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Ebere Omeje
UGWU, STELLA NGOZIKA
PG/M.Sc/10/55080
NURSING STUDENTS’ PERCEPTIONS OF CLINICAL NURSING TRAINING IN SELECTED NURSING PROGRAMMES IN ENUGU STATE
DEPARTMENT OF NURSING SCIENCES
FACULTY OF HEALTH SCIENCES AND
TECHNOLOGY
Ebere Omeje Digitally Signed by: Content manager’s Name
DN : CN = Webmaster’s name
O= University of Nigeria, Nsukka
OU = Innovation Centre
1
NURSING STUDENTS’ PERCEPTIONS OF CLINICAL NURSING TRAINING IN SELECTED NURSING PROGRAMMES IN ENUGU STATE
DEPARTMENT OF NURSING SCIENCES
HEALTH SCIENCES AND
Digitally Signed by: Content manager’s Name
DN : CN = Webmaster’s name
O= University of Nigeria, Nsukka
2
NURSING STUDENTS’ PERCEPTIONS OF CLINICAL NURSING
TRAINING IN SELECTED NURSING PROGRAMMES IN ENUGU
STATE
BY
UGWU, STELLA NGOZIKA
PG/M.Sc/10/55080
DEPARTMENT OF NURSING SCIENCES,
FACULTY OF HEALTH SCIENCES AND TECHNOLOGY
UNIVERSITY OF NIGERIA ENUGU CAMPUS
SEPTEMBER, 2015.
3
TITLE PAGE
NURSING STUDENTS’ PERCEPTIONS OF CLINICAL NURSING TRAINING
IN SELECTED NURSING PROGRAMMES IN ENUGU STATE
BY
UGWU, STELLA NGOZIKA
PG/M.Sc/10/55080
PRESENTED TO THE DEPARTMENT OF NURSING SCIENCES,
FACULTY OF HEALTH SCIENCES AND TECHNOLOGY
UNIVERSITY OF NIGERIA, ENUGU CAMPUS
IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD
MASTERS OF SCIENCE DEGREE (M.Sc.) IN NURSING SCIENCE
(NURSING EDUCATION)
SUPERVISOR: DR. (MRS) N.P. OGBONNAYA
SEPTEMBER, 2015.
4
5
6
DEDICATION
This work is dedicated to God Almighty and my lovely husband.
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ACKNOWLEDGMENT
I humbly express my sincere gratitude to Almighty God for His Mercies,
guidance and protection throughout the period of this programme and for
the patience and strength granted to me to carry out this project.
My special thanks go to my supervisor, Dr. (Mrs) N.P. Ogbonnaya for her
motherly advice constructive criticisms, useful inputs and also for bringing
light to this work. I will ever remain grateful to her. I am equally grateful to
all the lecturers in the Department of Nursing Sciences, UNEC for their
efforts towards the successful completion of this programme, especially my
readers Dr. (Mrs) G. Madubuko and Dr. (Mrs) A. Chinwuba for their useful
corrections to this work.
I sincerely appreciate my lovely husband Engr. Ugwu Gabriel Onyeka for his
understanding, endurance, encouragement, moral and financial support
while this programme lasted, especially for his participation during the data
collection. I also thank the HOD, principals, nurse educators and students
of the schools of nursing and department of nursing sciences in Enugu
State for their cooperation when visited for data collection.
Finally, I express my profound gratitude to my typist Miss Nkechi Nwonyi
and her boss Mr. Azubuike Ezenta for their effort and contribution toward
the successful completion of this work.
I thank you all!
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TABLE OF CONTENTS
Page
Title - - - - - - - - - - - i
Approval - - - - - - - - - ii
Certification- - - - - - - - - - iii
Dedication - - - - - - - - - - iv
Acknowledgement - - - - - - - - - v
Table of Contents - - - - - - - - - vi
List of Tables - - - - - - - - - ix
List of Figures - - - - - - - - - x
Abstract - - - - - - - - - - xi
CHAPTER ONE: INTRODUCTION
Background to the Study - - - - - - - 1
Statement of the Problem - - - - - - - 4
Purpose of the Study - - - - - - - - 6
Objectives of the Study - - - - - - - - 6
Research Questions - - - - - - - - 6
Hypotheses - - - - - - - -- - - 7
Significance of the Study - - - - - - - 7
Scope of the Study - - - - - - - - 7
Operational Definition of Terms - - - - - - 8
9
CHAPTER TWO: LITERATURE REVIEW
Literature Review - - - - - - - - - 9
Concept of Nursing Education - - - - - - - 9
Clinical Nursing Training - - - - - - - 13
Clinical Placement - - - - - - - - 17
Clinical Learning Environment- - - - - - - 24
Clinical Teaching - - - - - - - - - 24
Clinical Supervision - - - - - - - - 29
Clinical Evaluation - - - - - - - - 33
Concept of Perception - - - - - - - - 41
Theoretical Review - - - - - - - - 43
Empirical Studies- - - - - - - - - 46
Summary of Literature Review - - - - - - - 53
CHAPTER THREE: RESEARCH METHODS
Research Design - - - - - - - - - 55
Area of Study - - - - - - - - - 55
Population of Study - - - - - - - - 59
Sample - - - - - - - - - - - 59
Inclusion Criteria - - - - - - - - - 59
Sampling Procedure - - - - - - - - 60
Instrument for Data Collection - - - - - - - 60
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Validity of the Instrument - - - - - - - 60
Reliability of the Instrument - - - - - - - 61
Ethical Consideration - - - - - - - - 61
Procedure for Data Collection - - - - - - - 62
Method of Data Analysis - - - - - - - - 62
CHAPTER FOUR: PRESENTATION OF RESULTS
Demographic Characteristics of Respondents - - - - 64
Objectives - - - - - - - - - - 66
Test of Significance - -- - - - - - - 78
Summary of Findings - - - - - - - - 80
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of Major Findings - - - - - - - 83
Implications of the Study - - - - - - - 98
Limitations of the Study - - - - - - - - 100
Summary of the Study - - - - - - - - 101
Conclusion - - - - - - - - - - 102
Recommendations - - - - - - - - 103
Suggestions for Further Studies - - - - - - 104
REFERENCES - - - - - - - - - 105
APPENDICES - - - - - - - - - 115
Appendix 1: Perception of Clinical Nursing Training
Questionnaire - - - - - - 115
Appendix 2: Calculation of Reliability of Questionnaire - - 119
Appendix 3: Pearson Correlation Coefficient (R) for Questionnaire 120
Appendix 4: Correlations for Reliability of Instrument - - - 121
Appendix 5: Informed Consent - - - - - - 122
Appendix 6: Letter of Introduction - - - - - 123
Appendix 7: Administrative Permission of Research Work - - 124
Appendix 8: Ethical Clearance Certificate - - - - 125
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Appendix 9: Means and Standard Deviations of the 70 items of the
SPCNTQ - - - - - - - 126
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LIST OF TABLES
Page
Table 1: Demographic Characteristics of Respondents - 65
Table 2: Mean and standard deviation of nursing students’ opinion
of placement into the clinical setting/learning
environment with their ranking - - - 67
Table 3: Mean and standard deviation of nursing student’ view
about clinical teaching (Instruction) with their ranking 70
Table 4: Mean and standard deviation nursing students’ view
about clinical supervision with their ranking - - 72
Table 5: Mean and standard deviation nursing students’
perceptions of clinical evaluation with their ranking 74
Table 6: Adjusted mean scores and standard deviations for
nursing students’ perception of clinical training
for each subscale - - - - - - 76
Table 7: Showing differences in perceptions of clinical training
between university and hospital-based nursing
students - - - - - - - 77
Table 8: Showing differences in perceptions of clinical training
between male and female nursing students - 79
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LIST OF FIGURES
Page
Figure 1: James Gibson’s Ecological Perceptual Cycle 45
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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.
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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.
16
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
17
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
18
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 &
19
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.
20
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?
21
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
22
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.
23
CHAPTER TWO
LITERATURE REVIEW
This chapter presents the review of relevant and existing literatures as they
relate to the nursing students’ perceptions of the clinical nursing education.
It was presented and discussed under the following subheadings:
Conceptual Review
• Nursing Education
• Clinical Nursing Training
• Perception
Theoretical Review
• James Gibson’s Ecological Theory of Perception
Empirical review
Summary of reviewed literatures
Conceptual Review
Concept of Nursing Education
Functionally and operationally, “education” is a process which draws out the
best in the individual with the aim of producing well balanced personalities,
culturally defined, emotionally stable, ethically sound, mentally alert,
morally upright, vocationally self-sufficient and internationally liberal
(Basavanthappa, 2009). It is also the formal process of deliberate
transmission of accumulated knowledge, skills, customs and values from
24
one generation to another (May & Akikitnan, 2003). Basavanthappa (2002)
affirms that an educated person is not dependent on the information they
store in their heads because they have ability do find information, create
knowledge and develop skills when necessary. The result is an educated
person, a person who is able to perceive accurately, think clearly and act
effectively on self-selected goals and aspiration.
Nursing education can be referred to as the formal learning and training in
the science of nursing, which includes the functions and disciplines that
accelerate the patient’s return to health and helps maintain it. It is the
theoretical and practical training provided to student nurses with the
purpose to prepare them for their duties as future nursing care
professionals. This education is provided to nursing students by experienced
nurses and other medical professionals who have qualified for educational
tasks (Adah, 2012). Adah (2012) further stated that all nursing education
programmes have a clinical component in which students are supervised by
clinicians in the clinical setting.
Nursing education therefore is all about impacting the integral nursing
knowledge of theories, principles, facts, concepts and acquisition of
necessary and appropriate skills and proficiency to practice the profession.
That is why nursing is seen as a science and an art. Thus, the two are
inseparable. They must go together in order to train a well balanced nurse
who will perform proficiently in the clinical area anywhere in nursing field.
While the acquisition of theoretical knowledge, principles, facts, concepts
occur in classroom setting during the teaching - learning interaction
25
(process), the acquisition of the required skills and proficiency to practice
occur during clinical training which occur in the hospital setting,
community setting or else where outside classroom setting.
American Nurses Association (2012) stated that the aims of nursing
education include: Provision of opportunities for both in and out of hospital,
continuing education programmes that increase knowledge and skills
thereby enhancing quality care; Provision of resource materials which are
evidence based in order to keep all personnel informed and updated on
current practices in health care; Supporting research council; Providing
changed nurses and managers with leadership development programmes;
Provision of framework and support for mentors and clinical ladder nurse
and Provision of necessary orientation and training to all our new
employees. Basavanthappa (2009) further stated the general aims of nursing
education as thus: Nursing manpower development; Leadership; Personality
development; Professional development of each individual nurse; Ongoing
research; Knowledge.
According to Nursing and Midwifery Council of Nigeria (NMCN) (2008), the
two forms of nursing education in Nigeria include: Non University-based
Nursing Programme and University-based Nursing Programme. Non
University-based Nursing Programmes are the diploma certificate based
programmes done in schools of nursing and they include:
26
General Basic Nursing Diploma Programme: The duration of the training
is three calendar years and is done in hospital based schools of nursing. The
school exams for this programme are: introductory block/Preliminary
Training Section (PTS) exam, junior block, intermediate block, senior block,
hospital final and final council qualifying exams. Each exam is accompanied
by a practical and viva voce aspect of the exams. The registration obtained is
“Registered Nurse” (RN).
Advanced Post Certificate Diploma Nursing Programme: Some of these
programmes include orthopedic, ophthalmic, pediatric, burns and plastic
nursing programmes etc. The duration of training is one calendar year with
the exception of the advanced post basic diploma programmes (nurse
anesthetic programme and midwifery etc) that last for 18 months. The
school exams for these programmes include first semester, second semester,
hospital finals and final council qualifying exams. These programmes are
done in post basic schools of nursing.
The University Based Nursing Programmes include:
Baccalaureate Nursing Programme: It is the generic nursing programme
done in the department of nursing science in some of the Nigeria
universities. It is done for five years for candidates that came in through
jamb examination and four years for direct entry student in pursuit of
Bachelor of Nursing Science (B.N.Sc) Degree. The school examinations here
are the university semester exams from the first to the final year and
Nursing Council final qualifying examination during their fourth year for
B.N.Sc students, midwifery final qualifying examinations by the NMCN
27
during their fifth year, then the university degree examinations at the end of
5th year.
Higher Degrees in Nursing:- The programmes here are Master of Science
(M.Sc.) in nursing (from one year to eighteen months) and Doctor of
Philosophy (Ph.D) in nursing (from 3 years and above). These are offered in
some Nigerian universities. The modes of evaluation here are the course
work exams, clinical posting and thesis.
In all these forms of nursing education programmes, clinical nursing
training forms an integral part of their programmes and this starts with
clinical placement, clinical teaching, clinical supervision and ending with
clinical evaluation. Thus students’ perception of the clinical training is of
paramount important.
Concept of Clinical Nursing Training
Clinical nursing training is a combination of three words; clinical, nursing
and training. The Macmillian English Dictionary for Advanced Learners
defined clinical as relating to “working with people who are ill”, nursing as
the “professional training that a nurse receives” and training as “the process
of being trained for a particular profession”. The combination of these three
words therefore results to the professional training that an aspiring student
nurse receives in the clinical area. Clinical nursing training is the education
of students in the clinical setting. Most notably, clinical training is derived
through training apprenticeships, in which an aspiring student learns many
aspects of the profession from the “master” (Schen in kozier, 2008). National
Athletic Training Association Education in 2002 also defined clinical training
28
as the portion of the students’ professional preparation that involves the
formal acquisition, practice and evaluation of clinical proficiency through
clinical experiences in the hospital care environment. In the clinical
situation, nursing care becomes a reality and the student nurse can observe
the responses of patients to the care given (Melone, 2010). Contacts with
patients are important elements in learning in clinical practice. Here,
students are exposed to authentic life stories for example people with
serious illness and these experiences can arouse strong emotion and yet
they also offer meaningful learning experiences. These kind of clinical
situations are important impulses to students’ profession development
(Turumen, 2002).
In discussing the goals of clinical nursing training, Schindly, (2012) stated
that students gain real life experience by working in the clinical setting and
that clinicals move students from textbook theories to patient bedside care.
The primary drivers of transformation in clinical nursing education are
society’s need, increased patients’ awareness about health and nursing
practice, accountability for efficient and effective use of education resources
which include best clinical teaching practices based on research evidence
(Shariff & Masoum, 2005). The increased demand for quality care by the
public and increased struggle for quality assurance and quality
improvement by nursing profession have been confronting the theoretical
and clinical training of nursing students during the past decade. Thus,
Ehiemere, (2009) concluded that clinical training based on sound nursing
29
education is the only option to equip nurses with the current trend in
nursing practice.
Patterns of clinical training in nursing education
These refer to the ways in which the practical experiences of nursing
students are planned and organized in the clinical setting. The pattern
varies from school to school depending on each schools schedule of
programme and according to the curriculum. The pattern also varies
according to the type of school, that is, whether the school is hospital based
or generic nursing programme. The NMCN has a stipulated number of days
which each student must attend clinical experiences in the clinical
sites/wards for the period of training. For hospital based program, the
student must complete a minimum of 204 days or 4,400 hours in the
clinical areas before being qualified for the nursing council final qualifying
exam (Nursing and Midwifery Council of Nigeria Curriculum for General
Nursing Program, 2001). The patterns for clinical nursing training include:
Consolidated clinical training; Study day’s clinical training and Block system
of study clinical training
Consolidated clinical training: This is the pattern of clinical training
where the periods for student’s clinical experiences are scheduled to be at a
stretch towards the end of a semester. These periods ranges from 3months
for some schools of nursing to 6months in the universities.
Study day’s clinical training: This starts from the introductory class
where preliminary training students are introduced early to the wards to
30
practice what they have learnt on weekly bases. Students attend classes on
some days in a week and still go for clinical experiences on weekly
bases/or the same week. In some schools, two days in every week are
mapped out for this exercise.
Block system of study clinical training: Many schools of nursing practice
block system of study whereby there are periods allocated in the yearly
school programme for each set of students to be in the classroom and
periods for them to be in the practice area. Students are assigned to specific
area of experience during each period of about 3 to 4 weeks after classroom
learning of about six to eight weeks.
Components of Clinical Nursing Training
Component as defined by Macmillan English Dictionary for Advanced
Learners is the different parts or essential feature of something. It is used
synonymously with basic element which means an important basic part of
something. Component of clinical nursing education is the important basic
or essential feature (element) of clinical nursing education. Basavanthappa
(2009) identified some of the basic elements of clinical training in nursing
education as: Planning and organizing (placement), Teaching, Supervision
and Evaluation. Duteau (2012) in addition, opined that the benefit of clinical
training in nursing education is achieved through adequate clinical
placement, teaching, supervision and evaluation.
31
Clinical placement
The challenges confronting nurses in today’s rapidly changing health care
environments have highlighted the necessity for graduating students to be
prepared for practice. This necessity has in turn highlighted the increasing
significance of the nature and quality of student clinical learning experience
(Adams, 2002 & Chan, 2002). Graduate students will be required to have
adequate knowledge and skills to be able to transform competences into
effective performance. It is during their clinical placement that students are
expected to develop the relevant knowledge, skills and competence (Chan,
2002) to develop their capacity for “knowing how” as well as for “knowing
that” and to expand their perceptions of their future role as registered
nurses.
Placement is the act of putting someone into a place/position where he can
do a temporary job that is part of a course of study and gives experience of
the work he hopes to do at the end of the course (Rundel, 2006).
