Empowerment is defined as “the act of strengthening an individual's belief in his or her sense of effectiveness” [1]. The concept of empowerment was adopted by academia because of its great contribution to achieving the optimum goals at the individual and organizational levels. In academia, empowerment refers to the match between the internal factors, “intrapersonal empowerment,” and the external factors, “organizational empowerment,” which facilitates the learning environment and achieves the targeted goals [2]. Empowering organizations as educational institutions is manifested by encouraging activities and creating satisfying learning opportunities for students [3]. Teachers are responsible for creating an empowering environment [4] and building rapport in the teacher-student relationship, which reflects positively on the teaching-learning process [5]. In the clinical setting, clinical educators/instructors are responsible for facilitating and creating learning opportunities. An effective clinical environment is influenced by students' satisfaction with the adequacy of resources and learning opportunities to perform nursing practices and skills, consequently improving their performance and perception of empowerment [6-8].

Empowered students tend to be more motivated and engaged in classroom activities in the learning orientation process [9], have more positive attitudes toward course content that contributes effectively to learning [10, 11], and engage in technology practices in the classroom. The induction of technology into the classroom facilitates meeting students' learning objectives [4]. Moreover, Ahn and Choi (2015) emphasized that the essence of empowerment of nursing students at a clinical placement is to enhance their ability for clinical decision-making, their sense of being valued and respected as learners, their self-esteem, and acquaintance with the complexity of clinical learning skills in the clinical fields, which improve their clinical competencies. Empowered students report higher grades than disempowered students, they are less likely to skip classes, and more likely to participate in extracurricular activities [5]. Furthermore, empowered students perceive themselves as having greater level of self-efficacy and more confidence [12].

Students' satisfaction with the learning process influences their knowledge and skills during the studying years, which also impacts their post-graduate career [12, 13]. Satisfied students are required to meet the community and educational organization's expectations and goals. Also, they are concerned about their perception of the educational environment rather than their perception of the learning process itself. In accordance, it highlights the variation between satisfied and dissatisfied students, which suggests enhancing the teaching strategies [12, 13] and implementing innovative teaching strategies that may positively influence the learning outcomes [13, 14].

Undergraduate nursing students' perception and satisfaction with nursing curricula are strongly influenced by clinical placement, innovative teaching strategies, utilization of technology in teaching, and adequate coordination between faculty and clinical agency staff [14, 15]. Indeed, students' satisfaction improves their engagement and participation in nursing care and creates positive student learning outcomes [16]. For example, Ghanaian undergraduate nursing students reported that during their clinical training within hospitals, they were excluded from performing routine clinical practices and had fewer opportunities for complex and advanced skills, such as the application of physical examinations and nursing process, which reflected negatively on their satisfaction [17, 18].

Nursing students' empowerment has been assessed adequately worldwide. Many studies assessed and reported moderate nursing students' empowerment levels [10, 18-22]. Some of these studies assessed nursing students' empowerment in relation to clinical placement effects [19, 20, 23], classroom effects [5], and the use of technological devices [4].

Despite some regional studies, other studies have also assessed nursing students' learning attitudes and learning outcomes. These studies focused on assessing the learning environment, teaching methods, and learning styles. A Saudi study found that clinical instructors' characteristics influence the sense of belonging of nursing students and motivate them to participate actively with the ward's team in clinical practices and procedures [23]. On the other hand, another Iranian study claimed that nursing students’ readiness for self-directed learning is strongly correlated with their academic achievement. Moreover, the lack of learning opportunities and inconsistency of the educational goals by clinical placement with evaluation methods during clinical experiences negatively influence students’ learning [24].

Several Jordanian studies examined nursing students' clinical learning environment [25], learning-teaching methods [7], factors that may influence learning outcomes [26, 27], teacher-students relationships [28], and nursing students' perceived role towards their clinical instructors [26]. However, no studies focused on assessing students’ empowerment and its influence on learning outcomes. This study assessed undergraduate nursing students' perception of empowerment and its relationship with their academic satisfaction, thus contributing to the body of knowledge regarding the essence of academic environment and resources in the teaching-learning process.

This study aims to assess:

• The perception of empowerment among undergraduate nursing students.
• The relationship between selected demographic variables and perception of empowerment among nursing students.
• The relationship between students' satisfaction with in-class teaching, clinical teaching, program design and delivery, and support and resources and their perception of empowerment.

