Building Resilience and Competence in Bachelor Nursing Students: A Narrative Review of Clinical Education Strategies

1. Introduction

Preparing resilient and clinically competent nurses is an urgent priority for global healthcare systems grappling with workforce shortages, aging populations, and increasing complexity in care delivery. Clinical education plays a pivotal role in achieving this goal, bridging the gap between theoretical learning and real-world practice. However, the transition from classroom to clinic often exposes students to long hours, emotional stressors, and high-performance expectations that can challenge both their technical development and psychological well-being [1,2,3,4,5,6].

In this context, two complementary outcomes have emerged as essential in nursing education: clinical competence, which refers to the ability to apply technical and interpersonal skills effectively, and psychological resilience, or the capacity to adapt to adversity and maintain emotional stability under pressure. Resilience is defined by the American Psychological Association as “the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands” [7]. The importance of resilience is particularly evident in the context of clinical practice. As students transition into hands-on roles, they are required to apply theoretical knowledge in unpredictable, emotionally charged, and often high-stakes situations. This complexity demands both technical skill and emotional adaptability. Resilience helps students navigate clinical stressors, maintain well-being, and persist through the demands of training and has been linked to lower levels of burnout and a reduced intention to leave nursing programs [8]. Traditionally treated as distinct domains, emerging research suggests these outcomes are deeply interconnected. Students with higher resilience demonstrate better coping skills, greater self-efficacy, stronger academic performance, and a lower risk of burnout and attrition [8,9,10].

While some programs emphasize individual traits such as optimism or self-regulation, few provide structured pedagogical models that integrate resilience-building into teaching practices. The role of clinical educators such as models of coping, communication, and ethical conduct, is particularly underutilized, despite strong evidence that educator behaviors and learning environments profoundly shape student outcomes. Students frequently report inconsistent role modelling, a lack of psychological safety, and insufficient support during placements [11,12,13], underscoring the need for evidence-informed strategies that actively foster both competence and resilience.

This review adopts Bandura’s Social Cognitive Theory (SCT) [14] as a guiding framework to explore how competence and resilience are codeveloped in clinical education. According to the theory, learning results from the dynamic interplay between personal factors, behaviors, and environmental influences. Central to this framework is the concept of self-efficacy that is the belief in one’s ability to manage tasks and challenges, which is closely linked to clinical performance and psychological resilience [15,16]. Educator behaviors, observational learning, and supportive environments are key mechanisms through which students build self-efficacy and internalize professional norms.

Despite growing interest, efforts to foster resilience in clinical education often remain fragmented. While some programs emphasize individual traits such as optimism or self-regulation, few offer structured pedagogical models that intentionally integrate resilience-building strategies into clinical teaching [17]. Moreover, the role of educators as models of coping, communication, and professional behavior, is often underemphasized, even though educator behaviors and the clinical environment profoundly shape students' experiences [18,19,20]. Inconsistent role modelling, lack of psychological safety, and insufficient support are frequently cited by students as barriers to learning and emotional growth [11,21].

This narrative review is guided by the proposition that resilience is not a fixed personal trait but a dynamic, teachable capacity shaped by educator inputs, learning environments, and social processes. By applying SCT as a guiding framework, we aim to synthesize the evidence on how clinical educators can foster both clinical competence and psychological resilience in undergraduate nursing students. Specifically, this review addresses the following questions:

1.What teaching strategies and educator behaviors support the development of both clinical competence and psychological resilience in nursing students?

2. How do characteristics of the clinical learning environment promote these outcomes?

3. What educational processes mediate the relationship between educator inputs and the development of competence and resilience?

Through this framework, we seek to identify evidence-informed strategies that nurse educators can implement to better support students, reduce attrition, and strengthen the future nursing workforce.

2. Materials and Methods

2.1. Design

This study is designed as a narrative review, following guidance [22], aiming to synthesize existing literature on how clinical educators influence the development of both clinical competence and psychological resilience in undergraduate nursing students during clinical placements. A narrative review is appropriate for this topic, because it offers an expert’s perspective on a topic relevant to clinical practice [23] and it allows for the integration of diverse study types, theoretical frameworks, and conceptual insights that inform complex and context-specific educational processes.

