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NURSING STUDENTS’ PERCEPTIONS OF CLINICAL NURSING TRAINING IN SELECTED NURSING PROGRAMMES
Background to the study
Nursing education consists of acquisition of a body of knowledge that is partly delivered in a classroom setting which forms the theoretical basis of nursing knowledge, and an organized and supervised clinical training experience that takes place in the clinical setting where the nurse-patient relationship is experienced directly or indirectly (Sheriff & Masoumi, 2005). Clinical nursing training is the most critical step in transforming nursing education, because that is really at the heart of getting the nurse ready for clinical setting; and for providing safe and excellent patients care. Students must be offered clinical experiences that are of highest quality and of interest.
Clinical nursing training provides a practical approach for training prospective nursing students to acquire practical skills for practice as nurses (Emerson, 2002). The heart and soul of nursing education is the clinical practicum where nursing knowledge is shaped into professional practice (Diekelmann, 2004). Thus, basic knowledge and skills; and the ability to apply knowledge into the actual practice of nursing is developed and inculcated into the student nurses during clinical training. Barnes, Sutphen, Leonard and Day (2009) also stated that clinical nursing education is a fundamental part of nursing education and forms more than half part of nursing curriculum.
Historically, clinical training is derived through training apprenticeships as in the era of Florence Nightingale in which an aspiring student learns many facts of the profession from the “Master”. Even before the days of Florence Nightingale and continuing into this century, students have learned the practice of nursing from family members while caring for the patients. Therefore, the clinical setting remains the most effective caring situation for demonstrating theoretical possibilities and transforming the novice to beginning nurse (Karen, 2013). A study carried out at School of Nursing Oakland University on “getting the most out of students’ clinical experience” highlighted that student nurses are provided with several opportunities for clinical experiences. The students argued that more can be learned in these experiences than can be taught in classroom setting though both aspects are important and designed to complement each other (Crotty, 2011). The benefit of clinical nursing training in nursing education cannot be overemphasized and this is achieved through clinical placement, teaching, supervision and evaluation (Duteau, 2012).
During clinical placement, students are posted and rotated to different clinical learning environments such as the outpatient department, emergency units, clinical wards, other specialist units in the hospital, other health care institutions, health centers and communities under the direction and close supervision of experienced personnel in nursing profession. In the clinical learning environment, student nurses are offered an opportunity to work directly with competent professional nurses for patients in a particular area of expertise. Teaching in clinical learning environment presents educators with challenges that are different from those encountered in the classroom because clinical setting requires different approaches to teaching (Benis, 2000). One crucial element in students’ clinical training is the supervision system. For student nurses, supervision is a process where the learner is guided and supported through clinical professional knowledge and skill (United Kingdom for Central Council, 1995). The goal of supervision in clinical environment is to ensure that student learning occurs and that students are safe. Evaluation of clinical performances of the student nurses is an integral part of all programmes in nursing profession. It also plays a major role in the society by certifying competent nurse who can render quality nursing care to the public. Clinical evaluation is a more formal assessment of the students’ performances in the clinical nursing training (Raisler, O’Grandy & Lori, 2003).
As a learner in the clinical environment, the student nurse is an embodied spirit, a union of body and rational soul. His body experiences sensation and feels pleasure and pain. His soul is a spiritual act, the source of intellectual abstraction, self reflection and free rational volition (Balagot, 2012). He is the central focus in clinical nursing training therefore his perceptions of the whole process need to be ascertained. Perception is an individual’s awareness, insight and opinion about a situation. The nursing students are also the customers and consumers in the clinical nursing training. Their perception is a legitimate indicator of the quality of the training. And their benefits from the training will depend on how they perceive the clinical training experiences. If the students perceive the clinical nursing training as meaningful and helping, they will be motivated to learn and the experiences will be beneficial. If they have low perception about them, the reverse will be the case.
However, little has been done empirically on nursing students’ perceptions of clinical nursing education in nursing training institutions in Nigeria. The few published ones used only university-based student nurses and did not include the hospital-based student nurses. Thus this study examined the nursing students’ perceptions of clinical nursing training in selected nursing programmes in Enugu State. It also exposed areas of the clinical training that are deficient.
