Student nurse anesthetists' learning during clinical practice: a mixed-methods study

Clinical practice is essential for student nurse anesthetists to integrate theory with practical skills; however, the demanding clinical environment can impact both stress and learning outcomes. Responsibilities and expectations differ across healthcare systems, and research in the Swedish context remains limited. Addressing this gap is essential for understanding how clinical practice contributes to the development of professional readiness and competence. This study, therefore, aimed to describe the learning experiences of students and newly graduated nurse anesthetists, with a focus on the clinical learning environment and the stress it entails.

A convergent parallel mixed-methods design was used. In the quantitative strand, student nurse anesthetists were recruited using convenience sampling to complete a web-based survey that included the two instruments, "Clinical Learning Environment Supervision and Nurse Teacher evaluation scale" and "Perceived Stress Scale" (with 10 items). Data were analyzed with descriptive statistics, while free-text answers were analyzed using summative content analysis and word frequencies. In the qualitative strand, newly graduated nurse anesthetists were recruited using purposive sampling to participate in individual semi-structured interviews. Data were analyzed with content analysis. After separate analysis, the pillar integration process was used to integrate quantitative and qualitative data.

The analysis included data from 63 surveys (63/225, 28%) and 13 interviews. The integration of data from both strands yielded two divergent themes, "An unfamiliar but supportive learning environment" and "Experience of stress," and two convergent themes, "Supervisors, a facilitator to learning" and "Dynamic learning situations."

Despite the challenges of adapting to new knowledge contexts, participants reported high satisfaction with the clinical learning environment, as shown by elevated scores in the Clinical Learning Environment Supervision and Nurse Teacher evaluation scale. Clinical supervisors played a pivotal role in supporting learning, and the environment's pedagogical flexibility enabled both individual and collaborative approaches. Although stress levels varied, the average Perceived Stress Scale score remained low.