Clinical Learning in Nursing and Midwifery Education in Northern Morocco: A Fragile Balance Between Relational Support and Structural Constraints

Vollständiger Abstract

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Background: Clinical learning is a core component of nursing and midwifery education, shaping the development of professional competencies and students’ engagement in real care settings. While quantitative studies have widely examined factors influencing clinical learning, fewer studies have explored students’ lived experiences through qualitative approaches, particularly in low- and middle-income contexts such as Morocco. Aim: To explore the factors perceived by nursing and midwifery students as facilitating or hindering their clinical learning experiences in Northern Morocco. Methods: A descriptive qualitative study was conducted using inductive thematic analysis of responses to two open-ended questions embedded within a broader quantitative survey. Of the 311 students participating in the quantitative study, 289 provided usable responses to the two qualitative questions, which addressed factors that facilitated and hindered learning during clinical placements. Participants were second- and third-year nursing and midwifery students enrolled at Higher Institutes of Nursing and Health Techniques (ISPITS) in Northern Morocco. Results: Two main thematic axes were identified. Facilitating factors included support and availability of healthcare staff (63.7%), positive relational dynamics and team spirit (55.3%), integration of theoretical knowledge into clinical practice (43.1%), diversity of clinical situations and procedures (38.3%), and personal motivation and engagement (28.0%). Hindering factors included insufficient clinical supervision (72.0%), high numbers of trainees and workload pressure (64.6%), lack of equipment and material resources (56.6%), relational difficulties and lack of recognition (38.9%), stress and anxiety (35.0%), and organizational and coordination problems (30.9%). Conclusion: Clinical learning in Northern Morocco appears to be shaped by a fragile balance between relational and pedagogical facilitators and persistent structural constraints. Supportive relationships with healthcare professionals and positive team dynamics can foster students’ engagement and learning, but insufficient supervision, overcrowding, resource limitations, and organizational difficulties substantially restrict learning opportunities. These findings provide context-sensitive evidence to inform improvements in clinical supervision, placement organization, and pedagogical support in Moroccan nursing and midwifery education.