Statement of problem
From the international perspective, students’ instruction and supervision in clinical setting appear to have been shifted to clinical nurses only (Neary, 2000). Nurses who lack fundamental skills in nursing research, academic training and experiences in preceptor-ship and supervision still constitute the large group of nurses who often hold functions as clinical instructors, supervisors and evaluators. From the researcher’s observation in her areas of study too, students are sometimes left in hands of any available nurse on duty for supervision and teaching as opposed to sound selection criteria. Nurse educators and clinical instructors sparingly go to the clinical environments for teaching and supervision probably due to poor planning and busy tight academic schedule. Such things confuse the students, inhibit learning and make clinical training disjointed and laborious (Carr & Schoott, 2002). Consequently many students complain of one thing or the other about their clinical training.
Furthermore, the nursing students as learners in the clinical learning environment are the central focus and key players in clinical nursing training and their perception is legitimate indicator of the quality of clinical nursing training. But workplace incivility and aggression threaten the socio-emotional and physical safety of student nurses in the clinical environment. This was demonstrated by students who reported ostracizing, hostile and dismissive behavior from staff (Anthony & Yastik, 2011). They further reported that university-based student nurses felt particularly persecuted by non university trained nurses who believed that university trained nurses did not know much about real practical nursing. As a result, many students reported an adverse impact on their future careers and employment decision. The questions are: What are the nursing students’ perceptions of their clinical nursing training? Was it high/positive, meaningful and helping or was it low/negative and deficient? These are some fundamental questions the researcher wants to address in the present study. In the light of the current demand for measures of nursing students’ perceptions of clinical nursing training and the scarcity of focused research in this area in Nigeria, this study is both relevant and timely. All these prompted the researcher’s desire to investigate the nursing students’ perceptions of clinical nursing training in selected nursing programs in Enugu State.
Purpose of the study
The purpose of this study is to determine the nursing students’ perceptions of clinical nursing training in selected nursing programmes in Enugu State.
Specifically, the objectives are to:
- Determine the nursing students’ opinion on their placement in the clinical setting (clinical learning environment).
- Ascertain the nursing students’ view about clinical teaching.
- Ascertain the students’ view about clinical supervision.
- Assess the students’ perception of clinical evaluation.
- Determine the students’ overall perception of clinical nursing training.
The following research questions were formulated as a guide to the researcher.
- What is the nursing students’ opinion of their placement in the clinical setting/ learning environment?
- How do the nursing students’ view their clinical teaching?
- What is the students’ view about their clinical supervision?
- How do the nursing students perceive their clinical evaluation?
- What is the students’ overall perception of clinical nursing training?
Two null hypotheses were set for this study and they include:
H01: There is no significant difference in the nursing students’ perceptions of the clinical training between the university-based and hospital-based nursing students.
H02: There is no significant difference in perceptions of clinical nursing training based on gender.
Significance of the study
The findings will reveal the nursing students’ opinion on the different aspects of their clinical training. It will be of great benefit to the student nurses, nurse clinicians/administrators, nurse educators, clinical instructors and supervisors, other health care professionals, hospital management and policy makers. To the student nurses and other health care professionals in the areas of study, the findings will be a source of reference on students’ perceptions of clinical nursing training and could stimulate further researches among interested individuals.
To the nurse clinical administrator, clinical instructors, supervisor, nurse educators, hospital management and policy makers, the result of this study will help them improve and strengthen the aspects of the clinical placement, teaching, supervision and evaluation that are deficient
Scope of the study
The study is confined to the students of Schools of Nursing UNTH Enugu; Bishop Shanahan Hospital Nsukka and Department of Nursing Sciences University of Nigeria Enugu Campus, all in Enugu State of Nigeria. The study is also delimited to determining how the student nurses perceive their clinical placement, teaching, supervision and evaluation.
Operational Definition of Terms
Clinical Nursing Training: In this study means the sum total of the experiences of the student nurses in the clinical setting in terms of their placement, teaching/learning, supervision and evaluation.
Perception of clinical nursing training: In this study implies the nursing students’ view and opinion about their placement, teaching/learning, supervision and evaluation in the clinical setting.
Opinion on Clinical Placement: In this study refers to the students’ view and feelings about how they are posted and rotated in the clinical setting and the environment in which they are posted.
View about Clinical Teaching: In this context refers to students’ opinion and feelings about their clinical teaching, those that teach them and how they teach them.
View about Clinical Supervision: In this context means the nursing students’ opinion about those that supervise them and how they supervised them.
Perception of Clinical Evaluation: In the context of this study, refers to the students’ view about how they were tested and examined for clinical skills and those that examine them.
Selected Nursing Programme: In this study means university-based and hospital-based basic nursing programmes.