Commenting on this, University of Liverpool Online Programme (2013) noted
that clinical placements involved supervised practice in approved clinical
situation including teaching hospital, private hospital and clinics,
community health centre and specialist areas including early childhood and
women’s health services. They went further to state that clinical placement
may be undertaken during semester or in semester breaks and can vary
from regular one-day placement to block periods of several weeks.
32
Clinical placement can also be defined as any arrangement in which a
student nurse is present in an environment that provides health care or
related services to patients or the public. The placement can take place in
primary, secondary, community health centre or social care setting and
these are the places in which nursing students see the art of nursing
applied and begin to develop their unique style (Tobin Communications,
2005). Therefore, clinical placement is the process of posting or sending
students to the various clinical sites or environment for quality clinical
learning experiences that will help them develop relevant knowledge, skills
and competencies for their future role as registered nurses. It is usually
taken in a facility external to the university offering nursing sciences or
school of nursing and where the clinical education and supervision is
undertaken by a member of the school of nursing or university staff (nurse
educators, clinical educator preceptors) in accordance with guideline agreed
between the school or universities and the placement facility or sites
(University of Queensland, 2005).
This school went on to say that clinical placement site (facility) refers to the
workplace, organization, service, agency or practice that agree to provide
clinical education and supervision to the students and to oversee their
professional development and progress throughout the placement. During
this placement the students are rotated through various working services.
These facilities include out patient department, family planning units,
medical wards, surgical wards, theatre and CSSD, Orthopaedic unit, public
health unit obstetric and gynecological unit and community placement
33
facilities like health centre, school health visits, home visits, visit to the
community’s source of water supply, visit to market arbertuer. The schools
and hospitals must coordinate and schedule these rotations to clinical services
According to Australian Government Initiative (2012), the elements relevant
to quality in clinical placement are enablers and barriers. Enablers are
factors known to improve the quality of the clinical placement experience
and they include: A culture of quality comprising relationships, learning and
best practices; Effective supervision founded on a good supervisory
relationship; Learning opportunities largely supported by
participation in direct patient care; Effective communication and collaborati
on between students’ academic institutions and placement sites to ensure
adequate placement preparations and Resources and facilities to conduct
placement activities. And barriers are factors known to reduce the quality of
the clinical placement experience and they include:
Occupational stress: Psychological stressors such as high workload,
problematic working relationship, lack of supervisors support and low level of
recognition and reward are all too commonly reported in health service
delivery environments. These induce states of anxiety, inhibits learning,
impair performance and compromise health and wellbeing.
Workplace incivility and aggression: These threaten the socio-emotional and
physical safety of students in the placement environment. Incivility is defined
as intimidating and disruptive behaviours that are “low intensity deviant
behavior with ambiguous intent to harm the target, in violation of workplace
norms for mutual respect”. In a study exploring nursing students’ experience
34
of incivility in clinical environment, co-workers and supervisors can be a
source of stress (Anthony and Yastick, 2011).
Preparation/Guidelines for clinical placement:
According to Sobralske and Naegele (2001) clinical educators, staff, client,
students and faculty must all prepare for the students entry into the clinical
setting. Plans should be made to know the students very well, find out how
each of them learn best, orient them to the clinical and clarify expectations
and responsibilities of the education programme, to the student and the
clinical preceptor. Guidelines on how to do these as stated by Sobralske and
Naegele (2001) were similar in the field of midwifery and advance practice
nursing and they are summarized as thus: The school should do the
following: Provide learning objectives; Provide tools for feedback and
evaluation; Clarify grading criteria and responsibility; Initiate student and
clinical educator and preceptor contact; Resolve clinical problems in
collaboration with preceptor and students; Provide to preceptors/clinical
nurse educator with student bio-program objectives curriculum and
evaluation forms and Provide to students with description, location and
contact information for the practice and preceptor clinical objectives,
evaluation tools and grading criteria.
The preceptor/clinical educator should do the following: Be able to
demonstrate safe, evidence-based practice; Hold current licensure; Be aware
of curriculum, learning objectives and evaluation/grading criteria; Orient
students to site; Create optimal learning opportunities; Provide timely,
35
constructive feedback and Evaluate student performance fairly and
accurately. The students should do the following: Dress professionally;
Know their learning needs; Be familiar with clinical objectives, evaluation
forms and personal learning objectives; Know how to contact clinical area
and preceptors; Follow clinical area policies (Osler, 2013).
Providing monetary compensation to clinical sites may be necessary. Other
types of compensation that are offered include free or reduced-price,
continuing education programme, internet-e-mail accounts and library
privileges. In some programmes students fill out a clinical preferences form
before clinical assignments are made. They detail their prior experience,
personal constraints (for example family, travel constraints) and desires for
next clinical rotation for example patient population, volume, risk and
preceptor style that is most helpful to them (Turnbull, 2013).
It is helpful to have a class discussion about clinical survival skills before
the beginning of the clinical rotation. During this session, students
appreciate hearing from more advanced students or recent graduate who
recently completed similar clinical rotations. Some education programmes
have created a clinical coordinator position to link the academic programme
and clinical sites more effectively. The clinical coordinator has a key role in
recruiting and retaining preceptors and clinical sites and arranging student
placement. She/he may also provide teaching and learning resources to
faculty preceptors and supervisees’ clinical activities. This multifaceted role
requires clinical and academic competence, creative flexibility and good
communication skills. It is helpful to let other staff know that the student
36
will be coming and to involve them in welcoming and orienting the students
to the clinical setting (Corrin, 2015).
Nursing and Midwifery Council of Nigeria (2008) in discussing some of the
items needed for clinical experiences requires that each student must have a
schedule book which contain things learnt in the classroom and also things
learnt during clinical experiences in different aspects of care units. They
went on to say that schools must have a procedure manual which should be
reviewed every five years. This serves as a guide to both the students and
the teachers for clinical training. This procedure manual is developed by
each school to reflect their philosophy which must be in line with the NMCN
curriculum. Schools must also have a good library and demonstration
rooms with relevant charts, models, equipment, bones etc to help the
student practice. A total placement periods of 1530 hours in the basic
nursing curriculum for clinical training in nursing education is
recommended (Nursing and Midwifery Council of Nigeria, 2001).
Clearly, clinical placement environment not only plays an important role in
the development of students’ competency but also students’ confidence,
organizational skills and preparedness for practice. There has also been
recognition of the influence that individual ward or unit environments have
on students’ experiences and career intentions (Clare, White, Edward &
Van-Loon, 2002).
Furthermore, given the inadequate preparation of nursing graduates for
rural practice together with the concentration of clinical placements within
37
large metropolitan hospital, it would not be unexpected that most graduates
have little understanding of rural issues and generally do not choose rural
nursing as a career option. However research findings indicate that rural
placement programmes improve the clinical skills necessary for rural work,
increase appreciation of the variety of experiences offered in rural practice
(Talbot & Ward, 2000) and increase awareness of the multiple opportunities
to practice clinical skills during rural placements (Peach & Bath, 2000). By
undertaking rural placements, nursing students especially those with no
prior experience of a rural lifestyle-could be expected to gain an appreciation
of the rural practice environment as well as the employment options
available in these settings. Moreover, this strategy should also facilitate the
gaining of knowledge and the variety of skills required to practice effectively
in a rural environment.
A recent national study conducted in Australia as indicated by Clare et al,
(2002), found that nursing students and health care staff both desire clinical
placements which provide students with quality learning experiences that
meet the growing demands placed upon graduates on completion of their
studies. In addition, graduates are expected to demonstrate all the
attributes of caring considered essential by the relevant nursing authority.
These experiences cannot be successfully simulated in a laboratory setting
(Boxer & Kluge, 2000).
38
Concept of Clinical Learning Environment
Clinical learning environment is a group of stable characteristics unique to a
particular clinical setting and impacting on the behavior of individuals
within that setting. The settings encompass a wide range of health care
services and in the wider meaning of term; include all psychological, social
and cultural factors of the clinical placement (English National Board (ENB),
2001a). Clinical learning environment is also the interactive network of
forces within the clinical setting that influence students’ learning outcomes.
The clinical learning environment of the ward atmosphere incorporates
items like how easy the staff members are to approach, the spirit of
solidarity among nursing staff and encouragement of students to participate
in the discussion. The ward premises includes the nature of care delivery,
the wards nursing philosophy, the documentation of nursing using the
nursing care plans and the daily recording of nursing procedures
(Saarikoski, Leino-kilpi & Warne, 2002). The related concept of learning
climate also emphasizes the importance of the physical, human,
interpersonal and organizational properties and mutual respect and trust
among teachers and students.
Clinical Teaching
Clinical teaching as defined by Basavanthappa (2009) is a type of group
conference in which a patient or patients is (are) observed and studied,
discussed, demonstrated and directed towards the improvement of nursing
care. In nursing, clinical teaching may be given by the doctors and nurses in
order to discuss the medical aspects of a patient condition more vividly than
39
can be done in the classroom. It may also be given by other members of the
health team like the dietician, physiotherapist, psychologist etc.
Alternatively, clinical teaching may be given by any faculty members ie
clinical instructor or tutor or ward staff and will concentrate on a particular
patient’s needs as a person and how doctor’s treatment orders can be met
by the right understanding and nursing care (Basavanthappa, 2009).
[[
Teaching in the clinical environment is the teaching and learning focused on
and usually directly involving patients and their problems (Spencer, 2003).
This often takes place in the course of routine clinical where discussion and
decision-making take place in real time. Often the teaching will centre on
analysis of actual patient care that the student has undertaken. Irby and
Papadakis (2001) summarized the skills that make a clinical teacher
excellent as thus: Share a passion for teaching; Organized, accessible,
supportive and compassionate; Are able to establish rapport, provide
direction and feedback, exhibit integrity and respect for others; Demonstrate
clinical competence; Utilize planning and orienting strategies; Process broad
repertoire of teaching methods and scripts; Engage in self-evaluation and
reflection and Draw upon multiple forms of knowledge; they target their
teaching to the learners’ level of knowledge.
Furthermore, the pattern/ forms of clinical teaching according to Ende
(1997) in Ramani & Lister (2008) are in-patient and out-patient teaching. In-
patient teaching refers to the clinical teaching of the student nurses in the
various wards where the patients are admitted including the environments
of the ward with or without the patients’ presence. The role of the inpatient
40
teacher is one of the most challenging in medical/nursing education and
that of a master, mentor, supervisor, facilitator (Ende, 1997 in Ramani &
Leinster, 2008). Some of the challenges of inpatient teaching as stated by
the above authors are: Difficult to set teaching goals; Unanticipated events
occur frequently; Ward team usually composed varying level of learner;
Patients too sick or unwilling to participate in the teaching encounter;
Patient stays are too short to follow natural history of disease; Teacher could
compromise trainee-patient relationship. Trainees and teachers feel insecure
about admitting errors in front of the patient and the rest of the medical
team; Tendency by many clinical teachers to lecture rather than practice
interactive teaching; Engaging all learners simultaneously can be difficult
and Teachers need to pay close attention to learners fatigue, boredom and
workload.
In-patient teams also need to behave as a teaching community where each
member respects the other in order to maximize their learning. Teachers
should learn to challenge their learners without humiliating them and
provide support so that learning can be furthered.
According to MAHEC Officer of Regional Primary Care Education (2009),
bedside teaching is part of in-patient teaching and it is a specialized form of
small group teaching that takes place in the presence of the patient. It
involves teaching in the presence of the patient. In addition, Ramani (2003)
noted that there are many skills that cannot be taught in a classroom and
requires the presence of a patient, real or simulated. Jenkins, Page,
Hewamana and Brigley (2007) also added that bedside teaching can improve
41
students’ history taking, examination skills, knowledge of clinical ethics,
professionalism, can foster good communication and role modeling skills.
The practical tips that promote effective bedside teaching according to
Ramani (2003) are:- Preparation; Planning; Orientation; Introduction;
Interaction; Observation; Instruction; Summarize; Debriefing; Feedback;
Reflection and Preparation for the next encounter.
Out-patient teaching according to Prideaux, Alexander, Bower, Tallett,
Dacre, Haist, et al (2000), involves the clinical teaching of the learner by the
clinical educators at the outpatient department either during or after patient
consultation in the clinical. The above authors identified some of the
challenges of outpatient teaching as thus: busy clinical setting, teaching
time often too short ie no time for elaborate teaching, attending to several
patients at the same time with multiple learners, brief teacher-trainee
interaction, multiple patients problems must be addressed simultaneously,
so teachers cannot focus on one problem to teach. Learning and service take
place concurrently.
Teaching styles used during clinical teaching
Multiplicity of clinical teaching styles of nurse teachers were modified
according to situations, skill (course content) and learner level. This means
that the clinical teachers might use one or more teaching styles to ensure
student learning. These teaching styles as identified by Brown (2003)
include: Teaching by doing where clinical educators are involved in doing
tasks in real environments and conditions; Teaching by supporting where
reinforcing students and giving feedback to them will increase their
42
responsibility for learning; Teaching by being a role model where nurse
educators believed that being a role model in clinical education is the most
effective and right way for transmitting professional experiences and
attitudes; Teaching by creating learning context which involves creating a
suitable scenario and good condition for teaching; Teaching by monitoring
where the teachers constantly monitor the students’ attributes.
But Basavanthappa (2009) affirmed that in nursing, commonly used clinical
teaching methods include: Bedside clinic which utilizes the presence of a
selected patient as its focus for group discussion; Nursing round which is an
excursion into patient’s area involving the students. Students respond to
this method of teaching with enthusiasm; Nursing assignment which is part
of learning experience where the students are assigned with patients or
other activities concerning to patient in clinical laboratory; Nursing care
conference which consists of a group discussion using problem-solving
techniques to determine ways of providing care for patients to whom
students are assigned as a part of their clinical nursing experiences;
Morning and afternoon reports which summarizes the services of the nurse
and or the agency; Team nursing conference which refers to the use of two
or more teachers each having special competencies and knowledge in the
cooperative planning, teaching, supervision and evaluation of a given group
of students; Health team conference which is a group of professional
persons involved in accomplishing common goals for the purpose of
interchange of ideas and solving problems which are centered around the
client; Individual conference which involves a “conversation with a purpose”
43
or more simply put as an interview and process recording- which is an
exact report of the conversation between the nurse and the patient during
the time they were together.
Clinical Supervision
The concept of supervision is used here as an overarching concepts which
refer to the guidance, support and observation of nursing students by
clinical staff (Pires & Ferreira, 2012). The relationship is evaluative, extends
over time and has the simultaneous purpose of enhancing the professional
functioning of the junior member(s); monitoring the quality of the
professional services offered to the client. Secondly, it is the formal process
of professional guidance, support and learning which enable individual
practitioners to develop knowledge and competence, assume responsibility
for their own practice and enhance consumer protection and safety of care
in complex clinical situations. It is an interaction among two or more
professionals with the aim of improvement of the care quality rendered to
the customer in a safe and supportive atmosphere. From the above
definitions, clinical supervision in nursing education is therefore the process
of guiding, supporting and directing the nursing students in the clinical site
or during clinical posting by nurse educator to ensure that the theory-
practice gap is closed.
According to Kavani and Stillwell (2000), the nursing school and health
provider’s relationship at clinical site is crucial in providing ongoing support.
The school has a responsibility to give the health provider information about
its nursing curriculum and familiarizes them with the clinical components of
44
the programme so that appropriate levels of supervision can be provided.
They are also responsible for informing the health provider (clinical areas)
about the individual students attending the clinical placement, their level of
attainment and the clinical facilitator responsible for the placement.
The importance of clinical supervision cannot be overemphasized. Clifton
(2002) opined that health care organization have a responsibility to ensure
that their workforces are sufficiently developed to enable practitioners to
provide an appropriate standard of service. Clinical supervision must be
regarded as part of clinical governance that emphasizes the importance of
improving patient care and maintaining high standard of service and clinical
delivery.
In discussing the necessity for clinical supervision in nursing education,
Benard and Goodyear (1998) stated that effective supervision in clinical
nursing training will produce positive outcomes beneficial to all the
students, nurse educators, nurse practitioners and the patients. He
considered good supervision fundamental in producing a relationship which
is committed, adequate and in some important sense spontaneous for the
patients and nursing student. Through clinical supervision in nursing
education, nursing students are aided to build confidence in clinical
practice. Moore (2000) also added that clinical supervision in general is
fundamental in the safeguard of quality improvement, development of
professional expertise and delivery of care. Supervision in clinical nursing
training enhances the implementation of evidenced based practice, inputs to
research and development agenda and is a leading implement in monitoring
45
the delivery of quality care to patient through supervised learning, staff
support and development.
In planning for effective clinical training, the tasks and skills of supervision
considered basic to successful clinical teaching as highlighted by Newman
(2013) include: The importance of establishing and maintaining an effective
working relationship with supervisee; An atmosphere where learning is
supported should be provided and Open and ongoing communication
between the supervisor and the supervisee. This is central to the success of
the supervisory relationship. He further stated that, it is important for
clinical educators to meet with each supervisee prior to initiating the clinical
assignment/experience. For placements that are off-campus, the university
will: Typically establish a contract, which should outline the responsibilities
of the university and the clinical site and should serve to protect all parties;
Have a coordinator (or similar title) who will then follow through in setting
up the details of the student’s experience; Establish placements up to a year
in advance of the assignment and Determine start and end dates and review
any requirement of the particular setting.
