To explore the emotional challenges experienced by student nurses during clinical placements.

How do emotional challenges impact the mental well-being and professional development of student nurses?

The review question served as the foundation for the conceptual framework and guided the selection and synthesis of relevant studies. The central question was: How do emotional challenges impact the mental well-being and professional development of student nurses? This question was developed using the revised JBI critical appraisal tool to ensure alignment with the study’s objectives and scope. It enabled a broad yet structured exploration of the literature, allowing for the identification of recurring patterns and meaningful interpretations (Newman & Gough 2020; Campbell 2020). The review adopted a synthesised logic approach to investigate the underlying meaning and implications of emotional challenges within nursing education (Newman & Gough 2020).

A selection criterion was used during the initial screening to identify resources with relevant information. The eligibility criteria guided the search strategy and determined which studies were suitable for inclusion. Studies were included if they focused on student nurses in clinical environments and were published between 2019 and 2024. Reviews that analysed the impact of traumatic experiences on student nurses were considered, along with studies showing both short- and long-term effects on patient care. Excluded materials were those lacking evidence about affected students or focusing on postgraduate nurses. Articles that only provided abstracts, required payment or were duplicates were also excluded. Full thesis studies and non-peer-reviewed articles were not considered. Only English-language articles were included to ensure consistency in analysis.

A multi-dimensional data extraction process was conducted using the Covidence tool, managed by the University of Pretoria, with the scoping review registered on 31 March 2025. Following best practices outlined by Martinez et al. (2023), the review involved multiple reviewers analysing both adjusted and non-adjusted data. All reviewers accessed the full-text stage and used a standardised data extraction template to record key study details such as author, publication year, country, study design, population characteristics, interventions, outcomes and findings. This template was pilot tested and refined to ensure consistency across reviewers. A parallel quality assessment template was developed to evaluate the risk of bias, using Covidence’s customisable checklists. Each study was independently assessed by two reviewers, with discrepancies resolved within the platform by the supervisor in collaboration with the student reviewers.

The search strategy was developed using key terms derived from the review topic and refined with Boolean operators such as AND, OR and NOT. Databases used included PubMed, ScienceDirect, Google Scholar and Web of Science, all approved by a research specialist from the University of Pretoria. The search terms combined concepts like ‘student nurses’ OR ‘nursing students’ OR ‘nurse trainees’ with ‘challenges’ OR ‘stressors’ OR ‘barriers’ and ‘clinical placement’ OR ‘clinical rotation’ OR ‘practicum.’ Optional refinements included emotional support and the study period to narrow results. Covidence facilitated the initial screening of titles and abstracts, which were then reviewed by seven nursing students. The supervisor served as the final reviewer, resolving conflicts and ensuring quality control throughout the review process.

Following the search, every citation found was gathered and added to the supervisors’ registered Covidence account. The chosen sources for the scoping review were then managed and arranged, and duplicates were removed by importing the references into the Covidence tool. The researchers assessed the abstracts and titles, comparing them with the researchers’ inclusion standards. All possibly relevant sources were retrieved in full, and their citation data were included. The researcher thoroughly reviewed and assessed all the selected sources to ensure they met the criteria for inclusion. Full-text sources of evidence that did not meet the inclusion criteria were excluded, and the scoping review noted and recorded the rationale for these decisions.

A logical and descriptive summary of the outcomes is provided by data extraction or data charting, which also shows how well the results match the goals of the scoping review. The literature about the emotional challenges experienced by nursing student during clinical placement was the main topic of the data that were extracted. A data-extraction tool that was modified from the JBI Manual for Evidence Synthesis served as guidance for the data extraction or charting procedure (Barker et al. 2023). Table 1 illustrates how the tool was used to extract information from the publications about the scoping review, including authors, publication year, source details, methodology and important conclusions.

The data analysis in this scoping review followed the three-step process outlined in the framework by Arksey and O’Malley (2005). The first step involved developing an analytical framework using the PRISMA-ScR flow diagram to provide a comprehensive overview of the literature related to emotional challenges affecting nursing students’ learning. This visual tool helped map the selection process and ensured transparency in study inclusion. The second step applied descriptive statistical methods, with data presented in tabular format to illustrate key study characteristics such as author, publication year, study title and country of origin (Table 1). This helped categorise the types of research and identify trends across the selected studies. The final step employed thematic analysis to explore recurring patterns and concepts related to emotional challenges during clinical placements. Themes and sub-themes were identified and examined in depth to provide insight into the emotional experiences of nursing students.

