What factors facilitate good learning experiences in clinical studies in nursing: bachelor students' perceptions

Practice, Experiences, and Facilitators of Simulation-Based Training During One Year of Implementation in 30 Hospitals in Tanzania

Introduction

Enhancing the proficiency of healthcare workers (HCWs) in handling birth-related complications is crucial for reducing maternal and newborn morbidity and mortality. To achieve this, the Safer Births Bundle of Care offers a comprehensive set of innovative, simulation-based training interventions designed to strengthen the skills and competencies of HCWs working as skilled birth attendants.

Objective

To describe the use of in-situ low-dose, high-frequency simulation-based training, and the experiences of this usage among HCWs and stakeholders at facilities in Tanzania.

Methods

This mixed-methods study included quantitative and qualitative data collected between July 2021 and July 2022 across 30 health facilities in five regions of Tanzania. NeoNatalie Live (NNL) simulators were installed for independent skills and scenario training, and in-situ facilitator-led team simulations were introduced. The training frequency was analyzed using descriptive and analytical statistics, and mentorship and supervision reports were analyzed using qualitative content analysis.

Results

A large and sustained number of in-situ NNL skill-training sessions (n = 35,101) and facilitator-led team simulations (n = 266) were conducted during the first year. Clinical burden per HCW did not affect the frequency of NNL skills training at the health facility level (r = -0.16, p = .40) nor facilitator-led team simulations. There was a positive but weak correlation between the frequency of facilitator-led team simulations and NNL skills training (r = 0.34, p = .05). Qualitative data showed a high degree of motivation and participation among all stakeholders, and active use of hospital data, both clinical indicators and training data, was perceived as a success factor.

Conclusion

Facilitator-led in-situ simulation training was more likely to occur where individual skills-training sessions were recorded. Training sessions took place regardless of the increased workload.

Improving the quality of clinical training in maternal and neonatal health in undergraduate nursing students: a participatory action research

BACKGROUND

Improving the quality of clinical training is synonymous with accomplishing nursing education goals and improving the quality of nursing care. This study aimed to improve the quality of clinical training in Maternal and Neonatal Health (MNH) in nursing students.

METHODS

This action research was conducted in two cycles from June 2017 to June 2018. The study setting was the School of Nursing and Midwifery of Lorestan University of Medical Sciences in southwest Iran. The participants were nursing students, faculty members, clinical trainers, educational managers, and teaching personnel. In the first cycle, semi-structured interviews were held with stakeholders to identify clinical problems and improvement strategies. Based on the results of these sessions, the changes needed to improve the quality of clinical training were planned and implemented. The weaknesses and strengths of the implemented changes were then identified through group discussions with the stakeholders. In the second cycle, a second plan was carried out to correct the weaknesses of the changes planned in the first cycle, and the modifications were implemented and evaluated.

RESULTS

The main three categories extracted included an unsystematic curriculum and inadequate monitoring, inadequate resources and facilities, and the student's lack of motivation. The measures taken for improvement included holding communication workshops, developing and internalizing logbooks, reducing the number of students in clinical training groups, using modern clinical training methods, and changing clinical evaluation methods.

CONCLUSION

Improving communication skills among the students, trainers, and hospital personnel and using modern clinical training methods, such as conceptual maps, triple jumps, and clinical skill centers, are the best strategies for improving clinical training in MNH nursing students.

Strategy actions to include students in a private hospital's nursing teams: A qualitative study

Background

Student nurse education focusses on preparing competent professionals integral to nursing teams.

Aim

To develop strategic actions to include student nurses within the nursing team.

Setting

A private healthcare group in South Africa.

Methods

A qualitative approach in three phases was used. Thirty purposively sampled participants recorded reflective journals in phase one. Tesch's eight steps were utilised for analysis. Phase two involved non-probability volunteer sampling of 11 participants for the nominal group technique analysis. In phase three, total population sampling recruited nine panellists for an e-Delphi technique that provided data that were open coded.

Results

Phase one identified themes, including perceptions of responsibilities, support needs, recognition, conflict and communication issues. Phase two revealed five strategic actions: fair treatment, aligned work allocation, active participation, respect and acknowledgement of contributions. Phase three validated 19 strategic statements underpinning the strategic actions.

Conclusion

Unit managers play a key role in fostering inclusivity, impacting student nurse retention.

Contribution

Enhancing team cohesion can improve workplace wellness and patient outcomes while aiding in retention and recruitment efforts.

"Safety Means Everything": An ethnographic methodology to explore the formation of professional identity in nursing students

AIM

The aim of this qualitative study is to explore how various conditions within educational contexts impact nursing students' experiences of becoming professional nurses and how these conditions affect their agency and the formation of their professional identities.

BACKGROUND

Nursing education is essential to becoming professional and competent in caring for patients. A strong professional identity in nursing contributes to better patient outcomes and improves the well-being, retention, and recruitment of practitioners in the health care system. At the same time, research indicates that development of a professional identity during education is challenging and needs further investigation.