Linfield (2012) also stated that the preceptor performs the following roles
during clinical supervision: Provides faculty and the student with a copy of
preceptor’s work schedule to assist in scheduling student clinical days;
Coordinates the student’s orientation to the facility including staff roles and
client expectations; Ensures the student is identified as a student while in
the clinical area and is not regarded as staff for the clinical site; Foster
students’ integration into the work place culture and health care team by
46
involving student in the meetings related to client care and other
appropriate professional matters; Arranges for a substitute preceptor when
absent; Facilitates learner centered education through collaborative
identification of the students learning needs, open communication,
informing students about learning resource; Serves as a role model for the
student, demonstrating professional roles and behaviors such as caring
integrity, effective interpersonal communication, critical thinking and
conflict management to assists the student to cope with stress and reduced
consent associated with clinical practice and Stimulates development of
the students’ clinical judgment and critical thinking ability through
reflective practice and the application of evidence based practice.
The faculty (schools, department of nursing) also performs the following
roles: Notifies the student of the preceptor’s name and phone number;
Facilitates scheduling of the student’s clinical days; Orients students to the
course, including clinical outcomes and requirements of the course;
Orient them to the role expectation of the student faculty and the preceptor;
Orient the preceptors to the nursing curriculum, the course including
clinical outcome requirement of the course and Orient the preceptors to the
evaluation methods and role expectations of the preceptors, faculty and the
student.
Format for clinical supervision
Newman (2013) in differentiating clinical training from classroom education
stated that clinical training is generally one supervisor with one graduate
student clinician or one supervisor with a small group of graduate student
47
clinicians. Sometime, the supervisor will be assigned one graduate student
to spend an extended period of time working with the supervisor (a
semester). Sometimes a graduate student will be assigned for part of a day
once or twice a week. In a university setting, the supervisor may be assigned
to supervise general students but will generally spend sometimes working
individually with each graduate student.
Clinical supervision according to Newman (2013) can be delivered in a
variety of formats namely: Individual format where a clinical supervisor is
providing supervision to one supervisee and is probably the most common
format in nursing; Group format where a group of between four and six
supervisees is guided by a clinical supervisor (Price & Chalker, 2000) and
Triad format where a clinical supervisor usually offers supervision for two
supervisees when using this format (Sloam & Watson, 2002).
Clinical Evaluation
This deals with making judgment about the value or quality of clinical
placement, teaching and supervision after they have been carefully thought
of. Wren and Wren (1999) stated that evaluation of clinical performance is
an integral part of all programmes in nursing profession. In addition,
Raisley, O’Grandy and Lori (2003) stated that evaluation is a more formal
assessment of students’ performance. It is an assessment of whether a
learner has adhered to the educational outcomes expected. Assessment
plays a major role in the process of nursing education and in the society by
certifying competent nurse who can render quality nursing care to the
public. The public or society need to know that nurses that graduate from
48
nursing schools are competent enough and can practice their profession in a
compassionate and skillful manner (Shumway and Harden, 2003). As earlier
stated, clinical evaluation is therefore the process of eliciting the extent to
which the student nurses in the clinical learning environment have achieved
their clinical training objectives.
Wren and Wren (1999) assert that evaluation requires the preceptor to make
observations of performance and collect other types of data, then, compare
this information to a set standard. In additions, O’Connor (2006) developed
an evaluation process that can be applied in the clinical setting for nursing
students and this includes: Identifying the goals of evaluation; Clarifying the
standards for evaluation; Analyzing the results; Reporting the results;
Making decisions using the results and Evaluating the evaluation process.
The goals of evaluating students’ clinical practice according to Wren and
Wren include: Protecting the public; Satisfying students’ expectations;
Meeting institutional requirements; Ensuring graduates adhere to standards
and are clinically competent example professional socialization,
responsibility, certification, safety, critical thinking, communication ration
as they relate to patient safety and clinical supervision control as they relate
to patient safety student knowledge and ability.
Oermann and Gaberson (2009) stated that some of the evaluation strategies
in clinical nursing training include: Written assignment like use of case
study, evidence-based practice (research) papers, development of nursing
care plan and writing articles for journal publications using cases picked
from the ward; Practical assignment and examination which deals with
49
assessing the students’ ability to demonstrate the skills which they learnt in
the classroom and during clinical instruction and Oral questions which
deals with asking the students oral questions based on the clinical
instructions and practical procedures demonstrated in the clinical learning
environment.
Types of Evaluation
Different types of evaluations are used to assess clinical performance (Wren
& Wren, 1999 & O’Connor, 2006):
Formative evaluation: Is ongoing and leads to specific plans for
improvement. Its purposes include to: Enable students to develop clinical
knowledge skills and values; Indicate areas in which learning and practice
are needed; Provide a basis for suggesting additional instruction to improve
performance and Provide feedback to learners about their progress in
meeting the outcomes of the clinical practicum course or in developing
required clinical competencies. Wren and Wren (1999) and O’ Connor (2006)
went further to summarize that the purpose of formative is for judgment. In
terms of timing, the formative evaluation is ongoing and generally given at
the midpoint of the rotation and is used to guide the students in their
learning process. In terms of use, the formative is used to give feedback,
identify strengths and weaknesses while summative is used for grading. In
terms of competence, the formative evaluation develop plan while summative
evaluation judges competencies.
50
Summative Evaluation: Is designed for determining clinical grades
because it summarizes the competencies student has developed in clinical
practice. The grade resulting from the evaluation usually reflects a joint
determination by the preceptor and programme faculty (school) of whether
(and how well) the student has met the objectives of the rotation (Raisler,
O’Grandy and Lori, 2003). Summative evaluation also reflects progress over
a complete time period. That is, it is done at the end of a period of time to
assess the extent to which learners have achieved the clinical outcomes or
competencies.
Self evaluation: Is another type of evaluation mentioned by Wren and Wren
(1999) during clinical placement, training and supervision. Most students
have a realistic assessment of their progress, can be done daily and at the
end of a semester and should be specific and describe exact limit of
achievements.
The overall purpose of clinical evaluation of students includes to: Identify
existing competencies; Identify learning needs during clinical rotation;
Assess progress towards achieving competencies; Make judgments of
competencies met at the end of clinical experience. Evaluation of the
supervisee typically follows a schedule provided by the university setting
and the schools of nursing. The pattern of examination for clinical training
consists of: Continuous practical assessment in each unit of practice during
every period of experience and End of semester/block and yearly practical
examination which are conducted in the wards. The promotion to another
51
class or for certification depends on positive performance of the students on
clinical training examination (NMCN, 2008). Points to consider when
evaluating students progress in the clinical setting as stated by O’Connor
(2006) include: Establishing a nurturing and trusting relationship with
students; Knowing the course theory and clinical objectives thoroughly;
knowing what the expectations are for the students; Observing the students
while they carry out their assignment; Being responsible and objective;
Ensuring adequate time to respond to students questions and Being opens
minded.
Giving feedback:
Feedback regarding performance and how to improve it is essential for
clinical evaluation to be effective in the clinical environment. It is essential
to provide feedback to trainees as without feedback their strengths cannot
be reinforced nor their errors be corrected. It is a crucial step in the
acquisition of clinical skills. Omission of feedback can result in adverse
consequence, some of which can be long term especially relating to patient
care. Feedback can be formal or informal, brief and immediate or long and
scheduled, formative during the course of the rotation or summative at the
end of a rotation (Branch & Paranjape, 2002). Feedback is essential for a
student to gain an insight into what they did well or poorly and the
consequences of those actions. It tells the learners where they are in
comparison to where they ought to be and where they should go. Feedback
when well done, also promotes self-reflection and self assessment which are
valuable traits for lifelong learning (Ramani & Leinster, 2008).
52
Opportunities available for student nurses in clinical site-based
learning
In discussing clinical site-based learning, American Association of Clinical
Nursing (2002) stated that clinical site-based learning provides opportunities
to: Provide care along a continuum; Work with interdisciplinary teams; Work
within and across diverse health care delivery environments communities;
Provide care for diverse populations, including diverse ages, gender,
ethnicity healthy-ill, and acute-chronic health states; Exercise
delegation/Management skills: Students manage the delivery of care
provided by others; Practice case management; Manage health-related data;
Use information technologies to provide nursing care; Participate in nursing
research; Deal with the allocation and management of fiscal and human
resources; Work with role models and preceptors; Practice in the advanced
practice nursing role and Work with an agency staff committed to the
advanced practice nursing role.
Factors Influencing Students experience of clinical Training
Sass and Dama (2011) argued that in clinical nursing education, clinical
learning environment, behaviors of the clinical educators and learning of
appropriate clinical knowledge and skills have been found to influence
students’ perception. According to Nahas and Yam (2001), studies have
shown stressors associated with going out into the clinical fields as fear of
making mistakes, anxiety over possible criticisms from peers, being able to
communicate with health personnel and patients, providing care for the
seriously ill or terminal patients, attitudes of staff towards the students and
53
staff expectations of the students. The above source stated the facilitating
factors in clinical nursing training as thus:
Good physical conditions- These had a positive influence on the students’
clinical learning and include providing room to leave books, materials and
having meetings. If the environment is unpredictable, unstructured and
overwhelming, students can be left with feelings of vulnerability and anxiety
(Papp, 2003).
New Educational Environment- Here, students are exposed to different
practices and have opportunity to perform different interventions when they
attend practices in different hospitals. These different experiences help them
get ready for work after graduation.
Acceptance – Relationship with staff of the units and staffs’ attitude
towards students are the most two important factors that affect clinical
learning. Students are more motivated and eager to attend clinical when
they feel that they are part of the health- care team.
Communication and relationship –Students learn more from nurses that
demonstrate effective communication skills.
Feedback from nurses- Positive feedback from nurses generates high
motivation for students’ clinical learning. Feedback from mentors allows the
students to recognize their deficiencies and helped them improve their
knowledge and skills.
Teaching ability and nursing competence of mentors – Students learn
better when mentors present knowledge, demonstrate new interventions and
help them to perform these interventions.
54
Patients with severe illnesses- Nursing care for patients with severe
illnesses help them to gain experience and prepare them for professional
life.
Patients’ attitude – Student nurses have increased motivation for
learning when patients let the students care for them.
Shame in the clinical learning environment is another factor and a concept
that negatively influence students’ perception of their clinical nursing
training (Bond, 2009). He went further to say that negative behaviors such
as grilling the students with questions and watching them like a “hawk”
contribute to the students’ anxiety; make them develop feeling of
incompetence and insecurity which are manifestations of shame. Bond
(2009) also suggested that when students experience shame, socialization in
the nursing profession and with other professionals as well as the learning
experiences are compromised. Recognition of these shaming behaviors by
the instructors and making effort to correct them can therefore make great
difference in the quality of clinical learning environment and the clinical
nursing education for the students.
In addition, the four types of staff nurses that proved “toxic” to students
learning in the clinical environments according to Gray and Smith (2000)
are the avoiders, dumpers, blockers and criticizers. The avoider is suddenly
not around when it is time to have anything to do with students. The
dumpers do not take any responsibility for students learning in the clinical
site. The blockers may absolutely refuse to help the student, withhold
55
knowledge or over supervise the student. The criticizer belittles and
undermines the student.
Concept of Perception
Various scholars have defined perception in different ways. According to
Schacter (2011) perception is the organization, identification and
interpretation of sensory information in order to represent and understand
the environment. In addition, Goldstein (2009) puts forward that all
perception involves signals in the nervous system which in turn result from
physical or chemical stimulation of the sense organs. It depends on both the
psychological and physical characteristics of the perceiver in addition to the
nature of the stimuli.
Perception is also seen as our sensory experience of the world around us
and it involves both the recognition of environmental stimuli and actions in
response to these stimuli. This means that perception not only creates our
experience of the world around us but it allows us to act within our
environment. From the foregoing, perception can be summed up to be our
sensory experiences and interactions within our environment and our ability
to make good judgment from those experiences. Nursing students’
perception of clinical nursing education is therefore their sensory
experiences of the clinical training, their interaction with the clinical
learning environment and their ability to make good judgments based on the
experiences and interactions. It is the way in which they regard, understand
and interpret their clinical training experiences (Goldstien, 2009).
56
Perception can be positively or negatively influenced by a variety of factors
(Alam & Gary, 2011) . These factors are the personal characteristics of the
individual that heavily influence the way he interprets something and they
are grouped under the following:
Factors influencing the perceiver: The perceiver is the person who
becomes aware about something and come to a final understanding. These
factors include experience, motivational state, emotional state, attitudes and
expectations. In different experiences, motivational and emotional states, the
perceiver will react to or perceive something in different ways. The influence
of expectation on perception is the idea that what we see is at least to some
extent influenced by what we expect to see. In other words, if
expectations are met, the individual will have high/positive perception and if
not met the individual will have low/negative perception.
Factors in the target: The target is the person, object or event being
perceived or judged. The factors here include the motion, size, proximity,
similarity. Ambiguity or lack of information about a target leads to a greater
need for interpretation and addition.
Factors in the situation: Examples here are time, work setting, social
setting. Situation also greatly influences perceptions because different
situations may call for additional information about the target being
perceived. The time and setting at which an object or event is seen can
influence attention thereby influencing the individual’s perception of that
event or object.
57
Theoretical Review
James Gibson’s Ecological Theory of Perception
Gibson’s theory of perception was developed in 1950. According to Goldstein
(2009), Gibson was an American psychologist. His psychology of perception
is referred to as an “ecological approach” based on the interactive
relationship between the perceivers and their environment. Critical to
Gibson’s model is that perception is an active process and that meaning is
added through higher mental processes such as cognition or memory. He
argued that meaning is external to the perceivers and lies in what the
environment affords him. Gibson’s theory assumes the existence of stable,
unbounded and permanent stimulus information in the ambient optic array.
And it supposes that the visual system can explore and detect this
information.
Gibson argued that perception was crucial as it allowed humans to adapt to
their environments. His theory of perception is information-based rather
than sensation-based. And to that extent, an analysis of the environment (in
terms of affordances), and the concomitant specification information that
the organism detects about such affordances (environment) is central to the
ecological approach to perception (Noe, 2004). In order to receive
information from the actual environment, human beings are equipped with
sense organs. Each sense organ is part of a sensory system which receives
sensory input and transmits sensory information to the brain. According to
McLeod (2007), sensation detects the presence of an event or objective in the
environment and perception forms a mental representation of that event.
According to Gibson’s theory, perception of the environment inevitably leads
58
to some course of action. Ecological understanding of perception derived
from Gibson’s early work include: “perception-in-action” and “affordance”.
“Perception-in-action” is the notion that perception is a requisite property of
animate actions, that without perception, action would serve no purpose.
Gibson increased his focus on the environment through development of the
“theory of affordance”. “Affordance” is the real perceivable opportunities for
action in the environment that are specified by ecological system. The
affordance of the environment is what it offers the organism (human), what
it provides or furnishes either for good or ill. He regarded affordance as a
property of whatever the person interacts with.
59
Figure 1: Gibson’s Ecological Perceptual Cycle
Source: Neisser .U. (1976) in Kim, J. and Jens, R. (2010) Cognition and
Reality.
Application of the theory to this study
Gibson’s notion that perception is a requisite property of animate action and
that without perception, action would be unguided implies that student
nurses have the property/ability to perceive their clinical training. It is how
The Independent variable Clinical training (clinical placement, teaching,
supervision and evaluation).
The Intervening variable The activities, condition, nature, situation of the clinical training (how the training is being carried out)
Actual Environment, Available information event/object
Perceptual Exploration(overt Perception- in-action)
Knowledge of environment Schema (mental
Representation)
Modifies Samples
Direct
The Dependent Variable Nursing students’ perception (Negative/Positive)
in –action)
60
they perceive the training (positively/negatively) that determines how the
training is carried out. Without the student perceiving the training, there
may not be need for change and continuous quality improvement in the
training. The dependent variable is the perceptual exploration that is the
overt perception –in- action. That is the student’s (perceiver) perception of
the clinical training which may be positive or negative. The independent
variable is the available information and event in the actual environment
(target) being perceived. That is the clinical training (placement, teaching,
supervision and evaluation) being perceived. The affordance is the
intervening variable. That is the characteristic, nature, condition of the
training and the characteristics in the environment (experiences) that affect
the emotional and motivational state of the student nurses. The nursing
students sample information about their clinical training experiences from
the outside visual world through their knowledge of the environment from
mental representation (higher mental processes). If the timing, setting,
condition of the training and the experiences of the student nurses are poor,
the students will have negative perception about the training, and the
reverse is the case.
Empirical studies
There is a gross scarcity of literature on students’ perceptions of clinical
nursing training in Nigeria.
A study carried out in Cyprus and Finland using Schools of Health Science
Department of Nursing Cyprus, University of Nicosia Cyprus, University of
61
Applied Science Health Care Education Finland and University of Turkey
Finland, on student nurses experience of learning in the clinical
environment was by Leino–Kilpi, Haritini, Saarikoski, Lambrinous and
Papastavrous (2009). The research instrument used was a questionnaire
consisting of the English version of Finnish (Finland) Clinical Learning
Environment and Supervision scale tested in earlier studies. The reliability
of their instrument was established with the Cronbach’s reliability
coefficients. The total scale was 0.95 which is extremely satisfactory.
