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JOB-RELATED CHALLENGES OF CLINICAL TEACHING OF NURSING STUDENTS AMONG CLINICAL NURSE INSTRUCTORS

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Topic Description

CHAPTER ONE

INTRODUCTION

Background to the Study

Nursing is a professional discipline and its members are professionals whose preparations enable them practice at various levels either as nurse administrators, nurse clinicians, nurse researchers or nurse educators, among others (Oermann & Gaberson, 2009). As a profession, nursing programmes aim to produce safe, knowledgeable, skillful and caring practitioners and professionals who are able to provide effective evidence-based care (Gray, 2013 in Brooker & Waugh, 2013). A professional is an individual who possesses expert knowledge and skills in a specific domain. The expert knowledge and skills is acquired through formal education in institutions of higher learning and through experience. As a professional, the individual uses those knowledge and skills on behalf of society by serving specified clients (Oermann & Gaberson, 2009; Asfour & El-Soussi, 2011).

 

Professional disciplines, according to Oermann and Gaberson (2009) and Asfour and El-Soussi (2011) are differentiated from academic disciplines by their practice component, which for nursing profession is clinical practice. Clinical practice requires critical thinking and problem-solving abilities, specialized psychomotor and technological skills, and a professional value system to make it effective.  Fundamentally, effective clinical practice is a by- product of clinical experience which has always been an integral part of nursing education and at the heart of which, lies the clinical teaching (Asfour & El-Soussi, 2011). The importance of clinical teaching in education and training of student nurses cannot be overemphasized because preparation of skilled, safe and competent nurse graduates is an essential focus of nursing education (Oermann & Gaberson, 2009). Practice in clinical settings with the assistance and support of the clinical nurse instructors expose students to realities of professional practice that cannot be conveyed by a textbook or simulation (Oermann & Gaberson, 2009).

 

Clinical nurse instructors are expected to play several roles and responsibilities when they work with students. The clinical nurse instructor directs, manages and evaluates student learning in the clinical setting. In addition, he/she prepares clinical teacher assistants as well as preceptors for their teaching activities on approaches specific to the level of the learner and course outcomes. The clinical nurse instructor also assists the students in integration of theory and practice; evaluates student’s development of clinical reasoning skills; and facilitates clinical seminars. He / she is available at all times the students are in the clinical setting; directly observes and guides students’ learning activities with clients and evaluates students as related to the clinical posting outcomes (bhrylle sapphire publisher, 2012; University of Portland School of Nursing (UPSN), n.d ).

 

Clinical instructors are expected to play different or several roles as already outlined above. However, knowing which role to play depends upon an assessment of the situation; what the students need to learn, then ascertains how conducive the learning environment is in helping students to learn; and what constraints that are present (Jamshidi, 2012). In view of this, clinical teaching is really an onerous task to accomplish because it entails preparing skilled, safe, and competent nurse graduates for the kind of work they will have to do as practicing nurses (Phillips & Vinten, 2010).   Unfortunately, some of these roles / functions of clinical learning experience are neither performed nor accomplished; consequently, their benefits are not achieved due to some challenges being faced by the clinical nurse instructors.

 

Moreover, some of the new clinical nurse instructors neither have a solid foundation in clinical teaching courses nor teaching experience as identified by Kan and Stabler-Haas (2009). Consequently, they face performance insecurities along with the daily teaching challenges as nursing programmes currently are incorporated into the universities (Jamshidi, 2012). Majority of the older nurses have only diploma in nursing and probably lack fundamental skills in nursing research, hence, they face the challenge of lack of knowledge on how to find and utilize new knowledge gained by research, to effectively guide students in their clinical experiences and inspire them in making critical analysis of procedures and routines (Ehrenberg & Haggblom, 2007).

