The concept of nursing is dynamic and constantly evolving to meet the new healthcare demands of patients (Potter et al., 2023, Vujanić et al., 2020). World State of Nursing Report in 2020 called for several key actions to empower nurses and enhance their effectiveness in meeting the health goals of the 21st century, including the establishment of a robust nurse workforce, addressing anticipated shortages, facilitating nurses' active participation in decision-making processes, promoting greater representation of nurses in leadership roles and improving nursing education.

Enhancing the quality of nursing education has been shown to cultivate more idealistic perspectives toward the nursing profession and foster a more professional perception of the nursing role among nursing students (Topola and Miller, 2021). A recent study explored nursing students’ metaphorical perceptions of the nursing concept and the findings revealed that students held positive perceptions of nursing, employing metaphors that reflected important nursing roles and values associated with professionalism (Yılmaz and Güven, 2021). The study conducted by Yılmaz and Ordu (2022) highlighted that nurses, being on the front lines during the restrictions, were perceived as “heroes.” During the COVID-19 restrictions, the image of the nursing profession as having the status and power to directly save people’s lives has further positively affected nursing students' positive attitudes and perceptions towards the nursing profession (Blau et al., 2023, Choi et al., 2020, Foà et al., 2021, Smith et al., 2020, Tolyat et al., 2022). To understand the depth of nursing students' insights, feelings and thoughts about their perceptions of the nursing profession, metaphors have been recognized as one of the most effective linguistic tools. Consequently, the use of metaphors in evaluating the concept of nursing in nursing education by student nurses, who are prospective nursing professionals, may offer a more objective and impartial perspective.

Nursing education comprises both theoretical and practical components that synergistically facilitate the acquisition of knowledge, skills and attitudes by nursing students (Anselmann, 2023, Valizadeh et al., 2019). The practical aspect, commonly known as clinical practice, is a vital element of undergraduate nursing programs, serving as a transitional phase that enables nursing students to embody the role of a “real nurse” (Gökalp et al., 2018, Özsaban and Bayram, 2020, Sönmez et al., 2020). However, according to Abd Elmenem Ibrahim and Fathi Sleem (2021), during the shift from theoretical knowledge to clinical practice, nursing students confront several disparities between their anticipations of the workplace and the actual hospital environment, leading to what they term reality shock. Nursing students encounter a range of challenges and stresses in clinical practice, such as adjusting to clinic routines, experiencing a sense of unfamiliarity, apprehension regarding errors and communication issues with both trainers and clinical staff (Abd Elmenem Ibrahim and Fathi Sleem, 2021, Ching et al., 2020, Öner and Karabudak, 2021). Previous research has consistently indicated that the challenges encountered by nursing students in clinical settings lead to elevated levels of anxiety (Başaran et al., 2022, Öner and Karabudak, 2021, Özsaban and Bayram, 2020). This clinical anxiety has a detrimental impact on the learning and performance of nursing students (Başaran et al., 2022). Additionally, the negative emotions, including anger, sadness and anxiety, experienced during clinical practice can give rise to issues such as "depressive mood, loss of motivation and distancing from the profession" among students (Öner and Karabudak, 2021). The presence of restrictions-related challenges (concerns about infection transmission and dealing with a shortage of necessary equipment, etc.) is believed to have a detrimental impact on student nurses. These challenges compound the difficulties already encountered in clinical practice and hinder the development and acquisition of professional skills and competencies (Fadana and Vember, 2021, Lovrić et al., 2020, Özsaban and Bayram, 2020). Furthermore, the transition from online education to face-to-face clinical practice has been observed to result in students experiencing a lack of self-confidence, anxiety, fear, difficulties with concentration and challenges in adapting to the new learning environment, which collectively pose obstacles to the developmental process of nursing skills (Aslan and Pekince, 2021, Eminoğlu and Duruk, 2023, Karaman et al., 2021). Nursing students encounter greater challenges in adapting to clinical practice during their initial years compared with the third and fourth grades. This difficulty arises from the integration of foundational medical sciences courses in the first year, followed by the incorporation of basic nursing skills and the acquisition of intricate theoretical knowledge in the second year (Can et al., 2019, Jimenez et al., 2010, Karagözoğlu et al., 2014, Papathanasiou et al., 2014; Tastan et al., 2015). These students must synthesize and assimilate this knowledge through direct engagement with individuals afflicted by chronic diseases in practical settings (Admi et al., 2018, Reljić et al., 2019, Sprengel and Job, 2004). It is imperative to identify all these challenging situations of first and second year nursing students (Abd Elmenem Ibrahim and Fathi Sleem, 2021, Aslan and Pekince, 2021, Ching et al., 2020, Eminoğlu and Duruk, 2023, Fadana and Vember, 2021, Lovrić et al., 2020, Öner and Karabudak, 2021, Özsaban and Bayram, 2020) encompassing clinical practice comprehensively, mitigate conflicts and manage stress to facilitate students’ engagement in the nursing profession while enhancing education planning. Moreover, the emotions experienced by students in the context of clinical practice are integral to their learning, professional growth and personal development (Özsaban and Bayram, 2020, Topola and Miller, 2021, Yılmaz and Güven, 2021). Despite existing studies in the literature aimed at understanding the perceptions, feelings and thoughts of future health professionals regarding the nursing profession (Çınar, 2019, Ching et al., 2020, Hsu et al., 2018, Öner and Karabudak, 2021, Özsaban and Bayram, 2020, Özveren et al., 2018), none have employed the "Draw a Picture of a Cactus Test" technique to explore both the metaphorical concepts held by nursing students and their emotional responses to the challenging situations encountered in clinical practice. Another objective of this study was to examine the emotional responses of nursing students when encountered with challenging situations during clinical practice using the “Draw a Picture of a Cactus Test.” It is believed that the cactus drawings created by nursing students through the “Draw a Picture of a Cactus Test” can offer valuable guidance in understanding their emotional states in challenging situations encountered during clinical practice. The study will contribute to the literature, as there is currently no research examining the metaphorical perceptions of first and second year nursing students regarding the concept of nursing and analyzing the emotional states of students in difficult clinical practice situations through picture analysis.