matimbo, 2017 ; Lindtjørn et al., 2019 ; Molla & Cuthbert, 2016 ; Tsephe & Potgieter, 2022 ). Academic capital is the knowledge gained at a higher level of education with ideas and creativity that informs societal, economic, and scientific growth (Asongu & Nwachukwu, 2018 ; Bitzer & Matimbo, 2017 ; Gurib-Fakim & Signe, 2022 ). However, study delays, longer completion times, high attrition rates, low research training capacity and productivity pose challenges that impair the contribution of academic knowledge (Molla & Cuthbert, 2016 ; Alabi & Mohammed, 2018 ; Akudolu & Adeyemo, 2018 ).

In Africa, there has been an increase in the recognition of the need for investment in research and innovation, driven by African-led researchers to provide relevant solutions that address challenges within Africa (HIRSA, 2019 ). Reports by the British Council in partnership with the German Academic Exchange Service study included reports from six African countries: Ethiopia, Kenya, Ghana, Nigeria, Senegal, and South Africa (Alabi & Mohammed, 2018 ; Akudolu & Adeyemo, 2018 ; Barasa & Omulando, 2018 ; Nega & Kassaye, 2018 ; Herman & Sehoole, 2018 ; Dimé, 2018 ). The report commissioned a study that surveyed research and doctoral training capacity in sub-Saharan Africa. Several challenges were common across these countries. One of these was the limited source of funding to sustain quality PhD training, which was reflected in the experiences of the PhD candidates. Reports have indicated that candidates are generally satisfied with their programmes, but improvements are required in terms of funding, research infrastructure, and supervision (Alabi & Mohammed, 2018 ; Akudolu & Adeyemo, 2018 ; Nega & Kassaye, 2018 ; Herman & Sehoole, 2018 ; Dimé, 2018 , Barasa & Omulando, 2018 ). Supervision was reported to lack quality, especially due to supervisor shortages, and at times, candidates worked with supervisors who were not necessarily interested in their area of focus (Akudolu & Adeyemo, 2018 ; Molla & Cuthbert, 2016 ; Nega & Kassaye, 2018 ). As such, this has an impact on the quality of education, research output, and the challenges experienced in PhD training within universities.

A PhD is challenging regardless of the setting. Within the context of Africa, it appears that most PhD candidates are a cohort who work within the industry even though collaboration between academia and industry in Africa is lacking, especially in PhD training, which tends to follow a traditional, discipline-focused approach (Akudolu & Adeyemo, 2018 ; Nyemba et al., 2021 ; Osiru et al., 2022 ; Stackhouse & Harle, 2014 ). However, candidates may have to maintain full-time employment due to a lack of funding to support their PhD. Collaborations with international institutions are an important factor that has driven positive research output in some African countries (Herman & Sehoole, 2018 ), for example, South Africa has reported an increase in its research output due to strong international collaboration as well as national policies with strategic plans and visons (Gurib-Fakim & Signe, 2022 ; Herman & Sehoole, 2018 ). The number of PhD programmes available in some universities appears to have increased over the past decade, but several of these universities have noted low completion and high attrition rates (Barasa & Omulando, 2018 ; Dimé, 2018 ; Herman & Sehoole, 2018 ; Nega & Kassaye, 2018 ), for example, in Ethiopia, the completion rate has not consistently grown even though the number of programmes available has increased (Nega & Kassaye, 2018 ). Like Ethiopia, Kenya has a 5 to 50% attrition rate in its various institutions (Barasa & Omulando, 2018 ). At six Ghanaian universities, a total of 42,246 candidates were enrolled from 2012–2013, and only 65 of those candidates graduated (Alabi & Mohammed, 2018 ). These statistics show that intentional efforts are needed to address the challenges that doctoral candidates encounter.

Research output on a global level, from Africa currently occurs at a low rate of approximately 2%, indicating that Africa’s research capacity is lacking compared to that of other Western countries (Asongu & Nwachukwu, 2018 ; Gurib-Fakim & Signe, 2022 ). In addition, the World Health Organization’s (WHO) strategy for research in Africa has shown that improving global health and economic development is based on high-quality research and the best scientific evidence (WHO, 2012 ). While efficiency in research capacity and output in Africa has been identified as a priority, there are still gaps in education, health care, food insecurity, and skills. Thus, knowledge-driven by research outputs has been indicated to stimulate growth in various organisations and sectors (Whitworth et al., 2008 ; WHO, 2012 ). For growth to occur, the training of PhD candidates has been identified as a strategy to alleviate some of the poor outcomes in Africa’s health and economic development (Gurib-Fakim & Signe, 2022 ; Lindtjørn et al., 2019 ).

