Hrev_master Healthcare in Low-resource Settings 2025; volume 13(s1):13087 Exploring students’ perceptions of Islamic integration in the clinical nursing education curriculum: a descriptive qualitative study Dwi Setiowati, Maulina Handayani Department of Nursing, Faculty of Health Sciences, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia Abstract The integration of religious and spiritual beliefs into the nurs- ing education curriculum is an effort to build the characteristics of nurses as they become professionals. This study aimed to explore the experiences of nursing students who had undergone Islamic integration. The study employed a descriptive qualitative method, including five clinical nursing students selected through purposive sampling and interviewed online. Three main themes emerged from the data regarding the implementation of Islamic integration in the clinical nursing curriculum. The three themes included chal- lenges in implementation, factors supporting successful imple- mentation, and impact on students. Students face challenges in implementing Islamic integration principles, including resistance to change, limited understanding, and insufficient resources. However, with personal commitment, mentorship, and a support- ive environment, successful implementation leads to increased self-awareness, improved ethical decision-making, and enhanced empathy in patient care. Integration requires committed educa- tional effort from all academic staff, which necessitates continu- ous monitoring, mentoring, and habituation of integration prac- tices as part of an ongoing process. This ensures that the integra- tion of Islamic principles into the nursing curriculum is not only theoretical but also practical and transformative. Introduction Clinical nursing students are fully employed in practical health settings, such as hospitals. However, unlike nurses who already have full authority to treat patients, students are often required to behave in the same manner as professional nurses.1 Nurses have yet to demonstrate an increase in the quality of nurs- ing care. Lack of responsibility, sincerity, self-awareness, and pro- fessionalism indicate poor quality nursing care in the healthcare system. Thus, when students play a crucial role in contributing to patient safety issues, their contribution is significantly influenced by the implementation of clinical education.2 Student character building in higher education can be achieved through a science integration learning model,3 which requires nurses to have spiritu- al, interpersonal, and intellectual competencies. Spiritual care is a holistic reflection of nursing education.4 A previous study found that student perceptions affected individual values, suggesting a form of spiritual training and simulation in spiritual care-based learning scenarios.5 Spiritual intelligence strengthens the beliefs and personalities of nurses and their desire to grow, learn, and work more professionally to improve the quality of nursing.6 Religion was the most significant determinant of self-efficacy, capital of good self-control, and firm conviction in completing tasks and achieving goals. The higher the level of religiosity and social support, the easier the students will adapt.7 The comprehen- sion and interpretation of religious teachings is believed to play a role in the quality of interactions with adherents of other religions.8 Education is essential for nursing students’ spiritual care com- petence. Clinical nursing education is one of the components of nursing education conducted in a clinical setting, involving real situations, teaching, and learning processes in the clinical setting.9 Correspondence: Dwi Setiowati, Department of Nursing, Faculty of Health Sciences, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia. E-mail: dwi.setiowati@uinjkt.ac.id Key words: clinical nursing, education, Islamic integration, student per- ception Contributions: DS, conceptualization, data curation, formal analysis, methodology, validation, visualization, writing – original draft, review & editing; MH conceptualization, investigation, methodology, validation, and writing – original draft, review, and editing. Conflict of interest: the authors declare that they have no conflicts of interest. Ethical approval and consent to participate: the results of the researcher's ethical test were carried out first to the Ethics Committee of the Faculty of Health Sciences of Universitas Islam Negeri Syarif Hidayatullah with letter number: Un.01/F.10/KP.01.1/KE.SP/04.08.008/2023. During the research, the researcher paid attention to the ethical principles of infor- mation to consent, respect for human rights, beneficence, and non-malef- icence. Patient consent for publication: written informed consent was obtained from the anonymized patients for publication in the study. Funding: this research was supported by a research grant in 2023 from the Research and Publishing Center (PUSLITPEN) Universitas Islam Negeri Syarif Hidayatullah Jakarta with contract number: UN.01/KPA/ 189/2023. Availability of data and materials: all data generated or analyzed in this study are included in this published article. Acknowledgement: we would like to thankful to the research team would like to thank to the Research Center of Universitas Islam Negeri Syarif Hidayatullah, Kulliyah of Nursing International Islamic University Malaya (IIUM), clinical nursing student as respondent and all participant for their valuable insights and contributions to this study. Received: 12 September 2024. Accepted: 16 January 2025. Early access: 28 February 2025. