Do nursing students' attitudes to clinical practice training affect the levels of vocational motivation?

BACKGROUND

It is extremely important for nursing students to be professionally motivated to train qualified future professional nurses. Students' vocational motivation is affected by their experiences in clinical and academic learning environments.

OBJECTIVE

The aim of this study was to investigate the correlation between the vocational motivation levels of nursing students and their attitudes toward clinical practice.

METHODS

292 nursing students participated in the cross-sectional, descriptive study. The Student Information Form, Nursing Students' Attitudes Towards Clinical Practices Scale, Motivation Sources and Problems Scale (MSPS) were used to gather the data.

RESULTS

The average score for students' attitudes toward clinical practice was 107.08±18.13, while the total score for MSPS stood at 3.80±0.63. A positive correlation was identified between the attitude toward clinical practice and vocational motivation levels (r = 0.367; p < 0.001). There were positive correlations between the intrinsic motivation (r = 0.572; p < 0.001) and extrinsic motivation (r = 0.58; p < 0.001), and negative correlations were observed between the negative motivation (r = -0.324; p < 0.001) and the attitude toward clinical practice scale. There were positive correlations between belief and expectation (r = 0.492; p < 0.001) and positive approach (r = 0.532; p < 0.001) with the MSPS. In the multiple regression analysis, intrinsic motivation, extrinsic motivation, satisfaction with studying nursing, and participation in vocational courses were determined as effective predictors of attitudes towards clinical practice and explained 60.4% of the variance.

CONCLUSIONS

The study concluded that nursing students' attitudes toward clinical practices affect vocational motivation. Clinical learning environments should be arranged in a way to increase the motivation level of students towards professional learning.

Barriers and Facilitators to Clinical Supervision in Ghana: A Scoping Review

Background

Clinical supervision involves the professional relationship between an experienced and knowledgeable clinician and a less experienced clinician in which the experienced clinician provides support toward the skills development of the less experienced one. The concept, structure, and format of clinical supervision vary in various jurisdictions and is influenced by the availability of resources, the training needs of supervisees, and organizational structures.

Aim

The aim of this scoping review was to explore, map out and synthesize the available literature on the facilitators and barriers to clinical supervision in Ghana.

Methods

The methodological framework developed by Arksey and O'Malley and modified by Levac et al. for scoping reviews, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used to ensure a coherent and transparent reporting of literature. A systematic search was conducted in PubMed, CINAHL, Scopus, Medline, and Google Scholar using key words and key terms. Articles published between January 1, 2000, and February 28, 2023, were included in the review.

Results

The initial search across all the databases yielded 208 results. Two independent reviewers completed both the title and abstract, and full text screenings. A third reviewer helped to resolve all discrepancies that arose during the screening process. The review included 20 articles and generated four themes: clinical supervision as a collaborative effort, feedback mechanism, training and adaptation, and challenges with implementation.

Conclusion

Findings from this review highlight that healthcare professionals in Ghana valued clinical supervision. However, the implementation of clinical supervision is faced with individual and systemic challenges. There is the need for on-going collaboration between educational and clinical institutions to develop modalities that promote clinical supervision in Ghana.

Collaborative clinical facilitation in selected nursing and midwifery colleges in Northern Ghana

Background

Collaborative clinical facilitation converges key players to guide students individually and within groups towards achieving clinical nursing competence. However, experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and nursing and midwifery students are often fragmented and have been largely unexplored in Ghana.

Aim

To describe the experiences of collaborative clinical facilitation among nurse educators, clinical preceptors and final year nursing and midwifery students in Northern Ghana.

Setting

The study was conducted at two nursing and midwifery colleges and an academic hospital in Northern Ghana.

Methods

A qualitative, descriptive, exploratory design was utilized. Forty-six participants comprising 16 nurse educators, 10 clinical preceptors, 10 nursing students and 10 midwifery students were purposively sampled. Focus groups and in-depth interviews were used to gather data and analysed thematically.

Results

Three themes revealed facilitative experiences of collaborative clinical facilitation: team-based clinical mentorship and supervision, personalised preceptorship, and clinical conferences. Two themes emerged inhibitory to collaborative clinical facilitation: staff shortages and lack of timely communication.

Conclusion

This study found that team mentorship, preceptorship and conferences fostered collaborative clinical partnerships for students' clinical learning. However, failure to engage in timeous communication in the midst of staff shortages hampered its smooth practice. Orientation workshops need to be organised for key players to share relevant updates and explore ways to navigate the challenges often experienced within the clinical training environment.

Contribution

This paper provides insight into the collaborative nature of clinical facilitation; and highlights the need for coordinated clinical placements to enhance students' clinical learning.

Scaling up HIV viral load monitoring in Manicaland, Zimbabwe: challenges and opportunities from the field

Background

Demand for viral load (VL) monitoring is expected to increase; however, implementation of the multifaceted VL testing poses numerous challenges. We report experiences from Médecins Sans Frontiéres (MSF) and partners in the scale-up of HIV VL in collaboration with the Ministry of Health and Child Care (MoHCC) of Zimbabwe.

Methods

A retrospective data review of routine reports from MSF-supported health facilities in Manicaland Province (Zimbabwe) was conducted. These secondary aggregate data were triangulated, and emerging themes of lessons learnt from VL monitoring were shared.