Efforts to boost Africa’s research abilities are being made by various organisations and government bodies. Studies have examined ways to strengthen Africa’s research capacity and its integration into policies (Bates et al., 2014 ; Dean et al., 2015 ; Mugabo et al., 2015 ). One of these studies suggests setting goals early, collaborative planning with diverse teams, assessing current capacity, making action plans, and evaluating progress until capacity is strengthened (Bates et al., 2014 ). Research collaboration with international organisations as an initiative to improve research capacity has been shown to benefit both sides (Dean et al., 2015 ). The Consortium for Advanced Research Training in Africa (CARTA) model is a key player in boosting research capacity. It focuses on restructuring and strengthening African Universities to produce skilled local scholars (Ezeh et al., 2010 , Balogun et al., 2021 ). Evaluations of the CARTA model show its significant impact on doctoral training, networking, equitable resource provision, research quality, and supervisory satisfaction (Christoplos et al., 2015 ; Balogun et al., 2021 ; Adedokun et al., 2014 ). Moreover, investments in informatics, bioinformatics, and data science training in Mali are enhancing research capacity in sub-Saharan Africa, fostering scientific innovation and knowledge dissemination (Shaffer et al., 2019 ).

The training of PhD candidates was largely identified as one of the major focus areas to strengthen research capacity (Balogun et al., 2021 ; Bates et al., 2014 . Mugabo et al., 2015 ; Fonn et al., 2016 ; Adedokun et al., 2014 ). In the training of PhD candidates, personalised development plans, quality assurance in PhD training, institutional polices, research facilities, and student well-being were often identified as gaps for needing improvement. Some of the common suggestions identified to address these gaps include improving internet access, providing dedicated office spaces for PhD candidates, training supervisors, and increasing the number of supervisors. Similarly, CARTA’s model of training PhD candidates emphasises collaboration to strengthen African universities’ research capacity and infrastructure.

Research examining the perspectives of doctoral students reveals that despite finding aspects of their programmes challenging, they also perceive them as valuable opportunities for personal growth and development (Nyarigoti, 2021 ; Sibomana, 2021 ). These challenges often serve as catalysts for growth and advancement. Successful doctoral students attribute their achievements to their confidence in tackling difficult tasks with determination. However, female doctoral students express encountering obstacles related to gender biases in both social and professional domains, hindering the fulfilment of their PhD aspirations. Additionally, African students relocating to other African countries for their PhDs report a unique experience of feeling like outsiders despite being in an African country (Herman & Meki Kombe, 2019 ). There is a need to understand more about the challenges faced by PhD and doctoral candidates in the African context. It is important to determine whether improvements have been made to further inform the research capacity and training of PhD candidates in Africa. Therefore, the aim of this scoping review was to map out the available literature on the challenges faced by PhD candidates in Africa to identify gaps and inform future research, policy, and practice.

A scoping review was undertaken to map out the current available literature on the experiences of PhD candidates in Africa. A scoping review protocol that guided the process is available as an open-access publication (Omoya et al., 2023 ). The proposed scoping review was conducted in accordance with Arksey and O’Malley’s ( 2005 ) six-step framework in conjunction with the Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., 2020 ). The six-step framework includes the following steps: (1) developing the research question; (2) identifying relevant studies; (3) selecting the study; (4) charting the data; (5) collating, summarising, and reporting results; and (6) consultations (not required in this review). The JBI approach to conducting and reporting scoping reviews and the meta-analyses extension checklist (Fig. S1 ) for scoping reviews (PRISMA-ScR) are attached for consistency in reporting (Tricco et al., 2018 ).

Research question

The scoping review question was developed using the JBI population, concept, and context (PCC) mnemonic as well as the Arksey and O’Malley ( 2005 ) framework for identifying a research question. The research question was developed from the need to produce knowledge that informs the challenges facing doctoral training in African Universities. From this research question, the title of the review was structured to reflect the PCC mnemonics. For example, in the PCC mnemonic, P stands for the population, and in this review, these are the “PhD candidates”. C is a concept, that is the “challenges facing doctoral training”, and the C-context is “Africa”. The scoping review question was titled “Exploring perspectives: A scoping review of the challenges facing doctoral training in Africa . ”.

Inclusion and exclusion criteria

In the second step, the identification of the relevant studies was assessed against the eligibility criteria as well as the objectives and aims of the scoping review detailed in the previously published protocol (Omoya et al., 2023 ). The inclusion criteria were research studies examining participants who had undertaken their PhD in Africa, studies that focused on the barriers and facilitators that have impacted doctoral training in Africa, and research studies written in English Language with a 20-year limit range. Studies that focused on the experiences of PhD candidates and supervisors were included, and studies that compared the experiences of people who undertook their PhD in Africa and outside of Africa were included if they contained information relating to the experiences of doing a PhD in Africa. Studies were excluded if they were based on the perspectives of postgraduate students who were not doing a PhD, if they focused only on PhD candidates outside of Africa, if they were research studies not written in the English Language, or if they were reviews or expert reports. Studies that focused on the evaluation of training programmes provided to PhD candidates during their candidature were excluded.