DESIGN

The qualitative research design draws on the theoretical and methodological framework of critical psychology practice research. The practice research design and close collaboration with users ensure the continuous development and implementation of theory and practice.

METHODS

The data used in this study originated from ethnographic fieldwork, which involved following two nursing students through their final clinical placement training at the Geriatric Department of a university hospital in Denmark. Additionally, nursing students in two classes were observed as part of their nursing education practice at a university college from April to July 2022. The participant observational design, combined with in-situ interviewing, facilitated a comprehensive understanding of the students' engagement in social practices and interactions within the context of nursing education.

RESULTS

Our results show how the conditions of nursing students' everyday lives have a critical impact on their self-understanding and journey to becoming competent and professional nurses. Three main themes emerged from the analysis: (1) Perception of safety, (2) Motivation for learning in different communities of practice, and (3) The meaning of learning culture and role models.

CONCLUSION

The development of nursing students into professionals is profoundly influenced by factors affecting their ontological safety that are deeply embedded in socio-cultural and educational contexts. The results underscore the need to foster ontological safety in nursing education. Creating safe, participatory, and supportive learning environments is essential to the holistic development of students into caring, competent nurses. Educators and stakeholders must remember their crucial role in this context and focus on establishing these environments to facilitate students' sense of belonging in the nursing profession.

TWEETABLE ABSTRACT

The development of professional identity in nursing starts with safety. Ontological Safety in learning environments ensures competent and professional nurses. #NursingEducation#Safety#ProfessionalIdentity.

Development and validation of satisfaction with clinical practice questionnaire for mentors and students

OBJECTIVES

To develop and validate a questionnaire on satisfaction with clinical practice for mentors (QSCP-M) and a questionnaire on satisfaction with clinical practice for students (QSCP-S).

METHODS

Two versions of the questionnaires were constructed: a version for mentors and a version for students. Both surveys were conducted at two time points. The first survey was completed by 252 students and 86 mentors, and the second by 291 students and 94 mentors.

RESULTS

Several exploratory factor analyses were performed on the results obtained, and two factors were identified for the QSCP-M and one factor for the QSCP-S. The coefficients of internal reliability for both questionnaires indicated stable and reliable measuring instruments.

CONCLUSIONS

Clinical practice satisfaction questionnaires for mentors and students showed good metric characteristics. The validation shows that both questionnaires are appropriate for examining general and specific satisfaction with clinical practice.

A Technology-Supported Guidance Model to Increase the Flexibility, Quality, and Efficiency of Nursing Education in Clinical Practice in Norway: Development Study of the TOPP-N Application Prototype

BACKGROUND

The challenges of nursing shortage in the nursing profession and of limited nursing educational capacity in nursing education in clinical practice need to be addressed to ensure supply according to the demand of these professionals. In addition, communication problems among nursing students, nurse educators, and nurse preceptors; variations in the guidance competence of nurse preceptors; and limited overview from nurse educators on nursing students' clinical practice are common challenges reported in several research studies. These challenges affect the quality of nursing education in clinical practice, and even though these problems have been highlighted for several years, a recent study showed that these problems are increasing. Thus, an approach is required to ensure the quality of nursing education in clinical practice.

OBJECTIVE

We aimed to develop a guidance and assessment application to meet the challenges reported in clinical practice. The application intended to increase the flexibility, quality, and efficiency of nursing education in clinical practice. Furthermore, it intended to increase interactive communication that supports guidance and ensure structured evaluation of nursing students in clinical practice.

METHODS

This study employed a multidisciplinary user-participatory design. Overall, 23 stakeholders from the project team (ie, 5 researchers, 2 software developers, 1 pedagogical advisor, and 15 user representatives [4 educators, 6 preceptors, and 5 students]) participated in a user-centered development process that included workshops, intervention content development, and prototype testing.

RESULTS

This study resulted in the creation of the Technology-Optimized Practice Process in Nursing (TOPP-N) guidance and assessment application for use as a supportive tool for nursing students, nurse preceptors, and nurse educators in clinical practice. The development process included the application's name and logo, technical architecture, guidance and assessment module, and security and privacy.

CONCLUSIONS

This study offers insights into the development of an evidence-based technological tool to support nursing students, nurse preceptors, and nurse educators in clinical practice. Furthermore, the developed application has the potential to meet several challenges reported in nursing education in clinical practice. After a rigorous development process, we believe that the TOPP-N guidance and assessment application prototype is now ready to be tested in further intervention studies.

