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Nurse Education Today
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Learning environment and emotional well-being: A qualitative study of
undergraduate nursing students
Ambreen Tharania,⁎, Yusra Husainb, Ian Warwickc
a Aga Khan University School of Nursing and Midwifery, Stadium Road, P.O Box 3500, Karachi, Pakistan
b Department of English, University of Karachi, Pakistan
c Institute of Education, University College London, Department of Education, Practice and Society Room 733, 20 Bedford Way, WC1H 0AL, United Kingdom
A R T I C L E I N F O
A B S T R A C T
Background: Students can experience multiple stressors during their academic life which have an impact on their
emotional health and academic progress.
Purpose: This study sought to explore students’ understanding of and factors affecting their emotional well-being
in an undergraduate nursing programme at a private nursing institution in Karachi, Pakistan.
Method: In this qualitative study, data were collected through individual semi-structured interviews using a selfdesigned
guide from 16 participants in total, drawn from various years of the selected undergraduate programme.
Findings: Participants noted that the quality of the ‘learning environment’ was a key influence on their emotional
well-being. They highlighted faculty role and teaching approaches, academic expectations and availability of
learning resources as important factors that affected their emotional well-being as well as their academic performance.
Institutional support was also deemed important. Factors associated with a ‘hidden curriculum’ were
found to be a threat to students’ emerging sense of professionalism.
Conclusion: Suggestions are given as to how the learning environment in the nursing programme under study
can be improved to take into account students’ emotional well-being. Emphasis needs to be laid on developing
supportive faculty role to provide conducive learning environment and professional development of students.
Efforts to develop stress-free academic environment with supportive institutional policies need to be considered.
Stress is a common phenomenon which university students often
experience as part of their academic life. Although some level of stress
appears necessary for learning (Stuart, 2013), high levels of continuous
stress may produce tension and anxiety that can have a negative impact
on students’ learning and their academic productivity (Ni et al., 2010;
Reeve et al., 2013; Salam et al., 2015; Storrie et al., 2010). Learning is
not only a consequence of students’ cognitive abilities, but is also influenced
by an educational ethos or environment that should ideally
foster active learning (Christie et al., 2008). There are a number of
physical, social, and emotional factors within the learning environment
that can intensify students’ stress such as weak academic structure,
number of assessments, workload and lack of support from faculty
(Aghamolaei and Fazel, 2010; Elcigil and Sari, 2007; Reeve et al., 2013;
Shah et al., 2010). Students may respond and cope differently to these
stressors according to their emotional well-being (Friedli, 2009).
Emotional well-being is associated with the experiences individuals
encounter in their daily lives. The academic environment influences
students’ life to a great extent. For example, if a learning environment is
positive and student-centred, it enables the students to have a constructive
learning experience (Aghamolaei and Fazel, 2010; Christie
et al., 2008; Dooris, 2001; Lizzio et al., 2002; Ni et al., 2010). However;
students may have mixed feelings and apprehensions in their learning
environment that may impact their emotional health or well-being
(Christie et al., 2008; Friedli, 2009; Hutchinson, 2003). For the purposes
of this paper, the two phrases, emotional health and emotional
well-being, are used synonymously.
Awareness of one’s own stressors and emotional needs allows an
individual to seek acceptable and healthy modes of emotional expression
to attain optimal emotional health (Ni et al., 2010). At times,
however, students are unable to recognize and address their emotional
distress while they struggle to cope with the demands of education
(Salam et al., 2015). Their young age and accompanying emotional
instability may exacerbate psychological issues, including anxiety and
stress (Jamshidi et al., 2016). Due to these concealed emotions,
Received 7 October 2016; Received in revised form 21 August 2017; Accepted 14 September 2017
⁎ Corresponding author.
E-mail addresses: ambreen[email protected] (A. Tharani), [email protected] (I. Warwick).