2.2. Search Strategy

To identify relevant literature, a comprehensive search was conducted across three major databases: PubMed, CINAHL, and PsycINFO. These databases were selected due to their relevance to nursing, health sciences, and psychological research. The search strategy included combinations of keywords and Boolean operators focusing on four core concepts: nursing students, clinical education settings, teaching strategies and educator behaviors, and outcomes such as resilience and competence. Example search terms included in the text included a combination of population as “nursing students” OR “undergraduate nursing”; intervention as “teaching strategies” OR “educator behavior” OR “instructional methods”; context as “clinical education” OR “clinical placement” OR “clinical learning environment”, and outcomes as “clinical competence” OR “resilience” OR “psychological resilience” OR “emotional safety” OR “self-efficacy” OR “emotional intelligence”. Searches were limited to peer-reviewed articles published in English. Additional studies were identified through manual screening of reference lists from relevant articles to ensure a comprehensive inclusion of both theoretical and empirical works aligned with the review’s aim.

2.3. Inclusion and Exclusion Criteria

Studies were included in the review if they focused on nursing faculty or undergraduate nursing students engaged in clinical skills training (e.g., simulation), clinical education, or clinical placements, and explored teaching strategies, educator behaviors, or characteristics of the clinical learning environment. To be eligible, studies needed to report outcomes related to clinical competence and resilience. Qualitative, quantitative, and mixed-methods studies published in peer-reviewed articles published between 1 January 2000 and 2 May 2025 were included.

Studies focused on postgraduate students, licensed professionals, or students from non-nursing disciplines, and articles that addressed general academic performance without reference to clinical competence or resilience, or focused solely on educational technologies or online simulations without a clinical educator component were excluded. Additionally, editorials, commentaries, conference abstracts, non-peer-reviewed publications, articles not available in full text, or not written in English were also excluded.

2.4. Study Selection

Titles and abstracts were screened for relevance, followed by full-text screening of eligible articles. Final selection was based on the article's contribution to at least one of the review's core themes: clinical teaching, student competence, resilience, or the clinical learning environment.

2.5. Data Extraction and Synthesis

Key information relevant to the research questions was extracted from the selected studies and included: author(s), year, and country, study design and methodology, population and setting, teaching strategies or educator behaviors, and outcomes related to competence and/or resilience. The findings were synthesized thematically, guided by the conceptual framework based on Bandura’s SCT. Studies were grouped into the three core domains of the framework: teaching strategies and educator behaviors, characteristics of the clinical environment, and mediating factors. Themes and subthemes were identified deductively and organized to reflect how different educational strategies foster competence and resilience in students.

2.6. Quality Appraisal

As this study follows a narrative review methodology, there was no formal requirement to conduct a structured quality appraisal of the included studies [24]. Narrative reviews aim to provide a broad and integrative synthesis of literature across diverse study designs, theoretical approaches, and contexts.

3. Results

3.1. Characteristics of the Studies

This review included 19 studies published between 2016 and 2025, conducted across nine countries: USA [25,28,29,33], England [41], Taiwan[26,36], Hong Kong [27], South Africa [30,43], Iran [31,38], Ireland [32,39], South Korea [34,40], the Philippines [35], and China [37,42]. Study designs included mixed-methods [25,32], quantitative quasi-experimental [28,31,38,40], cross-sectional and correlational [26,34,35,37,42], descriptive case study [29], qualitative focus groups [27], exploratory/descriptive qualitative studies [30,33,39,41,43], and participatory action research [36]. Populations included undergraduate or BSN nursing students [25,26,27,28,30,31,32,34,35,36,37,38,40,41,42,43], mental health nursing students [39], and nursing faculty [33]. Studies examined both competence and resilience [25,27,28,29,30,31,32,33,34,35,36,37,38,39,43], while few studies focused on resilience [40,41] or competence [42]. Competence outcomes included clinical judgment, decision-making, emotional intelligence, work readiness, and clinical adjustment; resilience outcomes covered self-efficacy, stress management, ego-resiliency, adaptive learning, and psychological well-being (Table 1).

