Anxiety provoking behaviors of nursing clinical instructors and effects on undergraduate nursing students' wellbeing: A mixed methods design

This study aimed to investigate the relationships between anxiety-provoking teaching behaviors in clinical settings and nursing students’ self-reported anxiety levels, perceived quality of life and demographic characteristics. Anxiety has been consistently reported in the literature as a major barrier to nursing education. Peplau's Interpersonal Relations Theory (1992, 1997) served as a theoretical framework in the study to explore anxiety-provoking teaching behaviors in clinical settings. A cross-sectional, correlational, mixed methods design was used. Fifty-eight participants were recruited from the undergraduate nursing program at a Canadian university in the spring of 2021. An online survey, including demographic characteristics, the State-Trait Anxiety Inventory (STAI) and World Health Organization Quality of Life Instruments (WHOQOL-BREF), was distributed to the participants before a face-to-face interview. The interview was conducted by peer nursing students in the program to reduce the power imbalance relationship, given the sensitivity of the topic. The interview data were thematically analyzed and the subthemes were used to code the qualitative interview into quantitative data. Pearson's correlation was performed to analyze the relationships between the number of experienced anxiety-provoking teaching behaviors, the SATI and WHOQOL-BREF scores. The qualitative findings revealed two main themes, interpersonal relations and instructional styles and ten anxiety-provoking teaching behaviors as the subthemes. A significant positive relationship was observed between the number of anxiety-provoking teaching behaviors reported and the SATI score (r = .392, p < .001) and a significant negative relationship was observed between the number of reported anxiety-provoking teaching behaviors and the WHOQOL-BREF score in the domain of psychological health (r = −.343, p = .008), thus indicating that a higher number of reported anxiety-provoking teaching behaviors correlated with greater anxiety and lower psychological health. The study revealed that students’ perceptions of the clinical instructors' interpersonal relations and instructional styles significantly affected their anxiety levels and psychological health in life.