Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Ginette G. Ferszt


The challenge of translating knowledge learned in the classroom into real life situations for students has been an issue in nursing education for many years. Very few research studies have been conducted that address what factors positively and negatively affect nursing students’ self-confidence in the clinical setting. The purpose of this study was to explore the perceptions of nursing students’ self-confidence in the acute care setting and the factors that enhanced or inhibited their self-confidence. The specific research questions that guided this study were: What are the perceptions of nursing students’ self-confidence in the acute care clinical setting? What factors improve students’ self-confidence in the acute care clinical setting? and What factors negatively impact nursing students’ self-confidence in the acute care clinical setting? An exploratory descriptive qualitative design utilizing the Critical Incident Technique (CIT) was used to collect data from senior nursing students who had at least two acute care clinical practicums. In-person, open-ended, semi-structured face-to-face audio-recorded interviews were used to collect the data from 11 senior students from two different colleges of nursing. Data obtained from CIT’s were analyzed through an inductive classification process. A total of 21 incidents were derived from the data. Six of the incidents were related to the delivery of patient care and learning skills, another seven were related to medication administration, and eight were related to communication. The belief by the students that they could be successful in providing effective patient care was a contributing factor in enhancing their self-confidence. Knowing how to perform procedures and administer medications, and being educated prior to the performance of a nursing skill, resulted in the students feeling more self-confident in themselves and in their ability to be successful. Making a difference in a patient’s life, open communication, feeling like a member of a team, feeling that they (the student) could be trusted to care for the patient, and having support from the staff nurses and clinical instructors were also found to positively influence the students’ development of self-confidence. Factors that negatively impacted the students’ self-confidence included not being educated, a lack of communication, lack of support, lack of trust, and not feeling like a member of a team. Implications for knowledge development, research, nursing education, and nursing practice are discussed. Further research is needed to explore the development of self-confidence over the course of a students’ undergraduate education. Additionally, more qualitative research studies with larger samples, including male students, students with diverse backgrounds, and students with previous health care experiences will contribute to the literature on nursing students’ self-confidence.



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