Findings showed that mindfulness, stress management, and self-care interventions strengthened resilience [25,41], while instructor and faculty support improved resilience, self-efficacy, and clinical adjustment [26,35]. Emotional intelligence training enhanced self-awareness, communication, and coping [33], and reflective practices and simulation-based learning improved competence, critical thinking, and resilience [32,36,39]. Quasi-experimental studies demonstrated gains in decision-making, self-efficacy, clinical communication, and psychological well-being [28,31,38,40]. Social support and learning environments positively influenced resilience and competence [37,42,43], while ego-resiliency mitigated the negative effects of social anxiety [34]. Higher resilience was linked to better clinical integration, self-awareness, satisfaction, and retention, particularly during COVID-19 challenges [27,29] (Table 1).

3.2. Characteristics of Learning Environment

The included studies reported a wide range of learning environments shaping nursing students’ experiences. Supportive clinical or academic settings were common [26,33,34,35,37,42,43], along with safe and emotionally supportive environments [25,36,40,41]. Simulation-based learning environments with advanced setups were also frequently described [28,32,38], alongside inclusive and dialogue-driven settings [29,39], structured bedside or clinical supervision [31,42], and socially supportive ward cultures [27]. However, challenging or hostile environments were also reported [30], highlighting important contextual variations in clinical learning environments (Table 2).

3.3. Teaching Strategies

3.3.1. Simulation-Based Learning and Reflection

Several studies emphasized simulation as a foundational strategy, often paired with structured debriefing and reflection. Structured reflection and individualized resilience planning have shown positive effects on student preparedness and confidence [25]. When paired with structured debriefing and guided reflection, simulation created safe spaces for students to practice technical skills, process complex scenarios, and build confidence in their abilities. Across the studies, these strategies were shown to enhance students’ preparedness, promote emotional regulation, and foster adaptive responses to clinical stress [25,27,32]. Whether delivered through web-based scenarios or high- and low-fidelity simulations, the inclusion of role play, mentorship, and extended debriefing allowed learners to engage deeply with both the clinical and emotional dimensions of care [26,28]. Repeated exposure through mastery learning further strengthened self-efficacy and reinforced clinical reasoning, highlighting the importance of structured, reflective practice as part of simulation-based education [38] (Table 2).

3.3.2. Emotional and Psychological Skill Building

Several strategies specifically targeted emotional resilience and stress regulation. Life skills training was reported to improve students’ capacity to manage uncertainty and adapt to stress [39]. Poetry therapy provided students with a creative outlet for emotional processing and self-expression ([40]. Mindfulness and reflective practices were used to promote emotional regulation and enhance resilience [41]. Psychological support interventions helped buffer students from emotional exhaustion and supported mental well-being during clinical placements [34] (Table 2).

3.3.3. Communication and Reflective Practice

Teaching strategies also focused on improving communication and fostering reflective practice. ISBAR-based supervision improved students’ ability to communicate clearly and confidently in clinical settings [31]. Formal teaching on communication and reflective practice contributed to students’ self-awareness and interpersonal competence [33]. Reflective workshops created space for students to explore their experiences, process emotions, and develop critical thinking [36] (Table 2).

3.3.4. Experiential and Inclusive Learning

Several studies emphasized experiential, student-centered, and inclusive strategies that promoted both competence and resilience. Experiential learning approaches gave students opportunities to engage with complex patient scenarios and develop problem-solving skills [30]. Inclusive pedagogy fostered equitable learning environments that accommodated diverse needs [29]. Structured mentorship and feedback allowed for personalized learning and adaptive support [35]. The establishment of social support networks strengthened students’ sense of belonging and promoted emotional safety [37]. While supportive clinical environments that emphasized psychological safety and active supervision linking to better learning outcomes [42], mentorship promoted student independence and helped build confidence and transition readiness [43] (Table 2).

3.4. Educator Behaviors

3.4.1. Feedback, Guidance, and Supervision

Effective educator behaviors were essential in promoting both resilience and clinical competence. Structured feedback and guidance allowed students to reflect on their strengths and areas for growth [25]. Supportive clinical supervision, including continuous presence and timely feedback, enhanced students’ confidence and reduced their stress [26,42]. Simulation facilitation guided by experienced educators enabled safe skill development and reflective learning [28]. Bedside supervision contributed to real-time learning and emotional reassurance [31]. Formative feedback, when consistently delivered, strengthened students’ sense of self-efficacy and improved clinical judgment [38] (Table 2).

