qualitative research training courses 2023

Intro to Qualitative & Mixed Methods Research

Duke Graduate Academy Short Courses in Summer 2023

These free short course is open to all Duke graduate and professional students as well as postdocs, offered during Summer Sessions I and II. Enrollment and all course changes must be completed by the Drop/Add deadline for the relevant Summer Session (May 19 for Term I; July 6 for Term II). Take a look at all course descriptions.

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Introduction to Qualitative & Mixed Methods Research This course presents an introduction to qualitative research methods with a lens on combining qualitative and quantitative data (i.e., mixed methods). The course will emphasize qualitative research methods, examining their uses — when they are appropriate, what unique strengths they offer, what challenges they can introduce. In addition, we will explore when it is useful and valuable to utilize a research design that combines qualitative and quantitative data. It will cover gathering qualitative and mixed data using both primary (interviews, focus groups, participant observation, surveys) and secondary sources, and managing such data during and after their collection. The course will also examine what is involved in coding qualitative data, including how coding schema are developed and applied, how coding can be done in ways that are consistent and replicable, and how to use NVivo software in coding. It will also explore how quantitative and qualitative analyses can be sequenced and/or combined, including in NVivo. Finally, we will consider reporting findings, including integrating findings from multiple data sources, how a researcher assesses what their materials teach them and how they can compile and present those findings to make their case, as well as how to respond to criticisms. This course will include lectures, active discussion and classroom exercises.

Instructors:  Adrian Brown ,  Erin Haseley  &  Noelle Wyman Roth , Social Science Research Institute

Summer Session I GS990 Section 07; offered May 22 – June 1 (two-week course), MTTH 12:30 – 2:35 p.m. EDT

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• Study with us
• Short Courses in Qualitative Research Methods
• Introduction to Qualitative Research Methods

Now available as an online or face-to-face course

View all our courses:

• Introduction to doing Qualitative Interviews
• Introduction to Analysing Qualitative Data
• Introduction to conversation analysis and health care encounters
• Learning with the book: an introduction to qualitative research methods for health research

This highly-regarded 5 day course will provide you with a good introduction to qualitative research methods using a combination of lectures, workshops and small group work, group discussions, and expert tutor feedback.

Delivered by qualitative experts, this training course will introduce you to a broad range of skills in qualitative research methods.

Designed to follow the research process, this course offers delegates a blend of expert lectures and interactive practical sessions on how to prepare to begin collecting qualitative data, exploring the underpinning philosophy and the use of social theory. Course participants will gain hands-on practical experience of different data collection methods. Participants are actively supported to develop their skills in qualitative data analysis, with a strong focus on thematic analysis. Throughout the course we consider core features of the research process such as reflexivity, and ethics and how to recognise and conduct ‘good quality’ qualitative research.

We think the best way to learn new skills is for you to be well supported by expert teachers and have a good opportunity to practice. Therefore, this course provides virtual practical sessions for participants to practise their interviewing skills, and analyse data. Participants have good opportunity to ask questions and receive individual feedback from tutors and will regularly work in smaller breakout groups with a dedicated expert tutor.

This course is particularly suited for people who are starting work on a project with a qualitative component, doctoral students at the beginning of their studies, and those who are thinking about using qualitative research methods for the first time. The course also provides a useful introduction or refresher for researchers, academics, or managers who are supervising students or undertaking qualitative research projects themselves. While this course is aimed at health and care professionals, and researchers, academics and postgraduate students working in health and care research, the skills developed on our course can be useful in many settings - so please ask us if you are unsure whether QRM is the course for you.

Teaching team

This course is led by a highly experienced and research-active teaching team. Our team have a range of specialities and skills spanning the breadth of qualitative research methods, ensuring that each session is led by a knowledgeable expert in the field. As well as being accomplished researchers, our team are skilled at communicating qualitative research methods in an accessible and clear way. Our tutors are friendly and approachable and will be available to offer delegates tailored feedback. Our participants regularly emphasise our teaching team as a highlight of this course.

This course will include: 

• Practical sessions focussing on data collection methods, including qualitative interviewing and focus groups
• Expert-led lectures on research ethics, underpinning philosophy, using theory in qualitative research to guide sampling, recruitment, designing topic guides and data analysis (including an introduction to the OSOP technique) and on quality in qualitative research
• Small group sessions to practise coding and using thematic analysis
• Access to a range of additional resources including pre-recorded videos and reading lists

Learning Outcomes

By the end of this course, participants will:

• Have an understanding of different approaches to, and the underpinning philosophy of, qualitative research
• Understand the key issues around recruitment and sampling in qualitative research
• Have developed skills to draft an interview topic guide/schedule
• Have practical experience of conducting in-depth interviews
• Have developed skills to begin to analyse qualitative data using a thematic approach
• Be able to discuss ethical issues associated with conducting qualitative research
• Be able to appraise the quality of qualitative research
• Access to the online learning platform (CANVAS)
• Online access to slides and materials
• De-identified data for you to work on whilst developing your skills
• Experienced, approachable tutors who are research-active
• An optional social programme throughout the week, including a guest speaker.

Online Course

Date: 2024/25  

To be advised

Duration:  5 days Course fee: TBA Total places: TBA

Type:  Online Course

 If you have any questions and queries please   email us

In-Person Course

Date: 2024/25 To be advised

Duration:  5 days Course fee: TBA Total places:  TBA Type: Face to Face Course Venue:  TBA

“This has been the most enjoyable course / conference I have ever done…the clarity, structure, notes, examples, practical sessions were brilliant. I came away inspired and happy”

“This has been a fantastic week, an excellent combination of theory and practice. I feel much more confident to go back to work on my project. This should be an example to others of how to run a course.”

“There have been several Eureka moments this week – it has brought clarity to many areas I had previously found opaque and scary. Similarly, it has injected a huge, massive amount of enthusiasm into my attitude to my PhD and career. Also, the social element was brilliantly handled; felt very much that this group gelled well. Looking forward to working with and seeing many people here again. A brilliant course.”

Course Leaders

Lisa Hinton

Catherine Pope

Sue Ziebland

and expert tutors from the Medical Sociology & Health Experiences Research Group team 

Oxford Qualitative Courses

This highly-regarded programme is delivered in online and face to face formats to suit a range of learners.  We use a mixture of lectures and small group work, delivered by our team of qualitative researchers from the University of Oxford’s  Medical Sociology and Health Experiences Research Group . Our group has run these successful courses for almost twenty years alongside active involvement in qualitative research on a variety of different topics, ranging from studies of personal experiences of health conditions and of healthcare practice, to evaluations of organisational change. Our group also includes qualitative methodologists at the forefront of developing qualitative methods including conversation analysis and evidence synthesis.

Findings from our group’s research on patient experiences, together with supported video, audio and text extracts, have been compiled to form the multi-award winning  heathtalk.org   website and its sister site socialcaretalk.org . Our portfolio of research and expertise informs current local, national and international healthcare policy and research. 

The syllabuses of our qualitative courses draw on a wide range of expertise from within our research group, including the disciplinary areas of medical sociology, anthropology, and public policy. 

Receive our updates:

Our courses are popular and often sell-out quickly. To receive a bulletin of upcoming course dates, please register here . 

Got a question? Contact us:

Our friendly team are on-hand to answer your questions and queries

Email:     [email protected]

CRP 3201 - Qualitative Research and Design Methods

• CEU PU - Deutsch
• Közép-európai Egyetem

This course aims to introduce graduate students to the range of qualitative research methods popular in the discipline, as well as the epistemological and research traditions these are grounded in. After an overview of the broad characteristics of qualitative research and the kinds of questions we can answer using qualitative research methods, we will discuss the principles and practice of qualitative research in different epistemological and research traditions: Positivism, realism, interpretativism and historical research. We will discuss the different research tools that qualitative researchers use (such as informational interviews, ethnographic fieldwork, process tracing and comparative historical analysis). We will discuss the promises and pitfalls of mixed method research. In addition to reading and class participation, you will be expected to complete one reading response engaging with the readings for a week as well as larger assignment where you will develop a qualitative research design over the course of the semester. Note that the course does not aim to develop practical data-collection and analysis skills, rather it aims to make students aware of particular methods and their practice in the broader discipline, with the goal of creating a menu of approaches that students can pick from in developing their own research projects. Students are expected to develop the practical research skills with the support of elective courses focusing on particular qualitative methods, and through their own research practice.

ME305: Qualitative Research Methods

Subject Area: Research Methods, Data Science, and Mathematics

Course details

• Department Department of Methodology
• Application code SS-ME305

Key information

Is this course right for you.

Applications are open

We are accepting applications. Apply early to avoid disappointment.

How to apply

The purpose of this course is to equip participants with the skills to be able to sensitively and critically design, carry out, report, read, and evaluate qualitative research projects, focussing on in-depth interviews and participant observation.

It is taught by qualitative research experts who have experience of using the methods they teach. It covers the full cycle of a field-based qualitative research project: from design, to data collection, analysis, reporting and dissemination.

The course has the dual aims of equipping students with conceptual understandings of current academic debates regarding methods, and the practical skills to put those methods into practice.

Hear from some of our alumni and discover why 98% of Summer School students would recommend us.

Prerequisites: The course assumes little or no knowledge of qualitative methods. There are no formal prerequisites, however, applicants should be at an advanced undergraduate or postgraduate level.

Level : 300 level. Read more information on levels in our FAQs

Fees : Please see Fees and payments

Lectures : 36 hours

Classes : 18 hours

Assessment : One oral presentation (20%) and one 2,000 word essay (80%).

Typical credit : 3-4 credits (US) 7.5 ECTS points (EU)

Please note: Assessment is optional but may be required for credit by your home institution. Your home institution will be able to advise how you can meet their credit requirements. For more information on exams and credit, read Teaching and assessment

This course is suited to students who wish to gain the necessary skills for qualitative research projects.

It is ideal for advanced undergraduates and postgraduates, as well as professionals with an interest in using qualitative methods to undertake social research.

This course will provide students with:

• A solid understanding of the core methods of qualitative data collection and analysis
• Critical skills in interpreting and evaluating reports of field-based qualitative studies
• Experience in putting qualitative skills into practice
• Realistic and practical teaching from established researchers who put these tools to use in their ongoing research projects

The fundamentals of my course are covered at my home institution, but the summer school course gives me an extra breadth into how the industry works. It’s been a really good experience in diversifying my skill set.

Jonathan Tam, Canada University of Leeds/Transport for London

The design of this course is guided by LSE faculty, as well as industry experts, who will share their experience and in-depth knowledge with you throughout the course.

Dr Aliya Rao

Assistant Professor

Dr Chana Teeger

LSE’s Department of Methodology is an internationally recognised centre of excellence in research and teaching in the area of social science research methodology. The disciplinary backgrounds of the staff include political science, statistics, sociology, social psychology, anthropology and criminology. The Department coordinates and provides a focus for methodological activities at the School, providing methods training to students from across the School.

With the training in the core social scientific tools of analysis and research offered by the Department of Methodology, coupled with its numerous workshops in other transferable skills such as computer programming and the use of methods-related software, the Department of Methodology ensures that the School’s students and staff have the expertise and training available to maintain the School’s excellence in social scientific research. We also work closely with colleagues in the Departments of Statistics and Mathematics to cover advanced topics, including in the interdisciplinary area of social applications of data science.

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Course title: me306: real analysis.

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• Center for Qualitative and Multi-Method Inquiry
• Institute for Qualitative & Multi-Method Research

The Institute for Qualitative and Multi-Method Research (IQMR)

Since its founding more than twenty years ago, the Institute for Qualitative and Multi-Method Research has welcomed more than three thousand graduate students and junior faculty.

Participants in IQMR are either nominated by a member school or department or selected from an "open pool" (largely funded by the National Science Foundation, with additional support from the American Political Science Association).

