Advancing Self-Determination in Pre-Clinical Nursing Students: A Needs-Based Approach for Hospital Training Programs

Abstract

The transition from academic learning to clinical practice is a pivotal stage in nursing education, where students must develop autonomy, competence, and relatedness—core components of self-determination theory (SDT). However, many pre-clinical nursing students face challenges that hinder these needs, particularly during hospital training programs. This study explores the selfdetermination needs of pre-clinical nursing students in Indonesia, adopting a mixed-methods design. Quantitative data from 243 students, gathered through a modified Self-Determination Scale, were analyzed using partial least squares structural equation modeling (PLS-SEM). Additionally, interviews with 20 students provided qualitative insights. Findings indicate that autonomy was significantly influenced by prior clinical experience (β = 0.42, p < 0.001), while competence was linked to academic preparation (β = 0.38, p < 0.01) and mentorship quality. Relatedness depended on team cohesion and gender dynamics, with female students reporting higher support levels (β = 0.31, p < 0.05). Autonomy-supportive supervision (β = 0.47, p < 0.001), structured mentorship (β = 0.44, p < 0.001), and cohesive team dynamics (β = 0.36, p < 0.01) emerged as key perceived supports for enhancing self-determination. Qualitative data revealed that supportive supervision fostered confidence, while micromanagement hindered autonomy. Competence grew with hands-on guidance, and meaningful peer interactions promoted relatedness. The study highlights the importance of addressing systemic and cultural factors to improve students’ clinical learning experiences. These findings contribute to evidencebased strategies for fostering motivation, engagement, and preparedness in nursing students, enhancing their transition into professional practice