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2025 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2025; 13(s1):13087 doi:10.4081/hls.2025.13087 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any prod- uct that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [page 68] [Healthcare in Low-resource Settings 2025;13(s1):13087] Education still has suboptimal learning; training in student spiritu- ality is less important than training in spiritual interventions.10 Students need to prepare for spiritual care, and education in spiri- tual care contributes to those conditions.11 The nursing curriculum should include spiritual care courses or training.12 This is important in implementing Islamic integration, which is supported by research results indicating that the three main focuses of Islamic medicine are healthcare practitioners’ attitudes and personalities, clinical decision-making, and providing comprehensive spiritual care. When it comes to incorporating Islamic ideals into profes- sional practice, there are still many gaps and discrepancies, such as unpreparedness, distrust, role models, and environmental support. It is necessary to put more effort into developing and establishing a framework for all-encompassing Islamic medical practice.13 Integration-based curriculum changes require significant changes in terms of thinking and implementation. Integration into the nursing curriculum was carried out by formulating the nursing school’s vision and mission, continuing the vision and mission of the faculty and university, and describing the learning outcomes of the courses. Collaboration with Kulliyah of Nursing International Islamic University Malaya (KoN IIUM), namely sharing sessions from expert curriculum integration lecturers regarding the imple- mentation of ancient integration in the nursing curriculum at KoN IIUM with the head of the study program and several lecturers at the Syarif Hidayatullah State Islamic Univesity’s nursing school, then a review of the clinical nursing course guide was carried out by the research team, the lecturer in charge of the course and the Usluhudin lecturer at UIN Jakarta. A positive and significant rela- tionship exists between the science integration learning model and the formation of students’ Islamic character at Islamic universities in Indonesia and Malaysia.3 Implementation of integration by say- ing bismillah in learning activities both before and after, as well as the preparation of Islamic and scientific integration guidelines at the Faculty of Health Sciences since 2022 and on learning out- comes, study materials for each course in the Islamic integration curriculum. The integration of Islam and nursing in the nursing curriculum qualitatively suggests the need for assistance and col- laboration with Islamic experts in compiling the curriculum and the learning process to determine learning outcomes.14 The data indicate that only 52% of clinical nursing students in the integration curriculum at Syarif Hidayatullah State Islamic University Jakarta and Alaudin State Islamic University Makassar performed Islamic nursing care well.15 Clinical students’ commu- nication skills and spiritual awareness still require improvement to address this issue. Research shows no differences in perceptions of spiritual care between general nursing students and those from Islamic religious background.16 The literature on spiritual care in nursing applications, particularly in education, remains unclear,17 and the results of the study show that even though nursing students have good spirituality, they are still not good at implementing spir- itual care.18 Research on the integration of religion, particularly Islam, into nursing remains limited and largely perception-based. This gap necessitates further exploration of the data and interven- tion effectiveness in integrated nursing clinical education. A cur- riculum workshop at UIN Jakarta Nursing highlighted that 30% of the students lacked confidence in providing spiritual care, primari- ly because of their focus on physical aspects. Despite the integra- tion of Islamic courses into the nursing curriculum, this disparity persists, underscoring the need for improved clinical education strategies to enhance student confidence and competence in spiri- tual care. While integration guidelines were developed in February 2022, their implementation across programs, including nursing, remains unmonitored. Data from IIUM researchers indicated sim- ilar challenges in integrating Islam into nursing education in Kulliyah of Nursing. No prior studies have explored Islamic inte- gration in nursing education through inter-university collaboration, particularly with IIUM. This study examined IIUM’s experience with Islamic integration and evaluated the impact of the Islamic integrated professional course guide on clinical nursing students before and after the intervention. Materials and Methods Design This study employed a descriptive qualitative approach to explore clinical nursing students’ perceptions of Islamic integra- tion into the nursing education curriculum. The research was con- ducted during the Family Nursing Clinical Course, which is a two- week clinical practice period. This study was conducted in collab- oration with Kulliyah of Nursing, International Islamic University Malaysia (IIUM), and lecturers from the Ushuluddin Faculty of Syarif Hidayatullah State Islamic University, who contributed to the development of an Islamic Integration Guidebook for clinical nursing practice. This collaboration played a key role in shaping the curriculum framework implemented during the Family Nursing Clinical Course, a two-week clinical practice period in which stu- dents applied Islamic-integrated nursing principles in real clinical settings. Population, sample, sampling technique The study population consisted of 66 clinical nursing students from Syarif Hidayatullah State Islamic University, who were undergoing clinical practice in the Family Nursing Clinical Course. The study employed Purposive sampling was used to select five students who met the study criteria and had direct expe- rience with Islamic integration in clinical nursing education. All participants provided informed consent before data collection. A small