 

Nursing instructors thus are challenged by a broad set of teaching-learning issues that are related to their several roles as clinical teachers of senior nursing students in clinical settings. These challenges may have series of negative impacts on training of student nurses and the consequences of which may likely lead to production of poorly trained caregivers. This can pose a serious threat to lives they are meant to protect. Above all, the type of nursing care that will be provided by such poorly trained personnel will be substandard which will result to inefficient health care delivery, consumer dissatisfaction and none achievement of the aims/ goals of health care delivery , among others (Eta, Atanga, Atashil & D’ Cruz, 2011).

 

It is  noteworthy that as the complexity in nursing education increases, the practice of clinical education is highly valued in this current environment of nursing shortages (Kan & Stabler-Haas, 2009); therefore, high quality trained nursing care providers are needed for provision of quality care for the health care consumers. There is urgent need to optimize the effectiveness of clinical teaching to ensure adequate nursing educational training for 21st century professional nursing care providers in this fast changing and evolving technological age.

This apparently will be feasible and achievable if all the job-related challenges facing clinical nurse instructors as they organize clinical teaching of nursing students both in the classroom, demonstration room and in the clinical settings are minimized.  It is essentially necessary to identify the specific need in each environment in order to apply the proper remedy as each environment has its peculiar challenges at each point in time.  Hence, the need for this study which was designed,  to determine the job-related challenges of clinical teaching of nursing students among clinical nurse instructors in Imo State.

 

Statement of the Problem

New nurse graduates, according to Thembekile (2013), possess an in-depth knowledge of theory but very poor practical skills. Thus, there is problem of care provided by new graduates as they lack skills in performance of their duties. Furthermore, causal discussions with practicing professional nurses revealed a general perception of the poor practical skills of newly qualified nurses especially the BNSc products. This probably indicates a problem in the clinical education. The problem is compounded by the fact that the Departments of nursing in particular mostly use graduate nurse assistants instead of clinical nurse instructors in the clinical teaching of students. Most of these graduate assistants are newly qualified nurses who are not yet experienced and therefore not prepared for the clinical teaching.

 

There is also insufficient number of clinical nurse instructors compared to the population of students in training institutions in Imo State, leading to a high tutor: student ratio. For example, the tutor: student ratio in Department of Nursing, IMSU is 1: 100; Umulogho 1: 63; Mbano 1:23; Amaigbo and Emekuku 1:21 respectively (School records, 2015).  This is far above the Nursing and Midwifery Council of Nigeria (2005; 2010) Benchmark where the recommended student annual intake is 50 and tutor: student ratio is 1:10. In spite of this high tutor: student ratio, clinical nurse instructors have added responsibilities in their respective schools and departments.  These are the possible factors that create challenges in which effective clinical teaching may be compromised, neglected or jeopardized leading and consequently affecting the quality of graduates of these programmes (Thembekile, 2013; Keshk & El Dahshan, 2012; Gaberson & Oermann, 2007).  There is need, therefore, to identify these challenges facing the clinical nurse instructors in order to proffer solutions, solve them and improve the clinical teaching effectiveness of the clinical nurse instructors. It is pertinent here to mention that research on job–related challenges of clinical teaching of nursing students among clinical nurse instructors is limited; none is in existence among clinical nurse instructors, nor among clinical teachers in other allied professions in Nigeria. Hence, the need to carry out such a study in order to fill the existing gap. Therefore, the researcher designed this study to determine job-related challenges of clinical teaching of nursing students among clinical nurse instructors in Imo State, Nigeria.

 

Purpose of the Study

The main purpose of this study is to determine job-related challenges of clinical teaching of undergraduates and basic nursing students among clinical nurse instructors in Imo State, Nigeria.

 

 Objectives of the Study

The specific objectives of this study are to:

  1. determine personal – related challenges faced by clinical nurse instructors in the clinical

teaching of student nurses in Imo State.

  1. ascertain student- centered challenges facing clinical nurse instructors with clinical teaching of nursing students in Imo State.
  2. determine the administrative challenges facing clinical nurse instructors in the clinical teaching of student nurses in Imo State.
  3. assess clinical environmental sources of challenges confronting clinical nurse instructors in clinical teaching of student nurses in Imo State.

