Assessment of Obstacles in the Learning Process among Nursing Students in the Faculty of Nursing at Helwan University

,


INTRODUCTION
Nursing students face various obstacles in the learning process, which can impact their academic achievement, clinical performance, and professional development.In addition, nursing students also face specific obstacles related to their learning environment (1).
Learning is a behavior change (knowledge, attitudes, and/or skills) that can be observed or measured and occurs at any time or place resulting from exposure to environmental stimuli.The learning environment (LE), referred to, encompasses everything surrounding students in the learning space, including physical location, and social and psychological contexts (2).
The learning environment affects the transfer/acquisition of knowledge and skills needed in training medical students (3).The analysis of the learning environment from the perspective of the students is deemed an effective indicator of the quality of both learning and teaching processes in undergraduate studies in the field of health studies (4).
Learning obstacles describe problems that hinder learning and lead to learning deficits.The focus has been more on barriers and factors that impede learning than on determining the nature of learning deficits and their manifestations.Additionally, learning obstacles are used to describe any delay in improving school performance, and a major source of stress for nursing students (5).

I -Technical Item: Research Design:
A descriptive correlation design was used to achieve the aim of the current study.

Setting:
The current study was conducted at the Faculty of Nursing, Helwan University campus.The 3 rd grade nursing students were located on the 2 nd floor and the 4 th grade nursing students were located on the 3 rd floor.

Subjects:
A convenient sample was used in this current study including nursing students in 3 rd & 4 th grades, in the previously mentioned setting and who were present at the time of data collection.-The 3 rd & 4th-grade nursing students were chosen for this study, as they were more knowledgeable and experienced about the learning process obstacles faced them through their studying years in this faculty.
-Nursing students who were available at the time of data collection and had the will/agreed to participate in this study.

Data Collection Tools:
Two tools were used to collect data in this study:

II -Operational Item:
Preparatory phase: It included reviewing past, current, national, and international related literature, and theoretical knowledge of various aspects of the study using books, articles, the internet, periodicals, and magazines to develop tools for data collection, during this phase, the investigator also visited the selected place to get acquainted with the personal and the study settings.

A) Validity:
The developed tool was formulated and submitted to five experts.

Reliability:
Is the consistency of measuring instruments.
Moreover, it is the degree to which the used tools measure what was supposed to be measured in the same way each time & under the same conditions with the same subjects.

Pilot study:
The pilot study was done on 10% (44) of the nursing students to examine the clarity of questions and time needed to complete the study tools.There wasn't any modification.So, subjects included in the pilot study were included in the study.

Ethical considerations:
Before the study was conducted, research approval was obtained from the Scientific Research Ethical Committee in the Faculty of Nursing, Helwan University.In addition, approval was obtained from the heads of the departments (nursing administration, nursing obstetrics in addition to nursing pediatrics).Also, informal oral consent was sought and obtained from each participating subject before data collection, they were informed about the purpose and expected outcomes of the study, and they were assured that the study was harmless, their participation was voluntary, and they had the right to withdraw from the study at any time without any reason.They also ensured that anonymity and confidentiality were guaranteed; as well the gathered data was used for research purposes only.Ethics, values, culture, and beliefs were respected.

Field Work:
-Data was collected over one month starting from -The researcher asked for assistance from the responsible lecturer for each assigned student group for more organization and control.
Moreover, all subjects were asked to fill out the questionnaires in the presence of the researcher to ascertain that all questions were answered.Later, the researcher checked the questionnaires for any missing data.

III-Administrative Item:
Approval to carry out this study was obtained from the Dean of the Faculty of Nursing at Helwan University campus and individual oral consent was obtained from each nursing student who participated in the study.

IV -Statistical Item:
Data entry and analysis were performed using SPSS statistical package version 25.Categorical variables were expressed as numbers and percentages while continuous variables were expressed as (mean ±SD).Chi-Square (x2) was used to test the association between row and column variables of qualitative data.
ANOVA, (F) test was used to compare the mean in normally distributed quantitative variables in more than two groups.Pearson correlation was done to measure the correlation between quantitative variables.For all tests, a two-tailed p-value ≤ 0.05 was considered statistically significant, P-value ≤ 0.01 was considered highly statistically significant.
While p-value > 0.05 was considered not significant.

