Assessment of readiness characteristics for clinical practice among nursing students based on the ADKAR model: A meta-synthesis of qualitative studies

As healthcare systems become increasingly complex, it is essential to equip nurses with the knowledge and competencies needed to provide safe and high-quality patient care. This study aims to understand the characteristics of nursing students’ readiness for entering clinical practice by synthesizing and integrating qualitative research findings, using the dimensions of the Awareness, Desire, Knowledge, Ability, Reinforcement (ADKAR) model. We applied the meta-ethnographic process by Noblit and Hare (1988) to identify, interpret, and integrate existing qualitative evidence on the readiness of first-year nursing students for clinical entry. To this end, 22 qualitative studies were included and synthesized using directed qualitative content analysis. The findings indicate that first-year nursing students need adequate preparation before entering clinical settings. Key components, in the order of their appearance, include preliminary awareness, desire to enter clinical practice, clinical knowledge, functional ability, and reinforcement. Preliminary awareness involves educational requirements and understanding of care. Next, intrinsic motivation and desire (linked to altruism and professional development) play a crucial role. While acquiring sufficient knowledge is essential, challenges related to knowledge deficits and learning basic nursing knowledge are also significant. Functional ability for implementing new skills and behaviors depends on the clinical skills center facilities and skill enhancement. Finally, reinforcement through learning stimulation and a supportive interactive environment helps sustain favorable changes. This study demonstrates that first-year nursing students often lack sufficient readiness for clinical practice, facing challenges in preliminary awareness, intrinsic motivation, basic clinical knowledge, and the practical application of clinical skills. A structured focus on these dimensions, along with a supportive environment, can better prepare students for clinical transition and promote effective use of their competencies in practice.