IQMR 2024 will run from June 16-28

participants

nominating institutions

How to participate

There are four separate open pool competitions to attend IQMR 2024: the general open pool; applications from researchers at African scholarly institutions; applications from researchers at Latin American scholarly institutions; and applications from scholars based in the Arab MENA region. You can find links to the separate application forms in the table below.

Scholars admitted through the general track will have their participation at IQMR covered, receive a stipend to contribute towards cost of meals, as well as shared-accommodation for the duration of the program. General track attendees will be responsible for their own transportation costs to and from Syracuse University. Scholars admitted through the African, Latin American and MENA tracks will have participation at IQMR covered, meals, and shared-accommodation for the duration of the program, as well as roundtrip economy-class airfare.

Distinct from the open pool process, IQMR also accepts attendees who are nominated to attend by their home unit (center/department/school) using their own selection procedures. The participation fee varies depending on the number of people being nominated. For 2024, the participation fee per nominee is $1670 if one, $1640 if two, $1620 if three, $1600 if four, and $1580 if five. The participation may be paid by either the nominating home unit, or by the nominee. If you have any questions about the nominating process, please contact Colin Elman  at [email protected] . 

IQMR 2024 will offer nominees a range of lodging options with different costs. More details will be posted here when those arrangements have been finalized.

Application Information

Application deadline: 10/23/23 Number of slots: 15 Travel bursary: No Part, room and board: Yes

Latin America

Application deadline: 10/23/23 Number of slots: 5 Travel bursary: Yes Part, room and board: Yes

The Ethnography module at #IQMR2021 has me 🤯 over and over again. I feel like even the questions I didn't know I wanted to ask have been answered, and the description/reflexivity/analysis chart is going straight in my toolbelt. Thank You!" via Twitter.

Piper Biery @Piper_Biery

Download the IQMR Digital Brochure

Hear From Our Participants

Learn to create and critique methodologically sophisticated qualitative research designs, including case studies, tests of necessity or sufficiency, and narrative or interpretive work. Explore the techniques, uses, strengths, and limitations of these methods, while emphasizing their relationships with alternative approaches. And receive constructive feedback on your own qualitative research designs. 

Watch our YouTube playlist for video introductions to each of the conference sessions.

New Voices Initiative

IQMR’s New Voices Initiative aims to identify, encourage and support early career researchers (ECRs) who are interested in teaching at IQMR. Our hope is that each fall several ECRs will be selected through a transparent, competitive process, and will join the teaching team for particular module sequences during the following summer’s institute. Seasoned instructors will guide and mentor ECRs who are selected, and will learn from and draw on their fresh insights and perspectives about the methods being taught. The initiative’s broader goals are to grow the number and diversity of faculty who teach qualitative and multi-method research in the social sciences. As part of the New Voices Initiative, three ECRs were selected as teaching fellows at IQMR 2023. 

IQMR 2023 ECR Teaching Fellows:

Dana El Kurd

Gabreélla (Ella) Friday

Gabreélla (Ella) Friday is a postdoctoral researcher dually appointed in the Watson Institute for International and Public Affairs and the Center for the Study of Race and Ethnicity at Brown University. Her areas of specialization include mass incarceration, women, gender and sexuality studies, time and social theory, and social movements. She worked as a prisoner’s rights advocate, community organizer, and researcher for her forthcoming book project, Weaponizing and Resisting Time. Here, she explores incarcerated women’s relationship to and resistance of time in a rural upstate New York jail where she conducted four-years of ethnographic advocacy. Friday received her Ph.D. in Sociology from Binghamton University in 2022. 

Rachel Schwartz

Rachel Schwartz is an Assistant Professor of International and Area Studies at the University of Oklahoma. Her research focuses on civil war and its legacies, statebuilding, corruption, and human rights in Central America, as well as qualitative methods. Her book Undermining the State from Within: The Institutional Legacies of Civil War in Central America was published by Cambridge University Press in early 2023. Her research has been supported by the Fulbright Program and the United States Institute of Peace (USIP), and her work has been published in scholarly journals like the  Journal of Peace Research ,  Journal of Global Security Studies ,  Latin American Politics & Society ,  Revista de Ciencia Política, Small Wars and Insurgencies , and  Studies in Comparative International Development . During the 2019-2020 academic year, she was a postdoctoral fellow at the Center for Inter-American Policy and Research (CIPR) at Tulane University. Schwartz received her Ph.D. in Political Science from the University of Wisconsin–Madison in 2019.

Please note that while we are hopeful that participants in IQMR 2024 will be able to gather in Syracuse next summer, we realize that this will ultimately be dictated by health circumstances. If we are unable to hold an in-person institute, IQMR 2024 will take place online. We will offer details regarding specific arrangements early next year once we have further information on the progression of the COVID pandemic, and faculty and student needs.

• UNC Libraries
• HSL Subject Research
• Qualitative Research Resources
• Training Opportunities: UNC & Beyond

Qualitative Research Resources: Training Opportunities: UNC & Beyond

Created by health science librarians.

• What is Qualitative Research?
• Qualitative Research Basics
• Special Topics

About this Training Opportunities Page

Training at unc's odum institute, qualitative certificate programs at unc, workshops: unc & beyond.

• Help at UNC
• Qualitative Software for Coding/Analysis
• Software for Audio, Video, Online Surveys
• Finding Qualitative Studies
• Assessing Qualitative Research
• Writing Up Your Research
• Integrating Qualitative Research into Systematic Reviews
• Publishing Qualitative Research
• Presenting Qualitative Research
• Qualitative & Libraries: a few gems
• Data Repositories

Why is this information important?

• Quite a few departments and institutes on campus offer training in qualitative methods, but they may be difficult to identify due to discipline specific terminology.

On this page you will find the following helpful resources:

• Information about training resources at the Odum Institute
• Links to UNC certificates that involve qualitative studies
• Links to area workshops that feature qualitative methods or concerns.

UNC's Odum Institute (for advancing social science teaching and research) maintains a  calendar of all training at the Institute, including including public, private, and credit courses and additional education opportunities .  Some courses require registration and may have associated fees. Examples of qualitative themed classes offered at the Odum Institute include:

• Executing Your Survey Research Project
• MAXQDA Hands-On Workshop
• NVivo Hands-On Workshop
• Visual Design: A Hands-On Approach

UNC offers many graduate certificates; here are some that are relevant to those interested in qualitative research. Even if you aren't interested in completing the coursework for a certificate, the curricula of these programs are good sources of information on qualitative-related courses taught at UNC. You can see a list of other certificate programs offered at UNC on the central Certificate Programs homepage .

Certificates Open to Graduate Students and Non-Degree-Seeking Students:

• Digital Humanities (Department of American Studies and Carolina Digital Humanities Initiative)
• Survey Methodology (Odum Institute for Research in the Social Sciences)

Certificates Open to Matriculating Graduate Students Only:

A program advisor will work with you to determine how to best structure your certificate based on your research and career goals. A maximum of 4 credit hours may be drawn from required coursework in your graduate program.

• Workshops related to participatory research
• Events related to participatory research

These links will take you to schedules of qualitative workshops offered or co-sponsored by various departments on campus. You may be able to find more by visiting the UNC Events page.

• Qualitative Data Analysis Camp
• Qualitative Writing Camp
• Mixed Methods Research: Integrating Qualitative and Quantitative Methods
• Sort and Sift, Think and Shift: Let the Data be Your Guide
• Fundamentals of Qualitative Research
• Doing Qualitative Research Online
• Crafting Phenomenological Research
• Implementation Research: Using Qualitative Research Methods to Improve Policy and Practice
• 8 Criteria for Creating Quality in Qualitative Research
• Building a Codebook and Writing Memos
• All upcoming courses
• NC TraCS Qualitative Research Services (including training)
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• Next: Help at UNC >>
• Last Updated: May 14, 2024 12:50 PM
• URL: https://guides.lib.unc.edu/qual

Course details

• Mon 04 Nov 2024 to 08 Nov 2024
• Mon 23 Jun 2025 to 27 Jun 2025

Qualitative Research Methods

Introducing qualitative research

This module will provide an introductory overview of the principles and practice of qualitative research. Students will explore how people make sense of their lives, and recognise ways in which qualitative research bridges the gap between scientific evidence and clinical practice by examining the attitudes, beliefs, and preferences of both patients and practitioners. Participants will be introduced to the concepts underpinning qualitative research, learn to collect data using fundamental methods, including observation, interview and focus groups and become familiar with the techniques of thematic qualitative data analysis.

The last date for receipt of complete applications is 5pm Friday 7th June 2024. Regrettably, late applications cannot be accepted.

The overall aims of this module are to enable students to:

• Use qualitative research in evidence based practice;
• Understand commonly used qualitative methodologies in health care;
• Understand the ways in which qualitative and quantitative approaches can be combined;
• Discuss the issues involved in systematic review and synthesis of qualitative research;
• Describe steps to design, data collection and analysis for a qualitative project;
• Use qualitative methods, including observation, interviews and focus groups;
• Conduct thematic qualitative data analysis;
• Write up qualitative research results.

Comments from previous participants:

"All tutors had both solid theoretical understanding of their topic and wide practical knowledge of the application of the approach being taught in practice. This course was a good mix of theory, opportunities to practice new skills, and application of theory into (one's own) practice."

Programme details

This module is run over an eight week cycle where the first week is spent working on introductory activities using a Virtual Learning Environment, the second week is spent in Oxford for the face to face teaching week (this takes place on the dates advertised), there are then four Post-Oxford activities (delivered through the VLE) which are designed to help you write your assignment. You then have a week of personal study and you will be required to submit your assignment electronically the following week (usually on a Tuesday at 14:00 UK Local Time).

Recommended reading

• Ziebland, S., Coulter, A., Calabrese, J. and Locock, L.(Editors). (2013) Understanding and Using Health Experiences. Improving patient care. Oxford: OUP.

Details of funding opportunities, including grants, bursaries, loans, scholarships and benefit information are available on our financial assistance page.

If you are an employee of the University of Oxford and have a valid University staff card you may be eligible to receive a 10% discount on the full stand-alone fee. To take advantage of this offer please submit a scan/photocopy of your staff card along with your application. Your card should be valid for a further six months after attending the course.

Dr Anne-Marie Boylan

Module coordinator.

Anne-Marie Boylan is a Departmental Lecturer and Senior Research Fellow based in the Nuffield Department of Primary Care Health Sciences.

Assessment methods

Assessment will be based on submission of a written assignment which should not exceed 4,000 words.

Academic Credit

Applicants may take this course for academic credit. The University of Oxford Department for Continuing Education offers Credit Accumulation and Transfer Scheme (CATS) points for this course. Participants attending at least 80% of the taught course and successfully completing assessed assignments are eligible to earn credit equivalent to 20 CATS points which may be counted towards a postgraduate qualification.

Applicants can choose not to take the course for academic credit and will therefore not be eligible to undertake the academic assignment offered to students taking the course for credit. Applicants cannot receive CATS (Credit Accumulation and Transfer Scheme) points or equivalence. Credit cannot be attributed retrospectively. CATS accreditation is required if you wish for the course to count towards a further qualification in the future.

A Certificate of Completion is issued at the end of the course.

Applicants registered to attend ‘not for credit’ who subsequently wish to register for academic credit and complete the assignment are required to submit additional information, which must be received one calendar month in advance of the course start date. Please contact us for more details.

Please contact [email protected] if you have any questions.

Application

This course requires you to complete the application form and to attach a copy of your CV. If you are applying to take this course for academic credit you will also be required to provide a reference. Please note that if you are not applying to take the course for academic credit then you do not need to submit a reference.

Please ensure you read the guidance notes which appear when you click on the symbols as you progress through the application form, as any errors resulting from failure to do so may delay your application.

• Short Course Application Form
• Terms and Conditions

Selection criteria

Admissions Criteria: To apply for the course you should:

• Be a graduate or have successfully completed a professional training course
• Have professional work experience in the health service or a health-related field
• Be able to combine intensive classroom learning with the application of the principles and practices of evidence-based health care within the work place
• Have a good working knowledge of email, internet, word processing and Windows applications (for communications with course members, course team and administration)
• Show evidence of the ability to commit time to study and an employer's commitment to make time available to study, complete course work and attend course and university events and modules.
• Be able to demonstrate English Language proficiency at the University’s higher level . 