Search strategy

Within the second step of the framework, an in-depth process of the search process was performed, and the search terms were identified. The first search was initiated on August 08, 2023, across multiple databases: EBSCO Host, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline (Ovid), and Google Scholar. These databases were selected for a comprehensive overview across various disciplines. The initial search of the literature was performed with no inclusion or exclusion criteria applied.

Search terms

The search methods used the following keywords and phrases in combination: (“Experiences of doing a PhD”, OR “Attitudes”, OR “Lived Experience” OR “Perception”) AND (“PhD Candidate in West Africa” OR “Doctoral Candidate in Africa” OR “PhD Students in Sahara” OR “Doctoral Students in Nigeria”) AND (“West Africa” OR “South Africa” OR “Sahara” OR “Dark Continent” OR “East Africa” OR “North Africa”). As recommended by the JBI review methods, a three-step search strategy was employed. The first step utilised the use of EBSCO Host, Scopus, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline (Ovid), and Google Scholar. From this search, a list of keywords and phrases was generated by analysing the title and abstract of the identified studies. The second step of the database search was undertaken using the newly generated keywords across all the databases. Truncations were used in the second search to capture variations in terminologies and plural wordings in articles from different settings. Finally, a manual search of the reference lists and bibliographies of the articles was performed to identify other relevant studies. The full search strategy for one database, MEDLINE (OVID), is attached (Fig. 1 ).

Data base search. Data base search diagram showing the full search strategy of one database: MEDLINE (OVID)

Article selection

In accordance with the third step of the framework, relevant articles were selected and imported into Covidence. Duplicates were removed, and an initial title screen was performed (OO 1 ). The results obtained were then screened by examining their titles and abstracts (OO 1 , USJ, OO 3 ). The full texts of the studies were retrieved and further reviewed against the inclusion criteria (OO 1 , OO 2 , USJ). At this stage, three members of the research team (OO 1 , OO 2 , USJ) independently screened the articles, and any disagreements were resolved by unanimous decision (OO 1 , USJ, OO 2 ) and independently by another member of the research team (OO 3 ). The quality of the review was ensured by using Covidence to search for and remove duplicate articles. Evaluation of each article was based on the inclusion and exclusion criteria. One reviewer extracted all the data (OO 1 ). A flowchart of the review using PRISMA showed the detailed process of the initial search to data extraction (Fig. 2 ).

PRISMA flowchart. The PRISMA flow chart is the preferred reporting items for systematic reviews and meta-analyses that shows the detailed process of the initial search to data extraction

Data extraction

An adapted quality assessment tool by Hawker et al. ( 2002 ) was used to screen the 12 included studies (Table I ). All the included articles were rated as high-quality ranging between a score of 33–36. The data were extracted (OO 1 ) and reviewed by the research team (USJ, OO 2 , OO 3 ) for consistency and to ensure that the extracted data matched the aim of the scoping review. The data were incorporated into a template data extraction instrument using the JBI methodology guidance for scoping reviews (Tables 1 and 2 ). The draft data extracted in the scoping protocol were used, and no modifications were made throughout the process (Omoya et al., 2023 ) Footnote 1 . The descriptions of the data extracted into Table I included the author, date and location, title of the article, aims/purpose, sample size and setting, journal type, methodology, and key findings. This step allowed for a visual representation of the major findings of each article and how they address the aims of the scoping review.

A total of 51 articles were retrieved and imported into Covidence. After duplicates were removed and a brief tile screen was performed, 20 studies were subjected to the title and abstract screening stage. A total of 16 studies underwent full-text review, and 12 studies were included, as shown in the PRISMA flow chart (Fig. 2 ). Of the 12 studies included 33% ( N = 4) used mixed methods, 58% ( N = 7) were qualitative studies, and 8% ( N = 1) were descriptive quantitative studies. The studies were from different parts of Africa. There were two studies with participants from various African countries; others were evenly distributed, with two studies each from Ethiopia, Uganda, and South Africa. One study each was from Kenya and Nigeria. Two other studies, one from Ethiopia and one from Tanzania, collaborated with authors from South Africa. More articles were published in journals that focus on higher education, such as Higher Education Policy , Higher Education Research & Development , and the Journal of Education and Practice , Transformation in Higher Education , Higher Education , Innovations in Education and Teaching International . All the authors in the study worked in academia and higher education.