Software package SPSS was used for their statistical analysis. The total
sample of 645-students participated in their study. The supervisory
relationship was found problematic, since 30% of the students had “failed
supervisory relationship. Students were supervised by a variety of people,
ranging from staff nurses, to managers, doctors, fellow students or they
were not assigned to a supervisor. They perceived their clinical placements
as “good”. Nevertheless Cypriot students gave ward managers a low
evaluation score.
Another study carried out by Odunukwe (2015) in Nigeria was titled
perspective of clinical posting experience among undergraduate nursing
students of UNEC. Students in 500 level who met the inclusion criteria were
used and a descriptive survey was used too. Questionnaire was the
instrument for data collection which yielded a Cronbach alpha reliability co-
efficient of 0.87. The data were analysed using frequencies, percentages and
mean. Major findings of the study include: many of the students (66.7%)
perceived that the timing of their clinical posting is late; 59.4% perceived the
62
duration of the posting as short; the students perceived inadequacies in
56% of supervisory skills of their supervisor in the clinical area; 50% of the
student nurses perceived that 83% of activities in clinical supervision were
not carried out and that their achievement test in basic nursing tasks was
poor.
Sumari-Ayo (2006) in a quantitative study in Tanzania investigated on
“factors influencing clinical teaching of midwifery students” using three
schools of midwifery. Their study revealed that clinical instructors and
preceptors were overworked due to shortage of staff, the schools’ skill
laboratory and the hospital wards lack basic equipment and necessary
supplies, there were no clinical accompaniment guideline, teachers in the
classroom and supervisors in the clinical areas do not cooperate with each
other in training the students and that both the professional and
educational qualifications of the clinical instructors were low.
Another study carried out in Tehran University of Medical Science Iran by
Ziaee, Ahmadinejad and Morravedji (2000) was titled “Evaluation of
medical students’ satisfaction with clinical education and its effective
factors”. The research design used was a cross sectional descriptive
analytical study. Subjects were medical students during their medical
internship (the last two years of sixth and seventh year medical students). A
questionnaire based on job satisfaction was used for data collection. In this
study clinical education was classified into outpatient, bedside and
theoretical teaching in addition, the students’ satisfaction of the way they
63
were tested for clinical skills (clinical evaluation) was also assessed. Two
hundred and fifty (250) medical students were surveyed in their study. The
statistical package for the social science (SPSS version 9) was used for
statistical analysis. The mean age of the students was 36.5 years (23-
35year) and 216 (86.4%) of them were male. In their study, the overall
satisfaction was 38.8% (97/250). 61.2% (153/250) were not satisfied with
their clinical education. There was no statistically significant relationship
between age and gender. Satisfaction with the way through which they were
tested (methods of evaluation) was 64% (161 subjects). In their study, there
was no relationship between satisfaction and gender.
Odunukwe (2015) in a qualitative study in Nigeria investigated on perception
of students about factors influencing clinical training using students of
Department of Nursing Sciences UNEC. The research design was cross
sectional descriptive analytical study. Purposive sampling technique was
used to sample 161 fourth and fifth year students. The instrument for data
collection was a close ended questionnaire with 4 point Likert scale. Data
were analysed using SPSS version 16 and presented using descriptive
statistics such as percentages, means and standard deviations. The study
revealed that inadequate supervision of the students was the institutional
factor affecting clinical training of students. Unconducive clinical
environment was the clinical factor affecting clinical training of students.
Large class size was the individual factor affecting clinical training of
students.
64
Saarikoski, Leino-Kilpi and Warne (2002) carried out a study in Finland and
UK on the comparative analysis of the experiences of Finish and English
student nurses in clinical learning environment and supervision instrument.
The data were collected from a total population of 558 student nurses from
four nursing colleges in Finland and UK. Data were statistically analysed
using ANOVA. The findings showed that Finish students evaluated their
clinical placements and supervision more positively than students in UK.
Another study by Chapman and Angelica (2000) in Husserlian School of
Phenomenology in Western Australia titled “The Nursing Students’ Lived
Experiences of Clinical Practice”. A purposive sample was used and the
study question was “what is clinical practice like for you?”. The main source
of data used to understand the study was interviews conducted with 14
nursing students. The findings showed that participants perceived clinical
practice to be an essential component of their nursing education. Clinical
practice with functional teaching and learning materials provided the
student with the opportunity to link theory with the practice of caring for
clients. Data also revealed that the relationship that students had with their
clinical teachers, the agency staff and client was fundamental in the process
of learning.
A non-experimental qualitative descriptive study by Okoronkwo, Onyia-Pat,
Agbo, Okpala and Ndu (2013) evaluated students’ perception of effective
clinical teaching and teachers’ behavior in UNEC. A descriptive design was
employed using questionnaire to collect data. Respondents comprised of
65
direct entry and university matriculation examination students in their 400
level who had completed their six months consolidated clinical experiences,
totalling 101. Specifically, frequencies, percentage, mean and standard
deviations were used for descriptive analysis of scores. Their results showed
that having both clinical and teaching knowledge were the most important
teaching skills for effective clinical teaching. Five qualities ranked by
students as teacher behaviours important for effective clinical teaching
include being honest with students, motivation to teach, willingness to listen
and using good communication skills, supervising students effectively and
being positive role model.
Papathanasiou, Tsaras and Sarafis (2013) assessed students’ views and
perceptions on their clinical learning environment in a Greek nursing
school. In their study design, 196 students were included. A published
questionnaire of “Clinical Learning Environment Inventory (CLEI)” was used.
In their result, the lowest mean score of 19.21 was observed for the actual
clinical environment while the lowest mean score of 26.82 was observed for
preferred clinical learning environment. This study showed a noticeable gap
between the expectations and reality of the clinical learning environment for
students in nursing.
A qualitative study carried out by Rafiee, Moattari, Nikbakht, Kojuri and
Mousavinasab (2012) at Shiraz Nursing and Midwifery School Iran was on
the views of nursing students and trainers about problems and challenges of
nursing students’ clinical evaluation. A sample size of 8 nursing instructors
66
and 40 nursing students were used. Data were collected through semi-
structured deep interviews. Content analysis was employed in order to
analyze the data. The results showed that from the students and instructors’
point of view, inappropriate clinical evaluation methods, problems of clinical
evaluation process and problems related to clinical instructor were
considered the important evaluation problems.
Papastavrou, Lambrinou, Tsangari, Saarikoski and Leino-kilpi (2009)
assessed student nurses’ experience of learning in the clinical environment
using 645 undergraduate nursing students of the only public school of
nursing (Ministry of Health) in Cyprus. The research instrument used was
the Finish Clinical Learning Environment Supervision (CLES) instrument.
SPSS package was used and frequencies on the items of the scale were
found. Statistical tests such as ANOVA and Bonferoni were also performed.
Their result showed that the most unsatisfied nursing students were the
ones with a failed supervisory experience while the most satisfied students
were those with a successful mentor relationship. The Bonferoni tests
showed that students who had more frequency sessions with their
supervisors were more satisfied. The ward atmosphere and the leadership
style of the ward managers were rated as less important factor for clinical
learning (rated with lower scores with means of 3.44 and 3.43 respectively).
A study carried out by Esmaeili, Cheraghi, Salsali and Ghiyasvandian (2013)
in School of Nursing and Midwifery, Tehran University of Medical Sciences
Iran was titled “Nursing students” expectations regarding effective clinical
67
education: A qualitative study”. In this study, a semi-structured interview
process was utilized with 17 nursing students. Content analysis was
employed to analyse the data. Data analysis led to identification of three
main themes: (i) appropriate communication and interaction between
instructors and students (ii) incorporation of both theory and practice in
clinical teaching including the presence of the instructor in the clinical area
and evaluation based on appropriate criteria and (iii) having specialized
instructors with a specific emphasis on the instructor’s knowledge and
motivation as important factors in learning.
Summary of Reviewed Literature
Clinical training in nursing education comprise of placement/ posting of
student nurses to the clinical areas/sites where formal acquisition, practice
and evaluation of clinical proficiencies through experiences in hospital care
environment take place under the supervision of a qualified clinical nurse
educator, clinical instructor or preceptor. Nursing students’ perceptions of
the clinical training is of paramount importance because it has been
associated with their later professional attitudes, career commitment and
retention. The conceptual review was on nursing education, clinical nursing
training, clinical placement, clinical learning environment, clinical teaching,
supervision, evaluation and perception. James Gibson’s ecological theory of
perception was reviewed to provide a framework for this study.
68
Majority of the empirical studies were done outside Nigeria and they covered
both university and hospital-based student nurses. They centered mainly on
clinical learning environment and very few were on clinical evaluation
teaching and supervision. However there is paucity of indigenous studies in
this topic. The very little empirical studies that were done in Nigeria used
only university-based students and did not assess the views of the hospital-
based student nurses in all the subscales. The aspects of clinical placement,
supervision and evaluation were not well covered too. This is considered a
serious gap as this study included nursing students from both the
university and hospital-based nursing programmes and also exposed the
areas of clinical placement, teaching, supervision and evaluation that are
deficient. And as earlier stated, the student nurses’ perception of clinical
training is a legitimate indicator of the quality of the training. It is this gap
that informs the researcher’s choice of topic, nursing students’ perceptions
of clinical training in selected nursing programmes in Enugu State.
69
CHAPTER THREE
RESEARCH METHODS
This chapter presents the following: research design, area of study,
population of the study, sample and sampling technique, instrument for
data collection, validation of instrument, reliability of instrument, ethical
consideration, the procedures for data collection and methods of data
analysis.
Research Design
A descriptive cross-sectional design was adopted for the study. This design
was considered appropriate for the present study because it allowed the
investigator to describe the current and prevailing information about
nursing student’s perception of clinical training and reveal areas that need
change. The design was successfully used by Okpala, Iheanacho,
Okoronkwo and Stephens (2014) in a study of Students’ Perception of
Environment Sanitation: a study of a Nigerian university.
Area of study
The area of study is in Enugu State located in the South East geopolitical
zone and is one of the thirty- six states constituting the Federal Republic of
Nigeria. Enugu state derives its name from the capital city Enugu (top of the
hill) which is regarded as the oldest urban area in the Igbo speaking area of
south-east Nigeria. The city owes its geopolitical significance to the discovery
of coal in 1909 by a team of British geologists. The state shares borders with
Abia State and Imo State to the south, Ebonyi State to the east, Benue state
70
to the northeast, Kogi State to the northwest and Anambra State to the west
(Federal Republic of Nigeria Population Census, 2006). Economically, the
state is predominantly rural and agrarian. In the urban areas, trading is the
dominant occupation followed by services, mostly the public service.
Administratively, the state is administered at two levels of government the
state and local government. There are 17 Local Government Areas with
council headquarters located in each, some of which include: Enugu North,
Enugu South, Nsukka etc (Nigeria National Bureau of Statistics, 2008).
In Enugu state, health care services can be obtained at several institutions-
state government for example, Enugu State University Teaching Hospital
(ESUTH), federal government for example University of Nigeria Teaching
Hospital Enugu, private hospitals for example Niger Foundation Hospital
and Diagnostic Centre and mission hospitals for example Bishop Shanahan
Hospital Nsukka. Most of the nurses working in these health care
institutions were trained in the nursing schools situated in the state.
Majority of the nursing education programmes in the state are situated at
UNTH Enugu, ESUTH Parklane Enugu, University of Nigeria Enugu Campus
(UNEC), National Orthopedic Hospital Enugu, and Bishop Shanahan
Hospital Nsukka.
There are two schools of nursing offering a 3- year basic nursing
programmes in the state and one university offering a 5- year generic
nursing science programme with NMCN accreditation. These are School of
Nursing, UNTH Enugu, School of Nursing BSH Nsukka and Department of
71
Nursing Science, Faculty of Health Science and Technology in University of
Nigeria Nsukka, Enugu Campus respectively, and they are selected for this
study. The school of Nursing ESUT Hospital Parklane had their accreditation
status withdrawn by the NMCN in 2013 therefore will not be used in this
study.
[
Department of Nursing Sciences, University of Nigeria, Enugu Campus
(UNEC) came into existence in 1983 and commenced with a 3 year post
basic degree programme in three areas of specialty namely Nursing
Education, Nursing Administration and Public Health Nursing. In
2004/2005 academic session the department started a 5 year generic degree
programme in nursing sciences leading to the award of B.N.Sc degree. The
department is located at North-East region of the university which is located
in Enugu South Local Government Area of the State. It has 3 standard
classrooms, library, hostels, demonstration room etc. The department also
has about 20 teachers with other guest lecturers and 445 students. The
department was chosen because it is the only programme in the state that
offers generic nursing programme with NMCN accreditation. Their clinical
sites are located at UNTH Ituku Ozalla, at the health centres in the
communities within Enugu and Federal Neuropsychiatric Hospital Enugu.
The School of Nursing, UNTH Enugu, was initially established as a specialist
hospital school of nursing but later approved for training of general nurses
in 1971. On April 1st 1973, the school became the school of Nursing UNTH
Enugu. The school is located at the South-West region of the old site UNTH
72
Enugu which is located at Enugu North Local Government Area of the state.
The school was chosen for the study because it is the only teaching
hospital’s basic school of nursing in the state with NMCN accreditation. The
school has 3 standard classrooms, library & hostels both for the male &
female students all within the school premises. It has about ten teachers
with many guest lecturers and a total of about 175 students. But most of
their clinical sites are located at Ituku Ozalla in Nkanu West LGA of Enugu
State, the various health centres within the communities in Enugu and
Federal Neuropsychiatric Hospital Enugu.
[
The School of Nursing, Bishop Shanahan Hospital, Nsukka was established
in 1962 for training Nigerian registered nurses under the private mission
hospital built by His Grace Most Rev. Dr. Charles Henry CSSP of blessed
memory. It was closed down during the war and was reopened again in 1970
after the war. The school was chosen for this study because it is the only
mission owned school of nursing in the state accredited by NMCN. It is
situated towards the North West region of the hospital in Nuskka metropolis
Nsukka LGA of Enugu State. It has standard classrooms, students’ hostels,
about 10 teachers with several guest lecturers. Their clinical sites are
located within their hospital, at UNTH Ituku Ozalla, National Orthopaedic
Hospital Enugu, Federal Neuropsychiatric Hospital Enugu and the various
health centres within the various communities at Nsukka.
73
Population of study
The target population for the study included all the 4th and 5th year generic
nursing students in the Department of Nursing Sciences, UNEC, totalling
two hundred and twenty two (222) and all the 2nd and 3rd year nursing
students from the two basic nursing schools (UNTH Enugu, one hundred
and twenty-two (122) students and BSH Nsukka- ninety-eight (98)) giving a
total target population of four hundred and forty two (442) students. These
groups of students have had up to six months to one year or more clinical
training and can give better account of their experiences in the clinical
learning environments.
s
Sample
The total population of four hundred and forty two (442) student nurses was
used for the study because of its small size. However, because all the
subjects may not be around at the time of data collection, only those who
met inclusion criteria were used thus:
Inclusion criteria
1. Students in 4th and 5th year of study in the Department of Nursing
Sciences, UNEC.
2. 2nd and 3rd year student nurses in the 2 selected hospital-based
schools of nursing (UNTH, Enugu and BSH, Nsukka).
3. Physical presence of students at the time of data collection.
4. Willingness of the students to participate in the study.
74
Sampling procedure
Purposive sampling technique was used to select class level of the students;
the two hospital- based schools of nursing and one university-based nursing
programme with NMCN accreditation in the state. And because all the
nursing students in the selected years of study were used, there was no
sampling procedure used for the selection of the number of subjects.
Instrument for data collection
The instrument used for data collection was the researcher’s designed
questionnaire. The items in the questionnaire were generated from the
literatures reviewed based on the objectives set for the study to elicit
information from the students on the topic of study. The instrument has two
sections, A and B. Section A comprises the respondents’ demographic
characteristics. Section B contains items designed to address the research
objectives, questions and hypotheses. Items 6-75 were presented on a 4-
point Likert type scale ranging from strongly disagree (1) to strongly agree
(4). There are four subscales namely: clinical placement (18 items), clinical
teaching (25 items), clinical supervision (17 items) and clinical evaluation
(10 items). Negative items were scored in reverse manner. A copy of the
questionnaire is attached in appendix I.
Validity of instrument
The face and content validity of the questionnaire was carried out by project
supervisor and two senior lecturers in the Department of Nursing Science,
University of Nigeria, Enugu Campus and Department of Statistics, Nnamdi
75
Azikiwe University, Awka, who are experts in Nursing Education and
Measurement and Evaluation respectively. They examined the items in line
with purpose, objectives and the hypotheses set for the study. They also
assessed the language used in developing the instrument, made necessary
modifications and their input and suggestions were effected. Items were re-
arranged according to the item response group. The final draft of the
instrument was submitted to the researcher’s supervisor who approved it
after effecting the due corrections.
Reliability of Instrument
In order to establish the reliability of the instrument, a pilot survey was
carried out. Copies of questionnaires were administered to 40 student
nurses at School of Nursing Amachara, Ministry of Health Umuahia Abia
State and Department of Nursing Sciences Ebonyi State University using
test-retest method within two weeks interval. These nursing students are
similar to the group under study. The instrument was re-administered to
the same group of students after two weeks. The two sets of scores were
correlated using Pearson Product Moment Correlation statistics and the
coefficient of reliability of 0.970 was obtained which showed a high value.
This made the instrument reliable for data collection. (See appendix II).