Accommodation

Accommodation is available at the Rewley House Residential Centre , within the Department for Continuing Education, in central Oxford. The comfortable, en-suite, study-bedrooms have been rated as 4-Star Campus accommodation under the Quality In Tourism scheme , and come with tea- and coffee-making facilities, free Wi-Fi access and Freeview TV. Guests can take advantage of the excellent dining facilities and common room bar, where they may relax and network with others on the programme.

IT requirements

Please ensure that you have access to a computer that meets the specifications detailed on our technical support page.

Terms & conditions for applicants and students

Information on financial support

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• MSc in Evidence-Based Health Care
• MSc in EBHC (Teaching and Education)
• Postgraduate Diploma in Health Research
• Postgraduate Certificate in Health Research

and also available as an accredited short course in Health Sciences

Qualitative Health Research Network

• QHRN Training programme

Training programme

QHRN provides face-to-face and on-line workshops on specific qualitative methodologies and their applications in health research.

Our courses are for researchers at all levels of seniority, and in any area of health research who already have some basic understanding of qualitative research and wish to develop, refresh or expand their methodological skills and knowledge in specific areas.

Courses are delivered by workshop leads who are experts in the specific methodological topic of the workshop. Live sessions create friendly, informal settings, with numbers capped at 25-30 so that participants can share their particular concerns and create connections with other qualitative health researchers. These are complemented by non-synchronous content such as pre-recorded videos, preparatory reading or viewing, and follow-up resources. There may be expectations in some workshops for participants to complete specific tasks or preparatory work before attending the live component of the workshop.

We aim to offer a selection of training workshops every six months, with popular courses repeated according to demand.

The courses we currently offer

• Writing and Publishing Qualitative Research (Online)
• Applied Conversation Analysis: A practical workshop (In person)
• Introduction to Ethnography in Healthcare (Online)
• Introduction to Qualitative Process Evaluation in Healthcare (Online)
• Supervising a Qualitative or Mixed-Methods PhD (Online)

These courses will be run again in the future. 

Our next training courses

Details of our March/April workshops are provided below. 

Course dates and times

Course details.

For more details about each course, please see below:

This course is a comprehensive introduction to ethnographic research, focusing on current understandings, ethics and access in healthcare settings, research design, observational and interview-based methods of data collection, data management, analysis, and the written account.

Who this course is for:

The workshop is aimed at those who work in:

• Academic reseach
• Health and social care related charities
• Policy groups and think tank  

It's suitable for those with limited experience of conducting ethnographies, although some knowledge about ethnography and/or qualitative research generally is beneficial.

Course content

There are three parts to the course:

1. Pre-recorded videos

In four short pre-recorded videos (15-30 minutes each) we will talk you through the basics of ethnography in healthcare: •    What is ethnography and what does it tell us: how to use ethnography in healthcare settings,  •    Methodology and methods of ethnography,  •    Fieldwork preparation •    Analysis and writing up for publication.  These short lectures will prepare you to know how, why and when ethnography is useful as a research tool in healthcare, how to develop an ethnographic research question and how to use the different tools of ethnography as well as the basics of analysis and writing up. The videos will guide you step by step through the process of your self-directed fieldwork. They can be watched and re-watched as many times as you like and you should watch all the videos before coming to the live session.

2. Self-directed fieldwork

We would like you to experience what it is like to do some ethnographic data collection. You should complete the fieldwork before coming to the live session .

3. The live session

We will have a live session via Zoom that will extend your learning from the preparatory work. There will be time to discuss queries and further develop your understanding of ethnography.

Teaching and structure

This course takes up to three days to complete. The pre-recorded videos and self-directed fieldwork can be completed any time before the live session. The live session lasts 2.5 hours. You'll learn as part of a group, interacting through activities and questions and learning from others by taking part in the discussions that accompany each step.

Learning outcomes

By the end of the course you'll be able to:

•    explain how and why ethnography can be used in healthcare research •    develop an ethnographic research question •    conduct ethnographic fieldwork •    understand how to analyse and write-up ethnography for publication

Facilitators

Jennie gamlin.

Jennie is Associate Professor in Anthropology and Global Health in the UCL Institute for Global Health and director of the IGH Centre for Gender, Health and Social Justice. She leads the Wellcome Trust Funded research programme “Gender, Health and the Afterlife of Colonialism: Engaging new problematisations to improve maternal and infant health”, a mixed methods historical and ethnographic investigation into the historicity of gender in Indigenous Wixárika communities (see virtual exhibition of this project here). She is also co-investigator on the ‘Embodied Inequalities of the Anthropocene project’ together with Professor Sahra Gibbon (UCL Anthropology) , and collaborators in Mexico and Brazil. With Ros Greiner Jennie Co-Leads the MSc Module Gender and Global Health. She has previous led teaching modules Anthropology of Global Health, Qualitative Research Methods, Maternal Health and Risk (UCL Anthropology), and taught on undergraduate and postgraduate modules in UCL  Anthropology and Global Health.

Rosamund Greiner

Ros is a doctoral researcher in the UCL Institute for Global Health. Her PhD research is an ethnography of families raising children with Congenital Zika Syndrome in Barranquilla, Colombia. In her thesis she brings together critical disability studies with decolonial feminism, and explores themes of care work and reproductive labour, health system navigation and caregiver agency, and the social construction of disability. Together with Jennie, Ros co-leads the MSc module ‘Gender and Global Health’ and has taught on a range of modules including qualitative methods for global health and anthropological perspectives on global health.

This course provides an introduction to the methods and uses of applied conversation analysis in health, education, and social care research. The course introduces the core principles of CA before providing an opportunity for participants to take part in a live data session: making observations and shaping them into a more evidence-based formulation. The course will include presentations on data collection and formulating CA research questions. It will conclude with a focus on taking the next step to using CA and developing skills as an analyst.

The following topics will be discussed during the workshop:

• What CA is, and how it can be applied in health, education, and social settings.
• How data is collected, transcribed and analysed in CA.
• How to develop CA skills and how to embed CA methods in one's research

Who this course is for? 

This course would be of value to researchers, students and clinicians looking to conduct CA-informed research using recordings from naturally occurring conversations (particularly from health, education, or social care settings). A foundation in/familiarity with qualitative research methods would be preferred, as some basic knowledge will be assumed.

This is a single interactive workshop, lasting 4 hours, preceded by 2 hours online preparatory work.

Teaching will be delivered in person face-to-face by experienced applied CA researchers. You'll learn as part of a group, interacting through activities and questions and learning from others by taking part in the discussions that accompany each step. The final 30 minutes of the session will be for developing your personal goals and for further discussion.

We expect the course will require 6 hours to complete in total (including the preparatory work and the face-to-face session).

By the end of the course, you'll be able to:

• Understand the core principles of investigating naturally occurring conversation in applied health, education and social care settings.
• Recognise CA transcription conventions and be able to identify and describe basic features of talk-in-interaction.
• Understand the potential relevance, value and limitations of a CA approach to your own area(s) of enquiry

We are all from UCL’s Department of Language and Cognition, Division of Psychology and Language Sciences, Faculty of Brain Sciences

Suzanne Beeke

Dr Suzanne Beeke is a clinical academic whose research focuses on the impact of communication and cognitive disorders on the everyday conversations of adults with acquired neurological conditions talking to family, friends and health and social care professionals. She leads the Better Conversations Lab, a group of academics and clinical researchers using CA to understand communication difficulties and needs, and to underpin co-produced interventions: www.tinyurl.com/BetterConversationsLab 

Steven Bloch

Professor Steven Bloch is a clinical academic in communication and social interaction. He has a special interest in end-of life-care conversation, helpline interactions, and also interactions between people with progressive neurological conditions and family members. He is currently Head of Language and Cognition in the Division of Psychology and Language Sciences at UCL.

Andrea Bruun

Dr Andrea Bruun completed her PhD at the Marie Curie Palliative Care Research Department at UCL. She is specialised in the CA method and has worked with a variety of interactional data such as homecare visits, student counselling sessions, advanced lung cancer consultations, and hospice multidisciplinary team meetings. She is currently working at Kingston University as a postdoctoral researcher on a project on end-of-life care planning with people with learning disabilities.  

The session will cover how to write a qualitative academic paper, as well as tips for how to get your paper published in a peer-reviewed journal.  There are three parts to the course:

Who this course is for

The workshop is aimed at those who:

• Know the key principles of qualitative research
• Are already writing a paper based on qualitative research

This course may benefit those who have attended other QHRN training courses.

This is a one day course, lasting 2.5hrs.

Teaching will be delivered entirely online by experienced researchers. You'll learn as part of a group, interacting through activities and questions and learning from others by taking part in the discussions that accompany each step.

You will bring an example of your own writing based on qualitative research, and use it to learn principles of clear communication and effective writing.

By the end of the course you'll have gained knowledge about:

• How to write qualitative research for an academic journal
• How to increase the chances of a  paper being accepted by a journal
• How to practice thinking and writing clearly 

Julia Bailey

Dr Julia Bailey is a sexual health specialty doctor in South East London and senior researcher at the UCL eHealth Unit. Julia has a passion for bringing social science insights into health research, and is an expert in health communication including doctor-patient interaction, science communication for different audiences, and academic writing.

Tom Witney  

Cost and booking.

The cost of each course is £80, and places are limited to 25. Please use the link above to book.

Please note that bookings for each course close 5 days before the live workshop date. 

To support learning and encourage the dissemination of high quality qualitative research methodology we are pleased to offer a small number of bursary places for this course. 

Please email us at [email protected] before registering if you feel that you would benefit from this course, but the cost presents a barrier to your learning, and provide any details that you would like us to consider. If selected, the fees for this course will be reduced to £30. Note that the number of bursaries we will offer are limited so we encourage interested parties to contact us at their earliest convenience.

Certification

If you would like a certificate of attendance, please contact us after the course.

Terms and conditions

Our bursary policy is included in the terms and conditions, please send [email protected] a brief description of your need for a bursary towards specific training courses.

For information on terms and conditions, please read our training workshop terms and conditions document:

terms_and_conditions_for_qhrn_workshops_march_2024.pdf

Please contact us on:  [email protected]  if you have any questions about the training courses. 

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Professional Development Courses

AERA has announced a robust program of professional development courses for the 2023 AERA Annual Meeting in Chicago. The courses cover salient topics in education research design, quantitative and qualitative research methods, meta-analysis, and other data analysis techniques. The courses will be in-person and begin on Wednesday, April 12, one-day prior to the start of the Annual Meeting. Led by an expert faculty of researchers and scholars, these courses are designed at various levels to reach graduate students, early career scholars, practitioners, and other researchers who seek to increase their knowledge and enhance their research skills.

Professional development courses can be added to new or existing Annual Meeting registrations in the  My AERA  section of the AERA website. Early registration is encouraged as space is limited.  Questions about the courses should be directed to  [email protected] .

Click the link below to jump to each course. 

Full-Day Courses

• Introduction to Meta-Analysis
• Multilevel Modeling with International Large-Scale Assessment Databases Using the HLM Software Program

Half-Day Courses

• Designing Adequately Powered Cluster and Multisite Randomized Trials to Detect Main Effects, Moderation, and Mediation
• Qualitative Research From Literature Review to Large Dataset Analysis
• Foundations of Learning Analytics with Rstudio
• An Introduction to Bayesian Estimation and Missing Data Imputation for Education Research
• Developing Tools for Analysis Using Narratives
• How to Write Qualitative Research

This one-day course will introduce the basics of  meta-analysis. Topics covered include developing a research question, searching the literature, evaluating and coding studies, conducting a meta-analysis, and interpreting results for various stakeholders. Participants are encouraged to bring an idea for a systematic review to the course, with time reserved for discussion about it with course instructors. Course activities will include lecture, hands-on exercises, small group discussion, and individual consultation. The target audience includes both those new to systematic review and meta-analysis as well as those currently conducting either type of project. Knowledge of basic descriptive statistics is assumed. Participants are required to bring a laptop computer.

