Perceived importance, self-rated performance satisfaction, learning stress, and practicum experiences among nursing students: A cross-sectional study with supplementary open-ended responses

This cross-sectional study examined nursing students’ perceived importance and self-rated performance satisfaction regarding fundamental nursing practicum competencies, explored learning-stress scores across academic-achievement categories and psychological-counseling history, and descriptively summarized written practicum experiences. All 730 eligible third-year nursing students were invited; 28 did not participate, 702 returned signed consent forms and questionnaires, and 3 incomplete questionnaires were excluded, leaving 699 participants. Importance–performance analysis (IPA) used sample grand means (importance, 4.679; performance satisfaction, 4.503) as crosshairs. Paired importance–performance gaps and 95% confidence intervals were calculated, and 5,000 bootstrap samples assessed coordinate uncertainty and quadrant stability. Exploratory grade-group and counseling-history comparisons used analysis of variance and independent-samples t tests, respectively, with Benjamini–Hochberg false-discovery-rate correction. Exploratory adjusted linear models used heteroskedasticity-consistent (HC3) standard errors. The Core Competence in Fundamental Nursing Practicum Scale importance and satisfaction scores showed very high internal consistency (alpha/omega = .987/.987 and .985/.986, respectively), potentially indicating item redundancy. The nursing-process domain received high absolute ratings but fell below both sample grand means; its importance–performance gap was 0.229 (95% CI, 0.179–0.280). Communication and biomedical-science quadrant classifications were unstable across bootstrap samples, indicating sensitivity to the selected crosshairs. Exploratory analyses using the adapted learning-stress questionnaire showed higher reported stress scores among students in the lowest academic-achievement category. However, maximum-likelihood and ordinal diagonally weighted least-squares confirmatory factor analyses did not support the prespecified two-factor structure, and within-cluster dependence could not be modeled. Counseling-history comparisons were descriptive and did not evaluate counseling effectiveness. All 699 participants answered both open-ended questions; after non-substantive entries were excluded from thematic assignment, 217 non-mutually-exclusive segment-to-theme assignments remained. These findings describe students’ perceptions and exploratory associations rather than observed competence, validated stress constructs, or causal effects.