A significant portion of the studies employed qualitative designs, with 13 studies using approaches such as exploratory, descriptive, contextual or content analysis methods. These qualitative studies aimed to understand nursing students’ lived experiences, emotional responses and coping mechanisms during clinical placements. In contrast, cross-sectional quantitative designs were employed in five studies, including survey-based and correlational approaches, which aimed to measure variables such as resilience, stress and compassion fatigue across large student populations. Additionally, descriptive and relational studies were employed in two instances to explore the associations between psychological factors and student outcomes. One study employed a multi-site survey-based design, and another utilised a correlational quantitative approach to examine the relationships between faculty support and student adjustment.

A total of 344 studies were initially identified across eight databases, with 62 removed because of duplication and ineligibility. After screening 282 studies, 180 were excluded based on the predefined exclusion criteria. Of the remaining 102 full-text articles, 83 were excluded, leaving 19 studies that met the inclusion criteria. These studies were interpreted, summarised and reported using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (Figure 1), developed with the Covidence tool and aligned with Open Science framework standards. The final selection included a mix of study designs: 13 qualitative studies, five cross-sectional quantitative studies and one correlational quantitative study. The qualitative studies explored lived experiences, emotional responses and coping strategies, while the quantitative studies measured resilience, stress and psychological outcomes.

The included studies examined a range of emotional challenges and coping strategies among student nurses during clinical placements. Several studies focused on stressors and resilience, with the largest contribution coming from Hong Kong (three studies). Other research explored end-of-life care and inadequate preparation, as seen in studies from South Africa and Iran. Investigations from the United States examined health-related behaviours and coping mechanisms among baccalaureate students, while studies from Taiwan, Turkey, China and the Philippines addressed compassion fatigue, resilience and curriculum alignment. Additional studies from the Netherlands, Uganda, Thailand and Australia highlighted emotional exposure and the role of support systems.

Thematic analysis revealed three overarching themes and 17 sub-themes, identified through repeated patterns and structural meanings in the data. These themes reflect the global nature of emotional challenges in nursing education, shaped by cultural, institutional and healthcare contexts. Table 2 outlines these themes, emphasising the importance of resilience, support and preparedness in nursing education.

An application for full ethical approval was made to the University of Pretoria Faculty of Health Sciences ethics committee and ethics consent was received on 20 November 2024. The ethics approval number is 697/2024.

Nursing students frequently reported emotional fatigue, compassion fatigue and burnout, particularly in high-pressure clinical environments. In Hong Kong, moral distress and burnout were significantly linked to students’ intention to leave nursing programmes (Cheng, Tang & Siu 2024), with burnout being the most prevalent, followed by compassion fatigue and moral distress. Similarly, compassion fatigue was associated with lower resilience among final-year nursing students in Turkey (Karabey 2023). Feelings of insecurity and self-doubt were common when students entered unfamiliar wards or faced complex patient conditions, as seen in Ireland’s neonatal units, where preceptor support helped reduce stress (Mulligan & Frawley 2022). Iranian nursing students reported experiencing identity confusion related to their transition into the professional nursing role and used diverse coping strategies to manage challenges in clinical settings (Kalyani et al. 2019).

Iranian students experienced identity confusion and diverse mixed coping strategies in clinical settings (Kalyani et al. 2019), while Thai students emphasised the importance of supervisor support in building confidence (Aryuwat et al. 2024). Emotional exposure to patient death and suffering triggered intense reactions such as fear and helplessness, especially among South African first-year students who lacked adequate preparation (Molefe 2024). Ugandan students relied on spirituality and peer support to manage these experiences (Nabirye et al. 2025), whereas Australian students were left to self-reflect because of insufficient guidance (McCloughen et al. 2020). These findings highlight the need for structured emotional support and debriefing in nursing education.

