CHAPTER ONE
Statement of Problem
Despite the fact that clinical learning is an integral part of nursing education, yet it has been problematic. Various studies have suggested that not all practice settings are able to provide nursing students with a positive learning environment (Chan, 2004). Clinical experience has been linked to high levels of stress and anxiety in nursing students and literature shows that there is a link between the nursing student attrition and the stress related to the clinical experience (Mlek, 2011). Evidence also shows that clinical experience is one of the most anxiety producing components of the nursing program (Sharif & Masoumi, 2005) and some of the anxiety producing situations identified by nursing students include lack of clinical experience, unfamiliar areas, difficult patients, fear of making mistakes and being evaluated by faculty members. In addition nursing students in other studies (Levett-Jones, Latta, Hygins & McMillan, 2009) described nursing staff as unfriendly, hostile, indifferent, unreceptive and unapproachable. Their feelings of inclusion/exclusion affected directly their sense of belonging and subsequently increased their anxiety, capacity and motivation to learn (D’souza et al, 2013). Though mild anxiety is not detrimental to learning and may even enhance perception and memory but moderate or severe anxiety can alter one’s ability to learn and perform in a clinical setting (Levett-Jones et al 2009). The researcher having taught in School of Nursing for over five (5) years now have listened to comments from students regarding their perceived difficulties while on clinical placements. Some of the difficulties focused on their perceived lack of support and direction, not feeling part of the team and concerns regarding interpretation of their supernumerary status in the clinical areas. Supernumerary status means that student nurses are additional to the clinical workforce and undertake a placement in clinical practice to learn, not as members of staff (NMC, 2004 in Allan, 2009). However, this does not mean that students do not work whileon placement, they are expected to learn through supervised participation in clinical work (Arkell & Bayliss-Pratt, 2007). The researcher is interested in assessing perceptions of students’ actual clinical learning environment experiences and to determine what they would prefer this environment of experience to be like. Such an assessment is necessary in order to facilitate and maximize student nurses’ clinical training (Chan, 2002). Few studies have been conducted on the clinical learning environment (C.L.E) which has considered the students’ perceptions of the actual C.L.E as well as the C.L.E ideally liked or preferred (Chan 2002) in other countries. Unfortunately, in Nigeria, there is apparently no published research on students’ perceptions of the clinical learning environment in nursing literature.
Purpose of the study
The purpose of this study is to assess student nurses perceptions of their actual and preferred clinical learning environment in hospital settings in Enugu State. The researcher is interested in bringing the students’ perceptions into the public domain to ensure they have a voice within the wider nursing arena.
Objectives of the Study
The objectives of the study are to:1. determine student nurses view of their actual hospital clinical learning environment.2. establish student nurses preferred hospital clinical learning environment.3. determine if differences exist in student nurses view of their actual and preferred hospital clinical learning environment.4. identify differences between the actual and preferred clinical learning environment and students’ age, gender, location and year of study.5. identify factors that influence student nurses opinion of their hospital clinical learning environment.
Research Questions
1. How do nursing students see their actual hospital clinical learning environment?2. What is the student nurses preferred hospital clinical learning environment?3. What differences exist between perceptions of actual and preferred hospital clinical learning environment of student nurses?4. What differences exist between the actual and preferred clinical learning environment and the students’ age, gender, location and year of study?5. What factors influence student nurses’ opinions of their hospital clinical learning environment?
Statement of Hypothesis
1. There will be no significant difference in the students’ perception of the actual and preferred hospital clinical learning environment.2. There will be no significant difference in students’ perception of the actual hospital clinical learning environment between baccalaureate (UNEC) and hospital based (schools of Nursing-UNTH and Bishop Shanahan).3. There will be no significant difference in students’ perception of the preferred hospital clinical learning environment between baccalaureate (UNEC) and hospital based (schools of Nursing-UNTH and Bishop Shanahan).4. There will be no significant difference in students’ perception of the actual and preferred hospital clinical learning environment between baccalaureate (UNEC) and hospital based (schools of Nursing-UNTH and Bishop Shanahan).5. There will be no significant age difference in the students perception of actual hospital clinical learning environment6. There will be no significant age difference in the students’ preferred hospital clinical learning environment7. There will be no significant difference in students’ perceptions of actual and preferred hospital clinical learning environment and the year of study.8. There will be no significant gender difference in students’ perception of the actual and preferred hospital clinical learning environment.
Significance of the Study
The focus of this study is on the perceptions of actual and preferred clinical learning environment of student nurses in Enugu State. The findings of this study will reveal the students’ perceptions of actual and preferred clinical learning environment in the hospital setting, whether the practice settings are able to provide nursing students with a positive learning environment. It will also reveal a better understanding of what constitutes quality clinical education from the students’ perspective. An understanding of the students’ perceptions of their actual and preferred hospital clinical learning environment may reveal aspects of the actual environment that require improvement in order to maximise students’ learning in practice. Findings if published and utilized will also assist in improving the educative quality of students’ clinical education through understanding their perspective of clinical learning environment and the social climate in which they are (ward). It will also help nurse educators, hospital administrators, Nursing and Midwifery Council of Nigeria as well as Ministry of Education in ensuring that the problems identified by students in the clinical area is addressed accordingly by monitoring the activities in the clinical setting. This study will equally serve as a reference for future researchers writing on similar topic. The findings of this study will also contribute to the existing body of knowledge on the clinical learning environment in nursing literature in Nigeria. It is believed that the present study will provide a preliminary data that will fill the gap in the knowledge in nursing literature in this area.
Scope of Study
This study is delimited to student nurses in Enugu State. This includes second and third year students in schools of nursing, UNTH Enugu, and Bishop Shanaham, Nsukka respectively and fourth and fifth year nursing students in the department of nursing sciences, UNEC, because they had experienced adequate clinical exposure to be able to comment on a variety of situation. The study is delimited to actual and preferred hospital clinical learning environment of nursing students. It includes students of both sexes.
Operational Definition of Terms
1. Perception – refers to the rating by student nurses of items of the actual and preferred clinical learning environment inventory (CLEI 42 items), contained in the questionnaire. These ratings are based on the observations and experiences and exposures of thestudent nurses.2. Perceptions of actual hospital clinical learning environment – refers to student nurses description of what their clinical learning experience is actually like in the hospital setting as contained in the CLEI such as the CPC/Nursing staff considers students, Students are dissatisfied with what is done in the ward among others.3. Perceptions of preferred hospital clinical learning environment – refers to description of what or how students want their experience in the clinical area of the hospital to be like as contained in the CLEI such as the CPC/Nursing staff would consider students, Students would be dissatisfied with what is done in the ward among others .4. Hospital clinical learning environment – refers to student nurses’ clinical experience in the hospital setting.5. Clinical learning environment – is defined as an interactive network of forces within the clinical setting that influence the students’ clinical learning outcomes. It includes hospitals, wards, clinics, health departments, hospice units, and other health care settings utilized for student learning such as community visits, nursing homes, and mental health homes among others.6. Clinical education – is the teaching learning process which occurs in the context of real health care clinical practice mostly in a hospital setting. It involves practical integration and application of knowledge, skills and attitudes learned at the classroom and it is facilitated with professional support, supervision, feedback and evaluation among others.