Sociodemographic profile of PhD candidates

Of the included articles, 75% ( N = 9) focused on the impact of gender and age on the experiences of PhD candidates. The number of male candidates was significantly greater in most of the studies than was the number of female candidates (Adekunle & Madukoma, 2022 ; Bireda, 2015 ; Mbogo et al., 2020 ;Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ); however, studies that focused on women indicated that the challenges faced by doctoral students vary according to gender (Bireda, 2015 ; Mkhize, 2022a , 2022b ; Mkhize, 2023 ; Tsephe & Potgieter, 2022 ). Most of the candidates were within the age bracket of 30–45 years (Adekunle & Madukoma, 2022 ; Bireda, 2015 ; Mkhize, 2022a , 2022b ; Mkhize, 2023 ; Tamrat & Fetene, 2022 ). Most of the participants were identified as African but from different ethnic groups within the same African country. This was prominent in studies from South Africa that included participants who identified as Afrikaans, Coloured, or White (Mkhize, 2022a , 2022b ; Mkhize, 2023 ). One of the studies reported the marital status of the candidates in their study, and most of the candidates identified themselves as married with children (Bireda, 2015 ). According to a study of African and European candidates, African candidates were more likely to be married with children than their European counterparts (Stackhouse & Harle, 2014 ).

Many of the articles reported on funding and financial challenges experienced by PhD candidates (Adekunle & Madukoma, 2022 ; Bireda, 2015 ; Bitzer & Matimbo, 2017 ; Fetene & Tamrat, 2021 ; Mbogo et al., 2020 ; Muriisa, 2015 ; Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ; Tsephe & Potgieter, 2022 ). The availability of scholarships for African doctoral students studying in Africa was commonly reported to be low. The lack of funding was a barrier to the depth, scope, and quality of the research produced (Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ). Four studies reported on initiatives such as fee waivers, partial funding, travel, and thesis (proof reading, printing, and editing) grants that were more available but insufficient to reduce financial pressure and the need to work full-time while studying (Bireda, 2015 ; Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ; Tsephe & Potgieter, 2022 ). The need for training on how to access funding opportunities and grant writing was reported in three studies (Bireda, 2015 ;Muriisa, 2015 ; Tamrat & Fetene, 2022 ). Three studies (Bireda, 2015 ; Mkhize, 2022a , 2022b : Mkhize, 2023 ) reported the emotional, psychological, and social factors that stemmed from financial uncertainties for women due to the unique set of challenges involved in balancing personal and professional roles.

Resources and training

Similar to insufficient funding, 67% ( N = 8) of the included studies described how the unavailability of institutional resources impacted the experiences of PhD candidates (Bireda, 2015 ; Muriisa, 2015 ; Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ). The most reported resources that were lacking included information and communication technology services, library and electronic search resources, lack of provision for learners with disabilities, unequipped laboratory and clinical facilities, lack of personal and study workspaces, noise pollution, insufficient physical library space, and other general services (Fetene & Tamrat, 2021 ; Muriisa, 2015 ; Stackhouse & Harle, 2014 ) . However, a university based in South Africa reported that their institution had good support and resources (Tsephe & Potgieter, 2022 ), for example, access to internet services, library resources, and office spaces. Additionally, workshop training was available on key topics, such as methodologies, literature reviews, and proposal writing, and was found to be beneficial. Five articles reported on the specific resources and training needs of PhD candidates (Bireda, 2015 ; Fetene & Tamrat, 2021 ; Muriisa, 2015 ; Tamrat & Fetene, 2022 ). In the study by Muriisa ( 2015 ) and Tamrat and Fetene ( 2022 ), participants reported specific training needs on the literature review process and writing, proposal writing, in-depth information on methodologies, software used for data analysis, the publication process, and securing dissertation grants. However, resources to facilitate these requests were unavailable, and when additional training was provided, it was often unplanned, rarely organised, and not institutionally initiated. In the study by (Muriisa  2015 ), participants requested training on how to access funds and write grants. One of the studies (Bireda, 2015 ) examined the experiences of PhD candidates enrolled in distance learning; candidates in their study requested access to resources and training on academic and writing skills, digital literacy, and research software because they were not readily available. Two studies reported on the pre-training and unpreparedness of PhD candidates who enrolled in PhD programmes and struggled to meet the demands of writing a thesis (Fetene & Tamrat, 2021 ; Muriisa, 2015 ).

Supervision experiences

Supervision experiences during the PhD programme were identified in 75% ( N = 9) of the studies (Bitzer & Matimbo, 2017 ; Craig et al., 2023 ; Fetene & Tamrat, 2021 ; Mbogo et al., 2020 ; Mkhize, 2023 ; Muriisa, 2015 ; Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ; Tsephe & Potgieter, 2022 ). These studies provided various descriptors to characterise the experiences of participants. Two studies from Kenya and Ethiopia reported on supervisors’ lack of expertise and experience in the areas they were allocated to provide supervision (Mbogo et al., 2020 ; Tamrat & Fetene, 2022 ). Two other studies from Uganda and Ethiopia reported that the qualifications required to be able to undertake supervision were not met at some universities (Muriisa, 2015 ; Tamrat & Fetene, 2022 ). Supervisors also had excessive workloads, teaching, and administrative responsibilities with significant time constraints, which were reported as reasons for supervisory challenges in three studies (Craig et al., 2023 ; Mbogo et al., 2020 ; Tamrat & Fetene, 2022 ).