Data from international large-scale assessments (ILSAs) reflect the nested structure of education systems and are, therefore, well suited to multilevel modeling (MLM). However, because these data come from complex cluster samples, there are methodological aspects that researchers need to understand when using MLM, including the need to use sampling weights and multiple achievement values for accurate parameter and standard error estimation. Using the most recently released ILSA data, from TIMSS 2019, this course will teach participants how to conduct MLM. Although the course will include a basic overview of MLM, it will emphasize the assessment design features of ILSAs (TIMSS, PIRLS, and PISA) and implications for MLM analysis. Participants will learn how to specify two-level models using HLM as well as about model comparison, centering decisions and their consequences, and the resources available for doing three-level models. Time will be allotted for hands-on exercises, with instructors available to mentor and answer questions for participants. Step-by-step demonstrations of each practice item will also be provided. Participants should have a solid understanding of Ordinary Least Squares (OLS) regression and a basic understanding of MLM. Prior experience using a statistical software program, such as Stata, R, or SPSS, is helpful. Prior knowledge of ILSAs—and prior experience using their databases or HLM—is not required. So that they can fully participate in the hands-on exercises, participants without an HLM8 license will be informed prior to the course how to temporarily access HLM8, which works in Windows and Parallels Desktop on Macs.

The purpose of this course is to train researchers and evaluators how to plan efficient and effective cluster and multisite randomized studies that probe hypotheses concerning main effects, mediation, and moderation. We focus on the conceptual logic and mechanics of multilevel studies and train participants in how to plan cluster and multisite randomized studies with adequate power to detect multilevel mediation, moderation, and main effects. We introduce participants to the free PowerUp! software programs designed to estimate the statistical power to detect mediation, moderation, and main effects across a wide range of designs. The course will combine lecture with hands-on practice with the free software programs. The target audience includes researchers and evaluators interested in planning and conducting multilevel studies that investigate mediation, moderation, or main effects. Participants should bring a laptop to the session.

This course highlights digital tools and qualitative analysis software integral to helping researchers organize and manage large qualitative data analysis (QDA) projects. This course, divided into two modules, is designed to facilitate participants’ fundamental knowledge of conducting a systemic literature review and initial QDA. While NVivo® is the primary analysis software for this course, participants will learn the usefulness of Transana, Citavi, and other digital tools. This course is designed as an interactive lecture and consultation—exploring how digital tools expedites literature reviews and truncates large qualitative datasets. Upon completion of this course, participants would have gained applicable knowledge on:

• The basic features of NVivoâ and Transana.
• How to expedite a literature review.
• How to create their research design framework.
• How to conduct and interpret initial QDA through coding techniques and visualizations.

Participants should have moderate to advanced experience in qualitative research. Participants will need access to a laptop with at least the NVivoâ and Transana free trial version software. Additionally, participants should be equipped with a literature database (i.e., research manuscripts downloaded on laptops and ready to be uploaded) and at least preliminary units of analysis (e.g., transcribed interviews, documents, etc.). No prior experience with qualitative software is necessary. Instructors will guide participants through the essential elements of multiple digital tools. This course is appropriate for graduate students, early-career scholars, and advanced researchers desiring to expand their knowledge of QDA.

Learning Analytics, as a computational research methodology, increases the capacity to understand and improve STEM learning and learning environments through the use of new sources of data and powerful analytical approaches. Learning Analytics is a relatively new, rapidly growing field with significant potential to improve digital learning environments. To address the need for trained researchers on a much broader scale, instructors will focus on Learning Analytics foundations and Text Mining with a STEM education focus. Topics broadly emphasize methodologies, literature, applications, and ethical issues as they relate to STEM education. Participants develop basic proficiency with R and RStudio, apply computational analysis techniques (e.g. data visualization, text mining) relevant and appropriate to their STEM education research interests. The target audience includes those who aim to leverage new data sources and apply computational methods in R Studio following the Learning Analytics workflow. The level of instruction will be appropriate for those with little or no experience using R, a popular free open source software program for data science, research, and technical communication. The first part of the course lays the foundations of Learning Analytics and R programming basics. The second part uses that base to dive into Text Mining techniques (e.g. word counts, sentiment analysis) in a STEM education context. Course activities include conceptual overviews, code-alongs, blended-learning labs, small group discussions, and individual consultations. Knowledge of basic descriptive and exploratory analysis is assumed. Participants are required to bring a laptop computer with R and Rstudio downloaded.

This introductory course introduces attendees to Bayesian estimation and missing data imputation. The course addresses a number of practical issues that researchers are likely to encounter in their research, including mixtures of categorical and continuous variables, interactive and nonlinear effects, and multilevel data structures. The primary goal of this course is to provide participants with the skills necessary to understand and apply cutting-edge missing data handling methods to their own data. Technical information will be presented in an accessible manner that is readily understandable by researchers who use, but do not specialize in, quantitative methods. Accordingly, the course will target practicing researchers (graduate students, professors, research professionals) who possess typical graduate-level statistics training, in particular, familiarity with multiple regression. The course will provide a mixture of lecture and computer applications. Presentation software will be used to deliver the course content, and attendees will be provided with extensive handouts. Estimation and imputation will be illustrated using the Blimp application, which is available as a free download at www.appliedmissingdata.com/blimp. Blimp was developed as part of an Institute of Education Sciences funded projects, and the program implements a number of cutting-edge approaches that are not available in other software. Course handouts will include computer code and scripts that attendees can use to analyze data.

This course provides qualitative researchers opportunity to develop analytic skills with tools specifically designed for using narratives or stories within their research. Qualitative Researchers often collect narratives or stories as data within a research project, yet may struggle at the analysis stage. Even Narrative Researchers may wish desired to have more tools when they are analyzing narrative data. This course begins with a moderated panel discussion with researchers who teach particular research tools in the course. Attendees will choose and then participate in four 30 min hands-on courses. Each course engages researchers in developing or honing skills with a particular analytic tool. The course ends with invited course participants sharing their insights and a final moderated question answer session with the narrative scholars from the courses. The available skills to be taught include: Autobiographical narrative Inquiry using indigenous knowing; Narrative beginnings as a tool for narrative analysis; Memory work for narrative research; Literary elements in narrative research; Narrative beginnings as the basis for data collection and analysis; Attending to multicultural issues in narrative analysis; Using digital tools and musical elements in narrative analysis and Narrative vignettes in Narrative Research.

This course aims to help beginning qualitative researchers (whether graduate students writing a qualitative dissertation or those learning qualitative methods so they can do mixed methods) learn some of the key expectations, practices, and conventions of writing traditional qualitative research. The session doesn’t teach about data collection and analysis—just writing, perhaps the least discussed topic in qualitative methods texts and courses. Using a range of formats, including short lecture, hands-on activities, and group discussion, the instructor and participants will accomplish several course objectives.

Participants will learn about, discuss, and practice the following key qualitative writing skills:

• Writing to Show You Were There
• Writing About and With Qualitative Data
• Writing Valid Qualitative Findings, Assertions, and Conclusions
• Writing About Qualitative Methods
• Basic Revision Strategies

Though attendees can be relative beginners, they should have basic familiarity with qualitative research methodology and practices. Participants are encouraged to bring a small writing sample (or small sample of data) for group critique and discussion.

Staff - Department of Management

Qualitative research methods - 2023.

The PhD course on qualitative research methods is offered in a modular course design. To complete the mandatory course, the basic module - Module A (2.5 ECTS) - and one of the three supplementary modules - Modules B, C, D (2.5 ECTS each) - need to be completed (this only applies to PhD students at the Department of Management, Aarhus BSS, Aarhus University).

The modules are:

• Module A - Introduction & Research Design (13-15 March 2023) The mandatory module will enable participants to match research aims with an effective research strategy and suitable qualitative research methods. The course will leverage on contrasting of successful papers to form the ability to critically appraise research designs and further develop the participants' own research strategy and methods. Application deadline:  13 February 2023. More info and sign-up  
• Module B - Collecting Qualitative Data (19-21 April 2023) This module will enable participants to choose and utilise a variety of qualitative data collection methods, including interviews and participant observation, video recording, online data collection, and focus groups. Application deadline:  20 March 2023. More info and sign-up  
• Module C - Analysing Qualitative Data (2-4 May 2023) This module will teach advanced skills to analyse different data types related to text and talk. Different analysis methods will be discussed, including structured interview and text analysis (e.g. the Gioia method), cultural analysis, narrative analysis, discourse analysis, conversation analysis. Application deadline:  27 March 2023. More info and sign-up  
• Module D - Mixing Methods (22-23 and 26 May 2023) This module provides students with an overview of how different research strategies or methods may be integrated to meet a research aim. Students will have the opportunity to reflect on and critically appraise papers and research projects that mix different qualitative methods as well as combinations of qualitative and quantitative research methods. Application deadline:  19 April 2023. More info and sign-up

Students with a PhD project based on qualitative methods might want to choose more than one elective to gain deeper methodological knowledge and skills, e.g. the modules A, B and C. Students working on a quantitative research project might want to follow A and D, which would emphasize in particular the ability to critically reflect on and proactively design successful research designs that might include mixing methods. Students are, however, free to choose any combination that contains the mandatory module A.

• Open access
• Published: 11 May 2024

Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates

• Jacqueline Maria Dias 1 ,
• Muhammad Arsyad Subu 1 ,
• Nabeel Al-Yateem 1 ,
• Fatma Refaat Ahmed 1 ,
• Syed Azizur Rahman 1 , 2 ,
• Mini Sara Abraham 1 ,
• Sareh Mirza Forootan 1 ,
• Farzaneh Ahmad Sarkhosh 1 &
• Fatemeh Javanbakh 1  

BMC Nursing volume  23 , Article number:  322 ( 2024 ) Cite this article

430 Accesses

Metrics details

Understanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses’ sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.

A qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.

During their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students’ clinical experiences. We extracted three main themes that described students’ stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.

Conclusions

This qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

Peer Review reports

Nursing education programmes aim to provide students with high-quality clinical learning experiences to ensure that nurses can provide safe, direct care to patients [ 1 ]. The nursing baccalaureate programme at the University of Sharjah is a four year program with 137 credits. The programmes has both theoretical and clinical components withs nine clinical courses spread over the four years The first clinical practicum which forms the basis of the study takes place in year 2 semester 2.

Clinical practice experience is an indispensable component of nursing education and links what students learn in the classroom and in skills laboratories to real-life clinical settings [ 2 , 3 , 4 ]. However, a gap exists between theory and practice as the curriculum in the classroom differs from nursing students’ experiences in the clinical nursing practicum [ 5 ]. Clinical nursing training places (or practicums, as they are commonly referred to), provide students with the necessary experiences to ensure that they become proficient in the delivery of patient care [ 6 ]. The clinical practicum takes place in an environment that combines numerous structural, psychological, emotional and organizational elements that influence student learning [ 7 ] and may affect the development of professional nursing competencies, such as compassion, communication and professional identity [ 8 ]. While clinical training is a major component of nursing education curricula, stress related to clinical training is common among students [ 9 ]. Furthermore, the nursing literature indicates that the first exposure to clinical learning is one of the most stressful experiences during undergraduate studies [ 8 , 10 ]. Thus, the clinical component of nursing education is considered more stressful than the theoretical component. Students often view clinical learning, where most learning takes place, as an unsupportive environment [ 11 ]. In addition, they note strained relationships between themselves and clinical preceptors and perceive that the negative attitudes of clinical staff produce stress [ 12 ].

