A conceptual framework for interventions targeting stigma associated with academic failure among repeating nursing students in nursing education

Background: Academic failure among nursing students remains a significant challenge within nursing education institutions, often accompanied by stigma associated with academic failure (SAWAF). The SAWAF contributes to adverse psychological, social and academic consequences among repeating nursing students (RNS), potentially affecting their academic progression and professional identity formation. Despite increasing recognition of this issue, limited attention has been given to the systemic and cyclical nature of stigma-structured interventions aimed at addressing stigma within nursing education. Objectives: To develop a conceptual framework that explains and addresses the cyclical nature of SAWAF in nursing education. Methods: Qualitative descriptive design using triangulation. Data were drawn from three qualitative datasets exploring the experiences of RNSs, perceptions of nurse educators (NEs) and non-repeating nursing students. A triangulation approach was used to integrate findings and identify patterns of convergence and divergence. Thematic synthesis informed the development of a conceptual framework comprising root causes, key drivers, impacts and intervention points. Results: The findings revealed that SAWAF is sustained through interconnected institutional policies, NE behaviours and peer dynamics, which collectively contribute to psychological distress, academic underperformance, social exclusion and financial hardship among RNS. The proposed framework highlights NEs’ training, equitable teaching practices and institutional policy reforms as critical for disrupting the cycle. Conclusion: The proposed framework provides an evidence-informed model to guide interventions aimed at reducing stigma, strengthening educator practices and fostering inclusive learning environments in nursing education. Contribution: This study contributes an evidence-informed conceptual framework integrating institutional, educator and peer-level influences on SAWAF and identifying intervention points to disrupt its cyclical reproduction in nursing education.