The hypothetical conceptual model is developed by the researcher based on the literature (Fig. 1). An intrapersonal empowerment definition focuses on the conceptualization of empowerment in relation to a workplace context. Its domains are (1) Meaningfulness: individual's values of his/her tasks to be recognized, the more valuable tasks are, the more tasks suitable in the work setting, (2) Competence: individuals feel confident and able to perform tasks to achieve the desired goals, and (3) Impact: individuals perceive their tasks useful and may make a difference within work setting [2].

Fig. (1). The conceptual model of the relationship between the learners’ empowerment and their academic satisfaction.

It was found that individuals who connect strongly to their working environment perceived themselves as empowered [1, 29].

This model proposes that teaching-learning experiences and learning environments collectively and individually influence the learners' perception of empowerment (impact, meaningfulness, competence). The satisfaction of the teaching-learning experiences consists of in-class teaching, clinical teaching, and program design and delivery. Furthermore, the satisfaction of the learning environment depends on the support and resources for learning. Thus, empowered students have great control over task accomplishment, have motivation, and are confident and self-directed toward learning [4, 10, 30, 31]. The concept of empowerment in the manager-employee relationship was used to indicate the teacher-student relationship [10]. The researcher proposes that learners' orientation to learning is comparable to the employees' attitudes toward the organization, which would influence their perception of empowerment. Moreover, satisfaction with the work environment context and its influence on enhancing the sense of involvement in the organization is considered in the classroom/learning environment in addition to a willingness to participate in work activity and learning-teaching experiences.

A descriptive correlation design was used in this study. This study was conducted at five (3 public and 2 private) Jordanian universities.

The target population of this study was nursing students studying at universities in Jordan. The accessible population was all fourth-year nursing students in Jordan. Multistage sampling was used in this study. The first stage was a purposeful selection of the university with the largest number of students in each region of the country. The second stage was a convenient sampling of the nursing students from the recruited universities to represent the population. The sample size was estimated based on G* power software version 3.0.10. By n=166, the researcher increased the sample size to 184 to consider the attrition.

Ethical approval was obtained from the School of Nursing, University of Jordan. All instruments used in data collection were published and available online for free.

Data were analyzed using the SPSS^® version 22 [34] to answer research questions. A total of 164 fourth-year nursing students completed the instruments with a response rate of 90%.

Descriptive analysis showed the demographics of participants as presented in Tables 1 and 2.

Descriptive analysis showed that the total mean score of nursing students' perception of empowerment was 79.0 (SD=17.35). The obtained range was 0-118, while the theoretical range was 0-140. This indicates a moderate nursing students' perception of empowerment. The highest score of the instruments' subscales was for the impact component (M=35.13, SD=10.35, out of 22-43) (Table 3).

Pearson correlation test was used to assess the relationship between nursing students' perception of empowerment and their academic satisfaction; results showed a statistically significant relationship between the undergraduate nursing students’ empowerment and satisfaction with (1) in-class with r (162) = +.37. P<0.01; the mean score of the in-class subscale was M=56.61, SD=11.12, (2) clinical teaching with r (162) = +.27, p<0.01; the mean score of the clinical teaching subscale was M=54.26, SD=11.37, (3) program design and delivery with r (162) = .26, p<0.01; the mean score of the program design and delivery subscale was M=44.39, SD=7.33, and (4) support and resources with r (162) = .30, p<0.01; the mean of the support and resources subscale was M=31.40, SD=5.74 (Table 6).

Fortunately, the results of this study indicated that Jordanian nursing students perceived themselves as moderately empowered in general and in relation to each subscale: impact, meaningfulness, and competence. The perception of moderate empowerment indicates both that the students in the current study have an adequate internal state to become empowered and that the surrounding situation offers suitable empowering conditions. These results are consistent with those of several other studies across cultural and linguistic contexts using a range of assessment tools [10, 12, 18, 19, 21]. However, Houser and Frymier [10, 35] reported higher general empowerment scores and subscale scores for nursing students in their study.

The highest subscale score was the impact subscale, which was related to students' ability to make a decision during their courses; they might perceive their internal motives and power to make a change or be effective in the course, which was consistent with the total score of the students' perception of empowerment in the following studies; however, highest subscale score was for the meaningfulness subscales in both studies [10, 19].