Nurse Education Today 59 (2017) 82–87
0260-6917/ © 2017 Elsevier Ltd. All rights reserved.
students frequently experience feelings of failure, demotivation and
disappointment with (what they perceive as) painful academic requirements
(Christie et al., 2008; Griffiths et al., 2005). Consequently,
these feelings make students prone to decline in their academic performance
(Storrie et al., 2010) and indulge in maladaptive coping behaviours
like excessive worrying, sleeplessness, isolation (Seyedfatemi
et al., 2007), helplessness and dropping out (Storrie et al., 2010).
Similar educational environment stressors are usually faced by
students when they enter nursing education. In fact, comparison studies
(Bartelett et al., 2016; Benavente and Costa, 2011) have shown that
nursing students have higher level of stress and related symptoms as
compared to non-nursing students. In their review of literature on stress
among nursing students, Benavente and Costa (2011) report a study
which assessed the occurrence of psychological diseases among 558
students from diverse disciplines such as science, law and nursing, in
which it was found that students from the discipline of nursing are the
most prone to tension and stress.
Nursing students are required to meet several theory and clinical
demands which may make them feel strained and can have a negative
impact on their academic function and adaptive coping (Ni et al., 2010;
Seyedfatemi et al., 2007). Benavente and Costa’s (2011) review assembled
findings from various studies regarding causes of stress among
nursing students studying theory, for example, academic demands,
constant assessment, and the strain of maintaining relationships with
friends and classmates, as well as teachers, some of whom may be stern
and discouraging. A similar review of literature conducted by Alzayyat
and Al-Gamal (2014) discusses various stressors that nursing students
encounter during their clinical education such as workload, time
management and complexity in relationship with staff and patients.
Jamshidi et al. (2016) conducted a study in Iran in which 17 nursing
students were interviewed regarding the challenges they face in the
clinical learning environment. It was found that teachers’ censure and
students’ lack of confidence may affect their clinical performance and
their dealings with patients, and that they feel stressed when having to
look after patients or when meeting patients dependent on mechanical
equipment. In addition, Msiska et al. (2014) observe that lecturer supervision
in nursing performance of their sample of Malawian students
causes stress, sometimes deliberately on the part of the teacher.
Alzayyat and Al-Gamal (2014) suggested that more studies explore
stressors among nursing, particularly in clinical education, that can
provide guidance to universities and faculty to enhance students’
learning and related experiences. For example, Jamshidi et al. (2016)
suggest that teachers should be role-models who teach students about
values and show them respect, while student interviewees in Msiska
et al. (2014) requested that lecturers should greet students with a smile
to set them at ease and to avoid harming their self-esteem or their sense
of competence. Actually, emotion management is an integral part of
health professional education due to the nature of the occupations
classified under it. That is why nurse educators need to give special
consideration not only to students’ learning but also to students’ emotions
(Msiska et al., 2014). Hence, identifying and addressing the means
to ensure emotional the well-being of nursing students is crucial. It
impacts not only their academic performance but ultimately also the
quality of care provided to patients.
In Pakistan, few research studies have been conducted that focused
on students’ perceptions and its association with academic stress and
related maladaptive coping behaviours of medicine students (Shafiq
et al., 2006; Shah et al., 2010; Shaikh et al., 2004; Yousafzai et al.,
2009). A study conducted by Sohail (2013) at a public medical university
in Pakistan confirms that the high level of stress has a negative
impact on students’ academic performance. To the best of the authors’
knowledge, the issue of addressing emotional well-being and associated
factors remains underreported among nursing students in Pakistan,
despite strong evidence in the literature of the socio-psychological
impact of the learning environment. As the scarcity of local literature
reflects, higher education institutes in Pakistan appear to be focused on
only the cognitive impact of their programmes. Therefore, this study
was undertaken to explore students’ understanding of and factors affecting
their emotional well-being in an undergraduate nursing programme
at a private nursing institute in Karachi, Pakistan. The authors
anticipate that this information may lead to a consideration of what
concrete actions can be taken to foster a positive learning environment
and lead to enhanced academic achievement and learning in nursing.