3.4.2. Facilitating Reflection and Peer Learning

Educators played a central role in encouraging reflection and peer interaction. Facilitating reflection and fostering social support networks helped students make sense of emotionally complex situations [27]. Educators who encouraged peer learning fostered collaboration, mutual support, and team-based problem-solving [32]. Reflective mentorship helped students develop self-awareness and resilience in the face of clinical challenges [36] (Table 2).

3.4.3. Psychosocial Support and Role Modeling

Educators served as both emotional anchors and role models, shaping students’ resilience and professional identity. Proactive emotional support helped students manage stress and maintain motivation during clinical placements [29], while psychological support promoted emotional regulation and coping with adversity [34]. Supportive mentorship fostered safe, growth-oriented environments and strengthened students’ professional identity [35]. By encouraging student-led support networks, educators also promoted connection and resilience [37]. Inclusive and compassionate role modeling contributed to psychologically safe learning spaces where students felt respected and engaged [33,41]. Therapeutic approaches, including life skills training and poetry therapy, supported holistic development [39,40]. Mentorship that emphasized autonomy helped prepare students for independent practice and professional confidence [43] (Table 2).

3.5. Implications for Practice

A consistent recommendation across studies was the integration of resilience-building and reflective practices into the curriculum, highlighting their role in helping students manage stress and develop professional identity [25,27,32,33,34,35,39,40,41]. Structured simulation and clinical supervision were frequently emphasized as effective methods for developing competence and self-efficacy [28,31,32]. Supportive learning environments characterized by mentorship, regular feedback, and psychological safety, were also highlighted as essential for student growth and engagement [26,29,30,36,37,42,43]. Several studies emphasized the need to better align theory with clinical practice through structured support systems and reflective learning opportunities [27,30,36]. In addition, innovations in curriculum design were proposed, including the integration of emotional intelligence training [33], mastery learning approaches [38], and creative modalities such as art-based therapy [40] (Table 2).

3.5. Mediating Factors

Several mediating factors were found to promote resilience and competence in nursing students. Supportive relationships and instructor support were consistently emphasized [26,29,30,31,33,36,37,40,42,43]. Reflective practices and structured debriefings were widely used to enhance self-awareness and coping [25,27,28,32,33,36,39,40,41]. Peer support and engagement further contributed to resilience [29,32,36]. Feedback mechanisms, including frequent, individualized, and formative feedback, also supported learning and confidence [31,38,43]. Conversely, poor interpersonal support and ineffective communication were associated with negative outcomes [30] (Table 3).

3.6. Influence on Competence and Resilience

The studies reported multiple medicating factors influencing competence and resilience. Support and reflection improved student commitment to self-care, coping, and adaptability [25,33,43], and enhanced emotional regulation and interpersonal skills [39,41]. Instructor support and feedback improved self-efficacy and competence [26,31,38], while peer learning and reflective practices strengthened clinical judgment and resilience [32,36]. Technical preparation and debriefing led to higher competence, confidence, and knowledge retention (Curl et al., 2016). Psychological resilience factors mediated stress and improved competence [27,34,35,40]. Work readiness and clinical competence were enhanced through social support and self-regulated learning [37,42] (Table 3).

4. Discussion

This review provides a comprehensive synthesis of how teaching strategies, educator behaviors, and clinical environments coalesce to foster both clinical competence and psychological resilience in nursing students—a dual focus that remains underexplored in prior reviews. By applying Bandura’s SCT, this review uniquely bridges the gap between technical skill acquisition and emotional adaptability in clinical education

4.1. Teaching Strategies and Educator Behaviors

This review highlights that clinical educators play a foundational role in shaping nursing students’ development of both clinical competence and psychological resilience. Consistent with SCT, students learn not only through formal instruction but also through observational learning, where educator behaviors serve as powerful models for clinical conduct, emotional regulation, and communication [14,44]. Educators who consistently demonstrated compassionate care, reflective thinking, and ethical decision-making provided students with concrete examples of how to act under pressure [33,41]. These modeling experiences are central to the development of self-efficacy which is core SCT construct linked to motivation and performance [45].