sample size was chosen because of the qualitative nature of the research, which prioritizes in-depth insights rather than numer- ical generalizability. Additionally, practical constraints such as academic schedules, availability, and the feasibility of conducting detailed qualitative interviews influenced the selection process. Despite the limited number of respondents, thematic saturation was achieved, ensuring that no new themes emerged, and that the data were sufficiently rich for analysis. Phenomenon The phenomenon in this study was the perception of Islamic integration in the clinical nursing education curriculum. Instruments Data were collected using a semi-structured interview guide developed in consultation with Islamic integration experts and aligned with Islamic Integration Book Guidelines of the Faculty of Health Sciences. The guide consisted of ten open-ended questions designed to explore key themes, including the application of Islamic integration in family nursing practice, the role and effec- tiveness of guidebooks, the influence of academic and clinical mentors, students’ personal reflections on changes in attitudes and professional behavior, and the challenges faced in implementing Islamic integration in clinical nursing practice. The interview guide ensured a structured yet flexible approach, allowing for the consistent exploration of themes while accommodating individual variations in responses. Special issue Pathways of Change [Healthcare in Low-resource Settings 2025;13(s1):13087] [page 69] Data collection process Data were collected through semi-structured interviews, con- ducted online via Zoom, with five clinical nursing students who provided informed consent prior to participation. Each interview lasted approximately 30–45 minutes and was facilitated by the researcher to ensure a comfortable and open discussion environ- ment. The interviews were audio-recorded with participants’ per- mission and later transcribed verbatim for analysis. Source triangu- lation was applied to maintain data credibility by comparing responses across participants. During the two-week Family Nursing Clinical Course, students engaged in Islamic-integrated nursing care under the guidance of academic supervisors and clin- ical instructors who provided continuous support and evaluation. The implementation process included sharing sessions with men- tors, a review of clinical nursing course guidelines, and structured mentoring sessions to ensure that students applied Islamic values in their clinical practice. Data analysis The data were analyzed using thematic analysis following a structured approach to ensure a systematic and meaningful inter- pretation of the findings. First, audio-recorded interviews were transcribed verbatim and the transcripts were carefully read and re- read to gain an in-depth understanding. Next, data organization was conducted by identifying the codes and categories that emerged from the responses. These codes were then grouped into themes and subthemes representing key aspects of students’ per- ceptions of Islamic integration in clinical nursing education. The process involved data reduction, categorization, and interpretation, allowing for a clear synthesis of the findings. To enhance credibil- ity and trustworthiness, source triangulation was applied by com- paring data across participants to ensure consistency and reliability in emerging themes. The final step involved verifying and summa- rizing the results, ensuring that the analysis accurately reflected the participants’ experiences and insights. Ethical clearance The results of the researcher’s ethical test were carried out first to the Ethics Committee of the Faculty of Health Sciences of Universitas Islam Negeri Syarif Hidayatullah with letter number: Un.01/F.10/KP.01.1/KE.SP/04.08.008/2023. Results These data were supported by the results of informant inter- views. The following is a detailed explanation of these themes. Theme 1: Barriers during the implementation The findings indicated that clinical nursing students encountered several barriers to implementing Islamic integration during their family nursing practice. One of the primary obstacles was patient-and family related factors, particularly when the patients and their families were non-Muslim. Another barrier included a lack of family support for patients, Participants reported that they could not fully implement Islamic-based nursing care in these cases, as the patients and their families were not receptive to religiously integrated interventions. Additionally, the perceived status of students as trainees led to resistance from patients and their families. It was conveyed by the informant as follows: « The obstacle is when a family (and patients) is not Muslim, so we cannot apply Islamic integration…” (Informant 2) “… They ignored us while we were providing nursing care. The family chose not to be involved with students…” (Informant 3) Theme 2: Successful implementation of the pro- gram The findings indicated that despite various challenges, students were able to successfully apply Islamic integration in family nurs- ing practice under certain conditions. Participants highlighted sev- eral factors that facilitated the implementation of Islamic princi- ples, including the availability of guidebooks, role of academic and clinical mentors, and competence of supervisors.. The following explanation is provided in detail based on the following sub- themes. Books guide integrated Islam One of the key facilitators was the Islamic integration guide- book, which provides clear instructions on how to incorporate Islamic values into clinical nursing practice. The participants found the guidebook helpful and comprehensive, making it easier to align their nursing care with Islamic principles. « According to the guidebook, this is helpful. The content was clear, complete, and served as a structured guide for students when practicing in the