One study compared African and European candidates’ supervisory experiences and reported that African respondents rated their supervisors highly more than European students did even though supervisory meetings were less frequent (Stackhouse & Harle, 2014 ). In another study from Uganda, although most participants seemed satisfied with their supervision experiences, they still raised issues such as those of other studies including lack of communication and disengagement from student research (Bireda, 2015 ; Fetene & Tamrat, 2021 ; Muriisa, 2015 ; Tamrat & Fetene, 2022 ), low levels of support, delays in providing feedback, unhelpful feedback, inappropriate guidance (Bireda, 2015 ; Fetene & Tamrat, 2021 ; Mbogo et al., 2020 ; Mkhize, 2022a , 2022b ), and difficulty finding a suitable supervisor (Craig et al., 2023 ; Mbogo et al., 2020 ; Tamrat & Fetene, 2022 ). Four articles reported more specifically on the common style of supervision experienced in the African context (Fetene & Tamrat, 2021 ; Mbogo et al., 2020 ; Muriisa, 2015 ; Tsephe & Potgieter, 2022 ). Two studies (Fetene & Tamrat, 2021 ; Muriisa, 2015 ) described the context and setting of the research environment as unconducive due to power imbalances between supervisors and students. Two studies from South Africa (Bitzer & Matimbo, 2017 ; Tsephe & Potgieter, 2022 ) provided a different view of supervision. The supervisory relationship was based on effective communication, trust, and mutual respect, which contributed to successful completion. Eight of those studies (Bireda, 2015 ; Fetene & Tamrat, 2021 ; Mbogo et al., 2020 ; Mkhize, 2022a , 2022b ; Muriisa, 2015 ; Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ; Tsephe & Potgieter, 2022 ) explored the causes of delays and completion times. A supportive relationship was reported as a major precursor for timely completion (Mbogo et al., 2020 ; Muriisa, 2015 ; Tamrat & Fetene, 2022 ). Other common causes of delays were related to students juggling work with family commitments (Bireda, 2015 ; Fetene & Tamrat, 2021 ; Mbogo et al., 2020 ; Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ). However, the supervisory challenges and factors impacting the completion times experienced by female doctoral candidates were distinct (Mkhize, 2022a , 2022b ; Mkhize, 2023 ; Tsephe & Potgieter, 2022 ). In South Africa, female doctoral candidates’ experiences were more challenging due to reports of racism, classism, xenophobia, and patriarchy (Mkhize, 2022a , 2022b ; Mkhize, 2023 ).

Five studies explored the role of supervisors (Bireda, 2015 ; Fetene & Tamrat, 2021 ; Mbogo et al., 2020 ; Muriisa, 2015 ; Tsephe & Potgieter, 2022 ) and the role of PhD candidates (Mbogo et al., 2020 ; Muriisa, 2015 ). These roles were described from the perspective of the supervisors and PhD candidates. PhD candidates expected supportive supervisors who provided encouragement in tough times (Bireda, 2015 ; Bitzer & Matimbo, 2017 ; Fetene & Tamrat, 2021 ;Stackhouse & Harle, 2014 ; Tsephe & Potgieter, 2022 ) and supervisors who shared beneficial information, e.g., access to funding, professional development, and conference attendance (Bireda, 2015 ; Fetene & Tamrat, 2021 ; Mbogo et al., 2020 ; Tamrat & Fetene, 2022 ). Supervisors expect PhD students to be accountable, take initiative (Bitzer & Matimbo, 2017 ; Mbogo et al., 2020 ; Muriisa, 2015 ), have good writing skills (Mbogo et al., 2020 ), and be able to work independently (Mbogo et al., 2020 ; Muriisa, 2015 ).