Perspectives of Nurse Preceptors on a Web-based Clinical Pedagogy Program and Clinical Teaching: A Descriptive Qualitative Study

Nurse preceptors are key stakeholders in providing quality clinical education. The study aims to explore the perspectives of nurse preceptors on a Web-based clinical pedagogy program and clinical teaching. A descriptive qualitative design was adopted. The program was made accessible to the nurse preceptors who were assigned nursing students from July 2019 to June 2020. Upon completion of clinical teaching, focus group discussions were conducted and transcribed into verbatim. Thematic analysis was used for data analysis. A total of 19 nurse preceptors participated in four focus group discussions. Five themes and 11 sub-themes emerged: 1) Undergoing the process of self-awareness and development; 2) Mastering newly acquired skills to refine own teaching approach; 3) Implementing consistent evaluation and constructive feedback; 4) Dual roles and responsibilities of preceptor; 5) Benefits and barriers of the program. This study highlighted the knowledge and skills preceptors gained through the program which gave them newfound confidence and facilitated their clinical teaching and evaluation. As the shift towards online learning becomes more apparent, web-based learning can be a useful platform for professional development of nurse preceptors. This article is protected by copyright. All rights reserved.

Achievement of Clinical Learning Outcomes and Associated Factors Among Midwifery and Nursing Undergraduate Students of Jimma University, Ethiopia

BACKGROUND

Effective achievement of clinical learning outcomes indicates the success of the clinically oriented educational program including midwifery and nursing. In contrast, studies reported poor achievement of clinical competence in different health sciences programs in the country. Thus, this study aimed to determine the status of achievement of clinical learning outcomes and associated factors among midwifery and nursing students of Jimma University, Ethiopia.

METHODS

Institution-based cross-sectional study was conducted from March 25 to 30, 2021 among 147 midwifery and nursing students of Jimma University selected by simple random sampling technique. Data were collected by a semi-structured, pre-tested, self-administered questionnaire, entered into EpiData version 4.2, and analyzed by SPSS version 23. Bivariate and multivariable logistic regression analyses were done to test the association. The odds ratio at 95% confidence interval (CI) and P-value < 0.05 was used to ascertain statistical significance.

RESULTS

Only 65 (44.2%) participants achieved their clinical learning outcomes. Being a third year student (AOR 3.38; 95% CI = 1.5, 7.5) at p-value = 0.003, having good practice of COVID-19 preventive measures (AOR 2.25; 95% CI = 1.01, 5) at p-value = 0.047, perceived high students load in clinical teaching site (AOR 4.9; 95% CI = 1.6, 14.7) at p-value = 0.005, and students motivation to their clinical learning (AOR 3.1; 95% CI = 1.4, 6.63) at p-value = 0.004 were factors positively associated with achievement of clinical learning outcomes.

CONCLUSION

Less than half of midwifery and nursing students of Jimma University had achieved their clinical learning outcomes. Therefore, the students, clinical teachers, and all concerned bodies should struggle their best to enhance good practice of COVID-19 preventive measures, students motivation to their clinical learning, and facilitate clinical learning in clinical teaching site with high students load for better achievement of clinical learning outcomes.

Clinical instructors' Motivational roles and perceived effect on absenteeism among student nurses in a tertiary hospital, Benin-City, Nigeria

BACKGROUND

Absenteeism is a situation whereby students absence themselves from clinical posting without good reason, this incidence among student nurses contributed a significant problem that if not addressed will adversely affect the quality of nursing care; therefore, motivation of student during clinical posting found to be an important ingredient needed in eradicating absenteeism. Consequently, this study aims to determine the reasons why student nurses absenting themselves from clinical posting, its effect and how clinical instructor can motivate student nurses since they are the first role models and have a significant impact in their skill development.

MATERIALS AND METHODS

A descriptive, quantitative design was used to elicit the information from a sample of 80 nurses and 80 students' nurses. Nurses: 25 medical surgical ward, 23 surgical ward, 17 obstetrics and gynecology ward, 15 theaters, and 80 student nurses, statistically drawn through a stratified sampling technique across the wards and school of nursing. Data collected were analyzed using tables, percentages, means, and standard deviation at 0.05 level of significance through the Statistical Package for the Social Sciences software.

RESULTS

The student participants reported that non conducive working environment, working in infectious ward without adequate protection, noncooperation from clinical instructor, excessive number of clinical hours, embarrassment faced in front of patients and other medical personnel, lack of prompt medical treatment and care when sick, too much workload, and other number of clinical assignments as a major reason why they absenting themselves from clinical posting. The effect of student absenteeism and how students can be motivated is identified in this study.

CONCLUSION

Reported factors leading to absenteeism among nursing students and identified motivating care should be handled carefully by the hospital managers to produce better health-care delivery' nurses in future.

Enhancing student nurses' clinical education in aged care homes: a qualitative study of challenges perceived by faculty staff

Background

Ageing populations are increasing the demand for geriatric care services. As nursing schools respond to this demand, more high-quality clinical placements are required, and aged care homes offer suitable placement sites. Although an aged care experience for students is beneficial, the basis for effective implementation of these placements is yet to be fully established. The aim of this study was to explore faculty staff perspectives on the challenges associated with providing effective clinical education in aged care homes for first-year student nurses.

Methods

An exploratory qualitative study was performed. Fifteen in-depth interviews were conducted with program leaders of nursing degree programs (n = 4), course leaders (n = 6) and practice coordinators (n = 5) in three Norwegian universities. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR).

