Exploring Nursing Student Self-esteem and its Relationship to Clinical Competence Development: Protocol for A Multiphase Convergent Mixed Methods Study

Background: Self-esteem affects nursing students’ well-being and may impact their competence development. Nursing students appear to be at risk for low self-esteem, and their training may negatively impact that selfesteem. The existing research, with its controversies, methodological issues, and gaps, has failed to fully portray or explain this phenomenon. Mruk’s two-dimensional model of self-esteem offers an operative theoretical framework based on self-competence and self-liking. The model describes the nature of ‘selfesteem moments’ in which self-esteem changes. The aim of this study is to answer the question: “How does undergraduate nursing education influence students’ self-esteem, specifically regarding the development of their clinical competence?” Methods: A longitudinal design is needed to describe changes during undergraduate nursing education. A mixed methods study is required to measure and explain those changes, with a convergent, multiphase design. A nursing student cohort is created by accidental sampling in four Belgian high schools and followed for three years. Quantitative data including sociodemographic data, self-esteem (as measured by the Rosenberg scale and the Tafarodi & Swann scale), self-efficacy, and state anxiety (Spielberger scale) are collected each year. These data will be used to describe changes in self-esteem level and profile during nursing education. Multivariate analysis is used to identify correlated factors. Qualitative data are collected each year via semi-structured interviews with a cohort created by purposive sampling; content analysis is performed on that data(hermeneutic phenomenology) to identify themes using repetitions, similarities and differences, indigenous categories, and theory-related material. The quantitative and qualitative data are then combined into a meta-matrix. Discussion: The challenges encountered during study designing involved following the cohort while minimizing missing data, validating the French translation of a self-esteem scale using nursing students, and dealing with a large volume of data, especially when assembling it into a meta-matrix. The aim of the study is to help educational institutions tackle the self-esteem issue. Future studies might also compare nursing students to other students, explore the situation of dropouts, and evaluate self-esteem-related pedagogical devices. Trial Registration: This non-interventional study was approved by the ethics committee (Comited’ Ethique Hospitalo-Facultaire Universitaire de Liege (707)) and assigned reference no. 2017/233.