Nurs Midwifery Stud. 2015 September; 4(3): e29143. DOI: 10.17795/nmsjournal29143 Published online 2015 September 23. Research Article Clinical Self-Eﬃcacy in Senior Nursing Students: A Mixed- Methods Study Marzieh Abdal, 1 Negin Masoudi Alavi, 1,* and Mohsen Adib-Hajbaghery 1 1 Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran *Corresponding author: Negin Masoudi Alavi, Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155548987, Fax: +98-3155546633, E-mail: masudialavi_N@kaums.ac.ir Received: April 9, 2015; Revised: May 6, 2015; Accepted: May 11, 2015 Background: Clinical education has a basic role in nursing education, and eﬀective clinical training establishes a sense of clinical self- eﬃcacy in senior nursing students. Self-eﬃcacy is a key component for acting independently in the nursing profession. Objectives: This study was designed to outline senior nursing students’ views about clinical self-eﬃcacy and to determine its level in nursing students. Patients and Methods: A mixed-methods approach, including a quantitative cross-sectional study and qualitative content analysis,was used in this study. Participants were senior nursing students who were in their two last semesters. During the initial quantitative stage, all students in the 7th and 8th semesters of the nursing major were invited to participate. They were asked to complete the Nursing Clinical Self-Eﬃcacy Scale (NCSES) and, during the subsequent qualitative stage, the 14 students in the 7th and 8th semesters were asked to participate in semi-structured interviews. Results: In the quantitative part, 58 students completed the self-eﬃcacy questionnaire; the mean score was 219.28 ± 35.8, which showed moderate self-eﬃcacy in students. Self-eﬃcacy was diﬀerent across skills. In the qualitative part, the 355 open codes that were extracted from the interviews were clustered to 12 categories and 3 themes. The main themes included the factors related to self-eﬃcacy, outcomes of self-eﬃcacy, and ways to improve self-eﬃcacy. Conclusions: Students had moderate self-eﬃcacy. Several factors such as environment, nursing colleagues, and clinical educators could inﬂuence the creation of clinical self-eﬃcacy in nursing students. Keywords: Self-Eﬃcacy; Education; Nursing Students; Questionnaires; Interview Copyright © 2015, Kashan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non- Commercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. 1. Background Nursing education focuses on training competent stu- dents in all dimensions of knowledge, skills, and pro- fessional attitude. Clinical education has a basic role in nursing education (1). Approximately 50 percent of the education in nursing is spent in the clinical ﬁeld (2). The goal of clinical training is to achieve measurable changes in students’ competencies in clinical care (3). In clini- cal training, students ﬁnd the opportunity to construct their professional identity (2, 3), and to improve their psychomotor skills (4). Hence, providing high-quality ex- periences is essential in developing competent students. Without these experiences, even the most knowledge- able, well-informed students are confused at the patient’s bedside (5). There are some challenges in nursing clinical education, such as the gap between theoretical and prac- tical training and the obscured goals in clinical training (5, 6). A study in Mazandaran/Iran found that more than 50 percent of both students and trainers described the quality of their clinical training courses as weak (2). Proper training based on clinical realities has better and more stable results (6). Eﬀective clinical training brings about a sense of clinical self-eﬃcacy and self-es- teem in students. Lim et al. quoted Bandura’s deﬁnition of self-eﬃcacy as “trust on their own abilities to act eﬃ- ciently in diﬀerent situations.” Based on this deﬁnition, individuals with high self-eﬃcacy can cope and endure better in diﬃcult situations (7). A study showed that people with high self-eﬃcacy were more successful in their job (8). It seems that self-eﬃcacy is an important issue for eﬀective learning, professional development, and behaving independently (9). Self-eﬃcacy is a key component for behaving independently in the nursing profession, and is essential for nursing students (9). McConville believes that self-eﬃcacy comes from four sources: doing duties independently, high-quality ex- periences, encouragement, and controlling situations (10). The clinical environment, the trainer’s capabili- ties, and personal factors can have important roles in creating self-eﬃcacy (11). Currently, there are few stud- ies on the self-eﬃcacy of nursing students. Shellman et al. showed that students with higher self-eﬃcacy were more successful in providing care to elderly patients (12). Deanerly also found that senior nursing students had higher self-eﬃcacy in providing care for patients