Ethical considerations
Ethical clearance was obtained from the ethical committees of the University
of Nigeria Teaching Hospital Ituku Ozalla Enugu. Further permission was
also obtained from each school’s authority after presenting the introductory
letter from the head of Department of Nursing Sciences UNEC and
76
explaining the nature and purpose of the research to them. All participants
were fully informed of the objectives and design of the study. Copies of the
informed consent, introductory letter from the head of Department of
Nursing Sciences UNEC, permission letter to the principal of School of
Nursing Bishop Shanahan Hospital Nsukka and ethical clearance certificate,
are attached in appendices V, VI, VII and VIII respectively.
Procedure for data collection
The data collection was done by the researcher with the help of six trained
research assistants. The assistants were trained on the purpose of the study
and on how and whom to administer the questionnaire. Questionnaires were
administered to students on the spot in the classroom setting and were
collected immediately students reacted to them. It took about 15 to 20
minutes to react to the questionnaire. Data collection lasted for 7 weeks.
Method of Data Analysis
The data obtained from the instrument were collated, tallied and analyzed
using Statistical Package for Social Science (SPSS) version 17. Using
descriptive statistics, the means and standard deviations of the responses
were determined item by item and subscale by subscale. The total value of
the modified four point Likert scale for perceptions of clinical nursing
training is 10. The criterion (average) mean is 2.50. Mean scores of 2.50 and
above denotes acceptance of assertion, while the mean score below 2.50
denotes rejection of assertion. The higher the mean score for each item, the
better the perception and the reverse is the case. The inferential statistics,
specifically multiple t - test was employed for testing of the hypotheses at
77
0.05 level of significance. The mean standard deviations and t-test were
extracted and presented in Tables which answered the objectives.
78
CHAPTER FOUR
PRESENTATION OF RESULTS
The results of the data analysis are presented in this chapter. Out of the
four hundred and forty-two (442) copies of the questionnaires administered
to the respondents, four hundred and forty-one (441) were returned,
properly filled in and fit for analysis. This gives a 99.77% return rate. The
results of the data analyses were presented in Tables according to the stated
objectives and hypotheses that guided the study.
Demographic Characteristics of Respondents
Descriptive statistics involving frequencies and their percentages were used
to analyze data on demographic profiles of the respondents. The results of
the analysis were presented in Table 1 below.
79
Table 1: Demographic Characteristics of the Respondents
n = 441
S/N Variables f % 1. Name of institution Department of Nursing Science, UNEC 222 50.3
School of Nursing, UNTH 122 27.7
School of Nursing, Bishop Shanahan Nsukka Total
97 441
22.0 100
2. Type of programme University-based Nursing Students 222 50.3
Hospital-based Nursing Student 219 49.7 Total 441 100 3. Year of study Year 2 Year 3 Year 4 Year 5
100 (SON) 22.6 119 (SON) 27.0 123 27.9 99 22.4
4. Age (years) <20 181 41.0 20-24 203 46.0 25- 29 39 8.8 30 – 34 18 4.1
Mean age 25.6 (+ 2.7) years 5. Gender Male 59 13.4 Female 382 86.6
The results on Table 1 showed that 222 (50.3%) of the nursing students
used in this study were from Department of Nursing Sciences, UNEC which
constituted the university-based nursing students, while 122 (27.7%) and
97 (22.0%) of them were from School of Nursing, UNTH Enugu and School of
Nursing, Bishop Shanahan Hospital, Nsukka respectively which constituted
hospital-based nursing students. 100 (22.6%) and 119 (27.0%) of the
80
respondents were 2nd and 3rd year hospital-based student nurses
respectively, while 123 (27.9%) and 99 (22.4%) of the respondent are 4th and
5th year university based student nurses respectively. Majority 373 (84.6) of
respondents were within the age range of 20-29 years. The mean age of the
students was 25.6 (± 2.7). Majority of the respondents 382 (86.6%) were
females while 59 (13.4%) were males.
Objective 1: To determine the nursing students’ opinion of their
placement into the clinical learning environment/setting.
Students’ responses to the 18 items generated to realize this objective were
subjected to descriptive analysis using means and standard deviation. Data
were analyzed item by item and the mean scores and standard deviations for
each item presented on Table 2 below.
81
Table 2: Mean score and standard deviations of nursing students’
opinion of their placement into the clinical learning environment/
setting with their ranking.
n = 441
S/N Items Sum Mean Stdev Rank
6
Students opinion of their clinical placement
Students are actively involved in planning for the clinical placement
969
2.20
1.04
18
7 The orientation I received for the placement was adequate
1181 2.68 0.83 5
8 The duration for each clinical placement and exposure was adequate
1137 2.58 0.99 8
9 All the placements were timetabled 1331 3.02 0.90 1
10 The placement period was put to good use 1261 2.86 0.89 4
11 The placement gave me the opportunity to learn with students from other discipline
1308 2.97 0.88 2
12 Rotation to necessary specialist clinical units were adequate e.g. theatre, obstetric and gynae, med-surg, etc.
1190 2.70 0.98 5
13 Clinical setting (environments) were well organized
1146 2.60 0.95 7
14 Reasonable accommodation was made available for the student during outstation posting
984 2.23 1.01 17
15 Transport arrangements during the placement were adequate
1020 2.31 1.04 15
16 Aesthetic aspects of the physical infrastructure were adequate
1053 2.39 0.90 14
17 Access to leisure activities during the clinical posting was always allowed
1010 2.29 0.96 16
18 Reasonable steps were taken to ensure that the health of the students were not jeopardized during placement
1061 2.41 0.96 13
19 There was a positive atmosphere for learning throughout the period of the posting
1130 2.56 0.88 10
20 The clinical sites and faculty provide me with procedure book and movement scattergram during placement
1132 2.57 0.90 9
21 It improved my interpersonal relationship and skills
1303 2.95 0.84 3
22 Clinical learning environment was conducive in all clinical setting
1108 2.51 0.84 11
23 The nurses at the clinical setting were friendly and easy to approach throughout the period posting and rotation
1109 2.51 0.83 12
Subscale mean 2.57 0.51
82
The result on Table 2 shows the means scores and standard deviations of
each of the 18 items on nursing students’ opinion of their placement into
the clinical learning environment/setting. The item mean scores and
standard deviations for the 18 items on clinical learning
environment/setting ranged from 2.20 (SD = 1.01) to 3.02 (SD = 0.90).
The result shows that twelve (12) items had mean scores above 2.5 which is
the scale critical mean ranging from 2.51 (SD = 0.83) to 3.02 (0.90) while the
remaining six (6) items had mean scores below 2.5 ranging from 2.20 (SD =
1.04) to 2.41 (SD = 0.96). The findings that “All the placements were
timetabled” (Mean = 3.02; SD = 0.90); “The placement gave me the
opportunity to learn with students from other discipline” (Mean = 2.97; SD =
0.88); and “It improved my interpersonal relationship and practical (clinical)
skills” (mean = 2.95; SD = 0.84) were the three highest scored items in
placement into the clinical learning envrionment/setting subscale. The
items, “Students are actively involved in planning for the clinical placement”
(Mean = 2.20, SD = 1.04), “Reasonable accomodation was made avaliable for
student’s during outstation posting” (Mean = 2.23; SD = 1.01); and “Access
to leisure activities during the clinical posting was always allowed” (Mean =
2.29; SD = 0.96) were the three least scored items. The higher the item
mean score, the higher or more positive the students perception about their
placement into the clinical learning environment/setting and the reverse is
the case.
83
Objective 2: To ascertain the nursing students’ view of clinical teaching
The responses to the twenty five (25) items generated to realize this objective
were subjected to descriptive analysis using means and standard deviations.
The data were analyzed item by item and the means and standard
deviations for each of the 25 items in the clinical teaching subscale were
presented on Table 3 below.
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Table 3: Mean scores and standard deviations of nursing students’ view about clinical teaching with their ranking.
n = 441 S/N Items Sum Mean Stdev Rank 24
Students view of clinical teaching The clinical instruction was student centered
1119
2.54
0.84
16
25 The instruction was stimulating 1150 2.61 0.84 9 26 The clinical teaching contents were well organized 1074 2.44 0.85 21 27 The instructor challenged me to understand ideas and
concept 1133 2.57 0.87 13
28 The instructor encouraged me to ask questions 1295 2.94 0.83 1 29 The instructor communicated concept clearly 1166 2.64 0.86 5 30 The procedure and log books were accurate and useful
during the teaching 1165 2.64 0.93 6
31 There was a good coverage of the clinical instruction curriculum
1086 2.46 0.90 18
32 The teaching and learning materials were always provided
962 2.18 0.89 25
33 The facilities were always in good condition (adequate) 986 2.24 0.91 24 34 The clinical instructors were adequate in number 991 2.25 0.90 23 35 Varied teaching tips like preparation introduction,
interaction and summarization were used by the clinical instructor.
1063 2.41 0.88 22
36 Varied clinical teaching styles (methods) were used by the instructors
1082 2.45 0.89 19
37 I was taught by a number of difference clinical instructors
1137 2.58 0.94 12
38 The clinical teachers had good bedside manner 1111 2.52 0.86 17 39 Patients were involved during clinical teaching when
necessary 1128 2.56 0.92 14
40 In my opinion, all the clinical instructors were capable of integrating theoretical knowledge and the practical knowledge
1082 2.45 0.86 20
41 I felt socially comfortable in teaching sessions 1147 2.60 0.86 11 42 Opportunities are given to express my opinion and
develop interpersonal skills during teaching sessions 1152 2.61 0.88 10
43 I was encouraged and allowed to participate actively in the teaching and learning sessions
1282 2.91 0.87 3
44 Opportunities were given to me for demonstration of clinical skills learnt like carrying out basic nursing tasks
1286 2.92 0.89 2
45 I was able to constantly use the learning materials provided for practical demonstration
1205 2.73 0.89 4
46 I was able to participate in the clinical professional development events like research
1128 2.56 0.94 15
47 I was opportuned to develop collaboration and communication skills with members of other disciplines during the teaching.
1162 2.63 0.90 8
48 In my opinion the quality of clinical teaching and learning was good
1165 2.64 0.86 7
Subscale mean of means. 2.56 0.53
85
The results presented on Table 3 above shows the mean scores and
standard deviations of each of the 25 items on students’ view about clinical
teaching. The item mean scores and standard deviations for the 25 items on
this subscale ranged from 2.94 (0.83) to 2.18 (0.89). The result shows that
majority (17) of the items in this subscale had mean scores above 2.5,
ranging from 2.52 (SD = 0.86) to 2.94 (SD = 0.83) while the remaining eight
(8) items had mean scores below 2.5 ranging from 2.18 (SD = 0.89) to 2.46
(SD = 0.90). The 3 highest scored items in this subscale were “The instructor
encouraged me to ask questions” (Mean = 2.94; SD = 0.83); “Opportunities
were given to me to demonstrate clinical skills learnt like carrying out basic
nursing tasks” (Means = 2.92; SD = 0.89); and “I was encouraged and
allowed to participate actively in the teaching and learning session” (Mean =
2.91; SD = 0.87). The three (3) lowest scored items were “The teaching and
learning materials were always provided” (Mean = 2.18; SD = 0.89); “The
facilities were available and in good condition” (2.24; SD = 0.91); and “The
clinical instructors were adequate in number” (Mean = 2.25; SD = 0.90). The
higher the items mean score, the better the students’ view of their clinical
teaching experience.
Objective 3: To identify the nursing students’ view about clinical
supervision.
The responses to the seventeen (17) items generated to realize this objective
were subjected to descriptive analysis using means and standard deviations.
The data were analysed item by item and the means and standard
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deviations for each of the 17 items in the clinical supervision subscale were
presented on Table 4 below.
Table 4: Mean scores and standard deviations of nursing students’ view
about clinical supervision with their ranking
n = 441
S/N Items Sum Mean Stdev Rank
49
Students’ view of clinical supervision The clinical instructor and supervisors have adequate training knowledge and skills to supervise
1216
2.76
0.88
1
50 The supervisors were transparent 1139 2.58 0.82 3 51 The supervisors were friendly 1115 2.53 0.85 4 52 The supervisors evidenced a personal interest in
my success 1097 2.49 0.85 7
53 The clinical supervisors do not belittle and intimidate students
1069 2.42 0.97 10
54 The supervisor takes responsibility 1164 2.64 0.87 2 55 Supports from clinical supervisors were adequate 1080 2.45 0.81 9 56 Supports of teachers from the school were
adequate 1113 2.52 0.89 5
57 There was good support system for student who encountered difficulties
1056 2.39 0.90 12
58 The supervisory relationship was characterized by a sense of trust and mutual relationship
1050 2.38 0.88 14
59 The staff were generally interested in students supervision
1102 2.50 0.91 6
60 I received group supervision which was adequate 1059 2.40 0.87 11 61 I received individual supervision which was
adequate 1056 2.39 0.93 13
62 The supervisors were always available 998 2.26 0.91 17 63 The supervisors were always accessible 1044 2.37 0.89 15 64 The supervisors show respects for students 1033 2.34 0.87 16 65 The supervisors had good rapport with students
Subscale mean 1087 2.46
2.46 0.89 0.54
8
The result on Table 4 shows the mean scores and stand deviations of each of
the 17 items on the nursing students view about clinical supervision
subscale. The item mean scores and the standard deviations of the 17 items
in this subscale ranged from 2.26 (SD = 0.91) to 2.76 (SD = 0.88). The result
also show that 6 out of the 17 items in this subscale had mean scores of 2.5
and above which is higher than the scale critical mean of 2.5 ranging from
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2.5 (SD = 0.91) to 2.76 (SD = 0.88). The 3 highest scored items in this
subscale were “The clinical instructors and supervisors have adequate
training knowledge and skills to supervise “(Mean = 2.76; SD = 0.88); “The
supervisor takes responsibility” (Mean = 2.64; SD = 0.87); and “The
supervisors were transparent” (Mean = 2.58; SD = 0.82). The remaining
eleven (11) items had mean scores below 2.5 ranging from 2.26 (0.91) to
2.49 (SD = 0.85). The 3 lowest scored items were “The supervisors were
always available” (Mean = 2.26; SD = 0.91). “The supervisors show respect to
students” (Mean = 2.34; SD = 0.87); and “The supervisors were always
accessible (2.37; SD = 0.89). The average mean score for the clinical
supervision subscale was 2.46 (SD = 0.54). The higher the item mean score,
the better the students’ view of their clinical supervision experience and the
reverse is true.
Objective 4: To assess the nursing students’ perception of clinical
evaluation.
Students’ responses to the ten (10) items generated to realize this objective
were subjected to descriptive analysis using means and standard deviations.
Data were analyzed item by item and the means and standard deviations for
each item in the clinical evaluation subscale were presented on Table 5
below.
88
Table 5: Mean scores and standard deviations for nursing students’
perceptions of clinical evaluation and their ranking
n = 441
S/N Items Sum Mean Stdev Rank
66
Students’ perceptions of clinical evaluation I was evaluated in each unit of practice
1105
2.51
0.91
9
67 My clinical performance was evaluated only at the end of each semester
1181 2.68 0.90 4
68 I was given opportunity for self assessment 1112 2.52 0.95 8 69 The clinical evaluators were able to use
assorted techniques (strategies) like continuous assessment, assignment and examination
1230 2.79 0.96 2
70 The clinical evaluators were good at providing constructive criticism and feedback
1168 2.65 0.86 6
71 Through feedback, my strengths were reinforced and errors corrected
1173 2.66 0.91 5
72 The faculty informed me of the grading methods in practical exam
1117 2.53 0.98 7
73 I was duly informed of the duration and period of clinical evaluation
1282 2.91 0.93 1
74 The evaluator consistently informed me of my progress
1024 2.32 0.90 10
75 Assignment that required critical and creative thinking were provided or given Subscale mean
1185 2.69 2.63
0.95 0.54
3
The results on Table 5 show the means and standard deviations of each of
the 10 items on nursing students’ perception of clinical evaluation. The item
mean scores and the standard deviations ranged from 2.32 (SD = 0.90) to
2.91 (SD = 0.93). The result indicated that all the 10 nursing students’
perceptions of clinical evaluation statements, except item 74 (“The evaluator
consistently informed me of my progress” with item mean of 2.32; SD = 0.90
which is below the mean criterion value of 2.50) were scored above 2.50. The
3 highest scored items were, “I was duly informed of the duration and period
of clinical evaluation” (Mean = 2.91; SD = 0.93); “Assorted techniques were
used for clinical evaluation” (Mean = 2.79; SD = 0.96); and “Assignments
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that required critical and creative thinking were given” (Mean = 2.69, SD =
0.95). The 3 lowest scored items were, “The evaluator consistently informed
me of my progress” (Mean = 2.32; SD = 0.90); “I was evaluated in each unit
of practice” (Mean = 2.51; SD = 0.91); and “I was given opportunity for self
assessment” (Mean = 2.52; SD = 0.95). The averages mean score (mean of
means) for the clinical evaluation subscales was 2.63 (SD = 0.54) while the
total subscale mean was 26.25 (SD = 5.40). The higher the item mean
scores, the better the students’ perception of their clinical evaluation
experience.
Objective 5: To determine the students overall perception of
clinical nursing training.