The effects of stress on nursing students often involve a sense of uncertainty, uneasiness, or anxiety. The literature is replete with evidence that nursing students experience a variety of stressors during their clinical practicum, beginning with the first clinical rotation. Nursing is a complex profession that requires continuous interaction with a variety of individuals in a high-stress environment. Stress during clinical learning can have multiple negative consequences, including low academic achievement, elevated levels of burnout, and diminished personal well-being [ 13 , 14 ]. In addition, both theoretical and practical research has demonstrated that increased, continual exposure to stress leads to cognitive deficits, inability to concentrate, lack of memory or recall, misinterpretation of speech, and decreased learning capacity [ 15 ]. Furthermore, stress has been identified as a cause of attrition among nursing students [ 16 ].

Most sources of stress have been categorized as academic, clinical or personal. Each person copes with stress differently [ 17 ], and utilizes deliberate, planned, and psychological efforts to manage stressful demands [ 18 ]. Coping mechanisms are commonly termed adaptation strategies or coping skills. Labrague et al. [ 19 ] noted that students used critical coping strategies to handle stress and suggested that problem solving was the most common coping or adaptation mechanism used by nursing students. Nursing students’ coping strategies affect their physical and psychological well-being and the quality of nursing care they offer. Therefore, identifying the coping strategies that students use to manage stressors is important for early intervention [ 20 ].

Studies on nursing students’ coping strategies have been conducted in various countries. For example, Israeli nursing students were found to adopt a range of coping mechanisms, including talking to friends, engaging in sports, avoiding stress and sadness/misery, and consuming alcohol [ 21 ]. Other studies have examined stress levels among medical students in the Arab region. Chaabane et al. [ 15 ], conducted a systematic review of sudies in Arab countries, including Saudi Arabia, Egypt, Jordan, Iraq, Pakistan, Oman, Palestine and Bahrain, and reported that stress during clinical practicums was prevalent, although it could not be determined whether this was limited to the initial clinical course or occurred throughout clinical training. Stressors highlighted during the clinical period in the systematic review included assignments and workload during clinical practice, a feeling that the requirements of clinical practice exceeded students’ physical and emotional endurance and that their involvement in patient care was limited due to lack of experience. Furthermore, stress can have a direct effect on clinical performance, leading to mental disorders. Tung et al. [ 22 ], reported that the prevalence of depression among nursing students in Arab countries is 28%, which is almost six times greater than the rest of the world [ 22 ]. On the other hand, Saifan et al. [ 5 ], explored the theory-practice gap in the United Arab Emirates and found that clinical stressors could be decreased by preparing students better for clinical education with qualified clinical faculty and supportive preceptors.

The purpose of this study was to identify the stressors experienced by undergraduate nursing students in the United Arab Emirates during their first clinical training and the basic adaptation approaches or coping strategies they used. Recognizing or understanding different coping processes can inform the implementation of corrective measures when students experience clinical stress. The findings of this study may provide valuable information for nursing programmes, nurse educators, and clinical administrators to establish adaptive strategies to reduce stress among students going clinical practicums, particularly stressors from their first clinical training in different healthcare settings.

A qualitative approach was adopted to understand clinical stressors and coping strategies from the perspective of nurses’ lived experience. Qualitative content analysis was employed to obtain rich and detailed information from our qualitative data. Qualitative approaches seek to understand the phenomenon under study from the perspectives of individuals with lived experience [ 23 ]. Qualitative content analysis is an interpretive technique that examines the similarities and differences between and within different areas of text while focusing on the subject [ 24 ]. It is used to examine communication patterns in a repeatable and systematic way [ 25 ] and yields rich and detailed information on the topic under investigation [ 23 ]. It is a method of systematically coding and categorizing information and comprises a process of comprehending, interpreting, and conceptualizing the key meanings from qualitative data [ 26 ].

Setting and participants

This study was conducted after the clinical rotations ended in April 2022, between May and June in the nursing programme at the College of Health Sciences, University of Sharjah, in the United Arab Emirates. The study population comprised undergraduate nursing students who were undergoing their first clinical training and were recruited using purposive sampling. The inclusion criteria for this study were second-year nursing students in the first semester of clinical training who could speak English, were willing to participate in this research, and had no previous clinical work experience. The final sample consisted of 30 students.

Research instrument

The research instrument was a semi structured interview guide. The interview questions were based on an in-depth review of related literature. An intensive search included key words in Google Scholar, PubMed like the terms “nursing clinical stressors”, “nursing students”, and “coping mechanisms”. Once the questions were created, they were validated by two other faculty members who had relevant experience in mental health. A pilot test was conducted with five students and based on their feedback the following research questions, which were addressed in the study.

How would you describe your clinical experiences during your first clinical rotations?

In what ways did you find the first clinical rotation to be stressful?

What factors hindered your clinical training?

How did you cope with the stressors you encountered in clinical training?

Which strategies helped you cope with the clinical stressors you encountered?

Data collection

Semi-structured interviews were chosen as the method for data collection. Semi structured interviews are a well-established approach for gathering data in qualitative research and allow participants to discuss their views, experiences, attitudes, and beliefs in a positive environment [ 27 ]. This approach allows for flexibility in questioning thereby ensuring that key topics related to clinical learning stressors and coping strategies would be explored. Participants were given the opportunity to express their views, experiences, attitudes, and beliefs in a positive environment, encouraging open communication. These semi structured interviews were conducted by one member of the research team (MAS) who had a mental health background, and another member of the research team who attended the interviews as an observer (JMD). Neither of these researchers were involved in teaching the students during their clinical practicum, which helped to minimize bias. The interviews took place at the University of Sharjah, specifically in building M23, providing a familiar and comfortable environment for the participant. Before the interviews were all students who agreed to participate were provided with an explanation of the study’s purpose. The time and location of each interview were arranged. Before the interviews were conducted, all students who provided consent to participate received an explanation of the purpose of the study, and the time and place of each interview were arranged to accommodate the participants’ schedules and preferences. The interviews were conducted after the clinical rotation had ended in April, and after the final grades had been submitted to the coordinator. The timings of the interviews included the month of May and June which ensured that participants have completed their practicum experience and could reflect on the stressors more comprehensively. The interviews were audio-recorded with the participants’ consent, and each interview lasted 25–40 min. The data were collected until saturation was reached for 30 students. Memos and field notes were also recorded as part of the data collection process. These additional data allowed for triangulation to improve the credibility of the interpretations of the data [ 28 ]. Memos included the interviewers’ thoughts and interpretations about the interviews, the research process (including questions and gaps), and the analytic progress used for the research. Field notes were used to record the interviewers’ observations and reflections on the data. These additional data collection methods were important to guide the researchers in the interpretation of the data on the participants’ feelings, perspectives, experiences, attitudes, and beliefs. Finally, member checking was performed to ensure conformability.

Data analysis

The study used the content analysis method proposed by Graneheim and Lundman [ 24 ]. According to Graneheim and Lundman [ 24 ], content analysis is an interpretive technique that examines the similarities and differences between distinct parts of a text. This method allows researchers to determine exact theoretical and operational definitions of words, phrases, and symbols by elucidating their constituent properties [ 29 ]. First, we read the interview transcripts several times to reach an overall understanding of the data. All verbatim transcripts were read several times and discussed among all authors. We merged and used line-by-line coding of words, sentences, and paragraphs relevant to each other in terms of both the content and context of stressors and coping mechanisms. Next, we used data reduction to assess the relationships among themes using tables and diagrams to indicate conceptual patterns. Content related to stress encountered by students was extracted from the transcripts. In a separate document, we integrated and categorized all words and sentences that were related to each other in terms of both content and context. We analyzed all codes and units of meaning and compared them for similarities and differences in the context of this study. Furthermore, the emerging findings were discussed with other members of the researcher team. The final abstractions of meaningful subthemes into themes were discussed and agreed upon by the entire research team. This process resulted in the extraction of three main themes in addition to two subthemes related to stress and coping strategies.

Ethical considerations

The University of Sharjah Research Ethics Committee provided approval to conduct this study (Reference Number: REC 19-12-03-01-S). Before each interview, the goal and study procedures were explained to each participant, and written informed consent was obtained. The participants were informed that participation in the study was voluntary and that they could withdraw from the study at any time. In the event they wanted to withdraw from the study, all information related to the participant would be removed. No participant withdrew from the study. Furthermore, they were informed that their clinical practicum grade would not be affected by their participation in this study. We chose interview locations in Building M23that were private and quiet to ensure that the participants felt at ease and confident in verbalizing their opinions. No participant was paid directly for involvement in this study. In addition, participants were assured that their data would remain anonymous and confidential. Confidentiality means that the information provided by participants was kept private with restrictions on how and when data can be shared with others. The participants were informed that their information would not be duplicated or disseminated without their permission. Anonymity refers to the act of keeping people anonymous with respect to their participation in a research endeavor. No personal identifiers were used in this study, and each participant was assigned a random alpha-numeric code (e.g., P1 for participant 1). All digitally recorded interviews were downloaded to a secure computer protected by the principal investigator with a password. The researchers were the only people with access to the interview material (recordings and transcripts). All sensitive information and materials were kept secure in the principal researcher’s office at the University of Sharjah. The data will be maintained for five years after the study is completed, after which the material will be destroyed (the transcripts will be shredded, and the tapes will be demagnetized).

In total, 30 nursing students who were enrolled in the nursing programme at the Department of Nursing, College of Health Sciences, University of Sharjah, and who were undergoing their first clinical practicum participated in the study. Demographically, 80% ( n  = 24) were females and 20% ( n  = 6) were male participants. The majority (83%) of study participants ranged in age from 18 to 22 years. 20% ( n  = 6) were UAE nationals, 53% ( n  = 16) were from Gulf Cooperation Council countries, while 20% ( n  = 6) hailed from Africa and 7% ( n  = 2) were of South Asian descent. 67% of the respondents lived with their families while 33% lived in the hostel. (Table  1 )

Following the content analysis, we identified three main themes: (1) managing expectations, (2) theory-practice gap and 3)learning to cope. Learning to cope had two subthemes: positive coping strategies and negative coping strategies. An account of each theme is presented along with supporting excerpts for the identified themes. The identified themes provide valuable insight into the stressors encountered by students during their first clinical practicum. These themes will lead to targeted interventions and supportive mechanisms that can be built into the clinical training curriculum to support students during clinical practice.

Theme 1: managing expectations

In our examination of the stressors experienced by nursing students during their first clinical practicum and the coping strategies they employed, we identified the first theme as managing expectations.

The students encountered expectations from various parties, such as clinical staff, patients and patients’ relatives which they had to navigate. They attempted to fulfil their expectations as they progressed through training, which presented a source of stress. The students noted that the hospital staff and patients expected them to know how to perform a variety of tasks upon request, which made the students feel stressed and out of place if they did not know how to perform these tasks. Some participants noted that other nurses in the clinical unit did not allow them to participate in nursing procedures, which was considered an enormous impediment to clinical learning, as noted in the excerpt below:

“…Sometimes the nurses… They will not allow us to do some procedures or things during clinical. And sometimes the patients themselves don’t allow us to do procedures” (P5).

Some of the students noted that they felt they did not belong and felt like foreigners in the clinical unit. Excerpts from the students are presented in the following quotes;

“The clinical environment is so stressful. I don’t feel like I belong. There is too little time to build a rapport with hospital staff or the patient” (P22).

“… you ask the hospital staff for some guidance or the location of equipment, and they tell us to ask our clinical tutor …but she is not around … what should I do? It appears like we do not belong, and the sooner the shift is over, the better” (P18).

“The staff are unfriendly and expect too much from us students… I feel like I don’t belong, or I am wasting their (the hospital staff’s) time. I want to ask questions, but they have loads to do” (P26).

Other students were concerned about potential failure when working with patients during clinical training, which impacted their confidence. They were particularly afraid of failure when performing any clinical procedures.

“At the beginning, I was afraid to do procedures. I thought that maybe the patient would be hurt and that I would not be successful in doing it. I have low self-confidence in doing procedures” (P13).

