Clinical training challenges in critical care units for nursing students: A qualitative content analysis

Critical care units are among the most demanding clinical training environments for nursing students, due to complex technologies, unpredictable patient conditions, and intense emotional pressures. These factors create significant educational and psychological challenges that may hinder learning and professional growth. Despite the importance of these units, limited research has explored students' experiences in Iranian contexts such as Hamadan, where cultural and systemic factors may intensify these challenges.

This study aimed to explore the clinical training challenges faced by nursing students in critical care units in Hamadan using qualitative content analysis.

This qualitative study adopted a conventional content analysis design. Fifteen undergraduate nursing students were recruited through purposive sampling. The study was conducted in Hamadan, a city in northwestern Iran. Data were collected using semi-structured, in-depth interviews. Data collection and analysis were conducted concurrently, following an inductive thematic analysis approach.

Based on the analysis, four primary categories of challenges were identified: systemic and infrastructural deficiencies, pedagogical and instructional failures, professional socialization and role conflict, and psychological and emotional turbulence.

Transforming critical care clinical training necessitates a multi-faceted reform strategy supported by four key interventions. First, formalized clinical-academic partnerships must ensure alignment between student intake and clinical capacity while creating simulation-enhanced learning environments. Second, pedagogical quality should be improved through structured preceptor development and competency-based assessments that evaluate clinical judgment. Third, interprofessional education initiatives with clearly defined roles and regular ethics debriefings are essential for effective professional socialization. Finally, the implementation of mandatory emotional debriefing systems and graduated clinical exposure protocols will safeguard student well-being. Collectively, these evidence-based interventions systematically address the interconnected systemic, pedagogical, professional, and psychological challenges identified in the study.