Exploring nursing students' perceptions of the clinical learning environment: a sequential mixed-methods study at two Moroccan institutes.

The third phase of the International Study of Asthma and Allergies in Childhood reported that 13.7% of the children worldwide have asthma []. A recent epidemiological survey found that the incidence of childhood asthma in China has reached 3.02%, an increase of 50.6% compared with a previous survey [, ]. Paediatric asthma has a higher incidence of disease recurrence than other chronic diseases, further increasing the existing caregiver burden. In China, there are significant regional variations in prevalence of childhood asthma across the country owing to differences in air pollution, climate, medical resources, and health literacy. Qingdao, an eastern coastal city in China that has undergone rapid industrialisation and urbanisation, has shown 3,69% of bronchial asthma among children [], which is higher than the national average, placing a great burden on caregivers. Recurrent asthma attacks and long-term treatment demands create significant care burden and psychological stress for caregivers []. Caregivers play a key role in the management of asthma in children and are responsible for long-term drug monitoring and symptom management, in addition to meeting the daily needs of family life such as cooking, housework, and tutoring. However, no studies have specifically explored the mental health status of caregivers of children with asthma in Qingdao, or the factors influencing it (such as first-aid knowledge, coping styles, and family function). Understanding these issues in this urban Chinese context can generate evidence relevant to other rapidly developing regions facing similar environmental and healthcare challenges, thereby extending the applicability of our findings beyond Qingdao. According to Pearlin’s caregiver stress model [], caregiver stress is influenced by many factors including environmental factors, stressors, regulatory factors, and caregiver outcomes. Environmental factors include caregiver characteristics (e.g. first-aid literacy, age, education, and income). Stressors are divided into primary and secondary stressors; primary stressors refer to child-related factors (e.g. the child’s age, sex, disease stage, and frequency of asthma attacks) whereas secondary stressors refer to the caregiver’s family environmental factors (e.g. monthly family income, family functioning, and internal family relationships). Regulatory factors refer to coping styles, and caregiver outcomes include mental and physical health. First-aid literacy is defined as individuals’ cognition and ability in providing first aid []. Studies have shown that the incidence of anxiety and depression among caregivers of children with asthma is 23.56%, higher than that for caregivers of children with other conditions []. Recent studies have shown that caregivers’ anxiety can affect their ability to care for children and manage their disease, which is not conducive to asthma recovery []. Since there is substantial evidence that caregivers can induce both negative emotions such as anxiety and depression, and positive emotions such as self-affirmation, in the process of taking care-giving, positive emotions can enable caregivers to cope better with emergencies and manage children’s diseases []. Moreover, caregivers’ knowledge of asthma disease management and first aid positively impact children’s disease recovery and mental health [].