Nursing Students’ Perceptions Of Clinical Nursing Training In Selected Nursing Programmes In Enugu State

Project and Seminar Material for Nursing (Science)

Nursing Students’ Perceptions Of Clinical Nursing Training In Selected Nursing Programmes In Enugu State


Abstract


This study is aimed at assessing the nursing students’ perceptions of clinical nursing training in selected nursing programmes in Enugu State. Five specific objectives and two null hypotheses were formulated to guide the study. Descriptive cross-section design was adopted. Purposive sampling technique was used to select the nursing programmes and the class level of the students. A total population of 442 nursing students was used for the study. A self-developed questionnaire in 4 point modified Likert type scale with reliability of 0.970 was used for data collection. The questionnaire was distributed to the students in the classroom setting with 99.77% return rate.

Information derived from the questionnaire were subjected to descriptive and t-test statistics testing at 0.05 level of significance. Results were presented in Table as frequencies, percentages, means and standard deviations. Findings revealed that nursing students had positive perceptions in clinical placement, clinical teaching and clinical evaluation but revealed that the students showed negative perception in clinical supervision. There were significant differences in perception of clinical training between the university-based and hospital-based nursing students (P-value < 0.05).

There was no significant difference in the perceptions of clinical training between the male and female nursing students (P-value > 0.05), but female nursing students showed negative perception in clinical supervision. It is therefore recommended that; enough clinical supervisors should be employed and equal attention should be given to both male and female students, the university-based and hospital-based nursing students during clinical training etc. Suggestions for further studies were also made.


Chapter One


Introduction

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:

  1. Determine the nursing students’ opinion on their placement in the clinical setting (clinical learning environment).
  2. Ascertain the nursing students’ view about clinical teaching.
  3. Ascertain the students’ view about clinical supervision.
  4. Assess the students’ perception of clinical evaluation.
  5. Determine the students’ overall perception of clinical nursing training.

Research Questions

The following research questions were formulated as a guide to the researcher.

  1. What is the nursing students’ opinion of their placement in the clinical setting/ learning environment?
  2. How do the nursing students’ view their clinical teaching?
  3. What is the students’ view about their clinical supervision?
  4. How do the nursing students perceive their clinical evaluation?
  5. What is the students’ overall perception of clinical nursing training?

Research Hypotheses

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.

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Implications of the Study


The findings of this study have some implications as follows:

  1. Making adequate timetable for clinical placement will help the students cover their postings and rotations to the various clinical units, widen students required experiences, improve their practical skills, and the students offered the opportunity to work directly with competent professional nurses for patients in a particular area of expertise.
  2. Offering the students opportunity to learn with students from other discipline and improving their interpersonal relationship and skills during the placement will help the students develop collaboration, coordination and communication skills they can apply in patient care during and after the training.
  3. Not involving the student nurses in planning their placement into the clinical setting may lead to lack of interest and motivation in the actual carrying out of the plan.
  4. Lack of reasonable (enough, comfortable on the closeness to clinical setting) accommodation and access to leisure activities during outstation posting will expose the students to feelings of anxiety and vulnerability and then poor social development which interfere with the clinical training and learning.
  5. Encouraging students to ask questions, giving them opportunity for demonstration of clinical skills and allowing them to participate actively in the clinical teaching and learning sessions will help them develop proficiency in those skills and become competent trained nurses after the training.
  6. Non provision of the clinical teaching and learning materials (like bedsheets, trolleys, dressing packs, B/P apparatus etc), the available ones not being in good working condition and the clinical instructors not being adequate in number will not allow the students to do proper practice of the clinical skills thereby preventing the students from linking theory with the practice of caring for clients.
  7. Having adequate training, knowledge, responsibility and transparency by the clinical supervisors will help them demonstrate qualitative skills beneficial to students during the clinical supervision.
  8. The supervisors not being available, accessible and not showing respect to the students will make them not to carryout adequate supervision of the students, permit the students to work on their own and learn wrongly thereby exposing the students and the patients to serious danger.
  9. Informing the students of the duration and period of clinical evaluation, use of assorted technique and giving assignments that require critical and creative thinking will help the students to be well prepared for the clinical skills being evaluated on.
  10. Not consistently informing the students of their progress individually will deny them the opportunity for self-assessment and effort for self improvement.
  11. Because there are significant differences in the perceptions of clinical nursing training between the university-based and hospital-based nursing students, there may be differences in the quality of clinical skills acquired by the students of the different programmes leading to inadequate or adequate quality of care rendered to patients.
  12. Finally, because there is no significant difference in perception of clinical training between the male and female student nurses, there is no separate or special clinical placement, teaching, supervision and evaluation organized based on gender.