However, our review reveals that students often encounter fragmented role modeling due to the short duration of clinical rotations and lack of continuity with assigned mentors. This discontinuity weakens opportunities for pattern recognition and relational learning, which are critical to professional identity formation. Compounding this issue, clinical educators frequently report insufficient time, training, and institutional support for their teaching responsibilities [46,47]. Without access to consistent and engaged role models, students may struggle to internalize professional behaviors, undermining their development of confidence and clinical judgment. Addressing these gaps requires deliberate faculty development and better alignment between academic institutions and clinical sites. Structured mentorship programs, protected teaching time, and pedagogical training for clinical staff are essential to create conditions where role modeling can consistently occur and be recognized as a strategic teaching act.

4.1.1. Mastery Learning Through Simulation and Feedback

Simulation-based education, especially when coupled with structured debriefing and reflective dialogue, emerged as a highly effective method for promoting self-efficacy and adaptive coping. These structured experiences allow students to engage in mastery learning, which Bandura identifies as the most potent source of efficacy belief [45]. Simulation offered a psychologically safe environment where students could rehearse clinical decision-making, make mistakes without judgment, and engage in real-time self-assessment [25,28]. As prior studies show, simulation boosts confidence, enhances clinical skills, and reduces stress by providing emotional distance from high-stakes encounters [48,49]. While simulation training and structured feedback have demonstrated strong educational outcomes, implementing these strategies in low-resource settings poses challenges due to cost, staffing shortages, and infrastructure gaps. However, scalable adaptations such as low-fidelity simulations or peer-led debriefings may offer viable alternatives [42]. Addressing contextual constraints is essential to ensure equitable access to resilience-building interventions across diverse clinical education systems.

Consistently, feedback was cited as a critical mechanism for building self-efficacy. Verbal encouragement, formative assessments, and constructive critique function as “verbal persuasion,” a recognized source of efficacy development in SCT [26,31]. When feedback was timely, specific, and affirming, students gained clarity on their clinical strengths and areas for growth, reinforcing their confidence to perform under pressure. Despite its known effectiveness, access to high-quality simulation and educator feedback remains uneven across settings. Institutional investment in simulation labs and formal feedback training should be prioritized to ensure equitable access to these evidence-based strategies.

4.1.2. Social Learning and Peer-Based Resilience

Social learning processes were also central to student resilience. Consistent with SCT’s emphasis on social reinforcement, peer mentoring, group reflection, and interpersonal dialogue contributed to emotional regulation, a sense of belonging, and reduced academic stress [32,36]. Supportive peer networks helped normalize students’ emotional experiences, enabling them to cope more effectively with clinical adversity. These findings align with research showing that peer-based learning environments enhance psychological safety and mitigate burnout risks [27,50,51].

Experiential and creative methods such as role play, mindfulness, poetry therapy, and resilience planning also demonstrated utility in strengthening students’ emotional flexibility and adaptive coping. These approaches helped students process ambiguity, confront uncertainty, and engage in self-regulation, reinforcing the idea that resilience is not innate but can be cultivated through intentional educational design [16,52]. Still, peer-based learning benefits are not automatic. Unequal access to peer support, differences in student openness to feedback, and lack of structured reflection opportunities can limit their effectiveness. Faculty should actively scaffold these interactions through group-based assignments, co-reflection exercises, and routine peer debriefing sessions.

4.2. Clinical Learning Environment

The structure and culture of the clinical learning environment significantly moderated how students developed both competence and resilience. Supportive environments characterized by psychological safety, consistent supervision, inclusive communication, and structured learning activities allowed students to engage confidently and meaningfully with clinical care [53]. When these elements were present, students reported feeling respected, valued, and more integrated into the professional team. Conversely, variability in the quality of placements led to stark differences in student experience. Some encountered emotionally unsafe or disorganized settings that undermined their learning and well-being that aligned with the findings of previous research on the uneven distribution of quality supervision [54]. These disparities underscore the need for standardized preceptor training and institutional mechanisms to monitor the quality of clinical education across placement sites. From an SCT perspective, the learning environment represents the critical third element of Bandura’s triadic model (personal, behavioral, and environmental factors). Without a psychological and pedagogically sound context, neither observational learning nor self-efficacy can be reliably developed. Institutions must therefore view the clinical setting not just as a backdrop for practice, but as an active driver of student outcomes.