Results

Five themes were identified regarding the perceived challenges to implementing effective clinical education in aged care homes: (1) low staffing levels of registered nurses limit the capacity to effectively host students; (2) prevalence of part-time teachers can compromise the quality of students’ learning experiences; (3) tensions about the required qualifications and competencies of nurse teachers; (4) variation in learning assessments; and (5) lack of quality assurance.

Conclusions

These challenges signal key areas to be addressed in quality assurance for effective aged care placements. Further research into the minimum staffing levels required to support student learning in the aged care setting is required. Methods for developing shared practices to facilitate learning in aged care homes need to address the prevalence of part-time teaching appointments. Further research into the levels of qualification and competence required to support student learning in aged care facilities can assist with setting standards for this sector. Finally, academic-practice institutions must engage with government officials and national nursing bodies to develop national standards for clinical education in aged care homes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00632-0.

Nursing degree students' clinical placement experiences in Australia: A survey design

AIM

This study aimed to evaluate Australian nursing students' views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).

BACKGROUND

Clinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.

DESIGN

A survey design was used with a contemporary survey tool- the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.

METHODS

A total of 1263 nursing students completed the Placement Evaluation Tool (PET) - 19 items (rated 1-5), one global rating (rated 1-10) - following placement in three Australian States (July 2019-February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.

RESULTS

The total PET mean score was 78.3% with 29.8% being 'extremely satisfied' (10 out of 10 - Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.

CONCLUSIONS

Whilst students' clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.

Clinical learning environment of nursing and midwifery students in Ghana

Background

Data on student experience of the clinical learning environment in Ghana are scarce. We therefore aimed to assess students’ evaluation of the clinical learning environment and the factors that influence their learning experience.

Methods

This was a cross-sectional survey of 225 undergraduate nursing and midwifery students. We used the Clinical Learning Environment and Supervision + Nurse Teacher (CLES +T) evaluation scale to assess students’ experience of their clinical placement. The association between student demographic characteristics and clinical placement experience was determined using t-test or ANOVA.

Results

Most of the sampled students were Nurses (67%) and in the third year of training (81%). More students received supervision from a nurse (57%) during clinical placement and team supervision (67%) was the most common during clinical placement. Nursing students were more likely to rate their clinical experience better than midwifery students (p=0.002). Students who had increased contact with private supervisors were also more likely to rate their experience higher (p=0.002). Clinical experience was also rated higher by students who received successful supervision compared to those who had unsuccessful or team supervision (p=0.001).

Conclusion

Team supervision is high in health facilities where students undertake clinical placement in Ghana. Frequent contact with private supervisor and successful supervision are associated with better rating of clinical experience among Ghanaian undergraduate nursing and midwifery students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-020-00533-8.

Nursing students' first experience of death: Identifying mechanisms for practice learning. A realist review

OBJECTIVES

Many studies regarding nursing student's first experience of facing the death of a patient have focused on classroom methods or exploring attitudes towards death and related fears or anxieties. This review is the first to identify the mechanisms that facilitate practice learning as a result of students' first time experience of handling a patient's death.

DESIGN

A realist review as a form of a systematic review of the literature.

DATA SOURCES

The literature search focused on the earliest death experience of baccalaureate nursing students and end-of-life care, using databases MEDLINE, CINAHL, SCOPUS, ERIC, PSYCINFO.

REVIEW METHODS

Three research questions were addressed following a five-step process of (1) defining the scope of review and developing a theoretical framework, (2) conducting a theory-driven purposive search for evidence, (3) appraising evidence and extracting data, (4) synthesizing data and drawing conclusions, and (5) disseminating findings; with iterative expert consultation and discussion to answer the five questions of any realist review: 'what works, for whom, in what circumstances, how and why'.

RESULTS

Thirteen publications were included. Practice learning involves both changes and context improvements to be assessed and discussed by managers, leaders, nurse educators-facilitators and students. The environment and nursing role models are an inherent part of practice learning. Further work is needed to theorize the twelve key outcomes laid out in this review. These proposals require further consensus and the inclusion of inputs from both students and nurses.

CONCLUSION

The student nurse receives contradictory messages during the first experience of facing the death of a patient under their care. Considering the importance of this experience, specific indicators should be developed to track and guarantee and the optimal achievement of required competencies.

Improving quality in clinical placement studies in nursing homes (QUALinCLINstud): the study protocol of a participatory mixed-methods multiple case study design

INTRODUCTION

Improved quality in clinical supervision and assessment of student nurses in nursing home clinical placements is vitally important to effective recruitment and preparation for this healthcare sector. Knowledge regarding supervision and assessment practices within these settings is limited. Also, knowledge of evolving e-learning tools on the quality and effectiveness of these educational practices seems to be absent.