Limitations of the Study


There is a great limitation of literatures for this work. Time constraints prevented this study from covering the nursing students in other basic nursing programmes in the southeast geopolitical zone.


Summary


This study was carried out to assess the nursing students’ perceptions of clinical training in selected nursing programmes in Enugu State.

The objectives that guided the study were to:

  1. Determine the nursing students’ opinion of the placement into the clinical learning environment/setting.
  2. Ascertain the nursing students’ view about the clinical teaching (instruction).
  3. Identify the nursing students’ views about clinical supervisions.
  4. Assess the nursing students’ perceptions of clinical evaluation.
  5. Determine the students overall perception of clinical nursing training.

Relevant literatures were reviewed to cover the objectives. The research design used was descriptive cross-sectional survey. 441 out of the 442 2nd and 3rd year hospital-based and 4th and 5th year university-based nursing students in the NMCN accredited basic nursing programmes in Enugu State were used. A validated structured questionnaire constructed by the researcher with the help of experts was used for data collection.

  1. Data obtained were presented in Tables, percentages, mean, standard deviation and hypotheses tested using multiple analysis of variance at 0.05 level of significance. Major findings of the study revealed that:
  2. Majority of the students were females.
  3. Majority of the nursing students involved in this study demonstrated high perception of their clinical training especially in the aspects of the placement into the clinical setting and clinical teaching (instruction).
  4. Some of the nursing students also demonstrated low perception of their clinical training.
  5. Majority of the nursing students showed low perception of their clinical supervision.
  6. There was a high perception of clinical evaluation though the students were not constantly informed of their progress.
  7. There exists a significant difference in the perceptions of the clinical training between the university-based and hospital-based nursing students (P<0.05). • There was no significant difference in perception of clinical training between males and female nursing students (P>0.05), though female nursing students had negative views about their clinical supervision.

Conclusion


The nursing students involved in this study generally demonstrated positive perceptions of clinical training. A positive perception was shown on clinical placement, teaching and evaluation, while negative perception was shown on clinical supervision. University-based nursing students showed negative perception in all the subscales, while hospital-based student nurses showed positive perception in all the subscales. Also, the fact that there was no significant difference in perceptions of clinical training between the male and female student nurses indicated similarities in all the activities of clinical training.

The nursing students are the customers and consumers in the clinical nursing training. Their benefits from the training will depend on how they perceive the clinical training experiences. But since clinical nursing education is not meaningful without qualitative clinical placement, teaching, supervision and evaluation, it becomes essential for the schools of nursing, faculties, clinical setting and the policy makers to be highly committed to it and work together towards giving the students the required qualitative clinical nursing training.


Recommendation


In view of the findings and educational implications of the study it is therefore recommended that:-

  1. Nursing students should be actively involved from the planning stage of their placement and adequate accommodation made available for outstation posting.
  2. Access to leisure activities during the clinical posting should be allowed to permit the students to also develop socially during the clinical nursing training.
  3. Adequate and functional teaching and learning materials example blood pleasure apparatus, trolleys, nursing process charts etc. should be provided at the clinical setting.
  4. More qualified clinical instructors, supervisors and enough ward staff nurses who are experienced and are capable of integrating theoretical knowledge with practical procedure should be employed for clinical teaching, supervision and facilitation during clinical nursing training. This will also help to ease off the heavy workload of the nurses thereby providing enough attention to the student nurses.
  5. The clinical instructors and supervisors should do adequate planning of their supervision and duty roster made available so that they can always be available and accessible to the students.
  6. There should be equal attentions should be given to university-based and hospital-based nursing students during clinical placement, teaching, supervision and evaluation.
  7. Proper feedback on the students’ progress should be given to them individually and as groups after clinical evaluation to enable them work harder in areas they are having problems.

Suggestions for Further Studies


This present study and its findings opened up avenues for other areas that could be explored, for example;

  1. Further study is suggested to investigate the nursing students’ perceptions of clinical supervision.
  2. A comparative study on perceptions of clinical training between the university-based and hospital-based student nurses should be carried out.
  3. Similar study should be extended to other basic nursing programmes in the other states of the federation for better generalization.
  4. Since replication studies could provide empirical support for this study, it should be carried out as scientific empiricism demands that.
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