Clinical Practicum Under Strain: A Mixed-Methods Study Protocol in Spanish Nursing Education

• The protocol addresses the clinical nursing practicum in Spain, where ongoing workforce shortages and increasing student numbers exert pressure on learning environments.
• The aim is to analyze current challenges and develop a redesigned practicum model with potential applicability to other health education contexts and locations.

Nursing students and clinical mentors in Catalonia will complete questionnaires; semistructured interviews will capture perspectives from mentors and nurse coordinators.

A visual elicitation tool called the Emojional Calendar will gather student experiences.

Data will be analyzed with descriptive/inferential statistics (quantitative) and inductive thematic analysis (qualitative).

• A sequential mixed-methods approach spans two integrated phases.
• Phase I combines quantitative surveys, qualitative interviews, and a scoping review to map barriers and enablers.
• The scoping review uses Arksey and O’Malley framework to identify best-practice practicum models in nursing and related health fields globally.
• Phase II employs a three-round qualitative Delphi to present prior findings to stakeholders and decision-makers to redesign the practicum model.

• The practicum involves students, registered nurse clinical mentors (CMs), academic mentors (AMs), and ward nurse coordinators, all coordinating with academic faculty to supervise, evaluate, and guide learning.
• AMs act as the primary academic reference, ensuring alignment with practicum requirements, promoting evidence-based and reflective practice, and guiding overall student progress.
• CMs supervise clinical activities, model professional practice, foster autonomy, provide feedback, and coordinate with AMs to monitor learning outcomes.
• Ward coordinators allocate student placements, influencing mentor distribution and overall practicum experiences, though criteria for assignment are inconsistently applied.
• The framework in Spain has two predominant models—Dedicated Education Units and EPA/competency-based approaches—or blends thereof; mentor roles and evaluation practices vary across settings.
• Noted gaps include undervalued mentoring work, lack of protected time for mentoring within clinical duties, no standardized pedagogical competencies, and inconsistent recognition or rewards for mentoring.

• The protocol highlights variability in student-to-CM assignments and in mentoring responsibilities, with these factors linked to perceived quality of practicum experiences.
• It acknowledges limited standardization of mentoring competencies and support structures, potentially impacting feedback, psychological safety, and learning outcomes.
• The study recognizes generalizability limitations due to its Spain-centric setting but posits potential adaptation across fields and regions.

• Ethical approval has been obtained from the Hospital del Mar Clinical Research Ethics Committee.
• Findings are slated for publication in journals and conferences, with dissemination through forums, policy-maker briefings, and public outreach.
• The authors note potential generalizability constraints given national and organizational variability in nursing education practices.