This qualitative case study was conducted to explore students’ understanding
of the term ‘emotional well-being’ and the associated factors
they experience during their nursing education. Ethical approval
was obtained from the Institutional Ethical Review Committee before
commencing the research. Subsequently, written permission was attained
from the departmental head and consent of voluntary participation
was obtained from the participants.
Initially, all students in the selected undergraduate nursing programme
(n = 250) were approached as potential participants through
institutional email. In the second stage, purposive sampling was used to
select maximum variation in sample (Polit and Beck, 2004) from the
potential participants who responded and showed interest in participating
in the study (n= 37). Participants were selected to obtain equal
representation from each year of the selected programme as well as of
hostel-residing students and off-campus students. This was done to
encompass the variation among students caused by their being in various
years of study and their resident status.
2.2. Data Collection and Analysis
Data were collected from 16 participants by using a self-developed
pre-tested semi-structured interview guide. However, one participant
withdrew at the data analysis stage; therefore, data from 15 participants
are reported. Each interview lasted about 20–60 min. To ensure
participants’ comfort and appropriate expression, they were allowed to
respond in either Urdu or English, whichever language they preferred.
In the initial phase of the interview, participants were probed about
their concept of emotional well-being. Then the variance in their understanding
of the term was addressed by providing them with a brief
description of the literary concept of the term. This was done to ensure
uniformity in their conceptual understanding and facilitate them to
acknowledge the associated factors.
Data were analysed using the thematic analysis steps proposed by
Creswell (2014). Each tape-recorded interview was transcribed and
translated (where needed) by the researcher. Data were coded and
categories were identified for further analysis. Later, major themes
were extracted out of the categorized data. It is important to mention at
this point that the analysis of data revealed mostly similar responses
from participants regarding factors impacting their emotional wellbeing.
The rigor of the study was ensured by developing trustworthiness
(Koch, 1994). Additionally, member checking strategy was used by
sharing the study findings with the participants (Creswell, 2014; Polit
and Beck, 2004).
This section will report the findings related to participants’ understanding
of the term emotional well-being. The section will further
highlight the factors that participants’ depicted affecting their emotional
A. Tharani et al. Nurse Education Today 59 (2017) 82–87
3.1. Understanding of Emotional Well-being
Participants from various years of study in the programme had
varying understanding of the term emotional well-being. Participants
enrolled in initial years of the programme referred to emotional wellbeing
as ‘emotions an individual has,’ ‘thinking emotionally (rather
than rationally),’ and ‘impact of emotions on an individual health.’ On
the other hand, participants at nearly half or at the end of their undergraduate
nursing programme were able to connect emotional wellbeing
explicitly with stress management and coping as they describe it
as ‘…coping with daily stressors,’ ‘an appropriate expression of emotions’
and ‘managing stressors that doesn’t impact individuals functionality.’
The interviews were further progressed after ensuring that
the interviewer and interviewee had arrived at a shared understanding
of emotional well-being.
3.2. Factors Affecting Emotional Well-being
As opposed to the variation in participants’ responses regarding the
concept of emotional well-being, the factors that they associated with it
were largely uniform. Participants noted that the quality of the
‘learning environment’ has a key influence on their emotional wellbeing.
They highlighted teaching approach, unrealistic scheduling and
assessment demands, and lack of resources as key contributors in the
learning environment that impact their emotional well-being.
3.2.1. Teaching Approach
Study participants verbalized their apprehension associated with
the style of teaching at their institution. They felt that their educational
attainment is highly impacted by the way teaching is executed as it
lacks student-centeredness. They reported a lack of positive feedback
and teaching expertise by faculty. Participants also narrated their
struggle to comprehend ‘faculty expectations.’ Students defined faculty
expectations as the set of knowledge, skills and mannerisms that faculty
expect students to embrace including conceptual knowledge, behaviour
in classroom and clinical setting, body language, attire, positive attitude,
18.104.22.168. Lack of Positive Feedback. Participants felt that their stress level
increases when the teaching approach is focused on identifying only the
weak areas of their knowledge and skills but not their strengths,
because this affects their self-confidence. As one participant narrated:
My thinking gets blocked when faculty harshly tells me what I have done
wrong. I never feel comfortable asking how to make it better. (P7)
Another participant shared his/her discomfort as:
I feel there is no use of doing hard work. I know I can’t perform perfectly.