Resilience is commonly understood as the ability to adapt positively and recover from adversity, stress or trauma by demonstrating mental, emotional and behavioural flexibility and adjustment to challenging circumstances (American Psychological Association [APA] 2023; NursesLab 2023). Studies reported that workload and staffing shortages were major stressors, often requiring students to balance patient care with academic demands, which led to exhaustion and frustration (Molazem, Joghataei & Nikbakht-Nasrabad 2019; Mulligan & Frawley 2022). Heavy clinical hours contributed to compassion fatigue and doubts about long-term commitment to the profession (Karabey 2023; Martin et al. 2022). Interpersonal relationships with staff and preceptors also played a role, with negative interactions causing feelings of exclusion and insecurity (McCloughen et al. 2020; Molazem et al. 2019), while supportive mentorship fostered confidence and growth (Labrague et al. 2025; Zulu, Du Plessis & Koen 2021). Students with higher resilience demonstrated adaptive strategies such as mindfulness and emotional regulation (Ching et al. 2020; Lin & Chen 2023), whereas those with lower resilience tended to rely on avoidance and external validation (Ching et al. 2020; Watson et al. 2025). Overall, the studies indicate that resilience, along with stressors and support systems, plays a significant role in shaping emotional and clinical experiences during placements.

Workload and staffing shortages were major stressors affecting students’ resilience during clinical placements. Students often had to balance patient care with academic demands, leading to exhaustion and frustration (Molazem et al. 2019; Mulligan & Frawley 2022). Heavy clinical hours contributed to compassion fatigue and doubts about long-term commitment to the profession (Karabey 2023; Martin et al. 2022). Interpersonal relationships with staff and preceptors also shaped resilience, with negative interactions causing feelings of exclusion and insecurity (McCloughen et al. 2020; Molazem et al. 2019), while supportive mentorship fostered confidence and growth (Labrague et al. 2025; Zulu et al. 2021). Students with high resilience used adaptive strategies like mindfulness and emotional regulation (Ching et al. 2020; Lin & Chen 2023), whereas those with low resilience relied on avoidance and external validation (Ching et al. 2020; Watson et al. 2025). These differences illustrate how resilience influences coping strategies, with high-resilience students using adaptive approaches and low-resilience students relying on avoidance and external validation.

Resilience mediates stress and coping, influencing students’ ability to manage challenges effectively. Overall, Theme 1 reveals the complex interplay between emotional strain, resilience and support systems in shaping nursing students’ clinical experiences.

Nursing students face significant academic stress and performance pressure, as they are expected to demonstrate theoretical competence while simultaneously applying it in clinical practice without prior exposure (Ghorbanzadeh et al. 2023). This dual expectation often leads to anxiety and self-doubt, especially when students are required to manage unfamiliar patient conditions independently. Environmental challenges further compound these pressures, with students frequently placed in unfamiliar clinical settings without adequate orientation or debriefing (Lin & Chen 2023). The lack of guidance in patient-care approaches contributes to feelings of uncertainty and frustration (Lin & Chen 2023). Clinical placement factors such as fear of medical errors, lack of skills and emergency situations overwhelm students (Ching et al. 2020; Lin & Chen 2023). Emotional support from mentors, preceptors and faculty is often inconsistent, leaving students feeling neglected during critical learning moments (Mulligan & Frawley 2022). Without encouragement, students struggle to connect theory with practice, leading to burnout and early withdrawal from nursing programmes (Bakker et al. 2019). These findings highlight the importance of structured mentorship and emotional support in clinical education.

Gaps in student preparation were evident, particularly in areas such as emotional intelligence, emotion regulation and end-of-life care (Molefe 2024; South African Nursing Act 2019). Students reported receiving inadequate education on death-related topics, leaving them unprepared for emotionally intense clinical experiences (Nabirye et al. 2025). As a result, they were forced to bridge the gap between theory and practice independently, often without sufficient guidance (Ching et al. 2020; Najafi Kalyani et al. 2019). Curriculum design and alignment with clinical practice emerged as a critical factor in promoting resilience and reducing stress. Studies emphasised the need for curriculum adjustments to better prepare students for real-world challenges (Ghorbanzadeh et al. 2023; Karabey 2023; Williams-Jones 2023). Students also reported a mismatch between expectations and the realities of clinical placements, which negatively impacted their perceptions and learning outcomes (Ching et al. 2020). This challenge often stems from curricula that place greater emphasis on theoretical knowledge while providing limited opportunities for hands-on practice and insufficient integration of theory with real-world clinical experiences. As a result, students struggle to apply classroom learning effectively in unpredictable clinical settings.