To realize this objective, data collected from 441 nursing students were
analyzed item by item using descriptive statistics to indicate the mean
scores of students to each items with their corresponding standard
deviations in each subscale at 95% confidence interval (C.I.). The students’
total mean score on the “Students’ Perception of Clinical Nursing Training
Questinnaire (SPCNTQ) was 178.56 (SD = 37.86). Comparisons of the four
subscales, each with a different number of items, was facilitated by the use
of an adjusted mean derived by dividing the total mean score of each
subscale by the number of items in that subscale. The item means of the 70
students’ perceptions of clinical nursing training statements ranged from
2.18 to 3.02 (SD = 0.89 – 0.90)
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Table 6: Adjusted mean scores and standard deviations for students’
perceptions of clinical nursing training for each subscale
Subscale Number of items Mean Stdev 95%CI
Placement to clinical learning environment/setting.
18 2.57 0.51 2.53-2.62
Clinical teaching and learning 25 2.56 0.53 2.51-2.61 Clinical supervision 17 2.46 0.54 2.41-2.51 Clinical evaluation 10 2.63 0.54 2.57-2.68 Grand mean Mean
10.22 2.55
2.12 0.53
10.02- 10.42 2.51 – 2.61
The result on Table 6 showed the adjusted mean scores and the standard
deviations of the nursing students’ perceptions of clinical nursing training
for each subscale. The mean scores and the standard deviations for the 4
subscales ranged from 2.46 (SD = 0.54) to 2.63 (SD =0.54). The highest
scored subscale is “Perception of Clinical Evaluation” (Mean = 2.63, SD =
0.54) while the lowest one is “Views about Clinical Supervision”. (Mean =
2.46, SD=0.54). The result also showed that only 1 out of the 4 subscales
had the mean scores that is lower than the critical mean of 2.50. The grand
mean and mean of means score and standard deviation are 10.22 (SD =
2.12) and 2.55 (SD = 0.53) respectively.
Test of Significance
Hypothesis 1: There is no significant difference in the perceptions of
the clinical training between university-based and hospital-based
nursing students.
The mean scores of nursing students’ perceptions of the 4 subscales in
clinical training of university based and hospital based nursing students
91
were computed using multiple t-tests. The results of the t-test analysis were
presented on Table 7 below.
Table 7: Showing differences in perceptions of clinical training between
university and hospital-based nursing students.
Type of Institution t-test for Equality of Means
Subscale University-based Hospital-based t-test df p-value Nursing Students Nursing students (n=222) (n=219) Mean SD Mean SD
Opinion about placement to clinical setting/environment
2.29 0.37 2.86 0.47 - 14.02 439 0.000
Views about clinical teaching/learning
2.33 0.43 2.80 0.51 -10.439 439 0.000
Views about clinical supervision
2.28 0.48 2.66 0.53 -7.977 439 0.000
Perception of clinical evaluation Mean
2.44 0.45 2.35 0.37
2.82 0.57 2.78 0.45
-7.696 -11.246
439 439
0.000 0.000
From the result shown on Table 7 above on the perception of the clinical
training between the university-based and hospital-based nursing students,
the university-based nursing students had mean and standard deviation of
2.29 ± 0.37 while the hospital-based nursing students had mean and
standard deviation of 2.86 ± 0.47 on their opinion of placement to the
clinical setting/environment. This result is significant. On their views about
clinical teaching (instruction) /learning, the university-based nursing
students had mean and standard deviation of 2.33 ± 0.43 while the hospital-
based nursing students had 2.80 ± 0.51 and the result is also significant.
On their views about clinical supervision, the university-based nursing
students had mean and standard deviation of 2.28 ± 0.48 while the hospital-
based student nurses had 2.66 ± 0.53. This is also significant. The
university-based nursing students also had mean and standard deviation of
92
2.44 ± 0.45 while the hospital-based nursing students had mean and
standard deviation of 2.82 ± 0.57 on their perception of clinical evaluation.
This is significant.
On their overall average perception of clinical training, the university-based
nursing students had an average mean and standard deviation of 2.35 ±
0.37 while the hospital-based nursing students had mean and standard
deviation of 2.79 ± 0.45. This result is significant. The hypothesis is rejected
(P < 0.05, t-value = -11.246) and therefore, there is significant difference in
the nursing students’ perceptions of the clinical training between the
university-based and hospital-based nursing students. This implies that the
hospital-based nursing students have positive perceptions of the clinical
training while the university-based nursing students have negative
perceptions of clinical training.
Test of Significance
Hypothesis 2: There is no significant difference in perception of the
clinical training based on gender.
The mean scores of nursing students’ perceptions of the 4 subscales in
clinical training of the male and female nursing students were computed
using multiple t-tests. The results of the t-test analysis were presented in
Table 8 below.
93
Table 8: Showing differences in perceptions of clinical training between
male and female nursing students.
Subscale Gender t-test for Equality of Means
Male (n=59) Female (n=382) t-test df p-value Mean SD Mean SD Opinion about placement to clinical setting/environment
2.61 0.52
2.57 0.51
0.600
439
0.549
Views about clinical teaching/learning
2.65 0.55 2.55 0.52 1.292 439 0.197
Views about clinical supervision
2.59 0.55 2.45 0.53 1.924 439 0.055
Perceptions of clinical evaluation Mean
2.73 0.57 2.65 0.46
2.61 0.55 2.56 0.46
1.509 1.390
439 439
0.132 0.165
From the result shown in Table 8 above on the perceptions of the clinical
training between male and female nursing students, the males had mean
and standard deviation of 2.61 ± 0.52 while the females had 2.57 ± 0.51
respectively on their opinion of placement to clinical setting/environment
subscale. This result is not significant. The males also had mean and
standard deviation of 2.65 ± 0.55 while females had 2.55 ± 0.52 respectively
on their views about clinical teaching (instruction)/learning and this is also
not significant. On their views about clinical supervision, the male nursing
students had mean and standard deviation of 2.59 ± 0.55 while the female
student nurses had mean and standard deviation of 2.45 ± 0.53
respectively. This result is significant. On their perceptions of clinical
evaluation, male student nurses had mean and standard deviation of 2.73 ±
0.57 while the female students had 2.61 ± 0.55 respectively and this is not
significant.
94
On their overall perceptions of clinical nursing training, the male nursing
students had an average mean and standard deviation of 2.65 ± 0.46 while
the female students had 2.56 ± 0.46 respectively. This is not significant. The
hypothesis is accepted (P > 0.05, t-value = 1.390) and therefore, there is no
significant difference in perceptions of the clinical training based on gender
among the nursing students.
Summary of Findings
The following findings were made from the analysis of the data presented in
chapter four.
• The three highest mean scored items on placement into the clinical
setting were “All the placements were timetabled” (Mean 3.02); “The
placement gave me the opportunity to learn with students from others
discipline” (Mean 2.97) and “It improved my interpersonal relationship
and skills” (Mean 2.95).
• The three lowest mean scored items on placement into the clinical
setting were “Students are actively involved in planning for the clinical
placement” (Mean 2.20); “Reasonable accommodation was made
available for the students during outstation posting” (Mean 2.23) and
“Access to leisure activity allowed” (Mean 2.29).
• The three highest mean scored items on clinical teaching were “The
instructor encouraged me to ask questions” (Mean 2.94);
“Opportunities were given to me for demonstration of clinical skills”
(Mean 2.92) and “I was encouraged and allowed to participate in the
teaching and learning sessions” (Mean 2.91).
95
• The three lowest mean scored items in the clinical teaching and
learning were “The teaching and learning materials were always
provided” (Mean 2.18); “The facilities were always in good condition
(adequate)” (Mean 2.24) and “The clinical instructors were adequate in
number” (Mean 2.25).
• The three highest mean scored items in the clinical supervision are
“The clinical instructors and supervisors have adequate training,
knowledge and skills to supervise” (Mean 2.76); “The supervisors take
responsibility” (Means 2.64) and “The supervisors were transparent”
(Mean 2.58).
• The three lowest mean scored items in the clinical supervision were
“The supervisors were always available” (Mean 2.26); “The supervisors
show respects for students” (Mean 2.34) and “The supervisors were
always accessible” (Mean 2.37).
• The three highest mean scored items in clinical evaluation were “I was
duly informed of the duration and period of clinical evaluation” (Mean
2.91); “The clinical evaluators were able to use assorted techniques
(strategies) like continuous assessment, assignment and examination”
(Mean 2.79) and “Assignment that required critical and creative
thinking were given” (Mean 2.69).
• The three lowest mean scored items in students’ perceptions of clinical
evaluation were “The evaluator consistently informed me of my
progress” (Mean 2.32); “I was evaluated in each unit of practice” (Mean
2.51) and “I was given opportunity for self assessment (Mean 2.52).
96
• There were significant differences in the nursing students’ perceptions
of the clinical training between the university-based and hospital-
based students.
• The university-based nursing students had negative perceptions about
their clinical training in all the subscales, while the hospital-based
student nurses attracted positive perceptions about their clinical
training in all the subscales.
• There was no significant difference in the perception of clinical
nursing training based on gender.
• Female nursing students had negative views about clinical supervision
(Mean 2.45), while the male students had positive views about clinical
supervision (Mean 2.59).
97
CHAPTER FIVE
DISCUSSION OF FINDINGS
This chapter presents the discussion of the major findings of the study,
implications for nursing education and practice and limitations of the study.
The conclusion drawn from the findings, a brief summary of the entire work,
recommendations based on the findings, as well as suggestions for further
researches were also highlighted. The findings were discussed in line with
the research objectives and hypotheses that were formulated to guide the
study.
Nursing students’ opinion about placement into the clinical learning
environment/setting
The findings indicated that “All placements were timetabled” (Mean 3.02);
“The placement gave the nursing students the opportunity to learn with
students from other discipline” (Mean 2.97) and “It improved their
interpersonal relationship and skills” (Mean 2.95). The possible explanation
for these three highest scored items could be due to the effort of the school
to ensure that students posting and rotation to different specialist clinical
units are covered and the students offered the opportunity to work directly
with competent professional nurses for patients in a particular area of
expertise, develop their interpersonal skills with and learn from staff and
students from other discipline. This findings support the findings in the
study done by Saarikoski, Leino-Kilpi and Warne (2002) that Finnish
students evaluated their clinical placement more positively than students in
98
UK. The above findings and explanations are supported by Chan 2002 who
stated that, it is during clinical placement that students are expected to
develop the relevant knowledge, skills, competence and expand the
perceptions of their further role as registered nurses. American Association
of Clinical Nursing (2002) also supported this by stating that clinical site-
based learning provides the students opportunities to work with
interdisciplinary teams, role models and preceptors while students develop
coordination, collaboration and communication skills when working with
members of other disciplines for the purpose of improving the health status
of clients.
The findings clearly portray that, the students were not involved in planning
for their placement into the clinical setting (Mean 2.20), reasonable
accommodations not provided during outstation posting and access to
leisure activities during the clinical posting (Mean 2.23) was not always
allowed (Mean 2.29). The possible explanation for this could be lack of
knowledge of and inability to follow strictly the guideline for clinical
placement, improper arrangement by the school and the clinical setting for
the accommodation of the students during outstation posting. The findings
were supported by a study carried out by Papathanassiou, Tsaras and
Sarafis (2013) which showed a noticeable gap between the expectations of
the students and the reality of the clinical learning environment. The result
also affirms the statement of Papp (2003) that if the environment is
unpredictable, unstructured and overwhelming, students can be left with
feelings of vulnerability and anxiety. It also affirms the statement made by
99
University of Queensland (2005) that the placement should be in accordance
with the guideline agreed between the school, the placement facility (clinical
setting) and the accrediting body (NMCN). The result also differs from that of
the study of Leino-Kilpi et al (2009) in Cyprus and Finland on student
nurses experiences of learning in the clinical learning environment which
showed that students perceived their clinical placement as good, though the
Cypriot student nurses evaluated their ward environment with lower scores.
In relation to the type of programme, university-based nursing students had
low perceptions of placement to clinical setting (Mean 2.29) while the
hospital-based nursing students had higher perceptions of placement to the
clinical setting (Mean 2.86). The possible explanations for the low or negative
opinion of the university-based nursing students may be attributed to late
exposure to clinical experiences which starts towards the end of their 3rd
year of study compared to the hospital based student nurses. This could
have resultant negative effects on other aspects of their clinical training.
This finding is in agreement with the findings of the study carried out by
Odunukwe (2015) in UNEC, Nigeria using undergraduate 500 level nursing
students on perspective of clinical posting experience. The result showed
that many of the students perceived that the timing of their clinical postings
is late and the duration of the posting as short. Anthony and Yastik (2011)
also supported the above findings in their statement that clinical student
nurses are relatively powerless in health care setting and therefore
vulnerable targets for incivility. The higher/positive opinion of the hospital-
based student nurses towards clinical placement may be attributed to the
100
fact that they have early exposure (from their first year) to the clinical
setting, get acquainted to the staff nurses, activities in the clinical setting
earlier and develop good relationship with the nurses. This is in agreement
with Nahan and Yam (2001) who stated that relationship with staff of the
units and staff attitude towards the students are the two most important
factors that affect clinical learning. Students are more motivated and eager
to attend clinical posting when they feel that they are part of the health-care
team.
Nursing students’ view about clinical teaching and learning
The findings in Table 3 clearly portray that the instructor encouraged the
students to ask questions (Mean 2.94); opportunities were given to the
students for demonstration of clinical skills learnt like carrying out basic
nursing tasks (Mean 2.92) and the students were encouraged and allowed to
participate actively in the teaching and learning sessions (Mean 2.91)
respectively. These are commendable and may be attributed to the fact that
the instructors want to encourage the students to understand and
consolidate what they learnt in the classroom with what is on ground in the
clinical setting. This finding supports the study of Chapman and Angelica
(2000) in Hussserlian School of Phenomenology Western Australia titled
“The nursing students lived experiences of clinical practice which revealed
that the relationship students had with their clinical teachers was
fundamental in the process of learning This result is also in line with the
statement of Benis (2000) which says that for clinical training to be effective
and to bring about positive and skillful result, the things taught in the
101
classroom must be repeated and practiced in the wards for students to
understand them better. The findings are also in agreement with the
statement of Ramani and Leinster (2008) that in preparation for effective
ward teaching, the teachers should ask themselves a set of questions like
how will the learner be engaged and how will they meet the needs of each
learner. Hewamana and Brigley (2007) also supported this finding by noting
that bedside teaching can improve students’ history taking and examination
skills.
The findings still emphasized the fact that the clinical teaching and learning
materials were not always provided (Mean 2.18); the facilities were not
always in good working condition (Mean 2.24) and the clinical instructors
were not adequate in number (Mean 2.25). These results may be due to non
maintenance of the available materials, workload, shortage of staff and
clinical instructors in the clinical setting etc. The clinical instructors not
being adequate in number implies that the few available ones may not cope
with the large number of students to be taught in the clinical area and the
clinical training curriculum may not be covered. These may lead to poor
attention to students fatigue and workload leading to poor learning of the
clinical/practical skills. The lack of teaching and learning materials implies
that what is taught and learnt in the classroom may not be practiced in the
ward thereby encouraging theory-practice gap. Furthermore, all these could
jeopardize teaching and students’ learning in the clinical setting.
This result supports the result of the study of Chapman and Angelica (2000)
which showed that clinical practice with functional teaching and learning
102
material provided the students with the opportunity to link theory with the
practice of caring for client. It is also in line with one of the findings
identified in the study of Odunukwe (2015) that large class size was the
individual factor affecting clinical teaching of students. It also agreed with
some of the findings in the study of Sumari-Ayo (2006) which pointed out
that clinical instructors and preceptors were overworked due to shortage of
staff and that the hospital ward lack basic equipment and necessary
supplies. The findings also agreed with Ramani and Leinster (2008) and
Prideaux et al (2000) who stated some of the challenges of inpatient teaching
as thus: not paying close attention to the students fatigue, boredom and
workload, busy clinical setting, no time for elaborate teaching and brief
teacher students interaction.
In relation to the type of institution as reflected in Table 7, the findings also
revealed that university-based nursing students have a negative view of their
clinical instruction (Mean 2.33) compared to the hospital-based nursing
students (Mean 2.80). This may be related to their different experiences,
motivational and emotional state with clinical nursing training. University-
based student nurses may also have a better understanding of their clinical
training curriculum therefore may know when it is covered. They are better
exposed in the university community relating with students and teachers
from other departments and comparing the qualities and skills of those
teachers with that of their clinical instructors which might have contributed
to their negative view about their clinical teaching. This is in line with the
findings of the study carried by Okoronkwo et al (2013) on students’
103
perception of effective clinical teaching and teachers’ behavior using nursing
students in their 400 level at Department of Nursing Sciences UNEC. Their
result revealed that having both clinical and teaching knowledge were the
most important teaching skills for effective clinical teaching. That five
qualities ranked by students as teacher behaviors important for effective
teaching include being honest with students, motivation to teach,
willingness to listen and using good communication skills.
Nursing students’ views about clinical supervision
The finding shown in Table 4 indicated that the nursing students have
low/negative perceptions of their clinical supervision. This implies that they
are poorly supervised. The three highest scored items in this subscale (“The
clinical instructors and supervisors have adequate training, knowledge and
skills to supervise” (Mean 2.76), “The supervisor takes responsibility” (Mean
2.64) and “The supervisors were transparent” Mean 2.58) may be attributed
to the fact that some of the supervisors may have demonstrated dedication
and qualitative skills during the students’ clinical supervision and may have
certificate of clinical competence. This result supported the report of
Linifield (2012) and Newman (2013) which indicated that some of the tasks
and skills of supervision considered basic to successful clinical nursing
training include the importance of establishing and maintaining an effective
working relationship with supervisee, ongoing and open communication
between the supervisor and the supervisee, provision of the faculty and the
students with a copy of preceptor’s work schedule to assists in scheduling
students clinical days and arranging for a substitute preceptors when
104
absent. This result disagreed with one of the findings in the study of
Odunukwe (2015) on perception of students about factors influencing
clinical training which revealed that inadequate supervision of the students
was the institutional factors affecting clinical training of students.
