International Journal of Nursing & Clinical Practices Volume 7 (2020), Article ID 7:IJNCP-324, 12 pages
Study Protocol
Exploring Nursing Student Self-esteem and its Relationship to Clinical Competence Development: Protocol for A Multiphase Convergent Mixed Methods Study

Jacinthe Dancot*1, Benoît Pétré1, Pascal Detroz2, Rémi Gagnayre3, Nadia Dardenne1, Anne-Françoise Donneau1, and Michèle Guillaume1

1Public Health Sciences Department, University of Liege, Liege, Belgium
2Interfaculty Research Unit in Didactics and Teacher Training, University of Liege, Belgium
3Health Education and Practices Laboratory, Department of Health Sciences Education, University Paris 13-Sorbonne
Dr Jacinthe Dancot, Public Health Sciences Department-Quartier Hôpital, Avenue Hippocrate, 13, Bâtiment B23, 4000 Liège, Belgium, Phone number: +32 476 681 812; E-mail:
01 May 2020; 08 June 2020; 10 June 2020
Dancot J, Benoît P, Detroz P, Gagnayre R, Dardenne N,et al. (2020) Exploring Nursing Student Self-esteem and its Relationship to Clinical Competence Development: Protocol for A Multiphase Convergent Mixed Methods Study. Int J Nurs Clin Pract 7: 324. doi:


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 (Comitéd’ Éthique Hospitalo-Facultaire Universitaire de Liège (707)) and assigned reference no. 2017/233.