METHODS AND ANALYSIS

The aim of the "Improving quality in clinical placement studies in nursing homes" (QUALinCLINstud) study is to develop and evaluate how a web-based programme can optimise supervision, assessment and learning during nursing home placements. The study applies a participatory, mixed-methods case study design, organised in four work packages (WPs). WP1 will explore how the nurse education institution address the quality of student nurses' clinical placements in nursing homes. In WP2, clinical supervision and assessment practices will be explored, and described from multiple stakeholder perspectives. In WP3, based on the findings from WP1 and WP2, a web-based pedagogical supervision and assessment programme will be developed through a developmental co-productive process between nurse education institutions, practice settings and student nurses. In WP4, the web-based programme will be pilot-tested and evaluated through a mixed-methods approach. A range of data collection procedures will be used throughout the project, for example, questionnaires, interviews, observations and workshops.

ETHICS AND DISSEMINATION

The ethical conduct of the study is approved by the Norwegian Centre for Research Data (2018/61309 and 489776). The results will be disseminated through scientific articles, three PhD theses, presentations at national and international conferences, and through publicly accessible trade journals and newspapers. The results will generate knowledge to inform supervision and assessment practices in nursing home placements. Moreover, the study will generate knowledge concerning the developmental process of a web-based supervision and assessment programme, and the value of e-learning tools applied in clinical nursing education.

Measuring the quality of nursing clinical placements and the development of the Placement Evaluation Tool (PET) in a mixed methods co-design project

Background

The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia.

Methods

An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1263 nursing students, across all year levels at six Australian Universities and one further education college in 2019–20, to confirm validity, reliability and feasibility.

Results

The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r = .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 min) and students’ comments, the tool was deemed applicable and feasible.

Conclusions

The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.

Nursing and midwifery students' experiences and perception of their clinical learning environment in Malawi: a mixed-method study

Background

The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives' experiences and perception of the clinical learning environment in Malawi.

Methods

A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed.

Results

A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment.

Conclusion

Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

Nursing students' perceptions of clinical learning opportunities and competence in administration of oral medication in the Western Cape

BACKGROUND

Medication errors may result in patients' harm and even death. The improvement of nursing students' competence in the administration of medication through education and training can contribute to the reduction of medication errors.

OBJECTIVES

This study aimed at describing the Bachelor of Nursing students' perceptions about clinical learning opportunities and competence in the administration of oral medication.

METHOD

A quantitative descriptive design was employed. An all-inclusive sample of 176 nursing students registered at a university in the Western Cape, South Africa, in 2014 was considered for the study, of whom 125 students consented to participate and completed the questionnaires. Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis and descriptive statistics were conducted.

RESULTS

The findings showed that a minority of students did not have opportunities to rotate in all specific types of wards. The findings indicated that a total of 92% (115) and 86.4% (108) of the 125 respondents were placed in medical and surgical wards, respectively, where they more likely had opportunities to practise the administration of oral medication. However, 59.2% (74) did not practise administration of oral medication on a daily basis. Only 19.2% (24) of respondents perceived themselves as competent in the administration of oral medication.

CONCLUSION

The findings indicated that many students perceived their education and training as not providing sufficient learning opportunities to practise the administration of oral medication, whilst the majority of respondents perceived themselves as competent in some of the aspects related to the administration of oral medication, and very few perceived themselves as competent overall in the administration of oral medication.

Attitude of Nursing and Midwifery students towards clinical practice and its associated factors in Northwest Ethiopia: a cross-sectional study

OBJECTIVE

The aim of this study was to assess the attitude of Nursing and Midwifery students towards clinical practice and its associated factors at University of Gondar, Northwest Ethiopia. 2018.

RESULT

The prevalence of a favorable attitude towards clinical practice was found to be 42.9% in this study. The odds of having favorable attitude were found to be 2 times higher among students who prepared well for clinical practice [AOR = 2.07, 95%, CI (1.25, 3.44)] compared with counterparts. Similarly students who communicate well with clinical staffs [AOR = 1.89, 95%, CI (1.05, 3.41)], practiced in well-equipped hospital [AOR = 1.76, 95%, CI (1.01, 3.06)], and accompanying frequently by a clinical supervisor [AOR = 1.69, 95%, CI (1.02, 2.81)] were more likely to have favorable attitude compared with counterparts.

The Point of View of Undergraduate Health Students on Interprofessional Collaboration: A Thematic Analysis

Interprofessional education (IPE) is essential to prepare future professionals for interprofessional collaboration (IPC). Learning together is essential for students because it is a way to understand the roles of other colleagues, improve their skills, knowledge, competencies, and attitudes to collaborate with the interprofessional teams. To explore how undergraduate students who attend IPE courses define IPC, a qualitative study using semistructured interviews followed by a thematic analysis was performed. Four main themes were identifed: IPC as a resource, requirements for IPC, emotions linked to IPC, and tutor's role to facilitate students' perception of IPC. Students considered IPE important to build IPC, where clinical placement tutors play a key role. The most important findings of the present study include the students' considerations about the importance of IPE when building their IPC definition and the key role played by the tutor during the placement in building IPC in clinical practice.