Results

A VL testing coverage of 63% (5966/9456) was achieved among the 40 health facilities, together with a switch rate to second-line antiretroviral therapy (ART) of 46.4% (108/233). The key enablers to scaling-up the VL monitoring were well-equipped and supported VL laboratories, the operationalisation of the on-the-job clinical mentoring and systematic weaning off of better performing health facilities. Concerted efforts from different implementing partners and funders in the HIV programme, and close collaboration with MoHCC were pivotal.

Conclusion

Our experience indicates that clinical mentoring is effective, and resulted in high VL testing coverage and up-skilling primary health care workers in VL monitoring. Attention must be focused on innovations for improving VL result utilisation, especially the identification and management of patients who fail ART.

Promoting Local Ownership: Lessons Learned from Process of Transitioning Clinical Mentoring of HIV Care and Treatment in Ethiopia

Introduction

Focus on improving access and quality of HIV care and treatment gained acceptance in Ethiopia through the work of the International Training and Education Center for Health. The initiative deployed mobile field-based teams and capacity building teams to mentor health care providers on clinical services and program delivery in three regions, namely Tigray, Amhara, and Afar. Transitioning of the clinical mentoring program (CMP) began in 2012 through capacity building and transfer of skills and knowledge to local health care providers and management.

Objective

The initiative explored the process of transitioning a CMP on HIV care and treatment to local ownership and documented key lessons learned.

Methods

A mixed qualitative design was used employing focus group discussions, individual in-depth interviews, and review of secondary data. The participants included regional focal persons, mentors, mentees, multidisciplinary team members, and International Training and Education Center for Health (I-TECH) staff. Three facilities were selected in each region. Data were collected by trained research assistants using customized guides for interviews and with data extraction format. The interviews were recorded and fully transcribed. Open Code software was used for coding and categorizing the data.

Results

A total of 16 focus group discussions and 20 individual in-depth interviews were conducted. The critical processes for transitioning a project were: establishment of a mentoring transition task force, development of a roadmap to define steps and directions for implementing the transition, and signing of a memorandum of understanding (MOU) between the respective regional health bureaus and I-TECH Ethiopia to formalize the transition. The elements of implementation included mentorship and capacity building, joint mentoring, supportive supervision, review meetings, and independent mentoring supported by facility-based mechanisms: multidisciplinary team meetings, case-based discussions, and catchment area meetings.

Conclusion

The process of transitioning the CMP to local ownership involved signing an MOU, training of mentors, and building capacity of mentoring in each region. The experience shed light on how to transition donor-supported work to local country ownership, with key lessons related to strengthening the structures of regional health bureaus, and other facilities addressing critical issues and ensuring continuity of the facility-based activities.

An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholders' perceptions about clinical mentoring

BACKGROUND

An effective capacity building process for healthcare workers is required for the delivery of quality health care services. Work-based training can be applied for the capacity building of health care workers while causing minimum disruption to service delivery within health facilities. In 2012, clinical mentoring was introduced into the Jigawa State Health System through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 (PATHS2). This study evaluates the perceptions of different stakeholders about clinical mentoring as a strategy for improving maternal, newborn and child health service delivery in Jigawa State, northern Nigeria.

METHODS

Interviews were conducted in February 2013 with different stakeholders within Jigawa State in Northern Nigeria. There were semi-structured interviews with 33 mentored health care workers as well as the health facility departmental heads for Obstetrics and Pediatrics in the selected clinical mentoring health facilities. In-depth interviews were also conducted with the clinical mentors and two senior government health officials working within the Jigawa State Ministry of Health. The qualitative data were audio-recorded; transcribed and thematically analysed.

RESULTS

The study findings suggest that clinical mentoring improved service delivery within the clinical mentoring health facilities. Significant improvements in the professional capacity of mentored health workers were observed by clinical mentors, heads of departments and the mentored health workers. Best practices were introduced with the support of the clinical mentors such as appropriate baseline investigations for pediatric patients, the use of magnesium sulphate and misoprostol for the management of eclampsia and post-partum hemorrhage respectively. Government health officials indicate that clinical mentoring has led to more emphasis on the need for the provision of better quality health services.

CONCLUSION

Stakeholders report that the introduction of clinical mentoring into the Jigawa State health system gave rise to an improved capacity of the mentored health care workers to deliver better quality maternal, newborn and child health services. It is anticipated that with a scale up of clinical mentoring, health outcomes will also significantly improve across northern Nigeria.

Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks

INTRODUCTION

Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements.

METHODS

A redesigned clinical mentoring program was launched in a medical center according to previous theoretical and practical studies on clinical training workplaces, including the elements of mentor qualifications, positive and active enhancers for mentor-mentee relationship building, the timing of mentoring performance evaluation, and financial and professional incentives. A four-wave web survey was conducted, comprising one evaluation of the former mentoring program and three evaluations of the redesigned clinical mentoring program. Sixty-four fifth-year medical students in clerkships who responded to the first wave and to at least two of the three following waves were included in the study. A structured and validated questionnaire encompassing 15 items on mentor performance and the personal characteristics of the clerks was used. Mixed linear models were developed for repeated measurements and to adjust for personal characteristics.

RESULTS

The results revealed that the redesigned mentoring program improved the mentors' performance over time for most evaluated items regarding professional development and personal support provided to the mentees.

CONCLUSIONS

Our findings serve as an improved framework for the role of the institution and demonstrate how institutional policies, programs, and structures can shape a clinical mentoring program. We recommend the adoption of mentorship schemes for other cohorts of medical students and for different learning and training stages involved in becoming a physician.