4.3. Implications for Nursing Education

Our findings advocate for a shift from traditional competency-based models toward a holistic, resilience-informed framework for clinical education. While competence ensures technical proficiency, resilience safeguards long-term emotional sustainability which are essential in the context of increasingly complex and demanding healthcare systems. To prepare for a future nursing workforce that is both clinically skilled and psychologically resilient, institutions must treat resilience not as a soft skill, but as a core educational outcome. Embedding SCT-informed strategies such as role modelling, simulation, guided reflection, and peer support into national nursing curricula, backed by policy-level investment in faculty development and placement quality assurance, is critical. Doing so will not only enhance student outcomes but also strengthen health system sustainability in the face of growing workforce pressures.

4.4. Limitations

This review has several limitations that should be acknowledged. First, although a comprehensive literature search was conducted, inclusion was limited to peer-reviewed studies published in English between January 2000 and May 2025. This language restriction introduces potential selection bias and may exclude relevant studies from non-English-speaking regions, particularly those in low- and middle-income countries. As a result, the findings may disproportionately reflect perspectives from high-income settings with well-resourced clinical education systems. Second, no formal critical appraisal of study quality was conducted. While this aligns with narrative review methodology, it limits our ability to assess the rigor, credibility, and risk of bias in the included studies. Many relied on small samples, descriptive designs, or self-reported outcomes, which may affect the strength and transferability of the evidence. Future reviews may benefit from applying standardized tools such as the JBI critical appraisal checklists or the Mixed Methods Appraisal Tool (MMAT) to enhance methodological transparency. Third, most included studies were conducted in high-resource environments. The underrepresentation of low-resource contexts limits the generalizability of our findings, particularly in settings where access to simulation, structured supervision, or faculty development is constrained. Fourth, while Bandura’s SCT provided a valuable framework for synthesis, this deductive approach may have limited the emergence of alternative models or unanticipated insights. Broader conceptual frameworks and participatory research approaches may yield a more nuanced understanding in future work. Fifth, neither students nor clinical educators were involved in the design, selection, or interpretation stages of this review. Incorporating their perspectives could have strengthened the contextual relevance, especially regarding the lived realities of clinical education. Finally, most studies reported short-term outcomes. There was limited evidence on the long-term impact or sustainability of interventions aimed at building resilience and competence, which highlights the need for more longitudinal research in this area.

5. Conclusion

This narrative review highlights that clinical competence and psychological resilience are co-constructed outcomes in nursing education, shaped through educator behaviors, targeted teaching strategies, and supportive clinical learning environments. By applying Bandura’s SCT, the review synthesizes how self-efficacy, observational learning, and emotional support enable students to develop both professional capabilities and adaptive strengths. This study presents one of the first theory-informed syntheses that link resilience and competence development through a unified educational framework, addressing a gap in the fragmented literature. The evidence supports a shift away from isolated or informal practices toward structured, resilience-informed educational design. Integrating simulation-based learning with guided debriefing, consistent feedback, reflective practice, and peer-supported learning into nursing curricula can help students manage the emotional demands of clinical work while strengthening clinical reasoning and confidence. These elements are not supplementary but foundational to effective and sustainable clinical education. For institutions, the findings point to clear and actionable priorities. Investing in educator training, protecting time for clinical teaching, and enhancing placement quality are crucial to enabling educators to serve as effective role models and facilitators. Aligning expectations between academic and clinical environments and developing joint supervision models or shared educator roles may further improve continuity and student learning outcomes. Embedding these strategies into national curricula and accreditation frameworks could also promote more consistent and equitable educational quality.

Future research should extend beyond short-term evaluations to investigate the long-term effects of resilience-building strategies. Longitudinal, multicenter studies that reflect diverse cultural and resource contexts are especially needed. Involving students and educators in the co-design and evaluation of interventions will enhance their relevance, feasibility, and impact. Supporting resilience not only strengthens clinical competence but also contributes to student well-being, reduces attrition, and fosters a more emotionally prepared and sustainable nursing workforce. This review provides educators, researchers, and institutional leaders with practical, evidence-informed directions to inform educational planning, policy, and implementation.