Preceptor Knowledge on Preceptorship in an Academic Hospital in Kenya

BACKGROUND

Clinical preceptorship is critical for the acquisition of knowledge, skills, and attitudes in nursing care. Cardinal to the development of these competences is the preceptor's knowledge on preceptorship. In low-income countries, the responsibility of preceptorship rests with staff nurses whose knowledge on preceptorship is largely unknown.

METHOD

A survey was conducted among 254 nurses using a 3-point Likert scale questionnaire. Mean scale scores were computed for knowledge score. Association between training on preceptorship and level of knowledge was explored using chi square.

RESULTS

The mean knowledge score was 1.71 (SD ± 0.41). Few had undergone training on preceptorship; knowledge on preceptorship had been acquired experientially or through role modeling. More nurses who had undergone training agreed that preceptor-trainee roles should be clearly defined at the beginning of clinical placement, χ²(1) = 15.54, p = .016.

CONCLUSION

Although nurses were knowledgeable about preceptorship, few had been trained. A formal training program on preceptorship is warranted. J Contin Educ Nurs. 2017;48(11):496-500.

Clinical Supervision and Support: Exploring Pre-registration Nursing Students' Clinical Practice in Malawi

Background:

Supervised clinical practice plays a significant role in the nursing profession, as it has an influence on the students’ clinical learning.

Objectives:

The aim of this study was to explore how the pre-registration nursing students find their experience on clinical supervision in the clinical placements.

Methods:

The study used both quantitative and qualitative approach to collect data through focus groups (n = 144) and self-administered questionnaires (n = 590) from nursing students of various programmes in selected colleges in Malawi.

Results:

About 75% (n = 443) of the participants indicated that they received supervision from both clinical staff and Nurse Educator. However, qualitative results indicated that students received inadequate clinical supervision. Themes that emerged from the discussion included lack of human resources, learning support, availability of instructors yet not supporting learning, job insecurity and lack of remuneration as reasons for lack of supervision, role models and student guidance despite pressure and self-directed.

Conclusion:

There is a need for clear policies regarding clinical supervision as well as a structured and well monitored process.

Learning Situations in Nursing Education: A Concept Analysis

Background and purpose:

The nursing student requires opportunities to learn within authentic contexts so as to enable safe and competent practice. One strategy to facilitate such learning is the creation of learning situations. A lack of studies on the learning situation in nursing and other health care fields has resulted in insufficient knowledge of the characteristics of the learning situation, its antecedents, and consequences. Nurse educators need to have comprehensive and practical knowledge of the definition and characteristics of the learning situation so as to enable their students to achieve enhanced learning outcomes. The aim of this study was to clarify the concept of the learning situation as it relates to the education of nurses and improve understanding of its characteristics, antecedents, and consequences.

Methods:

The Bonis method of concept analysis, as derived from the Rodgers’ evolutionary method, provided the framework for analysis. Data collection and analysis were undertaken in two phases: “interdisciplinary” and “intra-disciplinary.” The data source was a search of the literature, encompassing nursing and allied health care professions, published from 1975 to 2016.

Results:

No agreement on the conceptual phenomenon was discovered in the international literature. The concept of a learning situation was used generally in two ways and thus classified into the themes of: “formal/informal learning situation” and “biologic/nonbiologic learning situation.” Antecedents to the creation of a learning situation included personal and environmental factors. The characteristics of a learning situation were described in terms of being complex, dynamic, and offering potential and effective learning opportunities. Consequences of the learning situation included enhancement of the students’ learning, professionalization, and socialization into the professional role.

Implication for Practice:

The nurse educator, when considering the application of the concept of a learning situation in their educational planning, must acknowledge that the application of this concept will include the student’s clinical learning experiences. More studies are required to determine factors influencing the creation of a successful learning situation from the perspectives of nurse educators and nursing students, clinical nurses and patients.

Opisna raziskava mnenj in stališč študentov zdravstvene nege ter kliničnih mentorjev glede ocenjevanja kliničnega usposabljanja