If I have any weakness, faculty should tell me timely as how I can make it
better (rather than identifying my mistakes). (P4)
Participants emphasized that there is a need for feed-forward approach
by faculty that can facilitate students’ self-esteem and receptivity
towards feedback. Similarly, provision of timely and constructive
feedback in a non-threatening manner motivates and helps
students to boost their confidence. In the words of a participant:
We are anxious as new learners while performing skills. We should be
supported. If a student does something appropriately, they should get
encouragement for it. Students’ motivation decreases when they are not
22.214.171.124. Paradoxical Faculty Role. Participants verbalized their distress
associated with the struggle to understand faculty roles/expectations.
To them, it becomes more difficult when the role demonstration of
faculty, in terms of knowledge and mannerism, is not at par with what
students are expected to exhibit. In addition, faculty requires student to
demonstrate their nursing knowledge according to their year of study in
the programme; whereas, at times faculty members are found to be
struggling with demonstrating their own required level of knowledge
and clinical application. One of the participants expressed:
Faculty lacks quality of a teacher. Students are penalized if they are not
prepared with the required knowledge at clinical setting. But there are
teachers whose level of knowledge is same as mine as student. Even at
times in classes, it is easy to figure out that faculty is not prepared and we
are questioned if we are unprepared with readings. (P10)
The role demonstration of faculty that is inconsistent with the expected
learning of professional behaviour promotes hidden learning
among students. These are the unintended attributes that students
adapt from their learning environment, predominantly from their faculty.
We are expected to behave as professionals. However, I have seen faculty’s
informal language and unprofessional behaviour in class. We are
restricted because we are students [participant appears aggressive]…faculty
should be proper model for us. (P6)
The ambiguous role performance by faculty often results in feelings
of uncertainty among students resulting in feeling of being ‘lost’ and
‘targeted.’ Participant shared her annoyance as:
It confuses me when faculty scold us for being a few minutes late on
clinical or class and usually they themselves take long tea breaks during
3.2.2. Unrealistic Scheduling and Assessment Demands
The participants in the study strongly felt that their academic
agenda and schedule created anxiety for them because it was too demanding.
They felt that they are treated as ‘machines’ and ‘inborn
learners’ rather than humans because the assessment criteria were too
high and too many, and deadlines were too close together.
126.96.36.199. High Academic Expectations. Study participants reported that
the academic requirements for clinical and theory, combined with the
struggle to handle ongoing demands and requirements, increases their
anxiety. Participants further reported presence of multiple and rigid
assessment criteria and educational expectations which make them feel
overwhelmed; hence affecting their emotional health.
We are expected to perform high, in terms of patient care, clinical assignments,
and grades. We need time to adjust but academic demands
require us to do each and every thing perfectly. It causes stress and I feel
disturbed. (P 12)
To make learning environment positive, participants emphasized
the need for an accommodating attitude that can enable students’
learning. One of the participants narrated:
Don’t give too much academic stress to students where students’ personal
life suffers. Assessment schedule should have breather for students so we
can work in a more productive way. (P2)
188.8.131.52. Demanding Schedule. Overly ambitious academic demands
often make it challenging for students to manage time effectively.
Students are required to study two semesters (each spread over
18 weeks) in an academic year. Meanwhile, time between semesters
is utilized to provide students with additional clinical experience.
During each semester students are expected to meet the requirement
of a number of courses for its successful completion. Therefore, the
students always seem to be struggling to meet the demands of this
overwhelming schedule. One participant verbalized stressor as:
I feel burdened with too many things scheduled together. There are exam
deadlines with clinical schedule followed by class assignment deadlines.