Coping mechanism

Four studies have reported on various strategies used by PhD candidates to address challenges concerning funding, resources, training, and supervisor support (Adekunle & Madukoma, 2022 ; Fetene & Tamrat, 2021 ; Tamrat & Fetene, 2022 ; Tsephe & Potgieter, 2022 ). In the study by Fetene and Tamrat ( 2021 ), students who had had similar experiences with these challenges in the past were supportive of how to access funding; they also gave tips on supervisor rapport building and shared library resources. In the study by Tsephe and Potgieter ( 2022 ), which examined contributors to African women’s doctoral graduate success, factors including family/spousal support and a belief in God were important for coping when they encountered difficulties. As a coping mechanism, self-efficacy and education resilience are personal attributes that candidates believe are important for survival and contribute to research productivity (Adekunle & Madukoma, 2022 ; Tsephe & Potgieter, 2022 ). Even though research productivity was low, research self-efficacy scores were high (Adekunle & Madukoma, 2022 ). Most respondents believe that they have the individual capacity and resilience to adhere to behaviours that are important for them to succeed in their research undertaking. Two studies examined mental and emotional health (Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ). Emotional difficulties were present at times, but participants rarely felt depressed . One study by Fetene and Tamrat ( 2021 ) discussed the coping strategies used by doctoral candidates in more detail, for instance, students adopted various coping mechanisms, such as diligently fostering positive relationships with their supervisors. Additionally, some resorted to utilising libraries beyond their institution, particularly those with dependable internet access, to obtain articles and research materials. Some also reached out to colleagues abroad, requesting assistance in downloading articles relevant to their field of study (Fetene & Tamrat, 2021 ). Other strategies include the use of YouTube videos to self-teach and gain knowledge in certain areas of research (Fetene & Tamrat, 2021 ). Some students stay with their families in the same household rather than paying rent in different locations or saving enough capital before commencing their programmes (Fetene & Tamrat, 2021 ).

The impact of sociodemographic factors: age

In this review, sociodemographic factors such as age, gender, marital status, and ethnic group were commonly reported. However, in some articles (Bireda, 2015 ; Fetene & Tamrat, 2021 ; Mkhize, 2022a , 2022b ; Mkhize, 2023 ; Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ), the challenges faced by doctoral students varied according to these demographic factors. African students were often reported to be within the higher age bracket due to personal life challenges and barriers that prevented enrolment in a PhD at an earlier age (Fetene & Yeshak, 2022 ;Sooryamoorthy & Scherer, 2022a , 2022b ; Tamrat & Fetene, 2022 ). This review revealed that doctoral students from Africa were studying later in life and reported a longer time between qualifications. Access to training and the ability to receive funding are also impacted by age, and funders have restrictions on the age limit for which students are eligible (Balogun et al., 2021 ; Stackhouse & Harle, 2014 ).

Most African candidates are mature-age students, with an average age of 45 years reported (Scherer & Sooryamoorthy, 2022 ; Tamrat & Fetene, 2022 ). Most PhD students, at the time of enrolment, will have the responsibilities of family and work, which can impact their ability to devote the time needed for their PhD studies (Tsephe & Potgieter, 2022 ). Furthermore, most candidates are left with no choice due to the economic climate but to seek additional work to supplement their income and support their family (Stackhouse & Harle, 2014 ; Tsephe & Potgieter, 2022 ). However, in South Africa, the percentage of graduates under the age of 30 was greater for white graduates than for their black counterparts (ASSF, 2010 ; Cloete et al., 2016 ). There is an inherent need for resources and interventions for PhD candidates in Africa with the knowledge that a high percentage of candidates are within the higher age brackets and need to juggle family and work commitments. Although the impacts of age on the experiences of African PhD candidates have been adequately reported, further research should focus on exploring the specific reasons why African candidates are studying at a later age so that interventions can be tailored to meet the needs of potential candidates.

The impact of sociodemographic factors: gender

Current evidence has shown that women may face a unique set of challenges during their PhD (Bireda, 2015 ; Mkhize, 2022a , 2022b ; Mkhize, 2023 ; Tsephe & Potgieter, 2022 ). Although the number of women enrolling is increasing in some African Universities, many others still report low enrolments. Moreover, African candidates were more likely to be married and have had children (Stackhouse & Harle, 2014 ). The traditional role of caretaking combined with the role of a PhD candidate tends to increase stress and cause delays in study (Tsephe & Potgieter, 2022 ). Although progress has been made in strengthening research capacity, as evidenced by The Consortium for Advanced Research Training in Africa (CARTA), that focused on addressing the practical needs of African women by providing support for gender roles that can inhibit their participation in training (Khisa et al., 2019 ). However, there is a greater need for support that is gender-responsive. According to a report by the British Council and DAAD ( 2018 ) examining several selected African countries (Ethiopia, Ghana, Kenya, Nigeria, Senegal, and South Africa), the number of females enrolling in PhD training is increasing, but the attrition rate is still significantly high (Ayee, 2022 ; Sooryamoorthy & Scherer, 2022a , 2022b ). The reasons for this difference were attributed to the cultural responsibilities and expectations that women give priority to family rather than professional accomplishments (El Allame et al., 2022 ).

