Midwifery Students’ Perceptions of Clinical Learning Experiences and Assertiveness Levels: The Serial Mediating Role of Anxiety and Stress

Introduction: This study aimed to examine the relationship between midwifery students’ perceptions of clinical learning experiences and assertiveness levels through a serial mediation analysis involving anxiety and stress.
Methods: This descriptive, cross-sectional, and correlational study included midwifery students in the 2nd, 3rd, and 4th years of study at a university in eastern Türkiye. Data were collected using the Student Introduction Form, Perceptions of Clinical Learning Experiences Scale, the Voltan-Acar Assertiveness Inventory, the State Anxiety Inventory, and the Clinical Stress Questionnaire (CSQ).
Results: The sample comprised 239 midwifery students. Students demonstrated low levels of clinical learning experience perceptions and assertiveness (44.65±12.03; 89.73±26.93), as well as moderate levels of anxiety and stress (46.30±8.63; 53.32±14.53). A statistically significant positive correlation was identified between CSQ scores and trait anxiety scale scores (β=0.343, p<0.001). State anxiety, clinical learning environment, and self-determination scale scores collectively explained 16.3% of the variance in CSQ scores (R2=0.163).
Discussion and Conclusion: The findings indicate that moderate levels of anxiety and stress adversely affect perceptions of clinical learning experiences among midwifery students and are associated with lower perceptions of clinical learning experiences and assertiveness levels. The quantitative model revealed that anxiety and stress serially mediated the association between clinical learning experience perceptions and assertiveness, elucidating the mechanisms underlying these relationships.