A. Tharani et al. Nurse Education Today 59 (2017) 82–87
You can imagine how much stress it can cause. (P2)
Another participant stated:
There is no break between semesters. It is very upsetting that we cannot
enjoy our lives. No break at all. I want to learn different occupational
skills that appeal to me like stitching, but how can I spare time when I am
not getting any recreational break. (P8)
3.2.3. Lack of Resources
Participants discussed how the non-availability of resources and
facilities tends to not only hinder their academic performance, but also
increase their anxiety levels. Availability of computer facility and students’
common room were reported as two major resource factors that
impact students’ performance and emotional health.
184.108.40.206. Computer Facilities. Overwhelming responses were received
from participants regarding availability and access to computers in
the computer lab. According to their perspective, students in need of
computers by far outnumber computers in the facility. For instance,
availability of computers becomes a nightmare when there is a
forthcoming assignment submission. One participant stated:
There are few computers in the computer lab as compared to the number
of students. I become very anxious when I am pressurized to complete my
assignment but it is never considered, whether I have the resources
available to complete it. (P5)
Participants verbalized their apprehension with respect to unavailability
of computers in times of dire need. They feel more ‘stressed’
because it restrains them from meeting the assignment submission
deadline. As a participant explained:
My anxiety increases, when at the eleventh hour I have to rush to the
computer lab and I find that all the computers are occupied. (P9)
Computer lab is equally used by day scholars and students residing
in hostel. Participants who were day scholars verbalized that they either
do not have individual computer facility at home or there is an
electric supply issue (e.g. low voltage, frequent power failure) that
limits their working at home.
Computer lab is the only option for me. Working on assignments from
home is an additional stress with electricity issues…at times it is a disaster.
220.127.116.11. Students’ Common Room. Participants raised the concern of
having limited space to rest during their break time. They felt that the
available common room can hardly accommodate a hand-full of
students and the facility is therefore insufficient for the great number
of students at the institution. The common room plays an important
role in students’ socialization and relaxation time therefore a congested
common room has an adverse effect on students’ emotional health.
We have only one student common room for many students. With harsh
weather, we cannot sit in open space and if we want to relax in the
common room, there is no space. (P5)
Considering that the institution is co-education, in this cultural
context, at times it is difficult for certain students to share the common
room. Participants strongly suggested that the institution should consider
their ‘mental health’ and provide them with ‘adequate space’ to
rest. A female participant verbalized:
We cannot spend time comfortably in common room. It’s difficult as we
have male students also using similar space. I feel uneasy. (P8)
The study participants shared their understanding of emotional
well-being and proposed factors associated with it based on their individual
experiences. Foremost among the interviewees’ concern was
faculty role. Participants reported unclear role demonstration of faculty
that strongly impacts their emotional well-being. For example, it results
in confusion among students. Although consistency is to be expected
among the teachers at least within programmes, there is actually wide
variety in the quality of their teaching. For example, students reported
that while some teachers stress punctuality and professional behaviour
and abide by it themselves, other teachers do not do so. This is just a
single example of how teachers selectively follow university rules and
regulations yet expect students to follow them cent percent. However;
the Quality Assurance Manual (Batool and Qureshi, 2006) of the Higher
Education Commission (HEC) of Pakistan affirms that the faculty should
have clear understanding of what is to be expected from students. In the
present study, it was found that the negative attitude of faculty results
in avoidance and de-motivation among students. This finding is aligned
with another study conducted at three associate degree nursing programmes
in the north-eastern U.S, that unveiled how the discourteous
behaviour of faculty made students feel demoralized, impacting their
self-esteem, confidence, learning and identity as a nurse (Prato, 2013).