 

      Research Questions

  1. What are the personal – related challenges facing clinical nurse instructors in the

clinical teaching of nursing students in Imo State ?

  1. What are the student- centered challenges confronting clinical instructors in the

clinical teaching of nursing students in  Imo State ?

  1. What are the administrative challenges confronting clinical nurse instructors in

clinical teaching of nursing students in Imo State ?

  1. What clinical (atmosphere) environmental sources of challenges do clinical nurse

instructors have to contend with in the clinical teaching of student nurses in Imo

State?

 

     Hypotheses

  1. There is no significant association between clinical nurse instructors’ age and their

perceived job-related challenges.

  1. There is no significant association between clinical nurse instructors’ educational

qualification and their perceived job-related challenges.

  1. There is no significant association between clinical nurse instructors’ years of experience and their perceived job-related challenges.

 

Significance of the Study

The identification of job- related challenges of clinical teaching of could play a significant role in reducing the amount of tension the clinical nurse instructors face in performance of their responsibilities of teaching, guidance and supervision of nursing students in the school and the clinical setting. The findings of this study will be beneficial to clinical nurse instructors because the findings will highlight various job- related challenges of clinical teaching facing them and how to eliminate or minimize those challenges. For instance, if the findings reveal that clinical nurse instructors are challenged by personal – related factors like lack of knowledge and preparedness for their work, the information from the study will enable them realize that they need some knowledge update or orientation before they can effectively occupy the post of clinical instructors. This information will stimulate them to take positive action to improve their skills and competency in clinical teaching through seminars and workshops or further training either on their own or seek for sponsorship where necessary. On the other hand, if the findings show that the clinical instructors are challenged by student–related factors like high tutor: student ratio, the clinical instructors will utilize the information as a powerful evidence-based tool for backing their requests and arguments concering observance of the Council recommended tutor: student rato of 1:10. The findings will strongly arm them in requesting either for the employment of more clinical instructors or adherence to annual intake of 50 students per school as recommended by the Nursing and Midwifery Council of Nigeria.

Similiarly, if the clinical instructors are challenged by administrative factors like lack of resources, the findings likewise will serve as supportive evidence in backing their requisitions for appropriate provision of resources, both human and materials for effective performance of their clinical teaching job. In like manner, if other additional responsibilities of the clinical nurse instructors create challenges for them, the findings of the study will serve as clear statistical evidence to the administrators of hospitals and schools regarding the need for employment of more qualified nursing/academic staff in order to relieve the clinical instructors of those additional non- clinical teaching responsibilities so as to maximize their effectiveness in clinical teaching. The findings of the study will help the administrators of the hospitals and the training institutions to understand the challenges clinical nurse instructors are facing in clinical teaching of nursing student. With the clear knowledge of the whole situation, the administrators of the hospitals and the training institutions will appreciate the urgency of the need of profrring solutions to minimize the challenges facing clinical instructors. Finally, the findings of the study will be beneficial to Nursing and Midwifery Council of Nigeria as a governing body, in policy making, planning and improving accreditation criteria,   enforcement and sanction if need be of any training school that exceeds the stipulated annual admission of 50 candidates or compromises the recommended Council benchmark (NMCN, 2005) and standard of education and practice in Nigeria (NMCN, 2010).

Scope of the Study

The study is delimited to clinical nurse instructors in nursing training institutions in Imo State, Nigeria. It is further delimited to clinical teaching challenges facing clinical nurse instructors in basic nursing schools and department of nursing science, Imo State, Nigeria. Finally, it is specifically delimited to personal-related, student- centered, administrative and clinical (atmosphere) environmental sources of challenges faced by clinical nurse instructors in clinical teaching of student nurses in the demonstration rooms as well as in clinical settings.