Uvod: Z nenačrtovanim ocenjevanjem na podlagi pomanjkljivo opredeljenih kriterijev lahko spregledamo neuspešnega študenta in tako prispevamo k njegovemu nevarnemu delovanju v kliničnem okolju. Namen raziskave je bil ugotoviti, kakšna so stališča in mnenja kliničnih mentorjev ter študentov zdravstvene nege glede ocenjevanja kliničnega usposabljanja. Metode: Uporabljena je bila kvantitativna deskriptivna metoda dela. Spletno anketo je izpolnilo 84 dodiplomskih študentov zdravstvene nege, njeno tiskano različico pa 37 kliničnih mentorjev. Zbiranje podatkov je potekalo od oktobra do novembra 2015. V analizi je bila uporabljena osnovna opisna statistika, hi-kvadrat test, Mann-Whitneyev U-test in Pearsonov koeficient korelacije. Rezultati: Klinični mentorji so v večji meri kot študenti mnenja, da bi se morali na klinično usposabljanje načrtno pripraviti (U = 790, p < 0,001). S Pearsonovim koeficientom korelacije (r = −0,215, p = 0,024) smo ugotovili, da je zadovoljstvo z ocenjevanjem vseh anketiranih večje, če je ocenjevanje sprotno in ne le končno. Hi-kvadrat test je pokazal, da anketiranci ocenjevalni list ocenjujejo kot samo zadovoljiv (n = 47, 43,5 %; χ2 = 4,3, p = 0,229). Diskusija in zaključek: Večina anketirancev ni zadovoljnih z načinom ocenjevanja kliničnega usposabljanja. Zavedajo se pomanjkljivosti ocenjevalnega lista, opozarjajo tudi na pomanjkanje časa pri mentoriranju študentov. Raziskava prispeva k boljšemu razumevanju razmer v procesu ocenjevanja kliničnega usposabljanja.

Student preparedness characteristics important for clinical learning: perspectives of supervisors from medicine, pharmacy and nursing

BACKGROUND

Student perspectives of clinical preparedness have been studied in the literature, but the viewpoint of supervisors is limited. Hence, the aim was to examine the perspective of supervisors on the characteristics of health professional students important for preparedness for clinical learning.

METHODS

This was a descriptive, questionnaire-based, cross-sectional study conducted at three higher education institutions in Malaysia. A previously published questionnaire with 62 characteristics was adopted with modifications after pre-testing. Descriptive analysis was completed for the demographic data. The sample was grouped based on health profession, clinical practice experience and teaching experience for further analysis. Non-parametric Kruskal-Wallis test was selected to evaluate differences in mean ranks to assess the null hypothesis that the medians are equal across the groups. Kruskal-Wallis post-hoc pair wise comparison was performed on samples with significant differences across samples.

RESULTS

The sample was comprised of 173 supervisors from medicine (55, 32%), pharmacy (84, 48%) and nursing (34, 20%). The majority (63%) of the supervisors were currently in professional practice. A high percentage (40%) of supervisors had less than 4 years of teaching experience. The highest theme ratings were for willingness (6.00) and professionalism (5.90). There was a significant difference (p < 0.05) in the medians, among medicine, pharmacy and nursing professional speciality for willingness (5.70, 6.00 and 6.00), professionalism (5.70, 5.90 and 6.15), communication and interaction (5.42, 5.67 and 6.00), personal attributes (5.42, 5.71 and 6.02) and the professional and interpersonal skills (5.50, 5.63 and 6.00) themes. Post-hoc analysis showed a significant difference (p < 0.05) between medicine and nursing groups in the willingness (5.70 and 6.00), professionalism (5.70 and 6.15) and personal attributes (5.42 and 6.02) themes. Supervisors who are currently in practice had given high ratings compared to other groups. There were no significant differences observed within groups with different level of teaching experiences.

CONCLUSIONS

All supervisors rated professionalism and willingness as the most important characteristics followed by personal attributes. Further strengthening learning opportunities related to these characteristics in the curriculum may improve the students' preparedness in clinical learning.

A Qualitative Inquiry into Nursing Students' Experience of Facilitating Reflection in Clinical Setting

Background and Aim. Reflection is known as a skill that is central to nursing students' professional development. Due to the importance and the role of reflection in clinical areas of nursing, it is important to know how to achieve it. However, nursing trainers face the challenge of how to help their students to improve reflection in clinical settings. The aim of this study was to investigate the nursing students' experiences of facilitating reflection during clinical practice. This qualitative study was conducted by qualitative content analysis approach. Twenty nursing students during the second to eighth semester of their educational program were selected for participation using purposive sampling. Data were collected through in-depth semistructured interviews. The interview was transcribed verbatim, and qualitative content analysis was used to analyze the data. From the data analysis, four main themes were extracted. Motivation to reflect, complex experiences, efficient trainer, and effective relations were four main themes obtained from study that, in interaction with each other, had facilitating roles in students' reflective process on experiences. The findings revealed that the nursing students' reflection in clinical settings is effective in personal and professional level. Reflection of nursing students depends on motivational and educational factors and these factors increase the quality of care in patients. Furthermore, nursing educators need to create nurturing climate as well as supporting reflective behaviors of nursing students.

Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study

OBJECTIVE

to identify the students' perception about the quality of clinical placements and asses the influence of the different tutoring processes in clinical learning.

METHODS

analytical cross-sectional study on second and third year nursing students (n=122) about clinical learning in primary health care. The Clinical Placement Evaluation Tool and a synthetic index of attitudes and skills were computed to give scores to the clinical learning (scale 0-10). Univariate, bivariate and multivariate (multiple linear regression) analyses were performed.