Another source of confusion is the divide between the expected
professional behaviour documented in programme policy (controlled
document) as opposed to the non-professional role demonstration of
faculty; often referred as ‘hidden curriculum’ (Glicken and Merenstein,
2007). While the HEC Quality Assurance Manual (Batool and Qureshi,
2006) suggests in a utopian manner that the standards laid out in the
curriculum have a crucial impact on setting the standards for teaching
and learning, the literature suggests that students are more likely to
adapt to the ‘hidden curriculum’ instead (Glicken and Merenstein,
2007; Heshmati-Nabavi and Vanaki, 2010; Prato, 2013). Hidden curriculum
refers to professional learning of students brought about by
observing undesirable role performance of faculty, for instance their
attitude (comments and use of language) or lack of enthusiasm. In
addition, students who look up to their faculty as perfect moral and
academic role models tend to become de-motivated with educators if
those educators exhibit unexpected and negative behaviours. Consequently,
the adoption of this undesirable role can have a negative impact
on students’ learning and professional development (Glicken and
Merenstein, 2007). Additionally, it can hinder their self-esteem, confidence,
learning and identity as a nurse (Prato, 2013). This is indeed a
threat to the future of the nursing profession, as students might be
prone to learning the unprofessional attitude of their faculty.
Focusing on emotional well-being, the literature informs us that a
supportive educational environment is essential in facilitating students
to gain required knowledge and manage academic stress (Hutchinson,
2003; Ni et al., 2010). It is worth remembering that the key ingredient
to a supportive educational environment is a supportive faculty. However,
in line with students’ views regarding the self-contradictory role of
their faculty, the participants in this study also reported a fragile institutional
support system. This is not an uncommon finding, for instance,
another cross-sectional study conducted with medical students
at Iranian Medical Sciences University affirms that students perceived
faculty role negatively in fostering effective learning environment
(Aghamolaei and Fazel, 2010). Students naturally look to their faculty
members for support, and those in the present study expressed the need
for faculty to play a major role in supporting and guiding students to
maximize their positive learning experience. This suggestion is strongly
backed by the HEC Quality Assurance Manual (Batool and Qureshi,
2006), which states that “Academic and general support to facilitate
students in dealing with possible academic problems ensures that they
can make progress satisfactorily through their programme and are informed
about their progress” (p. 22).
Informing students about their progress is also required to ensure
A. Tharani et al. Nurse Education Today 59 (2017) 82–87
their psychological welfare. Students expressed the view that teachers
are so focused on pointing out their weaknesses that they do not address
their strengths while giving feedback. In a related vein, participants in
Msiska et al. (2014) reported feeling ashamed and offended in response
to being disciplined in the clinical setting, as a result of which they tend
towards avoidance rather than learning. While it is true that constructive
criticism helps students refine their performance, positive
feedback, which acknowledges students’ strengths, is also important to
ensure that they keep up the good work. In the words of the HEC
Quality Assurance Manual (Batool and Qureshi, 2006), it is essential to
provide learners with “appropriate structured feedback that supports
their continuing learning” (p. 21).The literature also illustrates need of
faculty’s support and positive reinforcement to enhance students’
learning (Elcigil and Sari, 2007; Heshmati-Nabavi and Vanaki, 2010; Ni
et al., 2010; Papp et al., 2003; Seyedfatemi et al., 2007).
The second major source of emotional distress for the participants
was, what they deem to be, their demanding academic schedule and
expectations. Admittedly, while the proper dosage of pressure can cause
facilitative anxiety, too much pressure can cause debilitative anxiety
which is bound to have an adverse effect on students’ academic performance
(Brown, 2000; Sohail, 2013) as well as their emotional wellbeing.
Finding of this study affirms that students’ emotional health is
hampered while they struggle to balance the number of academic requirements.
These findings are in line with literature which affirms that
students often feel pressured and report psychological concerns while
struggling with the demands of the learning environment (Dooris,
2001; Shaikh et al., 2004; Seyedfatemi et al., 2007) and tough academic
schedule (Qamar et al., 2015).
The responses provided by the participants of this study correspond
to the survey conducted by Lizzio et al. (2002) among 5000 students
studying across 14 disciplines in a university. It affirms that higher
workloads results in superficial learning among students, resulting in
lack of satisfaction with learning environment. Their findings also
suggest that students should be provided with a less packed academic
schedule so that their analytical and problem solving skills can be enhanced.
