Clinical Learning Environments and Experiences of Nursing Students in West Bank Universities: A Mixed-Methods Study

Background Clinical learning environments (CLEs) are crucial for developing nursing competencies, yet their characteristics and impact in conflict-affected regions remain understudied. This research examined the relationship between CLE factors and clinical learning (CL) experiences among nursing students in Palestine's West Bank universities. Methods This convergent mixed-methods study combined quantitative data from 306 nursing students across three university types (governmental, public, private) with qualitative data from 14 in-depth interviews. The CLES + T scale assessed CLE dimensions, while an adapted Clinical Learning Experience Questionnaire measured student perceptions. Data collection occurred September-December 2023. ANOVA, correlation, and hierarchical multiple regression analyses were conducted alongside inductive content analysis for qualitative data. Results Quantitative findings revealed strong correlations between CLE and CL experiences (r = 0.758, p < 0.001). Hierarchical regression identified "pedagogical atmosphere" (β = 0.365, p < 0.001) and "supervisory relationships" (β = 0.264, p = 0.001) as significant predictors of CL experiences, together explaining 59% of variance (R²=0.59). Students at governmental hospitals reported higher CL experiences (M = 3.92 ± 0.91) than those at private facilities (M = 3.59 ± 1.06, p = 0.032, η²=0.023). Significant differences emerged across training wards (F[6,299] = 2.56, p = 0.019, η²=0.049), with orthopedic wards scoring highest (M = 4.92 ± 0.15) and pediatric wards lowest (M = 2.97 ± 1.32). Qualitative themes revealed four major dimensions: perceptions of clinical experiences, facilitators (instructor expertise, staff collaboration), barriers (resource shortages, movement restrictions), and improvement strategies (increased clinical days, diverse training sites). Conclusion Despite systemic challenges in conflict-affected Palestine, positive pedagogical environments and effective supervision significantly enhance nursing students' clinical learning. These human factors appear to partially mitigate resource limitations and geopolitical constraints. Our findings suggest targeted interventions in faculty development, resource optimization, and policy reform could strengthen nursing education resilience in this context.