field. The learning outcomes are also very clear, and from the beginning, we are reminded to be God-conscious (taqwa) to Allah.» (Informant 1) «. This is very helpful for the students. Besides serving as a guide, this book also becomes a practical material for students when they directly engage in applying Islamic-based nursing care.» (Informant 3) Role of academic and clinical mentor Another crucial factor was the role of the academic and clinical mentors who provided support, guidance, and reinforcement dur- ing clinical practice. Academic and clinical role mentors make it easier for students to integrate Islam during the practice profession nursing family. Five participants explained that role mentors as academic and clinical are already very comprehensive and impor- tant in helping students when practicing in the field. «.. My academic supervisor has been very supportive and always gives direction. During practice, the supervisor takes the time to visit the field and reminds us about etiquette and behavior that reflect Islamic values.” (Informant 3) «The clinical supervisor was always there to remind us to take notes during data retrieval, ensuring that it did not interfere with prayer times or moments of Quran recitation, except at the end of the event.» (Informant 1) “ Guidance from mentors helped students and made it easier for us to practice professionally…. Also, the clinical instructor helped us to ensure that Islamic values were integrated into nurs- ing care delivery.» (Informant 5) The ability of qualified academics and clinical supervisor The competence of both mentors and academic and clinical supervisors plays a significant role in facilitating Islamic integra- tion. The participants noted that well-trained supervisors could guide them effectively, ensuring that Islamic principles were easier to apply in a professional and ethical manner. « The ability of academic mentors to provide instructions is very good…… Clinical supervisors also directly guide students during practice.» (Informant 3) “ The role of academic mentors is essential as they provide Special issue Pathways of Change [page 70] [Healthcare in Low-resource Settings 2025;13(s1):13087] detailed explanations regarding the application of Islamic integra- tion in professional nursing family practice. The ability of clinical supervisors is also very good….” (Informant 4) Theme 3: positive impact to the students The findings indicated that the application of Islamic integra- tion in family nursing practice contributed to positive changes in students’ knowledge, attitudes, and behavior. These changes were observed in their self-awareness, ethical decision making, and con- fidence in applying Islamic-based nursing care. Knowledge The participants reported that the integration of Islamic princi- ples into their clinical practice enhanced their understanding of Islamic values in nursing care. They became more aware of the importance of spiritual aspects of patient care. « I have gained a deeper understanding of Islamic values in family nursing practice. .» (Informant 4) «..... Now, I know what actions are beneficial and what I should avoid ensuring my practice aligns with Islamic teachings” (Informant 5) Attitude Participants also experienced changes in their attitudes, partic- ularly regarding how they interacted with the patients and their families. They became more respectful and mindful of their diverse values and beliefs, demonstrating an improved sense of professionalism. « I always remind myself that my attitude is assessed by others. Islam teaches us to have good behavior, which will be well received by people around us.» (Informant 3) « I always try to apply religious attitude to patient, because its helpfully for us in practice nursing, its make us to appreciating dif- ferent values, beliefs, needs in accordance with mark Muslim.» (Informant 4) In addition, participants reported that Islamic integration increased their self-confidence in providing patient care as they were able to align their clinical practice with their faith. « I feel more confident because I have had many interactions with the public during practice.» (Informant 2) « I become more believe myself, and ready for do application integration at the next course.” (Informant 4) Behavior changes The integration of Islamic values also influences students’ daily behavior in clinical settings. Participants reported that they applied Islamic principles in their nursing practice, such as offer- ing spiritual support to patients and promoting healthy habits. « I always motivate patients to maintain a clean and healthy lifestyle, and also try to give spiritual support for patients like prayer, patience, be sincerity and reminding them to engage in worship.» (Informant 4) «… Before performing nursing care, I always start with ‘Bismillah’ (in the name of Allah) and conclude by hamdalah (thanking God).» (Informant 5) Discussion Clinical nursing learning develops professional skills, critical thinking, confidence, and independent decision making based on the Indonesian clinical nursing education curriculum. This curricu- lum guides teaching and learning in higher education. Nursing graduates serve as care providers, educators, managers, researchers, and communicators.19,20 Integration in nursing views humans as multidimensional beings who respond to health and ill- ness. Academic habituation shapes Islamic care in nursing stu- dents.21 Students in Islamic universities in Indonesia and Malaysia develop Islamic characteristics alongside scientific learning.3 A similar study found that nursing students in UIN Syarif Hidayatullah studied curriculum integration in clinical practice.22 The Al Islam and Muhammadiyah subject variables influence ante- natal care provided by clinical students.23 Integrating Islamic values into clinical nursing education pres- ents challenges, especially in diverse settings, with patients and families of different