Results
Table Table (1) shows that 60.2% of the studied nursing students' ages ranged from 20 to < 22 years, with a total mean SD = 21.61 ± 0.634.Moreover, 51.7% of the studied nursing students were in their third academic year.In addition, 70.9% & 73.7% held secondary school degrees and were from urban areas respectively.Finally, 43.9% were graded as good concerning previous academic achievement.

Figure (1):
shows that 61.6% of the studied nursing students perceived a mild level of learning process obstacles followed by a moderate level with a percentage of (22.4%).While 16% of them had severe learning process obstacles.In addition, there was a highly statistically significant difference between mild, moderate, and severe (Studied nursing student responses) at P value = 0.000.2) illustrates that 57.9% of the studied nursing students perceived mild learning and clinical environment obstacles followed by moderate levels with a percentage of (24%).While 18.1% of them had severe learning and clinical environment obstacles.In addition, there was a highly statistically significant difference between mild, moderate, and severe (Studied nursing student responses) at P value = 0.000.This might be due to these nursing students not having the support they need from their families, friends, or instructors.This can make it difficult to cope with the challenges of nursing education.
In the same direction, the study findings agreed with the study result by

Essa ( 2022 )
assessed students' perceptions of the learning environment and showed that although feedback is an integral and important part of the teaching and learning environment in the medical field, all students are not satisfied with the quality and quantity of teacher feedback (6).Additionally, the most common obstacles regarding clinical education are the lack of instructors with high academic and clinical skills, unpunctual presence of the instructor at the patient's bedside, instructor's poor communication skills, instructor's inattention to students' educational needs and impossibility of instructor evaluation by students were considered as the main barriers related to clinical education instructors from student's standpoint (7).Therefore, clinical education is an essential and integral part of the nursing education program.Since nursing is a performance-based profession, clinical learning environments play an important role in the acquisition of professional abilities and training of nursing students to enter the nursing profession and become qualified registered nurses (8).Many nursing educators confirm that adult learning takes place not by the teacher initiating and motivating the learning process but rather by the teacher removing or reducing obstacles to learning and enhancing the process after it has begun (9).The role of nursing education is to improve qualitative nursing practice.So, training competent nurses to preserve people's health is consistently one of the goals of nursing education Additionally, indicated that a high appreciation for clinical instructors could be seen as a motivation to push the clinical learning process for nursing students (10).Additionally, Imen et al., (2022) documented that examining the environment in academic teaching in nursing education is very insightful.Students' success and satisfaction are two indicators of the quality of the educational environment.Their assessment can guide schools and teachers to apply self-analysis and incorporate the best strategies to improve the learning environment (11).AIM OF THE STUDY This study aimed to assess Obstacles in the Learning Process among Nursing Students in the Faculty of Nursing at Helwan University through the following objectives: 1. Assess learning process obstacles among the studied nursing students.2. Assess the learning and clinical environment among the studied nursing students.Research Questions: 1.What are the learning process obstacles among the studying nursing students in the nursing faculty? 2. What are the obstacles regarding learning and clinical environment among the studied nursing students in the nursing faculty?

(
437) nursing students who joined from the 3 rd and 4 th grades at the Faculty of Nursing-Helwan University, with the following criteria.-Both genders -Nursing Students who studied at the Faculty of Nursing, Helwan University in the 3 rd and 4 th academic year (2022-2023).

February 27 ,-
2023. to March 26, 2023.Before beginning to collect data from the study subjects, the researcher met with the heads of the following departments (Nursing administration, nursing obstetrics in addition to nursing pediatrics) to get formal permission and to determine the most suitable time to collect the data.-The researcher introduced herself and explained the aim, objectives, and research questions of the study to the nursing students and informed them that their information would be treated confidentially and to be used only for the research.Additionally, each participant was notified about the right to accept or refuse to participate in the study.The study was carried out by assessing the learning process obstacles among nursing students in the Faculty of Nursing at Helwan University by using learning process obstacles in addition to learning and clinical environment obstacles structured interview questionnaires.The suitable time for filling out these questionnaires was 30 to 45 minutes.The researcher attended (5) times weekly for one month in different suitable free times to collect the data.
Figure (2): Percentage Distribution of Learning and Clinical Environment Obstacles among the Studied Nursing Students (n= 437) Figure (2) illustrates that 57.9% of the studied nursing students perceived mild learning and clinical environment obstacles followed by moderate levels with a percentage of (24%).While 18.1% of them had severe learning and clinical environment obstacles.In addition, there was a highly statistically significant difference between mild, moderate, and severe (Studied nursing student responses) at P value = 0.000.

