As noted in the result section, the mean score of the participants in the SCCQ was higher than the achievable average. It is possible that the proper use of coping styles, the adaptation of clinical environment characteristics with personality traits, and the spiritual view of caring patients have increased the readiness of students to enter the clinical clerkship. Although it is impossible to draw causal conclusions from a correlational study, the evidence suggests having the characteristics that prepare a student to deal with the problems of the clinical clerkship can reduce the "reality shock" and increase the clinical clerkship satisfaction [40].
All the variables presented in the study were positively correlated with the students' clinical clerkship satisfaction despite the fact that neurosis (of personality dimensions) was negatively correlated. Findings are in concert with the previous studies [8, 11, 41].
According to the previous studies and the logical exception, all the correlations with students' clinical clerkship satisfaction were sensibly assumed, except the positive correlation of emotion-focus coping which was presumed to be negative considering the previous literature [42, 43]. However, the use of emotion-focused coping strategies does not always have a negative consequence such as increasing stress. As an instance, under uncontrollable situations, this coping style can be helpful [25]. Due to the low experience of nursing students upon entering the clinical clerkship, they are likely to face many uncontrollable situations that require the use of emotion-focused coping strategy [8, 26]. The temporary use of emotion-focused coping in situations which are not controllable, such as experiencing a heart attack or waiting to undergo a surgery can be beneficial. Nonetheless, the case is different with long-run use of it as a special coping style [25]. As a result, a negative correlation between using emotion-focused coping style in students and satisfaction with their clinical clerkship cannot be taken for granted and the obtained results might be due to the situations in which the participants in the present study faced.
The results of hierarchical regression analysis showed (Hypothesis 1) personality dimensions which were fed in the first step for predicting clinical clerkship satisfaction in nursing students had a significant role. Among the five factors of personality, only extraversion predicted satisfaction with clinical clerkship of intern nursing students. Considering the definition of extraversion [13], students who were sociable, others’ lover and enjoyed talking to patients and also, those who had a tendency to acquire various experiences from their clinical practice, were more satisfied with their clinical clerkship [44, 45]. Nurses who are more extroverted are more likely to participate in teamwork and solve problems with the help of their colleagues. This in turn leads to increased clinical performance [46] and then satisfaction with the clinical course. However, as the length of the clinical clerkship increases, students become more skilled at communicating with patients, other nurses and their supervisors. As a result, they become more extroverted leading to their better performance [8].
The results of regression analysis showed that spirituality predicts satisfaction with clinical clerkship among intern nursing students (Hypothesis 1). In other words, considering the definition of spirituality, the students who found nursing as a meaningful and sacred career were more satisfied with their clinical clerkship. These findings are consistent with the previous studies [23, 47, 48]. The results of one study indicates that Iranian nurses consider helping patients an act of worship and believe that this contribution brings them spiritual rewards [22]. Evaluation of job values and job satisfaction among neophyte nurses [7], revealed "philanthropic" values play an important role in nurses' job satisfaction. Additionally, those nurses who view their job as an opportunity to help others have more satisfaction with their job. It seems that among Iranian students of nursing, some spiritual values penetrate into job values and cause an increase in their satisfaction with clinical practice [48]. Although this finding was expected, it cannot be declared that spirituality is always associated with positive outcomes in caregivers [49, 50] and cannot necessarily predict their satisfaction [50].
Finally, the results showed problem-focused coping can predict satisfaction with clinical clerkship and emotion-focused coping have no role to play (Hypothesis 1). Such a finding is consistent with the available evidence [42, 51]. In line with the definition of problem-focused coping, the students who try to encounter reality shock and the factors producing stress in clinical settings and find a way around it are more satisfied with their clinical clerkship compared with those who are motivated by excitation of stressful events. Students who are able to deal with the problems of the clinical clerkship and use designated problem-solving strategies outperform those who engage in dependent behaviors such as indisputable agreement with the decision made by others. They use knowledge and experience to identify or manage patient care problems, but do not expect the supervisor to solve their clinical problems. Therefore, they have better evaluation about their clinical performance [52]. However, it seems as the length of the clinical clerkship increases, students gain more professional competencies and use more problem-oriented coping [8, 29].
The hierarchical regression analysis showed personality dimensions and spirituality can significantly predict problem-focused coping of intern nursing students (Hypothesis 2). Among the personality dimensions, extraversion and openness could predict problem-focused coping. The findings are consistent with the previous studies [30, 53]. Extraversion, a general tendency to be assertive, is defined as being active and engaging in social interactions. These individuals tend to be cheerful and, therefore, it seems logical to have good relations with others [13] and seek social support as a subpart of problem-focused coping style [25]. Openness (to clerkship experiences) is also defined as the tendency to ponder novel ideas, unconventional values, and divergent thinking [13]. Therefore, it can be assumed that individuals with high scores in openness are flexible, creative, and capable of exploiting a number of more efficient coping strategies to deal with distressing situations [25]. In general, extraversion increases the openness to new experiences in clinical settings by improving the students’ communications with patients, other students and supervisors, thereby allowing students to cope with clinical problems by considering new experiences in a problem-focused manner [53].
It was also found that spirituality predicted problem-focused coping. In other words, students who were able to find meaning and sanctity in their clinical clerkship were more likely to use problem-oriented coping. A few studies have been carried out on the relationship between spirituality and general coping strategies, most of which refer to the role of spirituality as a way to cope with stress as "spiritual coping" [54, 55]. Spirituality can help gather or focus resources on problem solving. Hence, spiritual coping is expected to have a closer relationship with the problem- focused coping [56].
In coping with stress, three roles are considered for spirituality: 1) providing a meaning for life, 2) helping people to have a sense of control in various situations, and 3) improving self-esteem in coping with stressful situations [57].The role of spirituality in predicting problem-focused coping style for nursing students can be justified by the fact that spirituality gives students a sense of control and confidence in working with real patients so that they can seek to find solutions to problems. In other words, spirituality includes a wide range of personal, spiritual and existential beliefs that may be utilized in dealing with stress, leading a person to use problem-oriented coping; therefore, spirituality can improve life satisfaction by increasing the use of problem-focused coping styles. The problem-focused coping strategies can further play a mediating role in the relationship between spirituality and life satisfaction [58].
Finally, the results of regression analyses showed personality dimensions and spirituality were not able to significantly predict emotion-focused coping in nursing students (Hypothesis 3). The findings are inconsistent with the previous studies [38, 53]. This finding can be attributed to students' low use of emotion-oriented coping strategies. Evidence suggests nursing students tend to use more problem-oriented coping strategies in clinical situations than emotion-focused ones [29, 51]. Consequently, regardless of personality traits or spirituality, students may not have a tendency to use emotion-oriented coping strategies. On the other hand, the duration of the clinical clerkship in this study was not controlled while the students with more clinical experience may be more likely to use problem-oriented coping situations than the emotion-focused ones [8].