The call bell rings, and I am told to answer Room No. XXX. The patient wants help to go to the toilet, but she has two IV lines. I don’t know how to transport the patient… should I take her on the wheelchair? My eyes glance around the room for a wheelchair. I am so confused …I tell the patient I will inform the sister at the nursing station. The relative in the room glares at me angrily … “you better hurry up”…Oh, I feel like I don’t belong, as I am not able to help the patient… how will I face the same patient again?” (P12).

Another major stressor mentioned in the narratives was related to communication and interactions with patients who spoke another language, so it was difficult to communicate.

“There was a challenge with my communication with the patients. Sometimes I have communication barriers because they (the patients) are of other nationalities. I had an experience with a patient [who was] Indian, and he couldn’t speak my language. I did not understand his language” (P9).

Thus, a variety of expectations from patients, relatives, hospital staff, and preceptors acted as sources of stress for students during their clinical training.

Theme 2: theory-practice gap

Theory-practice gaps have been identified in previous studies. In our study, there was complete dissonance between theory and actual clinical practice. The clinical procedures or practices nursing students were expected to perform differed from the theory they had covered in their university classes and skills lab. This was described as a theory–practice gap and often resulted in stress and confusion.

“For example …the procedures in the hospital are different. They are different from what we learned or from theory on campus. Or… the preceptors have different techniques than what we learned on campus. So, I was stress[ed] and confused about it” (P11).

Furthermore, some students reported that they did not feel that they received adequate briefing before going to clinical training. A related source of stress was overload because of the volume of clinical coursework and assignments in addition to clinical expectations. Additionally, the students reported that a lack of time and time management were major sources of stress in their first clinical training and impacted their ability to complete the required paperwork and assignments:

“…There is not enough time…also, time management at the hospital…for example, we start at seven a.m., and the handover takes 1 hour to finish. They (the nurses at the hospital) are very slow…They start with bed making and morning care like at 9.45 a.m. Then, we must fill [out] our assessment tool and the NCP (nursing care plan) at 10 a.m. So, 15 only minutes before going to our break. We (the students) cannot manage this time. This condition makes me and my friends very stressed out. -I cannot do my paperwork or assignments; no time, right?” (P10).

“Stressful. There is a lot of work to do in clinical. My experiences are not really good with this course. We have a lot of things to do, so many assignments and clinical procedures to complete” (P16).

The participants noted that the amount of required coursework and number of assignments also presented a challenge during their first clinical training and especially affected their opportunity to learn.

“I need to read the file, know about my patient’s condition and pathophysiology and the rationale for the medications the patient is receiving…These are big stressors for my learning. I think about assignments often. Like, we are just focusing on so many assignments and papers. We need to submit assessments and care plans for clinical cases. We focus our time to complete and finish the papers rather than doing the real clinical procedures, so we lose [the] chance to learn” (P25).

Another participant commented in a similar vein that there was not enough time to perform tasks related to clinical requirements during clinical placement.

“…there is a challenge because we do not have enough time. Always no time for us to submit papers, to complete assessment tools, and some nurses, they don’t help us. I think we need more time to get more experiences and do more procedures, reduce the paperwork that we have to submit. These are challenges …” (P14).

There were expectations that the students should be able to carry out their nursing duties without becoming ill or adversely affected. In addition, many students reported that the clinical environment was completely different from the skills laboratory at the college. Exposure to the clinical setting added to the theory-practice gap, and in some instances, the students fell ill.

One student made the following comment:

“I was assisting a doctor with a dressing, and the sight and smell from the oozing wound was too much for me. I was nauseated. As soon as the dressing was done, I ran to the bathroom and threw up. I asked myself… how will I survive the next 3 years of nursing?” (P14).

Theme 3: learning to cope

The study participants indicated that they used coping mechanisms (both positive and negative) to adapt to and manage the stressors in their first clinical practicum. Important strategies that were reportedly used to cope with stress were time management, good preparation for clinical practice, and positive thinking as well as engaging in physical activity and self-motivation.

“Time management. Yes, it is important. I was encouraging myself. I used time management and prepared myself before going to the clinical site. Also, eating good food like cereal…it helps me very much in the clinic” (P28).

“Oh yeah, for sure positive thinking. In the hospital, I always think positively. Then, after coming home, I get [to] rest and think about positive things that I can do. So, I will think something good [about] these things, and then I will be relieved of stress” (P21).

Other strategies commonly reported by the participants were managing their breathing (e.g., taking deep breaths, breathing slowly), taking breaks to relax, and talking with friends about the problems they encountered.

“I prefer to take deep breaths and breathe slowly and to have a cup of coffee and to talk to my friends about the case or the clinical preceptor and what made me sad so I will feel more relaxed” (P16).

“Maybe I will take my break so I feel relaxed and feel better. After clinical training, I go directly home and take a long shower, going over the day. I will not think about anything bad that happened that day. I just try to think about good things so that I forget the stress” (P27).

“Yes, my first clinical training was not easy. It was difficult and made me stressed out…. I felt that it was a very difficult time for me. I thought about leaving nursing” (P7).

I was not able to offer my prayers. For me, this was distressing because as a Muslim, I pray regularly. Now, my prayer time is pushed to the end of the shift” (P11).

“When I feel stress, I talk to my friends about the case and what made me stressed. Then I will feel more relaxed” (P26).

Self-support or self-motivation through positive self-talk was also used by the students to cope with stress.

“Yes, it is difficult in the first clinical training. When I am stress[ed], I go to the bathroom and stand in the front of the mirror; I talk to myself, and I say, “You can do it,” “you are a great student.” I motivate myself: “You can do it”… Then, I just take breaths slowly several times. This is better than shouting or crying because it makes me tired” (P11).

Other participants used physical activity to manage their stress.

“How do I cope with my stress? Actually, when I get stressed, I will go for a walk on campus” (P4).

“At home, I will go to my room and close the door and start doing my exercises. After that, I feel the negative energy goes out, then I start to calm down… and begin my clinical assignments” (P21).

Both positive and negative coping strategies were utilized by the students. Some participants described using negative coping strategies when they encountered stress during their clinical practice. These negative coping strategies included becoming irritable and angry, eating too much food, drinking too much coffee, and smoking cigarettes.

“…Negative adaptation? Maybe coping. If I am stressed, I get so angry easily. I am irritable all day also…It is negative energy, right? Then, at home, I am also angry. After that, it is good to be alone to think about my problems” (P12).

“Yeah, if I…feel stress or depressed, I will eat a lot of food. Yeah, ineffective, like I will be eating a lot, drinking coffee. Like I said, effective, like I will prepare myself and do breathing, ineffective, I will eat a lot of snacks in between my free time. This is the bad side” (P16).

“…During the first clinical practice? Yes, it was a difficult experience for us…not only me. When stressed, during a break at the hospital, I will drink two or three cups of coffee… Also, I smoke cigarettes… A lot. I can drink six cups [of coffee] a day when I am stressed. After drinking coffee, I feel more relaxed, I finish everything (food) in the refrigerator or whatever I have in the pantry, like chocolates, chips, etc” (P23).

These supporting excerpts for each theme and the analysis offers valuable insights into the specific stressors faced by nursing students during their first clinical practicum. These insights will form the basis for the development of targeted interventions and supportive mechanisms within the clinical training curriculum to better support students’ adjustment and well-being during clinical practice.

Our study identified the stressors students encounter in their first clinical practicum and the coping strategies, both positive and negative, that they employed. Although this study emphasizes the importance of clinical training to prepare nursing students to practice as nurses, it also demonstrates the correlation between stressors and coping strategies.The content analysis of the first theme, managing expectations, paves the way for clinical agencies to realize that the students of today will be the nurses of tomorrow. It is important to provide a welcoming environment where students can develop their identities and learn effectively. Additionally, clinical staff should foster an environment of individualized learning while also assisting students in gaining confidence and competence in their repertoire of nursing skills, including critical thinking, problem solving and communication skills [ 8 , 15 , 19 , 30 ]. Another challenge encountered by the students in our study was that they were prevented from participating in clinical procedures by some nurses or patients. This finding is consistent with previous studies reporting that key challenges for students in clinical learning include a lack of clinical support and poor attitudes among clinical staff and instructors [ 31 ]. Clinical staff with positive attitudes have a positive impact on students’ learning in clinical settings [ 32 ]. The presence, supervision, and guidance of clinical instructors and the assistance of clinical staff are essential motivating components in the clinical learning process and offer positive reinforcement [ 30 , 33 , 34 ]. Conversely, an unsupportive learning environment combined with unwelcoming clinical staff and a lack of sense of belonging negatively impact students’ clinical learning [ 35 ].

The sources of stress identified in this study were consistent with common sources of stress in clinical training reported in previous studies, including the attitudes of some staff, students’ status in their clinical placement and educational factors. Nursing students’ inexperience in the clinical setting and lack of social and emotional experience also resulted in stress and psychological difficulties [ 36 ]. Bhurtun et al. [ 33 ] noted that nursing staff are a major source of stress for students because the students feel like they are constantly being watched and evaluated.

We also found that students were concerned about potential failure when working with patients during their clinical training. Their fear of failure when performing clinical procedures may be attributable to low self-confidence. Previous studies have noted that students were concerned about injuring patients, being blamed or chastised, and failing examinations [ 37 , 38 ]. This was described as feeling “powerless” in a previous study [ 7 , 12 ]. In addition, patients’ attitudes towards “rejecting” nursing students or patients’ refusal of their help were sources of stress among the students in our study and affected their self-confidence. Self-confidence and a sense of belonging are important for nurses’ personal and professional identity, and low self-confidence is a problem for nursing students in clinical learning [ 8 , 39 , 40 ]. Our findings are consistent with a previous study that reported that a lack of self-confidence was a primary source of worry and anxiety for nursing students and affected their communication and intention to leave nursing [ 41 ].

In the second theme, our study suggests that students encounter a theory-practice gap in clinical settings, which creates confusion and presents an additional stressors. Theoretical and clinical training are complementary elements of nursing education [ 40 ], and this combination enables students to gain the knowledge, skills, and attitudes necessary to provide nursing care. This is consistent with the findings of a previous study that reported that inconsistencies between theoretical knowledge and practical experience presented a primary obstacle to the learning process in the clinical context [ 42 ], causing students to lose confidence and become anxious [ 43 ]. Additionally, the second theme, the theory-practice gap, authenticates Safian et al.’s [ 5 ] study of the theory-practice gap that exists United Arab Emirates among nursing students as well as the need for more supportive clinical faculty and the extension of clinical hours. The need for better time availability and time management to complete clinical tasks were also reported by the students in the study. Students indicated that they had insufficient time to complete clinical activities because of the volume of coursework and assignments. Our findings support those of Chaabane et al. [ 15 ]. A study conducted in Saudi Arabia [ 44 ] found that assignments and workload were among the greatest sources of stress for students in clinical settings. Effective time management skills have been linked to academic achievement, stress reduction, increased creativity [ 45 ], and student satisfaction [ 46 ]. Our findings are also consistent with previous studies that reported that a common source of stress among first-year students was the increased classroom workload [ 19 , 47 ]. As clinical assignments and workloads are major stressors for nursing students, it is important to promote activities to help them manage these assignments [ 48 ].

Another major challenge reported by the participants was related to communicating and interacting with other nurses and patients. The UAE nursing workforce and population are largely expatriate and diverse and have different cultural and linguistic backgrounds. Therefore, student nurses encounter difficulty in communication [ 49 ]. This cultural diversity that students encounter in communication with patients during clinical training needs to be addressed by curriculum planners through the offering of language courses and courses on cultural diversity [ 50 ].