religious backgrounds. This aligns with stud- ies highlighting cultural and religious differences as obstacles to implementing faith-based healthcare practices.24–27 Students often face resistance from patients’ families because of their trainee sta- tus, which leads to a lack of recognition during nursing. Literature emphasizes that students sometimes struggle with patient trust due to perceived inexperience.28 The lack of family support compli- cates integration, as families play a crucial role in patient care, and their reluctance to engage in religious-based interventions limits their ability to apply Islamic principles in practice.29 These find- ings indicate efforts should focus on strengthening cultural compe- tence training, providing strategies for diverse patient interactions, and developing policies supporting inclusive nursing educa- tion.14,30 Implementing mentorship programs, enhancing collabora- tion between nursing educators and Islamic scholars, and provid- ing psychological support for students may help address barriers and ensure effective Islamic integration into nursing practice in diverse clinical settings.31,32 This study found students successfully applied Islamic integra- tion in clinical practice with structured guidelines, mentorship, and supervision. The Islamic integration guidebook provided clear directions for incorporating Islamic values into nursing care, which students found beneficial. Previous research underscores the role of structured materials in facilitating the application of spiritual and religious principles in healthcare settings,12,14,30,33 emphasizing the necessity of instructional tools in religious and ethical integra- tion within professional education.34 Academic and clinical men- tors are crucial for guiding students through the integration process. Studies have shown mentorship and role modeling signif- icantly influence students’ professional behaviors and ethical deci- sion-making.35–37 Effective mentorship ensured students received professional support for maintaining ethical and religious prac- tices, aligning with literature on the importance of strong mentor- mentee relationships in shaping professional identity and satisfac- tion.38–40 The competence of academic and clinical supervisors affected the success of Islamic integration, as well-trained mentors provided effective guidance in aligning clinical practice with Islamic principles. However, challenges, such as curriculum incon- sistencies and the need for ongoing support remain.41–43 Addressing these barriers through structured policies, continuous training for supervisors, and enhanced collaboration between nursing educa- tors and Islamic scholars are essential for sustaining successful integration of Islamic values in clinical nursing education. Integrating Islamic principles in nursing practice improved stu- dents’ knowledge, attitudes, and behaviors, enhancing professional development and ethical decision making. Students better under- stand Islamic values in patient care, promoting a holistic approach. This aligns with studies showing that religious and spiritual educa- tion in healthcare improves compassionate, patient-centered care.44,45 The knowledge gained deepened students’ understanding Special issue Pathways of Change [Healthcare in Low-resource Settings 2025;13(s1):13087] [page 71] of spiritual aspects of patient care, reinforcing holistic approach- es.24,46 Changes in attitudes, such as increased respect, mindful- ness, and professionalism, align with studies suggesting that inte- grating religious principles fosters empathy and ethical sensitivity among healthcare professionals. Research shows that spiritual intelligence fosters ethical professionalism and moral sensitivity, and improves patient interactions and satisfaction.6,26,47–49 Integration also boosted students’ confidence in providing nursing care by incorporating Islamic principles. Research has shown that Islamic caring enhances the psychospiritual comfort and prepared- ness of nurses.50,51 Behavioral changes, including the incorporation of spiritual support and ethical considerations in patient interac- tions, indicate that Islamic integration translates into practice.14,52 The nursing education system should address the spiritual well- being of its students.53 This topic is crucial for preparing nursing students to provide spiritual care in a clinical context.2,54 Challenges remain in ensuring sustainable integration, such as the need for structured policies, collaboration between nursing and Islamic scholars, and continuous monitoring.41,42,55 Addressing these barriers is essential to maximize the benefits of Islamic inte- gration in clinical nursing education and create a culturally compe- tent nursing workforce. Conclusions The integration of Islamic principles into clinical nursing edu- cation presents both opportunities and challenges. This study found that while students encountered barriers such as patient resistance and trainee status, structured support systems—guide- books, mentorship, and supervision—facilitated implementation. Islamic integration in clinical practice enhanced students’ knowl- edge, ethical decision-making, and confidence in patient-centered care. However, challenges persist, including inconsistent curricula, limited family support, and the need for institutional guidance. Sustainable integration requires structured policies, educator train- ing, and collaboration with Islamic scholars. Future research should assess long-term impacts on professional practice and patient outcomes to refine curriculum development. References 1. Sukartini T, Asmoro CP, Pradana FA. The factors related to the caring behavior of clinical nursing students. J Ners 2019;14:82–6. 2. Sari DWP, Arief YS, Ahsan A. The relationship between clini- cal education and nursing students’ patient safety competen- cies. 2024;22. 3. 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