Operational Definition of Terms

Job–related challenges:  In this study refer to constraints, problems or difficulties and

setbacks the clinical nurse instructors encounter in clinical teaching and supervision of

nursing students in the clinical area, classroom and demonstration room. These job-related

challenges include personal-related, students-centered, administrative and clinical

(atmosphere) environmental sources of challenges.

Personal – related challenges: In this study refer to militating factors or setbacks, constraints,

that are centered on the clinical nurse instructor such as work pressure/overload, insufficient

time in workplace, work  experience, level of professional education, deficient role

preparedness, and lack of knowledge update and skill, etc. The 11items on this subscale were

designed in six- points rating scales, to elicite information on personal – related challenges

facing clinical nurse instructors in clinical teaching ranging from ‘extremely challenged’

(6), ‘very challenged’ (5), ‘moderately challenged’ (4), ‘fairly challenged’ (3), ‘rarely

challenged’(2) to ‘not challenged at all’ (1). The scoring mean was 3.5. Therefore, the

decision rule was any score:  > 4 very/extremely challenged; score > 3 but < 4 moderately

challenged; score < 3 but > 2.5 fairly challenged, while score < 2.5 not challenged at all.

 Student-centered challenges: In this study, mean problems or constraints associated with nursing students’ population, lack of interest, absenteeism from clinical posting from their clinical placement and dissatisfaction of students with teaching hours. The 5 items on this subscale were also designed in six- points rating scales, to elicite information on student – centered challenges facing clinical nurse instructors in clinical teaching ranging from ‘extremely challenged’ (6) , ‘very challenged’(5), ‘moderately challenged’ (4), ‘fairly challenged’(3), ‘rarely challenged’(2) to ‘not challenged at all’ (1). The scoring mean was 3.5. Therefore, the decision rule was any score:  > 4 very/extremely challenged; score > 3 but < 4 moderately challenged; score < 3 but > 2.5 fairly challenged, while score < 2.5 not challenged at all.

Administrative challenges: In this study, refer to problems, militating factors or difficulties

that emanate from the administrators such as lack of adequate workforce (nursing shortage),

lack of materials or equipment needed for teaching, lack of incentives such as finance and

lack of opportunity for knowledge update or acquisition, etc. The 11 items on this subscale

were  designed in six- points rating scales, to elicite information on administrative – related

challenges facing clinical nurse instructors in clinical teaching ranging also from ‘extremely

challenged’ (6), ‘very challenged’(5), ‘moderately challenged’ (4), ‘fairly challenged’(3),

‘rarely challenged’(2) to ‘not challenged at all’ (1). The scoring mean was 3.5. Therefore, the

decision rule was any score:  > 4 very/extremely challenged; score > 3 but < 4 moderately

challenged; score < 3 but > 2.5 fairly challenged, while score < 2.5 not challenged at all.

 

Clinical (atmosphere) environmental sources of challenges: In this study, refer to all the  constraints, militating factors and setbacks that clinical nurse instructors face in relation with clinical teaching of nursing students both during classroom teaching in the school or during

clinical accompaniment of the students in clinical placement. They include lack of adequate

space for teaching; lack of teaching aids including projectors, video players etc, lack of

students’ support by the teachers, lack of continuity in clinical teaching among clinical

nurse instructors, student’s duties in the hospital wards are not clearly defined, etc. The 9

items on this subscale were also designed in six points rating scales, to elicite information on

clinical (atmosphere) environmental – related challenges facing clinical nurse instructors in

clinical teaching ranging from ‘extremely challenged’(6), ‘very challenged’(5), ‘moderately

challenged’ (4), ‘fairly challenged’(3), ‘rarely challenged’(2) to ‘not challenged at all’ (1).

The scoring mean was 3.5. Therefore, the decision rule was any score:  > 4 very/extremely

challenged; score > 3 but < 4 moderately challenged; score < 3 but > 2.5 fairly challenged,

while score < 2.5 not challenged at all.

Demographic characteristics: used in this study were: age, gender, highest educational

qualification, clinical teaching experience and cadre which were specified.

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