Similarly, in an Ethiopian study, the underrepresentation of female doctoral students was found to be significant at all postgraduate levels, including doctoral studies (Tamrat & Fetene, 2022 ). In other countries, such as Mozambique, Ghana, and Uganda, female students enrolled in a doctoral study was still lower than that of men (Ayee, 2022 ; Etomaru et al., 2023 ; Mariano et al., 2022 ). The disproportionate representation of women in PhD training in Africa signifies the need for additional investigations to address the inadequate participation of women in research and innovation. Balancing personal and professional roles is challenging, and support that meets African women’s needs during their PhD candidature is warranted. Moreover, in countries where apartheid and colonisation policies still permeate into present times, the experiences of women during their PhD were challenging, and women candidates rarely completed on time (Mkhize, 2022a , 2022b ; Mkhize, 2023 ). Black women felt that they were looked down on, undermined, and underestimated in a structural system that worked to exclude them (Mkhize, 2022a , 2022b ; Mkhize, 2023 ). Beyond the need to further understand the expectations placed on women academics, an opportunity exists to explore the environmental and cultural barriers that are oppressive to the needs of women during their PhD journeys.

The role of supervisors

The significant impact that supervisors have on the successful completion of a PhD has been reported in several studies. With respect to the supervisory experiences of students, studies have shown an increased chance of completion (Bitzer & Matimbo, 2017 ; Tsephe & Potgieter, 2022 ); longer duration (Adekunle & Madukoma, 2022 ; Mkhize, 2023 ; Muriisa, 2015 ; Stackhouse & Harle, 2014 ; Tamrat & Fetene, 2022 ); or an increase in attrition rate (Adekunle & Madukoma, 2022 ; Fetene & Tamrat, 2021 ; Muriisa, 2015 ; Stackhouse & Harle, 2014 ) based on the supervisor–student relationship. For PhD candidates, having a relationship with their supervisor based on mutual respect was one of the highest reported accounts of successful completion (Bitzer & Matimbo, 2017 ; Fetene & Tamrat, 2021 ; Tsephe & Potgieter, 2022 ). Although, evidence has shown that some African Universities have increased the amount of PhD enrolment and the availability of potential supervisors, but completion rate has remained low (Akudolu & Adeyemo, 2018 ; Jowi, 2021 ; Muriisa, 2015 ). This difference was attributed to the style of supervision used in most African institutions, which is often characterised by power imbalances between the supervisor and the supervisee (Fetene & Tamrat, 2021 ; Mkhize, 2023 ; Muriisa, 2015 ).

In addition to the supervisor–student relationship, expectations are placed on each other’s roles. Like PhD candidates, supervisors also had expectations of their students. Nonetheless, when expectations are clearly communicated immediately from the onset, successful completion, and a smooth relationship are achieved (Bitzer & Matimbo, 2017 ; Fetene & Tamrat, 2021 ; Muriisa, 2015 ; Tsephe & Potgieter, 2022 ). Furthermore, supervisors’ expectations are based on the approach that a PhD is an independent study and largely driven by the student; students should be accountable, motivated, and take initiative (Muriisa, 2015 ). Based on these insights into supervisory experiences, the importance of defined expectations and joint understanding of roles is a facilitator in the completion of doctoral studies. In a report exploring the research and PhD capacities in sub-Saharan Africa that surveyed alumni to determine their satisfaction with their PhD programmes, the top aspects that indicated how satisfied they were with their training were based on competence, capacity, and quality of supervision, as well as the professional relationships they had with their supervisors (Alabi & Mohammed, 2018 ). Overall, the high workload of supervisors also impacts the quality of supervision (Dime, 2018 ; Barasa & Omulando, 2018 ).

Therefore, reforms and policies to enhance the quality of supervision are warranted. Recommendations have been made for establishing ethical guidelines for supervisors to alleviate issues around hierarchical organisational culture and poor supervisory practices (Barasa & Omulando, 2018 ; British Council & DAAD, 2018 ). Additionally, potential PhD candidates need to be aware of expectations regarding workload, research capacity, and the knowledge of the research itself. To boost research capacity, the professional development of supervisors by providing training and courses has been reported in some South African Universities (Molla & Cuthbert, 2016 ). Even though there is recognition of the need for training potential supervisors, the impacts of the training that has been provided in some contexts have not often been reported (Lindtjørn et al., 2019 ; Maluwa et al., 2019 ). More research exploring the evaluation and benefits of these professional trainings are needed. A recent study by Alio et al. ( 2021 ) investigated the enhancement of research capabilities for innovation in sub-Saharan Africa. The report highlighted certain African nations including Nigeria, South Africa, Senegal, Kenya, Angola, and Ethiopia have addressed their limited research capacity by investing in training initiatives to enhance research skills. These efforts aim to improve the standard of research activities and productivity. Training such as this is crucial because it is important that both supervisors and students have the resources needed to support them in order to fulfil their roles.

