THE ROLE OF THE CLINICAL ENVIRONMENT AND SUPERVISION IN STUDENTS’ SATISFACTION WITH ROTATION PRACTICE EXPERIENCE IN THE UNIVERSITY FOR DEVELOPMENT STUDIES

ABSTRACT

Clinical rotation experience is an integral part of the nursing curriculum and crucial component of nursing education, which transforms theoretical knowledge to practice. However, due to the complex nature of the clinical learning environment as a social entity, it often influences student-learning experience. This study was to assess the role of clinical learning environment and supervision in Nursing and Midwifery students’ satisfaction with rotation practice experience in University for Development Studies (UDS), Tamale. A cross-sectional analytic survey design was used to assess students’ satisfaction with clinical rotation experience from UDS Tamale campus. Participants were selected using stratified random sampling technique. SPSS was used to analyze data, using frequencies, percentages, and means. Inferential statistics such as Fisher’s exact test, linear regression and Spearman’s Correlation were used. The result showed that the level of nursing and midwifery students’ satisfaction with clinical rotation experience was high (65.6%). Similarly, the level of students’ satisfaction with the clinical supervision and clinical learning environment were also high (60.3% and 63.5% respectively). The major factors identified, that influence students clinical rotation experience were clinical supervision, clinical learning environment and its dimensions (pedagogical atmosphere of the ward environment, leadership style of nurse manager, and premises of nursing in the ward). These findings call for the need for nurse educators and clinicians to pay more attention to the areas highlighted in this study.

CHAPTER ONE

INTRODUCTION

Background to the Study

Clinical experience is an important aspect of nursing and midwifery education as it is the transformation of theoretical knowledge into practice and the cornerstone of nursing as a health profession (Atakro, 2017; Cuellar‐ Rodriguez et al., 2009; Killam & Heerschap, 2013; Lambert & Glecken, 2005; Lawal, Weaver, Bryan, & Lindo, 2016). Clinical nursing education is teaching and learning which takes place near a patient (Mantzorou, 2004) and prepares nursing and midwifery students for their professional roles and affords them opportunities for applying the knowledge, concepts, and skills they have learnt in classrooms (Esmaeili, Cheraghi, Salsali, & Ghiyasvandian, 2014). Moreover, there is global evidence to support the fact that effective clinical education and training contributes to quality nursing education and that both lead to improved patient outcomes (Al-kandari, Vidal, & Thomas, 2009; Cowan, Norman, & Coopamah (2007).

The purpose of clinical rotation is for the students to learn how to perform physical and psychosocial assessments, interact with clients, families and staff, administer medications and perform other needed skills, develop critical thinking skills; and plan for nursing care in the clinical environment (Presbyterian University College, 2007 as cited in Awuah-Peasah, Sarfo, & Asamoah, 2013). These are necessary for a successful clinical learning experiences and good patient management. In addition, the clinical setting is the most influential context for acquiring knowledge and nursing skills (Chan, 2003).

However, acquiring the needed knowledge and skills in the clinical setting does not come easily. The clinical learning environment is a complex social entity that influences student learning (rotation) experience during clinical rotation. It is made up of a network of interacting forces that influence student-learning experiences. It has been described as a major source of anxiety and stress among nursing students globally (Goff, 2009; James & Chapman, 2009; Sharif & Masoumi, 2005).

The cornerstone for successful clinical rotation experience is high-quality clinical supervision of nursing students (Health Workforce Australia [HWA], 2010, 2011). This concept can be traced back to Florence Nightingale who instructed that student nurses should be trained under the direct supervision of experienced nurses who were “trained to train” (Franklin, 2013). However, clinical nursing education in Ghana is currently facing challenges of poor working relations between hospitals and health training institutions, inadequate preceptor preparations, and inadequate supervisions (Atakro & Gross, 2016). Anecdotal notes from stakeholders shows some shortfalls in nursing education due to poor clinical learning (rotation) experience resulting in a large gap between theory and practice, and inadequate clinical rotation experience.