RESULTS

the response rate was 91.8%. The most commonly identified tutoring process was "preceptor-professor" (45.2%). The clinical placement was assessed as "optimal" by 55.1%, relationship with team-preceptor was considered good by 80.4% of the cases and the average grade for clinical learning was 7.89. The multiple linear regression model with more explanatory capacity included the variables "Academic year" (beta coefficient = 1.042 for third-year students), "Primary Health Care Area (PHC)" (beta coefficient = 0.308 for Area B) and "Clinical placement perception" (beta coefficient = - 0.204 for a suboptimal perception).

CONCLUSIONS

timeframe within the academic program, location and clinical placement perception were associated with students' clinical learning. Students' perceptions of setting quality were positive and a good team-preceptor relationship is a matter of relevance.

OBJETIVO

identificar a percepção dos estudantes de enfermagem sobre a qualidade das Práticas Clínicas em Atenção Primária à Saúde e avaliar a influência dos diferentes processos de tutoria na aprendizagem clínica.

MÉTODOS

um estudo analítico transversal realizado com alunos do segundo e do terceiro ano de enfermagem (n = 122) na aprendizagem clínica nos serviços de Atenção Primária à Saúde. A Ferramenta de Avaliação de Práticas Clínicas (Clinical Placement Evaluation Tool) e um índice sintético de atitudes e habilidades (escala de 0 a 10) foram calculados para marcar a aprendizagem clínica. Foram realizadas análises univariadas, bivariadas e multivariadas (regressão linear múltipla).

RESULTADOS

a taxa de resposta foi de 91,8%. O processo de tutoria mais indicado foi o de "preceptor-professor" (45,2%). As Práticas Clínicas foram avaliadas como "ótimas" por 55,1%, o relacionamento com a equipe-preceptor foi considerado bom por 80,4% dos casos e a classificação média para a aprendizagem clínica foi de 7,89. O modelo de regressão linear múltipla, com mais capacidade explicativa incluiu as variáveis "ano acadêmico" (coeficiente de beta = 1.042 para alunos do terceiro ano), "área de cuidados de saúde primários" (coeficiente de beta = 0,308 para a Área B) e "percepção de práticas clínicas" (beta coeficiente = - 0,204 para uma percepção menos que ótima).

CONCLUSÕES

O momento dentro do programa acadêmico, a localização e percepção das Práticas Clínicas foram associados com a aprendizagem clínica dos alunos. A percepção dos alunos sobre a qualidade do lugar das Práticas Clínicas foi positiva e um bom relacionamento da equipe-preceptor é uma questão de relevância.

OBJETIVO

identificar la percepción del alumnado de enfermería sobre la calidad de las Prácticas Clínicas y evaluar la influencia de los diferentes procesos de tutoría en el aprendizaje clínico.

MÉTODOS

estudio analítico transversal realizado con estudiantes de segundo y tercer año de enfermería (n = 122) en el aprendizaje clínico en los servicios de atención primaria de salud. La Herramienta de Evaluación de Prácticas Clínicas (Clinical Placement Evaluation Tool) y un índice sintético de las actitudes y habilidades (escala de 0 a 10) se calcularon para puntuar el aprendizaje clínico. Se realizaron análisis univariados, bivariados, multivariados (regresión lineal múltiple).

RESULTADOS

la tasa de respuesta fue del 91,8%. El proceso de tutoría más comúnmente identificado fue "preceptor-profesor" (45,2%). Las Prácticas Clínicas se evaluaron como "óptimas" en un 55,1%, la relación equipo-preceptor fue considerada buena por el 80,4% de los casos y la calificación media para el aprendizaje clínico fue de 7.89. El modelo de regresión lineal múltiple con mayor capacidad explicativa incluyó las variables "año académico" (coeficiente beta = 1.042 para los estudiantes de tercer año), "Área de Atención Primaria de la Salud" (coeficiente beta = 0,308 para el Área B) y la "percepción de las Prácticas Clínicas" (coeficiente beta = - 0,204 para una percepción subóptima).

CONCLUSIONES

el momento dentro del programa académico, la ubicación y la percepción de las Prácticas Clínicac se asociaron con el aprendizaje clínico de los estudiantes. La percepción de los estudiantes de la calidad del lugar de las Prácticas Clínicas fue positiva y la buena relación equipo-preceptor es una cuestión de relevancia.

Nursing Students' Qualitative Experiences in the Medical-Surgical Clinical Learning Environment: A Cross-Cultural Integrative Review

BACKGROUND

The nature of the clinical learning environment has a huge impact on student learning. For instance, research has supported the idea that a positive learning environment increases student learning. Therefore, the ability to gain information from the student perspective about the learning environment is essential to nursing education.

METHOD

This article reviews qualitative research on nursing students' experiences of the clinical learning environment. The significance of the issue, the purpose of the integrative review, the methods used in the literature search, and the results of the review are presented.

RESULTS

Seventeen studies from 12 countries are identified for review, and six common themes are discussed. An exhaustive literature review revealed that among the 17 articles evaluated, six themes were common.

CONCLUSION

The findings indicate the need to continue quality improvement to advance clinical education.