Scarcity of resources is the final issue that students felt needs to be
addressed. The lack of resources reportedly hampers their performance
and their ability to meet deadlines. Similar to participants in the present
study, participants in Sohail (2013), all medical students in Lahore,
Pakistan, report lack of facilities, such as electricity, to be a cause of
stress. For one thing, assignments are increasingly tied to the use of
technology and the internet. Especially in tertiary levels of education,
Lizzio et al. (2002) notes a rise in the utilization of media and technology.
However, teachers often fail to consider the fact that students
may come from underprivileged backgrounds and not own personal
laptops. In such circumstances, it is the responsibility of the institution
to provide an adequate number of computers. In case it does not, the
faculty should take into account this scarcity when assigning tasks to
students. Furthermore, the institution is responsible for facilitating
students’ emotional, social and relaxation needs, yet the participants of
the present study reported an overpopulated common room which is
too small to house the large number of students at the institution.
Participants in Sohail (2013) also observed that overcrowding of students
in rooms is quite stressful.
The provision of facilities is important for mental health, as the
WHO report (Friedli, 2009) demonstrates that psychological issues
prevail in deprived societies. In the author’s own words (Friedli, 2009,
p. 37), “The fact that the experience of relative deprivation influences
health does not diminish the importance of access to material resources
that support health and wellbeing.” The need for supply of facilities is
also supported by a clause under “Learning Resources” (p. 22) in the
HEC Manual (Batool and Qureshi, 2006) which highlights the necessitation
of adequate, suitable and useful learning resources to aid students.
Hence, access to adequate facilities is imperative not only for
learning but also for emotional well-being.
The Quality Assurance Manual has been extensively referred to in
this discussion for two reasons. The first is that the manual has been
designed precisely to enable practitioners of higher education in
Pakistan to apply quality and uniform academic standards (p. 21) and
this paper is concerned with factors which affect quality standards of
the learning environment. The Manual similarly states that the objective
of quality assurance is to develop a uniform understanding of
quality (p. 22). The second reason for the relevance of the Manual is
that it aligns closely with the concerns of students in the present study.
The relevance of the Manual with the issues addressed in this study
demonstrates two things: 1) that students are on the right track in
pointing out significant aspects of their learning environment, and 2)
that quality in education, as defined by the HEC, is closely linked to
students’ emotional well-being.
With that being said, it is still important to acknowledge that not all
of the concerns voiced by the participants have been addressed in the
manual. For instance, there is no mention of a hidden curriculum, or of
the need for an academic schedule which does not place undue pressure
on students. In addition, even though the HEC Manual suggests a threelevel
system of evaluation to ensure that higher education institutes are
actually meeting the advised standards, participants’ reports about the
institution under study suggest that the check and balance system laid
out in the Manual is either inefficient or not being implemented, because
so many of the issues it has warned about are still problematic.
Hence, there is a need for the Manual to be more inclusive of concerns
raised by students and for monitoring of the standards it so succinctly
5. Conclusion and Recommendations
To conclude, this study has identified significant impact of learning
environment on students’ positive learning and emotional health. It
strongly emphasized the need for faculty to play a clear and distinct role
in providing conducive learning environment and support for the professional
development of students. In addition, academic environment
with minimal stress, supportive institutional policies and adequate facilities
are crucially needed to assist students to meet academic demands
This study has limited generalization because it is qualitative in
nature and draws conclusions from a single undergraduate programme.
However, the findings of this study can be considered as pilot data that
can give insight to other nursing institutes in developing nations to
assess and address this neglected phenomenon in a larger population of
undergraduate students. Indeed, there is a great need to address the
impact of the ‘hidden curriculum’ on professional development of students.
Faculty training and mentoring programme can also help to
develop faculty as professional role models. The data can be shared in
faculty development programs to emphasize the need for consistency in
instructions and expectations. A similar set of ideas can be researched
among faculty as well to know their perspective of students’ academic
The authors would like to acknowledge the participants of this study
for their participation, and the departmental head and ethical review
committee of the study site for their approval.
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