Figure ( 3 )
Figure (3): Scatter Dot between Learning Process Obstacles and Learning and Clinical Environmental Obstacles among the Studied Nursing Students (n= 437).

Figure ( 3 )
Figure (3) Scatter Dot between learning process obstacles and learning & clinical environment obstacles among the studied nursing students.It clarifies that there was a highly statistically positive correlation between learning process obstacles and learning & clinical environment obstacles among the studied nursing students at (r= 0.987&p= 0.000)

--
Concerning the correlational matrix between the total score of learning process obstacles and the total score of learning & clinical environment obstacles among the studied nursing students.The study results indicated that there was a highly statistically positive correlation between the total score of learning process obstacles and the total score of learning & clinical environment obstacles among the studied nursing students.From the researcher's point of view, the learning process and learning & clinical environment were interactive networks of forces that impacted the learning outcomes in the real world.In this phase, the nursing students were expected to learn the basic nursing courses while they were in the academic environment.While in hospitals and other healthcare facilities, the nursing students applied relevant concepts to clinical practice with their faculty preceptors which in turn reflected in the achievement of learning outcomes.Additionally, the learning environment was a behavioral determinant and the student's understanding of the environment was very effective in learning and was very important in clinical education.On the same line, the study findings were compatible with descriptive correlational study results conducted by Fath-Elbab et al., (2020) who evaluated the relationship between nurse educators' empowerment and nursing students' clinical competence and concluded that there was a positive correlation between nurse educators' empowerment and nursing students' clinical competence (27).The study data followed the study result by Ahmad et al., (2018) who evaluated challenges in the clinical environment: the Saudi student nurses' experience and indicated that resolving clinical obstacles is crucial in helping student nurses to achieve positive learning outcomes (28).CONCLUSION Based on the findings of the research questions, it was concluded that; 61.6% of the studied nursing students perceived a mild level of learning process obstacles, and 57.9% of the studied nursing students perceived mild learning and clinical environment obstacles.Moreover, there was a highly statistically significant relation between learning process obstacles and learning & clinical environment obstacles additionally; there was a highly statistically positive correlation between learning process obstacles and learning & clinical environment obstacles among the studied nursing students.RECOMMENDATIONS In light of the findings of the current study, the following recommendations can be suggested:  Develop a nursing curriculum in which the nursing students are actively involved in their education and training plans.Arranging an advisory committee for the teaching staff and the clinical partners' leaders to discuss how academia and practice can work together optimally to improve the nursing students' education, training, and experience.Recommendations for Students: Academic counseling unit provides appropriate services to nursing students especially those with learning difficulties to enhance their academic and overall performance.Psychological counseling unit provides services to nursing students who get stressed about their emotional and psychological development.Recommendations for Further Studies: Further research by performing regular qualitative follow-up studies for nursing students (under and post-graduates) to assess their learning obstacles and challenges as a reference point for improvement and repetition of faculty accreditation.Disclaimer: None Conflict of Interest: None Funding Disclosure: None

Henderson, & Eaton, 2017; Beigzadeh et al., 2019; El-Husseini, & El-Gohary, 2021) (15,16, and 17). Additionally
4. The administrative factors.The 4 th dimension concerned (13) items.5. Situational Variable Factors.The 5 th dimension concerned (6) items.(18).The total scoring system learning process obstacles structured interviewed questionnaires consisted of (146 items) with a total score of (730).While learning and clinical environment obstacles structured interviewed questionnaires consisted of (86 items) with a total score of (430).The total grades for each item were summed up and then converted into a percentage score.They were classified into three levels (18).and (statistics).The 1 st. is a mild level, which means slight and not extreme (19).Additionally, it is computed if the total score is less than 60%.The 2 nd . is moderate level, which means average neither too much nor too little (20).Additionally, it was computed if the total score was equal or more than 60 % to less than 75%.The 3 rd .was severe level, which means extreme and too much (19).Additionally, it was computed if the total score was equal to or more than 75 %.

of Obstacles regarding Learning and Clinical Environment Percentage 57.9 24 18.1 Table (3): Relation between Learning and Clinical Environment Obstacles and Demographic Data among the Studied Nursing Students (n= 437).
Table (3) clarified that there was a highly statistically significant relation between learning & clinical environmental obstacles and demographic data with age, gender, academic year, previous education, residence, and previous academic achievement among the studied nursing students at p= 0.000).