The relationship between coping strategies and research productivity

In this review, various survival strategies that are used as coping mechanisms are commonly linked to research productivity (Adekunle & Madukoma, 2022 ; Fetene & Tamrat, 2021 ; Tamrat & Fetene, 2022 ; Tsephe & Potgieter, 2022 ). Generally, PhD productivity and success tend to be linked to institutional and governmental practices, whereas most African institutions have inefficient systemic practices and relatively low government budgetary allocations to facilitate completion and productivity (Akudolu & Adeyemo, 2018 ; Molla & Cuthbert, 2016 ). Therefore, to enhance research productivity, African candidates must develop their own coping mechanisms and strategies outside of institutions. In one study, one of the coping mechanisms that accounted for success for African women who completed their PhD was their belief in God (Tsephe & Potgieter, 2022 ). The women in the study stated that their belief in God played a significant role in their success and completion. As a coping mechanism, the women believed that God had orchestrated their undertaking of a PhD and that God would see them through, and even when they encountered any difficulties, their belief in God was a source of strength not to give up but rather to keep going (Tsephe & Potgieter, 2022 ). Despite the strong association between the belief in God and the completion of a PhD, the available literature in this area is scarce. A qualitative exploration of this phenomenon will inform supervisors, stake holders, international collaborators, and government bodies of some specific aspects that contribute to success for African PhD candidates.

In two other studies, a strong sense of self-efficacy was used as a coping strategy that contributed to research productivity (Adekunle & Madukoma, 2022 ; Tsephe & Potgieter, 2022 ). The PhD candidates’ self-efficacy was demonstrated through their belief and confidence in their own abilities. Candidates who rated their research self-efficacy believed they could conceptualise research that was feasible, collect data, analyse data, and disseminate findings, with the individual capacity to adhere to behaviours that are important for them to succeed in their research undertaking. However, most of the issues surrounding research productivity were external factors and were out of their own control, for example, issues such as publications, grants, and funding for projects were not always supported by their home institution. Despite these issues, resilience has been demonstrated, and other ways to achieve success have been sought by individual candidates (Tsephe & Potgieter, 2022 ), for example, other coping mechanisms and survival strategies candidates used involved seeking international collaborations and networks that provide access to funding and resources (Stackhouse & Harle, 2014 ). Some African Universities have partnered with international collaborators to develop PhD programmes and research profiles (Jowi, 2021 ). Collaborations with international agencies and institutions can support partial or fully funded scholarships, access to equipment, subject expertise, and training to enhance the quality of PhD programmes (Alabi & Mohammed, 2018 ; British Council & DAAD, 2018 ; Dimé, 2018 ). Currently, there is a lack of evidence on the coping mechanisms and strategies of African PhD candidates. Further research examining the capabilities that enable research productivity may assist in informing the development of specific interventions for PhD candidates in Africa. A qualitative approach to exploring the coping strategies of African PhD candidates may inform the practice of higher institutions and supervisors of the support needed to ensure success.

Limitations

A limitation of the review lies in the overrepresentation of research articles from some African countries as opposed to others. The second limitation is the exclusion of articles that were not in English since the reviewers cannot use resources to interpret articles published in languages other than English. The review was limited to peer-reviewed literature, and gray literature was not included. The review acknowledges that Africa is vast in numerous sociocultural values and norms that impact people’s experiences, and this review does not attempt to minimise these experiences. Thus, this review should be interpreted in light of the fact that some of these distinctive values and norms from various African settings might not have been captured here.

The literature examining the experiences of pursuing a PhD in Africa reflects a combination of challenges and achievements that significantly influence the journey toward completion and the attainment of a doctoral degree. These factors encompass the sociodemographic characteristics of PhD candidates, financial obstacles, insufficient resources and training, supervisory encounters, and the coping strategies employed by those undertaking PhD programmes. The distinct sociodemographic, cultural, and institutional contexts present opportunities for comprehending the specific issues within the African higher education landscape. Resources and interventions are essential for African PhD candidates, particularly as many are older and must balance family and work commitments, necessitating further research into the specific reasons behind their delayed study to tailor interventions accordingly. While there has been notable progress in the number of women obtaining PhDs, environmental and cultural barriers that hinder women’s academics during their PhD journeys still exist. Systematic and institutional barriers need to be acknowledged and addressed to foster women’s contribution to knowledge-based economic growth. For supervisors and student relations, training with the necessary resources for fulfilling their roles is crucial. Subsequent research should delve into understanding some of the specific environmental and cultural barriers impacting potential candidates from diverse backgrounds, genders, and ethnicities. Addressing the identified needs of doctoral students, such as inadequate investment in research funding, substandard infrastructures, and systemic challenges, requires collaborative initiatives involving academic institutions, government bodies, and international partners to enhance the quality of PhD training in Africa. By doing so, a supportive system can be fostered that effectively caters to the diverse needs of doctoral students.

Authors with same initials and superscript numbering for differentiation:

OO 1 Oluwatomilayo Omoya

OO 2 Olumide Odeyemi

OO 3 Omowale Odeyemi

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Omoya, O., Jacob, U.S., Odeyemi, O.A. et al. Exploring perspectives: a scoping review of the challenges facing doctoral training in Africa. High Educ (2024). https://doi.org/10.1007/s10734-024-01264-4

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