Regarding the third and final theme, nursing students in clinical training are unable to avoid stressors and must learn to cope with or adapt to them. Previous research has reported a link between stressors and the coping mechanisms used by nursing students [ 51 , 52 , 53 ]. In particular, the inability to manage stress influences nurses’ performance, physical and mental health, attitude, and role satisfaction [ 54 ]. One such study suggested that nursing students commonly use problem-focused (dealing with the problem), emotion-focused (regulating emotion), and dysfunctional (e.g., venting emotions) stress coping mechanisms to alleviate stress during clinical training [ 15 ]. Labrague et al. [ 51 ] highlighted that nursing students use both active and passive coping techniques to manage stress. The pattern of clinical stress has been observed in several countries worldwide. The current study found that first-year students experienced stress during their first clinical training [ 35 , 41 , 55 ]. The stressors they encountered impacted their overall health and disrupted their clinical learning. Chaabane et al. [ 15 ] reported moderate and high stress levels among nursing students in Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan. Another study from Bahrain reported that all nursing students experienced moderate to severe stress in their first clinical placement [ 56 ]. Similarly, nursing students in Spain experienced a moderate level of stress, and this stress was significantly correlated with anxiety [ 30 ]. Therefore, it is imperative that pastoral systems at the university address students’ stress and mental health so that it does not affect their clinical performance. Faculty need to utilize evidence-based interventions to support students so that anxiety-producing situations and attrition are minimized.

In our study, students reported a variety of positive and negative coping mechanisms and strategies they used when they experienced stress during their clinical practice. Positive coping strategies included time management, positive thinking, self-support/motivation, breathing, taking breaks, talking with friends, and physical activity. These findings are consistent with those of a previous study in which healthy coping mechanisms used by students included effective time management, social support, positive reappraisal, and participation in leisure activities [ 57 ]. Our study found that relaxing and talking with friends were stress management strategies commonly used by students. Communication with friends to cope with stress may be considered social support. A previous study also reported that people seek social support to cope with stress [ 58 ]. Some students in our study used physical activity to cope with stress, consistent with the findings of previous research. Stretching exercises can be used to counteract the poor posture and positioning associated with stress and to assist in reducing physical tension. Promoting such exercise among nursing students may assist them in coping with stress in their clinical training [ 59 ].

Our study also showed that when students felt stressed, some adopted negative coping strategies, such as showing anger/irritability, engaging in unhealthy eating habits (e.g., consumption of too much food or coffee), or smoking cigarettes. Previous studies have reported that high levels of perceived stress affect eating habits [ 60 ] and are linked to poor diet quality, increased snacking, and low fruit intake [ 61 ]. Stress in clinical settings has also been linked to sleep problems, substance misuse, and high-risk behaviors’ and plays a major role in student’s decision to continue in their programme.

Implications of the study

The implications of the study results can be grouped at multiple levels including; clinical, educational, and organizational level. A comprehensive approach to addressing the stressors encountered by nursing students during their clinical practicum can be overcome by offering some practical strategies to address the stressors faced by nursing students during their clinical practicum. By integrating study findings into curriculum planning, mentorship programs, and organizational support structures, a supportive and nurturing environment that enhances students’ learning, resilience, and overall success can be envisioned.

Clinical level

Introducing simulation in the skills lab with standardized patients and the use of moulage to demonstrate wounds, ostomies, and purulent dressings enhances students’ practical skills and prepares them for real-world clinical scenarios. Organizing orientation days at clinical facilities helps familiarize students with the clinical environment, identify potential stressors, and introduce interventions to enhance professionalism, social skills, and coping abilities Furthermore, creating a WhatsApp group facilitates communication and collaboration among hospital staff, clinical tutors, nursing faculty, and students, enabling immediate support and problem-solving for clinical situations as they arise, Moreover, involving chief nursing officers of clinical facilities in the Nursing Advisory Group at the Department of Nursing promotes collaboration between academia and clinical practice, ensuring alignment between educational objectives and the needs of the clinical setting [ 62 ].

Educational level

Sharing study findings at conferences (we presented the results of this study at Sigma Theta Tau International in July 2023 in Abu Dhabi, UAE) and journal clubs disseminates knowledge and best practices among educators and clinicians, promoting awareness and implementation of measures to improve students’ learning experiences. Additionally we hold mentorship training sessions annually in January and so we shared with the clinical mentors and preceptors the findings of this study so that they proactively they are equipped with strategies to support students’ coping with stressors during clinical placements.

Organizational level

At the organizational we relooked at the available student support structures, including counseling, faculty advising, and career advice, throughout the nursing program emphasizing the importance of holistic support for students’ well-being and academic success as well as retention in the nursing program. Also, offering language courses as electives recognizes the value of communication skills in nursing practice and provides opportunities for personal and professional development.

For first-year nursing students, clinical stressors are inevitable and must be given proper attention. Recognizing nursing students’ perspectives on the challenges and stressors experienced in clinical training is the first step in overcoming these challenges. In nursing schools, providing an optimal clinical environment as well as increasing supervision and evaluation of students’ practices should be emphasized. Our findings demonstrate that first-year nursing students are exposed to a variety of different stressors. Identifying the stressors, pressures, and obstacles that first-year students encounter in the clinical setting can assist nursing educators in resolving these issues and can contribute to students’ professional development and survival to allow them to remain in the profession. To overcome stressors, students frequently employ problem-solving approaches or coping mechanisms. The majority of nursing students report stress at different levels and use a variety of positive and negative coping techniques to manage stress.

The present results may not be generalizable to other nursing institutions because this study used a purposive sample along with a qualitative approach and was limited to one university in the Middle East. Furthermore, the students self-reported their stress and its causes, which may have introduced reporting bias. The students may also have over or underreported stress or coping mechanisms because of fear of repercussions or personal reasons, even though the confidentiality of their data was ensured. Further studies are needed to evaluate student stressors and coping now that measures have been introduced to support students. Time will tell if these strategies are being used effectively by both students and clinical personnel or if they need to be readdressed. Finally, we need to explore the perceptions of clinical faculty towards supervising students in their first clinical practicum so that clinical stressors can be handled effectively.

Data availability

The data sets are available with the corresponding author upon reasonable request.

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Jacqueline Maria Dias, Muhammad Arsyad Subu, Nabeel Al-Yateem, Fatma Refaat Ahmed, Syed Azizur Rahman, Mini Sara Abraham, Sareh Mirza Forootan, Farzaneh Ahmad Sarkhosh & Fatemeh Javanbakh

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JMD conceptualized the idea and designed the methodology, formal analysis, writing original draft and project supervision and mentoring. MAS prepared the methodology and conducted the qualitative interviews and analyzed the methodology and writing of original draft and project supervision. NY, FRA, SAR, MSA writing review and revising the draft. SMF, FAS, FJ worked with MAS on the formal analysis and prepared the first draft.All authors reviewed the final manuscipt of the article.

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A qualitative survey on factors affecting depression and anxiety in patients with rheumatoid arthritis: a cross-sectional study in Syria

• Fater A. Khadour   ORCID: orcid.org/0000-0001-6049-0687 1   na1 ,
• Younes A. Khadour 2   na1 &
• Bashar M. Ebrahem 3  

Scientific Reports volume  14 , Article number:  11513 ( 2024 ) Cite this article

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• Medical research
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• Rheumatology

Depression and anxiety often coexist with rheumatoid arthritis (RA) and affect the course of the disease. These mental health conditions can be overlooked or underdiagnosed in people with RA. There is conflicting evidence in previous studies regarding this topic, indicating that further research is necessary to provide a thorough understanding of the relationship between anxiety, depression, and RA. This study aims to determine the factors correlated with depression and anxiety symptoms in RA patients by evaluating disease activity at the same time. This cross-sectional study was conducted at four outpatient rehabilitation centers in four Syrian provinces: Damascus, Homs, Hama, and Latakia. The study included RA patients who attended the RA department of rehabilitation centers from January 1 to June 31, 2023. RA patients who presented at a rheumatology clinic were selected consecutively. RA patients were included in the study in accordance with the ACR/EULAR classification criteria, disease activity was assessed by disease activity score based on the 28-joint count (DAS28), and patients with DAS28 > 2.6 were considered to have active RA. The demographic data, as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), health assessment questionnaire (HAQ) score, and the hospital anxiety and depression scale (HADS), were the parameters used in the analysis. Two hundred and twelve patients (female, 75%) with a mean age of 49.3 ± 13.1 years and a mean disease duration of 8.3 ± 6.9 years were studied. Depression was diagnosed in 79 (37.3%) patients and anxiety in 36 (16.9%) patients. Patients with depression and/or anxiety had higher HAQ and DAS28 scores compared to other RA patients. Blue-collar workers exhibited a higher prevalence of anxiety, whereas females, housewives, and individuals with lower educational attainment demonstrated a higher prevalence of depression. The current study found high rates of anxiety and depression in RA patients, highlighting the significant burden of these mental health conditions compared to the general population. It is essential for healthcare providers not to overlook the importance of psychiatric evaluations, mental health assessments, and physical examinations of RA patients.

Introduction

Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily characterized by joint inflammation and damage. While its primary symptoms are related to joint pain, swelling, and stiffness, RA can also have systemic effects that extend beyond the joints. These systemic effects can include fatigue, sleep disturbances, and mood changes. This overlap can result in RA patients experiencing symptoms similar to those observed in individuals with depression 1 . Anxiety is also prevalent among individuals with RA, with approximately 20% of patients undergoing anxiety 2 . Another study has indicated that nearly 30% of RA patients experienced symptoms of depression during developing the disease 3 .

Patients diagnosed with RA who present with comorbid anxiety and depression symptoms tend to exhibit worse health outcomes, including poor medication adherence 4 , suboptimal response to treatment 4 , elevated medical costs 5 , increased mortality 6 , and diminished quality of life 7 . As a result, it is critical to investigate the risk factors for anxiety and depression symptoms in RA patients and to incorporate psychological management into their medical care. Several research studies have been carried out to improve RA control and prevention 8 , 9 , 10 , 11 .

According to a meta-analysis, depression was present in 17% of RA patients 8 . Additionally, another meta-analysis that included 10 cohort studies revealed that RA patients are at a significantly higher risk for anxiety than individuals without RA, with an odds ratio of 1.20 (95% confidence interval: 1.03–1.39) 9 . Another study of RA patients revealed a prevalence of 38.4% for patient-reported depression or anxiety, but only 17.7% of patients were diagnosed with depression or depression by their physicians. According to the same study 10 , patients with anxiety or depression had significantly higher levels of treatment dissatisfaction and impaired job and everyday activity.

The incidence of anxiety and depression in RA patients and their relationship with disease severity has varied among researchers. These inconsistencies could be related to differences in study populations, diagnostic criteria applied, the severity of depression or anxiety evaluated, and the distribution of associated factors in the general population. Furthermore, disease activity in RA patients, which reflects the aforementioned conditions, may contribute to developing depression and anxiety symptoms. However, study findings on the correlation between disease activity and anxiety and depression are inconsistent. Some studies have suggested a positive association between RA disease activity and anxiety and depression symptoms 12 , 13 , whereas others have not identified an association 14 .

Depression and rheumatoid arthritis (RA) demonstrate an interconnected relationship, as both conditions are linked to inflammation. Numerous studies have explored the impact of depression and inflammation on pain perception in RA 12 . These studies highlight that depression is frequently associated with more severe RA and unfavorable outcomes 6 . Additionally, symptoms of depression and anxiety correlate with subjective aspects of disease activity, reducing the likelihood of RA remission and influencing treatment decisions.

Research has shown that individuals with RA may experience higher rates of anxiety and depression compared to the general population. The chronic pain, physical limitations, and unpredictable nature of the disease can contribute to increased psychological distress. Additionally, the inflammatory processes involved in RA can have an impact on the central nervous system and neurotransmitter function, potentially contributing to the development or exacerbation of anxiety and depression 15 , 16 . It's important to note that anxiety and depression in RA can be influenced by various factors, including disease activity, pain levels, functional limitations, and socioeconomic factors. Therefore, it is crucial to address both the physical and psychological aspects of RA to provide comprehensive care for individuals with the condition 17 , 18 .

