Nursing Students' Perceptions, Challenges, and Barriers in Applying the Nursing Process During Clinical Training in Cambodia: A Cross-Sectional Study.

Background: The nursing process is a systematic framework for delivering safe, individualized patient care and is embedded within nursing curricula in Cambodia. Nonetheless, empirical evidence examining nursing students' experiences when applying this framework during clinical training remains scarce. Objective: To examine nursing students' perceptions of the nursing process and to identify the practical challenges and organizational barriers encountered during clinical practice at a private university in Phnom Penh, Cambodia. Methods: A cross-sectional online survey was conducted among 170 nursing students with confirmed clinical experience enrolled in ADN and BSN programs at the University of Puthisastra. A structured self-report questionnaire assessed perceptions (12 items), challenges (10 items), and barriers (10 items). The instrument demonstrated strong content validity (S-CVI/Ave = 0.93) and acceptable internal consistency (Cronbach's α = 0.82-0.88). Results: Participants reported positive perceptions (mean = 3.93 ± 0.68), with 81.6% agreeing that the nursing process facilitates better clinical decisions. Moderate challenges were reported (mean = 3.32 ± 0.68), principally patients' inability to provide sufficient assessment information (56.1%), documentation variability across hospitals (50.9%), and difficulty obtaining consent for physical assessment (48.6%). Perceived barriers were lower (mean = 2.79 ± 0.91), with heavy workload (30.2%), insufficient background knowledge (28.8%), and limited role modeling (28.3%) most frequently identified. BSN students reported significantly higher perceptions than ADN students ( Conclusion: Nursing students hold favorable views of the nursing process but face substantive practical and organizational constraints during clinical training. These constraints are mainly related to patient assessment limitations, variability in documentation systems, workload pressures, and limited role modeling and clinical support. The findings highlight the need for standardized documentation and strengthened clinical mentorship, as well as improved collaboration between academic institutions and clinical settings. They also suggest that simulation-based learning, flipped classroom approaches, technology-enhanced education, and family-centered communication training may be considered as potential strategies in future curriculum development to address the identified gaps. Further multisite research, including public and provincial institutions, is recommended to enhance generalizability.