Further interpretation of the findings showed that some of the supervisors
were not always available (Mean 2.26), accessible (Mean 2.37) and that the
supervisors did not show respect for the students (Mean 2.34). One could
probably say that the above findings may be due to selection of
inexperienced and unqualified clinical supervisors/educators and preceptors
by the school. Any available nurse on duty in the clinical area acts as
clinical supervisor. Heavy workload, poor remuneration, difficult transport
system to the clinical site (distance) and unavailability of materials to work
with, may have contributed to these.
This result agrees with that of the study carried out in Cyprus and Finland
by Leino-Kilpi, et al (2009) on “student nurses experience of learning in the
clinical environment” which showed that supervisory relationship was
problematic. This finding is also in line with some of the findings of the
study of Odunukwe (2015) which revealed inadequacies of about 56% of
supervisory skills of their supervisors in the clinical area. That most of the
student nurses used in the study perceived that most of the activities in the
clinical supervision were not carried out. This is also supported by Neary
(2000) who poised that students’ instruction and supervision appear to have
been shifted to clinical nurses only. That nurses who lack fundamental
skills in nursing research, academic training and experiences in preceptor-
105
ship still constitutes the large group of nurses who often hold functions as
clinical instructors, supervisors and evaluators. The results of this study
disagreed with that of the study of Saarikoski, Leino-Kilpi and Warne (2002)
which showed that Finish students evaluated their clinical supervision more
positively than students in UK.
The findings in Table 7 also revealed that university-based nursing students
have a negative view (Mean 2.28) about their clinical supervision compared
to the hospital-based student nurses (Mean 2.66). This may be related to the
fact that some of hospital-based trained nurses who mostly work as the
clinical supervisors do not relate well with the university-based student
nurses because of the current reform in nursing education which
emphasizes B.Sc. Degree in nursing. The hospital-based non B.sc trained
nurses have the fear and jealousy that the university-based student nurses
will take over the leadership position from them when they graduate thereby
resulting to the tendency of having more frequent supervisory sessions with
the hospital-based student nurses than the university-based student
nurses. These may result to failed supervisory experiences thereby
contributing to the negative view of clinical supervision by the university-
based nursing students. This findings support that of the study of
Papastavrou et al (2009) which revealed that the most unsatisfied nursing
students were the ones with a failed supervisory experience and that
students who had more frequent sessions with their supervisor were more
satisfied.
106
The negative views (Mean 2.45) of female nursing students in clinical
supervision as shown in Table 8 may be attributed to the popular saying
that females have more domineering and strict attitudes towards life
situations than males. They are in a position to give true/ better
interpretation of life situations and they are also the majority in this study.
This is in line with the statements of Alam and Garry (2011) which included
attitudes as one of the factors that influence perception.
Nursing students’ perception of clinical evaluation
The fact that the evaluators do not consistently inform the students of their
progress (Mean 2.32) as shown in Table 5 may be attributed to the facts that
results are not released individually to the students. Rather it is released by
the school pasting it on the notice board after addressing the students as a
group about their general performance. This result was supported by Wren
and Wren 1999) who stated that evaluation of the supervisee nursing
students typically follows a schedule provided by the university setting and
the school of nursing.
The high/positive perception of the clinical evaluation (Mean 2.63) by the
nursing students as revealed in this study in Table 5 may be attributed to
the fact that the evaluators selected by the school and NMCN are well
trained knowledgeable, attend examiners workshop and are experienced in
clinical evaluation, its goals and strategies. They follow the guiding rules
and practice the evaluation process in clinical evaluation as stipulated by
NMCN. This result supports the study of Esmaeli, Cheraghi, Salsali and
Ghiyasvandian (2013) which reported evaluation based on appropriate
107
criteria as one of the important factors in clinical education. This result is
also in line with goals and purposes of clinical evaluation of nursing
students as identified by Wren and Wren (1999) and some of them include:
identifying existing competencies and learning needs during clinical
rotation, assessing progress and making judgments of competencies met at
the end of clinical experience thereby protecting the public, satisfying
students’ expectations and meeting institutional requirements. But the
finding here differs from that of the study of Rafiee et al (2012) which
identified that from the students and their instructors point of view,
inappropriate clinical evaluation methods, problems of clinical evaluation
process and problems related to clinical instructor were considered the
important evaluation problems.
Furthermore, despite the above result, university-based nursing students
had a low perception (Mean 2.44) of the clinical evaluation compared with
hospital-based nursing students (Mean 2.82) as shown in Table 7. The
possible explanations for this may be that they are not always exposed to
continuous practical assessment in each unit of practice during every period
of experience, far distance of their clinical setting from the school and
workload of their clinical instructors. The result of this study is in line with
one of the results of the study of Odunukwe (2015) on perspective of clinical
posting experience among 500 level university-based nursing students
which showed that the achievement test in basic nursing tasks was poor.
This result and explanations also disagreed with the stipulation of NMCN
(2008) that continuous practical assessment in each unit of practice is one
108
of the patterns of examination for clinical nursing training and should be
enforced.
Nursing students overall perceptions of clinical training
The finding shown in Table 6 portray that the nursing students have an
averagely high (positive) overall perceptions (Mean 2.55) of their clinical
training. It also revealed high/positive perception of the clinical placement
(Mean 2.57), teaching (Mean 2.56) and evaluation (Mean 2.63) with the
clinical evaluation ranking the highest. But there is low or negative
perception of clinical supervision (Mean 2.46). This implies that the students
are poorly supervised.
This may be attributed to selection of inexperienced and unqualified clinical
supervisors/educators and preceptors by the school, which may bring about
poor planning and gross inefficiency on the parts of the supervisors. There
may also be non sponsorship and attendance of seminars and workshop by
the supervisors to acquaint themselves with their roles on clinical
supervision, clinical supervision formats and importance of effective clinical
supervision. The above agrees with the common saying that “one cannot give
what he or she does not have”. The poor supervision may also be as a result
of poor relationship between the clinical setting staff and the school and
“when two elephants fight the grass suffers”. So the students suffer and
when they are not well supervised, they may not give what they do not have
therefore the patients suffer.
109
These finding contrast the findings in the study of Saarikoski, Leino-Kilpi
and Warne (2002) where Finish students evaluated their clinical supervision
more positively than students in UK. This finding agrees with the statement
of Kaviani and Stillwell (2000) that the nursing school and health provider’s
relationship at clinical site is crucial in providing ongoing support. The
school has a responsibility to give the provider information about the
nursing curriculum and familiarizes them with the clinical components of
the programme so that appropriate levels of supervision can be provided.
They are also responsible for informing the nurses in the clinical setting
about the individual students, their level of attainment and the clinical
facilitators responsible for the placement. Moore (2000) also supported the
above findings by stating that supervision in clinical nursing training
enhances the implementations of evidenced based practice, inputs to
research and development agenda and is a leading implement in monitoring
the delivery of quality care to patient through supervised learning, staff
support and development.
The average overall high or positive perception of the clinical placement,
teaching and evaluation by the nursing students may be attributed to the
efforts of the schools in trying to meet up with the public demands for
quality nursing care. This result is commendable but needs quality
improvement for better quality assurance in clinical nursing training and
nursing education in general. This finding disagreed with that of the study
of Ziaee, Ahmadinejad and Moravedji (2000) where 61.2% of the medical
students showed negative satisfaction with their clinical training. But the
110
aspect of their satisfaction with clinical evaluation (the way they were tested)
agreed with the result of this study. The above finding was also supported
by Karen (2013) who stated that effective clinical setting remains the most
effective caring situation for demonstrating theoretical possibilities and
transforming the novice to beginning nurse. Duteau (2012) also supports
this finding by commenting that the benefit of clinical nursing training in
nursing education cannot be overemphasized and this is achieved through
clinical placement, teaching, supervision and evaluation.
Differences in the perceptions of the clinical training between
university–based and hospital–based programme
In comparing the results from university-based and hospital–based nursing
students in this hypothesis, the findings in Table 7 revealed that there is
significant difference in the perceptions of the clinical training between the
university-based and hospital-based nursing students (P<0.05). Significant
differences are noted in the aspects of perceptions of placement to clinical
setting, clinical teaching/learning, clinical supervision and clinical
evaluations. This result implies that the hospital-based nursing students
have a higher/positive perception of the clinical training than university-
based nursing students.
The high /positive perception of the hospital-based student nurses could be
attributed to the early exposure of hospital-based nursing students to
clinical setting from their first year during the introductory class to cover for
the stipulated number of days or hours by the NMCN and this placed them
in a better position for early assessments of and acquaintances with the
111
activities in the clinical setting. This is in line with the view of the Nursing
and Midwifery Council of Nigeria Curriculum for General Nursing
Programme (2001) which stipulates that hospital-based nursing students
must complete a minimum of 204 days or 4,400 hours in the clinical areas
before being qualified for the NMCN final qualifying exams. This takes the
patterns of study day and block system of study clinical training.
Difference in perceptions of clinical training between male and female
nursing students
The findings showed that there is no significant difference in the perception
of clinical training between male and female nursing students (P>0.05).
There is also no difference in perception of clinical training based on gender
noted in the aspects of perceptions of clinical placement, clinical teaching,
supervision and clinical evaluation. This portrays that there is no significant
difference between the way male nursing students perceive their clinical
nursing training and the way female nursing students perceive it. This
could be attributed to the fact that there is no separate and special clinical
placement, teaching, supervision and evaluation organized for male or
female nursing students. They are trained together. This result is similar
with that of the study carried out in Tehran University of Medical Science
Iran by Ziaee, Ahmadinejad and Morravedji in 2000 on “Evaluation of
medical students’ satisfaction with clinical education and its attending
factors’ which showed that there was no relationship between satisfaction
and gender.
112
The negative views of female nursing students in clinical supervision as
shown in Table 8 may be attributed to the popular saying that females have
more domineering and strict attitudes towards life situations than males.
They are in a position to give better interpretation of life situations and they
are also the majority in this study. This is in line with the statements of
Alam and Garry (2011) which included attitudes as one of the factors that
influence perception.
Implications of the study
The findings of this study have some implications as follows:
• 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.
• 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.
• 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.
113
• 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.
• 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.
• 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.
• Having adequate training, knowledge, responsibility and transparency
by the clinical supervisors will help them demonstrate qualitative
skills beneficial to students during the clinical supervision.
• 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.
114
• 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.
• Not consistently informing the students of their progress individually
will deny them the opportunity for self-assessment and effort for self
improvement.
• 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.
• 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.
115
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:
• Determine the nursing students’ opinion of the placement into the
clinical learning environment/setting.
• Ascertain the nursing students’ view about the clinical teaching
(instruction).
• Identify the nursing students’ views about clinical supervisions.
• Assess the nursing students’ perceptions of clinical evaluation.
• 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.
• 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:
• Majority of the students were females.
• Majority of the nursing students involved in this study demonstrated
high perception of their clinical training especially in the aspects of
116
the placement into the clinical setting and clinical teaching
(instruction).
• Some of the nursing students also demonstrated low perception of
their clinical training.
• Majority of the nursing students showed low perception of their
clinical supervision.
• There was a high perception of clinical evaluation though the students
were not constantly informed of their progress.
• 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.
117
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.
118
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.
119
REFERENCES
Adah, C. (2012). Clinical performance of nursing students. Retrieved from: http://www.ehow. com/about-6163234clinical-performance- nursing-
student.htmp. December 8th, 2012.
Adams, V. (2002). Consistent clinical assignment for nursing students compared to multiple placement. Journal of Nursing Education, 41(2), 80-82. Alam, S & Gary, J. (2011). Perception, Attribution and Judgment of others, organizational Behaviour: Understanding and managing life at work. Retrieved from: http://En.Wikipedia.Org/Wiki/Perception.
On February 12th, 2014.
Advice Supplementary for Tomorrow’s Doctor (2009). Clinical placements for medical students. Tomorrow’s Doctors. Retrieved from: www.sinc.uk.org/clinical. On January 16th, 2014. Afzal, W., Akram, A., Akram, M.S. & Ijaz, A. (2010), Students’ perspective of quality in higher education. 3rd International conference. Assessing Quality in Higher Education, 417-418,422.
Anthony, M & Yastik, J. (2011). Nursing students experiences with incivility in clinical education. The Journal of Nursing Education 50(3)-140-144.
Australian Government Initiative. (2012). Promoting quality in clinical placement. Retrieved from:www.Hva.Gov/An/Sites/Uploads/Promotin g-Quality-In-Clinical-Placements-Report-20130408.Pdf. January 22nd 2014.
Balagot, J. (2012). The elements of teaching and learning process. Retrieved from:www.slideshare.net/jamettebalagot/theelements+of-teaching- and-learningprocess. On May 27th, 2013.
Basavanthappa, B.T. (2002). Nursing Education; Maryland, USA: Japee Brothers Medical Publishers Limited.
Basavanthappa, B.T.(2009). Nursing Education; Maryland, USA: Japee Brothers Medical Publishers Limited.
Benard, J.M. and Goodyear, R.G. (1998). Fundamentals of Clinical Supervision. Boston, USA: Allyn and Bacom Publishers.
120
Benner, P., Sutphen, M., Leonard, V. & Day L. (2009). Education nurse: A call for radical transformation. San Francisco: As Jossey-Boss.
Retrievedfrom:Blockmedicaldictionarythefreedictionary.com/clinical+rotation. On August 7th, (2013).
Bond, E. (2009). Exposing shame and its effect on clinical nursing education. Journal of Nursing Education, 48(30),132-140.
[
Boxer, E. and Klugea, B. (2000), Essential clinical skills for beginning registered nurses. Nurse Education Today. 20(4). 327-335.
Branch, W.T & Paranjape, A. (2002). Feedback and reflection: Teaching methods for clinical setting Acad. Med, 77,1185-1188
Brown, B.L. (2003), Teaching styles Vs Learning styles: Myths and
Realities Eric publication. Retrieved from:
http://www.cete.orh/acve. December 8th, 2012.
Cao-Criffing, T.E & Bai, X. (2009). The importance of synchronous interaction for student satisfaction with course websites, Journal of Information Systems Education. 20(3), 331-338. Careers.bnj.com/careers/advice/view.articlehtml=20000377. Retrieved on July 14th, 2014.
Chan, D. (2002). Development of the clinical learning environment inventory. Using the theoretical framework of learning environment studies to assess nursing students’ perceptions of hospital as a learning environment. Journal of Nursing Education, 42(2), 69-75.
Chapman, R. & Orb, A. (2000). The nursing students lived experience of clinical practice The Australian Electronic Journal of Nursing Education5(2).Retrievedfrom:http://scu.edu.au/schools/nhcp/aejne/archive/vol5-2/chapmanrvol 5-2. February 26th, 2014.
Clare. J., White J., Edwards, H & Van-Loon, A. (2002). Curriculum, clinical education recruitment, transition and retention in nursing. AUTC Phase one final Report Flinders University Adelaide Australia Clifton, E. (2002). Implementing clinical supervision. Nursing time 98(36). Retrieved from: htt://www.nursingtime/implementingclinicalssupe Revision on/2000-410.article. December 8th, 2012.
Corr, C. & Schott, A. (2002). Differences in evidence-based care in midwifery and education. Nurse Scholar, 34,153-8.
121
Corrin, A. (2015). Nursing Placement Guideline fro Students and Mentors; University of Esses. Retrieved from: [email protected] September 8th, 2015.
Crotty, J. (2011). Getting the best out of your clinical experience”. School of Nursing Oakland University. Retrieved from:http://Oaklandnursing On December 8th, 2012.
Curtis, J, Bowen, I & Reid, A. (2007). You have no credibility: Nursing students experiences of horizontal violence. Nurse Education in Practice. 793), 156-163.
Dictionary.reverso.net/English-definition/expectation. Retrieved 7th March 2014.
Diekelmann, N. (2004). Experienced practitioners as new faculty: New Pedagogies and new possibilities. Journal of Nursing Education. 43(3), 101-103.
Duteau, J. (2012). Making a difference. The value of preceptors programs in nursing education. Journal of Continuing Education in Nursing. (43)
37- 43.
Ehiemere, I.O. (2009). Current trends in nursing education, Research and Practice. West African Journal of Nursing. 53(2)87-93. Elliot, K.M & Healy, M.A. (2001). Key factors influencing student satisfaction related to recruitment and retention. Journal of Marketing for Higher Education. 10(4).1-11.
Elliot, M. (2002). Clinical Education: A challenging component of undergraduate nursing education. Contemporary Nurse, 12(1).69- 71.
Emerson, R.J. (2006). Nursing Education in clinical setting Mosby Elsevie store. Retrieved from: storeelgevier.com/Nursing-Education- in the-
clinical-setting/Roberta-Emerson/isbon- 9780323036085/. June 17th, 2013.
English National Board/ENB. (2001). Preparation of member and teachers: A new framework of guidance. Department of Health Children press;
Luton. Federal Republic of Nigeria population census. (2006).
Goldstein, E. B. (2009). Encyclopedia of Perception. Sage 309-31. Retrieved from:http://books.google.comp/books?id=Y4ToEN4F52Mc&PgPA301.
On February 12th, 2014.