What is also worrying is that despite the recognition of the importance of the complex social context of the clinical environment, the influence of the clinical learning environment on the achievement of student learning experience during clinical rotation has not been assessed critically. And only a few studies have focused on the perceptions of students nurses on their clinical rotation experiences and learning outcomes (Al-kandari, Vidal, & Thomas, 2009; Lawal et al., 2016).

Exploration of the clinical learning environment gives insight into the educational functioning of the clinical areas and allows nurse teachers to enhance students’ opportunities for learning (Chan, 2002; Sharif & Masoumi, 2005). Moreover, as universities continue to increase nursing student’s intake to meet the demand for an expanded workforce and healthcare infrastructure, it is crucial to identify factors, which have the greatest influence on student progression in both theory and practice. However, previous research has focused primarily on factors that influence nursing students' academic performance (Pitt, Powis, Levett-Jones, & Hunter, 2012) to the neglect of factors that influence students' satisfaction with clinical rotation experience. This has therefore created a paucity of studies in the area of factors that influence students' satisfaction with clinical rotation experience. Additionally, considering the pivotal role of the clinical learning environment in training the nurse, there is an urgent need for further exploration of that area.

Problem Statement

Several studies have reported faculty shortages and large student numbers, which in turn has a negative influence on nursing and midwifery students’ clinical experience (Bvumbwe, 2016; Sawatzky & Enns, 2009). Other studies have stressed a significant association between faculty competence and nursing students’ clinical learning experience, where poor faculty competence has not done well to enhance nursing students learning experience (Ali, 2011; Bvumbwe, 2016; Helgesen, Gregersen, & Roos, 2016). Commitment on the side of clinical faculty/supervisor has also been reported to be on a decline (Henderson, Twentyman, & Eaton, 2010; Ohaja, 2010) and this undoubtedly affects nursing and midwifery students’ clinical rotation experience. As a consequence, nursing students have often reported poor clinical supervision in their practice environment (Bvumbwe, 2016; Sharif & Masoumi, 2005).

Also, complaints of dissatisfaction with clinical experience or nursing training in the clinical setting has been reported due to the vulnerability of nursing and midwifery students to several factors in clinical environment (Nayeri, Nazari, Salsali, Ahmadi, & Hajbaghery, 2006) which requires an immediate assessment. Corroboratively, concerns have been expressed in recent times about newly qualified nurses performing below the expected standard of nursing practice. During the past decade, the image of nursing in Ghana has fallen at a steady rate due to the poor nursing care rendered by qualified nurses to patients (Ghana Registered Nurses' Association [GRNA], 2011). This has been and continues to be a major concern for all, especially nurse educators in Ghana.

Additionally, complaints of dissatisfaction with available clinical models during training have been outlined by students as being a reason for their poor clinical learning experience which places severe anxiety on students in the clinical learning environment (Lubbers & Rossman, 2017). While a rich amount of literature exists in the developed world to address these challenges associated with students clinical learning experience, scanty evidence exists in the developing and under developing areas where there is already a shortage or unavailability of standard clinical teaching and learning models (Ali, 2011; Graham, Lindo, Bryan, & Weaver, 2016)

Moreover, a methodological gap exists with respect to the existing studies. Most studies are qualitative and explanatory in nature and do not explore the construct (Clinical Rotation Experience) to ascertain the magnitude of the challenges with quantitative approaches. Even for those studies that have explored quantitative approaches, it is common to find the use of statistical tools that are suitable for data that are normally distributed, and do not consider the fact that such approaches will not adequately measure a construct with deep latent content, herein, student clinical rotation/learning experience. Thus, it would be more evident to use composite medians instead of means to measure such construct.

In furtherance, many studies have been done in United States (US) exploring factors that have potentially impacted on undergraduate nursing and midwifery student’s progression and completion (Jeffreys, 2007). However, a major gap in the literature is the exploration of factors that influence students' clinical rotation experience (Cowan et al., 2007). Yet, the practical nature of nursing warrants an immediate assessment of factors that influence students' clinical rotation experience.

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Item Type: Ghanaian Topic  |  Size: 144 pages  |  Chapters: 1-5

Format: MS Word  |  Delivery: Within 30Mins.

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