The unpredictable nature of clinical environments often undermines the effectiveness of theoretical education (Ghorbanzadeh et al. 2023).

Nursing students employed a variety of adaptive coping strategies to manage the emotional demands of clinical placements. Techniques such as mindfulness, physical exercise, self-reflection and spirituality were commonly used to maintain emotional balance and resilience (Ching et al. 2020; Martin et al. 2022; Nabirye et al. 2025; Watson et al. 2025). Positive reframing, acceptance and humour were found to enhance students’ ability to adapt to demanding environments (Ching et al. 2020). Spiritual practices and peer support offered emotional comfort, while self-care routines helped strengthen psychological well-being (Nabirye et al. 2025; Watson et al. 2025). These findings support the integration of mindfulness training, reflective opportunities and wellness activities into nursing curricula to reduce burnout and promote long-term resilience. In contrast, maladaptive coping strategies such as avoidance, emotional disengagement and denial were also reported. These behaviours were linked to increased psychological distress and reduced resilience (Ching et al. 2020; Molazem et al. 2019; Nabirye et al. 2025). Students who relied on avoidance were more vulnerable to compassion fatigue and burnout, highlighting the need for early intervention and mentorship to promote healthier coping mechanisms.

Health-related behaviours such as sleep, diet and exercise were consistently identified as key contributors to emotional resilience. Students who maintained positive lifestyle habits were better equipped to handle clinical stress, while poor habits increased vulnerability to anxiety and fatigue (Martin et al. 2022; Watson et al. 2025). Sleep deprivation and disrupted routines were perceived as barriers to coping, often leading to emotional instability and reduced competence (Watson et al. 2025).

Social support from faculty, mentors and peers played a vital role in strengthening resilience and promoting emotional well-being (Aryuwat et al. 2024; Labrague et al. 2025; Zulu et al. 2021). Supportive supervisors fostered collaboration and empathy, while preceptors ensured safety and guidance during emotionally taxing tasks (Mulligan & Frawley 2022). Repeated exposure to clinical environments also contributed to emotional adjustment, with students developing confidence and problem-solving skills over time (Ching et al. 2020; Ghorbanzadeh et al. 2023; Lin & Chen 2023; Molazem et al. 2019; Zulu et al. 2021). Junior students were more likely to struggle, while senior students demonstrated greater emotional stability.

To enhance nursing students’ experiences, recommendations should directly address the emotional, educational and support gaps identified in this review. Firstly, curricula should be revised to better integrate theory and practice through simulation-based learning, extended clinical rotations and structured debriefing sessions. These changes will reduce educational gaps and improve students’ preparedness for emotionally demanding situations. Secondly, targeted education on coping mechanisms such as mindfulness, emotional regulation and peer support should be embedded in nursing programmes. Faculty and mentor-led support systems, including regular supervision and reflective practice, are essential for fostering resilience and reducing stress. Thirdly, resilience-building strategies should be incorporated into training, as resilience is linked to improved coping and reduced burnout. Education on trauma and end-of-life care must also be prioritised to prepare students for challenging clinical realities. Fourthly, wellness initiatives focusing on sleep, nutrition and physical activity should complement academic training to promote holistic well-being and professional development.

This review was limited by its reliance on six databases, which may have introduced selection bias and restricted the scope of the findings. Consequently, the ability to generalise the results regarding emotional challenges faced by nursing students during clinical placements may be constrained. Additionally, the exclusion of non-English articles and journals may have narrowed the breadth of available evidence, potentially omitting valuable insights from non-English-speaking regions. The screening process, while rigorous, may have inadvertently excluded relevant studies because of language barriers. Another limitation is the absence of a deep critical appraisal of the included studies, which may have affected the depth and robustness of the conclusions drawn. The descriptive and thematic analyses provided a broad overview but lacked a detailed evaluation of methodological quality. These limitations should be considered when interpreting the findings and applying them to broader educational or clinical contexts.