However, the prevalence of depression and anxiety among RA patients and their association with RA severity exhibit variability across different studies. This variability can be attributed to various factors, including the characteristics of the study population, criteria used for diagnosing and assessing the severity of depression or anxiety, methods employed for measuring RA activity, and the distribution of factors associated with depression or anxiety within the general population. Moreover, the coexistence of depression and anxiety with RA often goes undiagnosed or unrecognized due to the overlap in symptoms between these conditions and RA itself. In light of these challenges, the current study aims to determine the factors associated with depression and anxiety symptoms in RA patients by evaluating disease activity at the same time.

Patients and setting

This cross-sectional study was conducted at four outpatient rehabilitation centers in four Syrian provinces: Damascus, Homs, Hama, and Latakia. The study included RA patients who attended the RA department of rehabilitation centers from January 1 to June 31, 2023. This study included all the patients who met the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria 19 ,while depression and anxiety were diagnosed using the hospital anxiety and depression scale (HADS) 20 , a 14-item questionnaire with seven subscales for anxiety and depression symptoms. Each item is scored on a scale of 0–3, the total score range for each condition is 0–21. Scores of 0–7 indicate no or few anxiety or depression symptoms, 8–10 indicate mild anxiety or depression, and ≥ 11 indicate severe anxiety or depression . The Arabic version of the HADS has been widely used to screen patients with a variety of diseases and has been previously validated for use with the Arabic population 21 . In this study, we defined anxiety and depression as a HADS anxiety score ≥ 8 and a HADS depression score ≥ 8, respectively 21 .

Patient data has been obtained, including age, gender, marital status, employment position, BMI, disease duration, comorbidities, and medication use. The DAS28-ESR was used to assess disease activity, which is based on a 28-joint assessment; 28 tender joint counts (TJC), 28 swollen joint counts (SJC); and the patient global assessment (PtGA) 22 . [R1] The HAQ score was used to evaluate functional status 23 . Pain was evaluated using either the visual analogue scale (VAS), on which items were scored from 0 (no pain) to 100 (maximum pain) 24 .

This study included all patients who met the ACR/EULAR classification criteria, aged between 18 and 85 years and were willing to participate and provide informed consent. Any patient has a history of other autoimmune or inflammatory conditions (e.g. systemic lupus erythematosus, psoriatic arthritis), severe cognitive impairment or neurological disorders that may hinder accurate reporting of depression and anxiety symptoms, pregnant or lactating women, as hormonal changes during these periods can affect mood and anxiety levels, in addition to any patients has a history of psychological disorders (e.g. bipolar disorder, schizophrenia) or had coexisting chronic conditions such as chronic low back pain, chronic non-RA musculoskeletal diseases, cardiovascular disease, cerebrovascular diseases, and gastrointestinal diseases, were excluded from the study.

The Ethical Committee approved this study in the Al Baath University Institutional Review Board Consent Letter – IRB 2023168-S and all procedures were conducted under the ethical principles outlined in the 1964 Declaration of Helsinki and its subsequent revisions. Patients were informed of the study's purpose and procedures. In addition, written informed consent to participate in this study was provided by the participants.

Statistical analysis

The statistical analyses were performed with the assistance of version 23.0 of the SPSS for Windows software package. The data was evaluated using descriptive statistics such as means, standard deviations, and frequencies. Categorical data was measured using the chi-square test, while continuous variables were computed using Student’s t -test or the Mann–Whitney U test. Multivariate logistic regression analyses were used to determine the relationship between clinical and demographic factors and anxiety depression or anxiety among rheumatoid arthritis patients. The results were presented as odds ratios with 95% confidence intervals. A p-value less than 0.05 was considered statistically significant.

Ethics approval and consent to participate

This study included a cohort of 212 patients diagnosed with RA. The patients had a mean age (SD) of 49.3 ± 13.1 years (ranging from 20 to 73 years), and the average duration of the disease was 8.3 ± 6.9 years (ranging from 2 to 46 years). Among the participants, 70% were female. The mean DAS28 (SD) was 2.6 ± 1.2, and the mean HAQ score was 1.08 ± 1.2.

Tables 1 and 2 provides an overview of the descriptive statistics for various variables, including age, BMI, disease duration, DAS28, HAQ, and HADS scores, as well as information on gender, marital and working status, education level, comorbidities, and medications utilized. Based on the Arabic validation scores of the hospital anxiety and depression scale (HADS), anxiety symptoms were present in 16.9% of the patients, while depression symptoms were detected in 37.3% of the participants.

Tables 2 comprehensively compare various factors, including gender, marital and employment status, education level, comorbidities, and medication usage, among patients with and without anxiety and depression. The results revealed statistically significant differences in the working status between patients with and without anxiety and depression (p = 0.033, p = 0.042), respectively. Additionally, significant differences were observed in terms of sex and working status between patients with depression and those without depression (p < 0.05). Of particular note, it was found that anxiety levels were considerably higher in individuals employed in blue-collar occupations compared to retired patients. The prevalence of depression was significantly higher in women compared to men. Additionally, it was found to be more prevalent among patients with lower levels of education (uneducated) compared to those with a high school or university education. Furthermore, housewives had a higher prevalence of depression compared to retired patients.

Regarding medication usage, a comparison was made between users of bDMARD and csDMARD. The analysis revealed no statistically significant difference in the levels of anxiety and depression between these two groups of medication users. This information is detailed in Table 2 .

Table 3 presents the comparisons of BMI, age, duration of disease, HAQ, and DAS28 scores between different groups. It was observed that patients with both anxiety and depression had significantly higher DAS28 and HAQ scores compared to patients without depression and anxiety (p < 0.05), indicating higher disease activity and worse functional status.

Table 4 shows the multivariate logistic regression analysis results with anxiety and depression as dependent variables. The HAQ score and DAS28 were both significantly associated with anxiety (OR = 1.09, 95% CI 0.94–1.05, p = 0.012) (OR = 1.44, 95% CI 0.95–1.87, p = 0.041) and depression (OR = 1.23, 95% CI 1.25–2.87, p = 0.032) (OR = 1.43, 95% CI 1.03–1.67).

RA is a chronic autoimmune disease that primarily affects the joints. It is characterized by inflammation of the synovial lining in multiple joints, leading to joint pain, swelling, stiffness, and progressive joint damage. RA is classified as an inflammatory type of arthritis. RA can also present with extra-articular manifestations, meaning it can affect other organs and systems in the body. These extra-articular manifestations can include symptoms such as depression, fatigue, and sleep disturbance 25 , 26 . This study aimed to determine the frequency and the factors affecting depression and anxiety in patients with RA.

In this study, depression was determined in 37.3% of the patients, and anxiety in 16.9%. Patients with depression and anxiety had significantly higher DAS28-ESR and HAQ scores than those without depression and anxiety. Depression was determined at a higher rate in females, patients with a low level of education, and housewives, while a university education level was associated with a reduced risk of depression. Anxiety was determined at higher rates in blue-collar workers. Our results are consistent with a study conducted by Altan et al. 27 reported a depression rate of 44% and an anxiety rate of 38% in patients with RA, and a study conducted by Isık et al. 28 that used the HADS-A and HADS-D scales and found anxiety and depression rates of 41.5% and 13.4% in patients with RA, On contract, in a systematic review of 21 studies that included 4,447 RA patients, found a prevalence of depression of 48%among RA patients 29 .

Different rates of depression and anxiety have been recorded in various research, and these disparities have been associated with factors such as study design, scales employed, and a probable relationship with geography and social and economic status 29 . In a study of Brazilian patients with RA, depression was more prevalent among Brazilians and high disease activity is associated with depression 30 . In another study conducted in Italy among RA patients, depression was detected in 14.3%. and it found a substantial rise in the risk of depression with male sex, a high HAQ score, patient global evaluation, and the use of antidepressants 31 . The results of this study are not consistent with previous studies, where sex, a high HAQ score, age, BMI, and disease duration do not show the risk of depression and anxiety, in return, it found that the work status has a significant increase in the risk of depression and anxiety among RA patients.

It is accepted that there is a two-way relationship between RA and depression 20 , 29 . Depression is seen more in RA patients, and there has been found to be an increased risk of RA development in individuals with depression. There are increased proinflammatory cytokines in depression similar to in RA, and these cytokines are reduced with antidepressant treatment 8 . In patients with severe depressive disorder, the risk of developing RA is increased by 38% compared to the normal population and the risk of RA development has been reported to be reduced in those using antidepressants compared to non-users 32 , some anti-cytokine treatments used in RA have been found to affect depression positively 33 .

In a study by Ng et al. 34 , anxiety and depression were strongly associated with DAS28-ESR. The study also found that depression was significantly lower in patients using etanercept, and these results are consistent with our study where anxiety and depression were associated with DAS28-ESR (p = 0.032, p = 0.021), respectively.

It is necessary to highlight the importance of the impact of depression and anxiety on the management and outcomes of rheumatoid arthritis. Understanding the association between mental health conditions and disease activity can aid in developing comprehensive treatment approaches for individuals with rheumatoid arthritis, wherein a study conducted by Matcham et al. 35 on 18,421 RA patients receiving biological treatment revealed that the response to treatment in the first year was reduced by 20–40% when depression was present at the beginning of the treatment. These results suggest that depression can have a negative impact on the effectiveness of biological treatment in RA patients. In another study by Fragoulis et al. 36 , which involved 848 early RA patients, anxiety was reported to be 19.0%, while depression was 12.2%. The study also identified a relationship between depression and anxiety, disease activity, and poor functional outcomes in patients with early rheumatoid arthritis.

A low socioeconomic status, female sex, young age, and functional limitations have been reported to be factors associated with depression in RA patients 34 . Depression is generally associated with the severe form of RA 35 . In a meta-analysis, Zhang et al. 33 determined higher disease activity and lower quality of life in RA patients with depression compared to those without depression 37 . In addition, Watad et al. 38 found higher levels of anxiety in RA patients compared to a control group, and low socioeconomic status was reported to be an independent factor associated with anxiety. In another study, low socioeconomic status and high DAS28 scores were determined to be associated with anxiety 36 . Our results are in line with previous studies which showed that individuals diagnosed with RA who also experienced depression and anxiety displayed higher levels of disease activity and lower quality of life compared to RA patients without, but no difference was determined concerning pain.

In our study, when bDMARD and csDMARD users were compared, no statistically significant difference was found in terms of anxiety and depression. However, we noticed a substantial variation in patients' DAS28 and HAQ scores and the presence of depression and anxiety. Similarly, in another study, bDMARDs and csDMARDs were not superior in depression 36 . More research is needed to investigate the impact of bDMARDs on anxiety and depression. A study of 464 RA patients found that depression was associated with the global health score, while anxiety was associated with being married and having a functional disability 39 . In another study, it was reported that the presence of anxiety and depression in patients with RA can cause suicide and diminished quality of life and can worsen the prognosis of RA 40 . The study had some limitations, including a relatively small sample size, and a cross-sectional design. Additionally, there was no control group in the study, and the patients' social and economic situation was not investigated. Since in just four rehabilitation centers, the results may not be generalizable to all RA patients.

Anxiety and depression are highly prevalent among (RA) patients, and it is important to consider that this may impact the patients’ response to treatment, prognosis, and even mortality. Therefore, it is recommended to collaborate with the psychiatry department in managing these cases.

Data availability

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.

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These authors contributed equally: Fater A. Khadour and Younes A. Khadour.

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Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

Fater A. Khadour

Department of Physical Therapy, Cairo University, Cairo, 11835, Egypt

Younes A. Khadour

Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria

Bashar M. Ebrahem

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FAK critically revised the manuscript and supervised all the course of the study; YAK wrote the initial draft of the manuscript provided language help, and critically revised the manuscript; BME co-initiated the study and critically revised the manuscript providing language help and proofreading the article.

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Khadour, F.A., Khadour, Y.A. & Ebrahem, B.M. A qualitative survey on factors affecting depression and anxiety in patients with rheumatoid arthritis: a cross-sectional study in Syria. Sci Rep 14 , 11513 (2024). https://doi.org/10.1038/s41598-024-61523-3

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DOI : https://doi.org/10.1038/s41598-024-61523-3

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