In this study, male nursing students were found to be more empowered, which was consistent with the results of a study conducted by Burton [36] on undergraduate students’ perception of their own empowerment, capability, and achievement. On the other hand, the results of a study by Kirk et al. [5] contradicted the findings of the current study in that female nursing students were more empowered than male students. This may be attributed to the fact that the Jordanian community is considered male-dominant (masculine), meaning in part that the social context supports males in general, which gives them extra self-confidence and motivation. This difference may also be related to the significant level of physical, psychological, and social stressors for female students during clinical training [37]. According to the United States Agency for International Development (USAID) report Promoting Gender Equality and Women’s Empowerment, in Jordan, females have equal access and opportunity to education as males. Despite political and governmental opportunities and support provided to facilitate women’s engagement and political and social participation, females are still facing many cultural and traditional constraints at the organizational and societal levels [37-39].

Interestingly, the current study’s results showed that nursing students’ perception of empowerment is not correlated with high academic achievement. Another study supports this finding that pioneer students focus on maintaining their academic achievement by working hard on their exams and graded assignments, unlikely empowered students who focus on extracurricular activities, exams, academic works, and graded assignments simultaneously which may explain these results [33, 38].

The results of this study showed a strong positive relationship between participants’ perception of empowerment and their satisfaction with in-class teaching, clinical teaching, program design and delivery, and program resources and support. These results were consistent with a study conducted by Zraa et al. [33], who reported a positive relationship between students’ perception of empowerment and effective classroom activities, suggesting that structured classroom activities make students more confident and motivated. In-class teaching is the primary source of knowledge and information needed to support students’ skills and clinical practice in clinical placements. Educators contribute to an enriched learning experience, for example, by giving examples and telling stories from their own experiences [38-40]. In this study, the students reported that they do participate in activities in the classroom and that they consider the classroom to be a valuable source of knowledge. The results of the current study support those of Houser and Frymier [10], who reported that empowered learners are motivated to take part in meaningful classroom tasks that reinforce the teaching-learning process. Moreover, teachers’ clarity and immediacy, as expressed in teacher-student communication, make students feel more empowered. Therefore, adequate in-class teaching strategies and content are priceless tools for educators because they reduce the theory-practice gap, making students feel more confident and empowered [10].

The results of this study showed a significant relationship between participants’ perception of empowerment and their satisfaction with program design and delivery and with resources and support. The participants reported satisfaction with most of the subscale items, congruent with studies that discussed teaching strategies and their impact on learners and learning outcomes [12, 17, 39-43]. Previous studies have mentioned that emerging teaching strategies to meet educational requirements have a great impact on learning outcomes; students perceive themselves as empowered after attending a simulation program [12] or problem-based learning program [39], as such programs enhance their confidence and improve their competencies. In an educational organization, learners aim to learn within the context of the organizational structure. Access to educational resources has a direct impact on learners’ perception of empowerment. Furthermore, clear and direct access to information in class and clinical teaching, as well as equal opportunity to gain the best available learning experiences, resources, and support from faculty, administrative, and legislative personnel, positively impact learners’ perception of empowerment [21].

Clinical teaching is complementary to in-class teaching in terms of achieving the target learning outcomes. The results of this study indicated a positive relationship between participants’ perception of empowerment and their satisfaction with clinical teaching. Participants reported high agreement with most of the clinical items’ subscale assessing the clinical teaching. Many studies have highlighted the value of effective clinical placement and clinical teaching [6, 25, 44-48]. Sweet and Broadbent [43-45] reported that the qualities of good clinical facilitators include the availability to provide support, respect, communication, reflection, objectivity, passion, and confidence. Moreover, competent clinical instructors enhance nursing students’ perception of engagement in clinical placement [16, 45, 46]. Nursing educators, who have professional competence, use advanced teaching strategies, have theoretical and clinical skills [48-50], and have goal orientation to learning [46, 49, 50] are able to empower their students. The results of previous studies supported the positive relationship between the students' perception of empowerment and clinical teaching.

In accordance with the theory, clinical gaps are reported in many studies; the availability of learning opportunities, the context and environment of clinical placement, and the clinical instructor’s role and characteristics influence nursing students’ clinical training experiences [25, 48]. According to a study [45, 46], clinical learning environments should be prepared and equipped for students to demonstrate proper clinical skills and procedures to promote the clinical experience, enhance students’ sense of belonging, and help them become more competent while performing procedures. Moreover, improving the clinical learning environment tends to enhance new students’ personal capabilities, such as performing professional communication, critical thinking, and problem-solving [50] and help them feel relaxed, motivated, and supported in their clinical placement [7].