122
Gray, M & Smith, I. (2000). The qualities of an effective mentor from the student nurses’ perspectives: Findings from a longitudinal qualitative study. Journal of Advanced Nursing, 32(6), 1542-1549.
Ham, l. & Hayduk, S. (2003). Graiwing competitive advantages in higher education. Analysing the gap between education through balance scerccard. Paper presented at the 2nd International conference on Assessing Quality in Higher Education.
Hapern, D.F & Hakel, M.D. (2003). Applying the science of learning to the university and beyond, teaching for long-term retention and transfer change 35 (36-43). Retrieved from: www.nattarej.org. On March 17th, 2014.
Harvey, L & Williams, J. (2010). Fifteen years of quality in higher education. Quality in Higher Education. 16(1), 3-36.
Hersh, R.N. (2007). Going Naked. Peer Review Journal of the Scholarship of Teaching and Learning, 10(1).
Institute of Medicine. (2003). Health Professions Education: Abridge to quality, Washington DC; The National Academics Press.
Institute of Medicine (2009). Redesigning continuing education for health professional. Washington D.C: The National Academics press.
Institute of Medicine. (2011). The future of nursing: leading change advancing health. Washington DC: The National Academics press.
Irby, D.M. & Papadakis, M. (2001). Does good clinical teaching really make a deference? American Journal of Medicine, 110,231-232.
Jannecke, W.J., Stensaker, B. & Grogaard J.B. (2010), Norwegiam Institute for Studies in Research.
Jenkins, C.. Page, C., Hawamana, S & Brigley, .S. (2007). Techniques for effective bedside teaching. Hosp.Med. 68 M150-153. Retrieved from: Careers bnj.com/careers/advice/view.crticlehtml?id=20000377. On July 4th, 2014. Karen, M. (2013). Clinical Nursing Education: current reflection. Portland. Retrieved from: www.thefreelibrary.com/clinical+Nursing+Eduction% 3a+ current+ Relection-0234930406. On June 17th, 2013.
Kaviani, N. & Stillwell,y. (2000). An evaluative study of clinical preceptorship. Nurse Education Today, 20(3), 218-226.
123
Kerlin, C. (2000). Measuring students satisfaction with the service processes of selected student, Educational services at Evereth Community College. Differentiation Abstracts International, 99661458
pp.1-32.Retrievedfrom: http://porquest.Uni.commovcat.nora.Edu/ login ?COPT+ EJJPNIMGYmSUSUPTAmUKVSPI=&Clientld=17038. On January 18th, 2014.
Kilmon, C., Brown, L., Ghosh, S. & Mikitiuk, A. (2010). lmmersive virtual reality simulation in nursing education. Nurse Education Perspect, 31,314-317. Kim, J.V & Jens, R. (2010). Perceptual cycle. Cognition and Reality, 209- 249. Retrievd from: rociajimerez.Tripod.com on April 15th, 2015.
Kozier, B., Erb, G.g, Synder, S. & Berman, A. (2008). Fundamentals of Nursing process and practice. Upper saddle river New- Jersey: Pearson Education.
Leino-Kilpi, H., Haritini, T., Saarikoski, M., Lambrinou, E. & Papastavrou, E. (2009). Students nurse experiences of learning in the clinical environment. Nurse Education in Practice. Retrieved from: Doi.10.101b/j.nep.2009.07.003. On December 18th, 2012.
Linfield-Good Sanaritan School of Nursing. (2012). Clinical Teaching Associate Preceptor Manual.
Lofmark, A., Thorkildesn, K., Raholm, M.B. & Natvig, G.k. (2011). Nursing students satisfaction with supervision from preceptors and teachers during clinical practice. Department of Health, staid/Hargesund University College Postboks, Norway: Elsevier Limited.Retrieved from: anna.lofmark (a) telia. Com. On August 8th, 2013.
MAHEC Office of Regional Primary Care Education. (2009). Teaching at the bedside. Retrieved from:www.oucom.ohiou.edu/fd/monographs/bedside.htm. On July 25th, 2014.
McGree, S.R. & Irby, D.M. (1997). Teaching in the outpatient clinical: Practical tips. Journal of General Internal Medicine. 12(2), S34-40.
McLeod, S. M. (2007). Visual Perception Theory. Retrieved from: www.simplypsychology.perception-theories.html. On April 15th, 2015.
Melone, S. (2010). Basic Nursing skills and concepts. Nursing Times Magazine. Retrieved from: www.nursingtimes.net. On May 30th, 2013.
Nahas, V.L. & Yam, B.M.C. (2001). Hong Kong nursing students’ perceptions of effective clinical teachers. Journal of Nursing Education, 40 (5) , 233-237.
124
National Athlectic Trainers’ Association Education Council Clinical Education. (2002). Retrieved from: http://www.com/.com:http://www.ncbi.n/m.mih.gov/pinic/a rticlespnic164429. On April 14th, 2013.
Neary, M. (2000). Supporting students learning and professional development through the process of continuous Assessment and mentorship. Nurse Education Today, 20(6), 463-474. Newman, W. (2013). Clinical education and the profession. American Speech Language Hearing Association. Retrieved from: http://www.asha.org/academic/teach- tools/supervision.htm. On December 4th, 2012. Nigeria National Bureau of Statistics. (2008).
Noe, A. (2004). Action In Perception. MIT Press. Retrieved from: http://en.wikipedia.org/w/indexphp?title=Ecologicalpsychology&oldid =6322545. On April 15th, 2015.
Nursing and Midwifery Council of Nigeria. (2001). Curriculum of General Nursing Education in Nigeria.
Nursing and Midwifery Council of Nigeria. (2008).
Ocker, R.J. & Yaresbaum, G.J. (2001). Collaborative learning environments exploring student attitudes and satisfaction in face- to faceas gurchononos computer conferencing setting. Journal of Interactive Learning Research, 12(4), 427-448.
O’Connor, A.B. (2006). Clinical instruction and evaluation (2nd ed.) Boston, M.A: Jones and Bartlett. Retrieved from:
Sjvnec.org/Fresnocity/Evaluation of Students in the clinical setting pdf. On July 25th, 2014.
Odunukwe, R . C. (2015). Perception of nursing students about factors influencing their clinical training in Nigeria Retrieved from: www.uniprojectsearch.com.factors-influencing-nurses-clinical- training-nigeria. On April 8th, 2015.
Odunukwe, R . C. (2015). Perspective clinical posting experiences among undergraduate nursing students in Nigeria. Retrieved from:
http://www.uniprojectsearch.com/perspectives-clinical posting experiences. On April 9th, 2015.
Oermann, M.H & Gaberson, K. R. (2009). Clinical Teaching Strategies in Nursing. New York: Springer Publishing Company.
125
Ojo, A.O. (2010). The challenges of best practices and standards in nursing in Nigeria. Inaugural lecture series. (4th Edition), Igbendion University Okada.
Okoronkwo, I.L, Onyia-Pat, J., Agbo, M., Okpala, P.U. & Ndu, A.C. (2013). Students’ perception of effective clinical teaching and teacher behavior. Open Journal of Nursing. 3(1).
Okpala, P.U., Iheanacho, P.N., Okoronkwo, I.L and Stephens, R. (2014). Students’ Perception of Environmental Sanitation in Female Hostels: a study of a Nigerian university. West African Journal of Nursing. 25(1), 71-83.
O’ Leary, P.F & Quinlan, T.J. (2007). Learners instructor Telephone Interaction: Effects on satisfaction and Achievement of online student. The American Journal of Distance Education, 2(3), 133-143.
Olsler, W. (2013). Ingtructor/student Guidline for Clinical Placement; Canada.RetrievedFrom:www.williamoslerh’ska/research-and-education/education/student-placements/September 8th, 2015
Papastavrou, E. & Lambrinou, E. (2009), The validation of the clinical learning environment scale in Greek working Papes University. Papastavrou, E., Lambrinou, E., Tsangari, H., Saarikoski, M & Leino-kilpi, H. (2009). Student Nurses experience of learning in the clinical environment. Nurse Education in practice. Retrieved from:
www.elsevier.com/nepron. On February 26th,2014. Papathanasion, I., Tsaras, K. & Sarafis, P. (2014). “Views and Perceptions of Nursing students on their clinical learning environment: Teaching and learning” Nurse Education Today 34 (1) 57-60.Retrievedfrom: http://www.researchgate.net/publication/235818456-views-and-pe. On February 26th, 2014. Papp, L., Markkanen, M & Von-Bonsdoff, M. (2003). Clinical environment as a learning environment: student Nurses’ perceptions concerning clinical learning environment. Nurse Education Today, 23 (4), 262- 267.
Peach, H.G. & Bath, N.E. (2000). Comparison of rural and non-rural students undertaking a voluntary rural placement in the early years of a medical course. Medical Education, 34, 231-233.
Pires, R.M & Ferreira, M.M. (2012), Nursing student clinical supervision. Retrieved from: [email protected]. On December 8th, 2012.
Price, A. & Chalker, M. (2000). Our Journey with clinical Supervision in an intensive care unit. Intensive and Critical Care Nursing, 16(1), 51- 55.
126
Prideaux, D., Alexander, H., Bower,R, Tallett,S., Dacre, j., Haist, S., Jolly, B., Norcine, j. Roberts, T., Rothman, A. & Rowe, R. (2000), Clinical teaching: Maintaining an educational role for doctors in the new health care environment. Medical Education, 34, 820-826.
Proctor, B. (1998). Supervision: A working Alliance Alexia, Sussex.
Rafiee, J., Moattari, M., Nikbakht, A.N., Kojuri J & Mousarinasab, M. (2014). Problems and challenges of nursing students’ clinical evaluation. Iranian Journal of Nursing and Midwifery Research, 19(1), 41-49. Retrieved from:
http://www.ncbi.nlm.nith.go/pun/articles/PMC3917184/. On April 9th, 2015.
Raisler, J., O’ Grandy, M. & Lori, J. (2003). Clinical Teaching and Learning
in midwifery and women’s health. Journal of Midwifery and Women’s Health, 48(6), 398-403.
Ramani, S. & Leinster, S. (2008). Teaching in the clinical environment.
AMEE Guide Medical Journal, 30,347-364.
Ramani , S. (2003). Twelve tips to improve beside teaching. Medical
Teaching, 25,112-115.
Reid, N. (2008). Quality assurance in higher education in Pakistan: Focus
on the learner. Paper presented at the 2nd International
Conference an Assessing Quality in Higher Education.
Rundel, M. (2006). Macmillam English Dictionary for Advanced Learner U.K:
Bloomsbury Publishing Plc.
Saarikoski, M., Leino-Kilpi, H. & Warne, T. (2002). Clinical learning
environment and supervision: testing a research instrument in an
international comparative study. Nurse Education Today, 22(4), 340-
349.
Sass, E & Dana, N.R. (2011). Clinical Education Experiences: perceptions
of student registered Nurse Anesthetists. American Association of
Nurse Anesthesia Journal, 76(4), 35-42. Retrieved from:
www.aana.com/aanajournalonline.aspx. On February 12th, 2014.
Schacter, D. (2011). Psychology Worth Publishers. Retrieved from:
http://en.wikipedia.org/wiki/perception. On February 12th, 2014.
Schindly, B.S. (2012). Evaluating students in the clinical setting.
Demand Media Inc. Retrieved from: http://www.ehow.com/info-
838115/-evaluating-nursingstudnet-clnical-setting.html.
On June 18th, 2013.
127
Schultz, S.D. (2010). Psychology and work Today New York: Prentice Hall.
Retrieved from: En.wikipedia.org/wiki/Apprenticeship. January
18th, 2014.
Sharif, F. & Masoumi, S. (2005). A qualitative study of nursing students
experiences of clinical practice. Bio-Medical central Nursing Magazine.
4:6.
Shunway, J.M & Harden, R.M (2003). The Assessment of learning outcomes
for the competent and reflective physician. Medical Teaching. 25,569-
584.
Sloam, G. and Watson, H. (2002). Clinical Supervision model
for nursing: structure research and limitation. Nursing Standard,
17(4), 41-46.
Sobralske, M. & Naegele, L.M. (2001). Worth their weight in gold: The role
of clinical coordinator in a family nurse practitioners program.
American Academic Nurse Practioner, 13,537-544.
Spencer, J. (2003). Learning and teaching in the clinical environment.
Br Medical Journal, 326,591-594.
Talbot, J. & Ward, A. (2000). Alternative curricular options in rural
Networks (ACORNS) impact of early rural clinical exposure in the
university of West Australia Medical course. Austrailan Journal of
Rural Health, 8(1), 17-21
Thurmand, V.A, Wambach, K, Connos H.R & Fery, B.B. (2002). Evaluation
of students’ satisfaction: Determining the impact of a web-based
environment by controlling for student characteristics. The American
Journal of Distance Education, 16(3), 169-189.
Tobin Communications in association with Forlery Associates Inc. (2005).
Massachusetts board of Higher Education. Retrieved from:
http://wwwmassedi/pp/home.asp?d=9andiid-9ic. On June 18th,
2013.
Turnbull, L. (2013). Undergraduate Nursing student Clinical Placement
Manual; Nursing Education Royal Children’s Hospital Melbourye.
Retrievedfrom:http://www.wch.org.ciu/mcpc/prof.cfm?docid=1d=129
46. On September, 2015.
128
Turumen, H. (2002). Critical Learning incidents and use as a learning
method – A comparison of Finnish ands British nurse student
teachers. Doctoral dissertation kupio University publications social
Sciences 93.
United Kingdom for Central Council. (1995).
University of Liverpool Online Program. (2013). Retrieved from:
http:// www.mondofacto.com/facts/directionary? Clinical +
placement. On April 14th, 2013.
University of Queensland. (2005). Handbook of university policy and
procedures: Placement course. Retrieved from:
http://www.qoltc.edu.au/resource/index.html?page = 65-336 and
pid = 0. On April 14th, 2013.
Walker, W.O, Kelly, P.C. & Hurue, R.F. (2002). Mentoring for the New
Millennium. Medical Education. Retrieved from: www.med-ed-
online.org. On July 4th, 2013.
Williams, A., Wellard, S.J. and Bethune, E. (2001), Assessing Australian
undergraduate clinical learning collegian, 8(4),9-13.
Worldtrans.org/TP/TPI/TPI-9HTML. Retrieved on February 12th, 2014.
Wren, K. & Wren, T. (1999). Legal implication of evaluation procedures for
student in health care professions. Journal of the American Association
of Nurse Anesthetists. 67,1.
Ziaee, V., Ahmadinejad, Z. & Morranedji, A.R. (2013). An Evaluation on
Medical Students satisfaction with clinical Education and its effective
factors” Tehran University of Medical Science. Retrieved from:
http://www.med-ed- online.org/F0000082. htm. On June 18th,
2013.
129
APPENDIX 1
QUESTIONNAIRE
Department of Nursing Science, Faculty of Health Science and, Technology, University of Nigeria,
Enugu campus. 2nd June, 2014. Dear Respondent,
QUESTIONNAIRE ON NURSING STUDENTS’ PERCEPTIONS OF CLINICAL NURSING TRAINING IN SELECTED NURSING PROGRAMMES IN ENUGU
STATE
The researcher is a post graduate student of the Department of Nursing Sciences, University of Nigeria, Enugu Campus. This questionnaire is designed to obtain information on the nursing students’ perceptions of clinical nursing training in selected nursing programmes in Enugu State.
The research work is purely an academic exercise and information obtained will be treated with utmost confidence. You are requested to be as honest and objective as possible in answering the questions. Your sincere opinion on each question will be highly appreciated. Do not write your name or registration number. Thanks for your anticipated co-operation.
Ugwu Stella Ngozika
Instruction: Tick (√) in the appropriate box in section A Tick (√) at the column that represents your opinion against the statement in section B
Section A: Demographic characteristics 1. Name of Institution: (a) Department of Nursing Science UNEC (b) School of Nursing UNTH Enugu (c) School of Nursing Bishop Shanahan Hospital Nsukka 2. Type of Nursing Programme (a) University-based nursing programme (b) Hospital-base nursing programme 3. Year of study (a) Year 2 (b) Year 3 (c) Year 4 (d) Year 5 4. Age last birthday (a) < 20 years (b) 20-24 years
(c) 25-29 years (d) 30 -34 years
130
5. Gender: (a) Male (b) Female
SECTION B:
Students’ Perceptions of Clinical Nursing Training
Use the following scale to answer questions 6 to 75.
4 – Strongly Agree “SA”, 3-Agree “A”, 2-Disagree “D” and 1 – Strongly Disagree “SD”.
S/n Items SA A D S D
Opinion about Placement to Clinical setting/ environment
4 3 2 1
6 Students are actively involved in planning for the clinical placement
7 The orientation I received for the placement was adequate 8 The duration for each clinical placement and exposure was
adequate
9 All the placements were timetabled
10 The placement period was put to good use 11 The placement gave me the opportunity to learn with
students from other discipline
12 Rotations to necessary specialist clinical units were adequate e.g theatre, obstetric and gynae, med-surg etc
13 Clinical settings (environments) were well organized
14 Reasonable accommodation was made available for the student during outstation posting
15 Transport arrangements during the placement were adequate
16 Aesthetic aspects of the physical infrastructure were adequate,
17 Access to leisure activities during the clinical posting was always allowed
18 Reasonable steps were taken to ensure that the health of the students were not jeopardized during placement
19 There was a positive atmosphere for learning throughout the period of the posting
20 The clinical sites and faculty provide me with procedure book and movement scattergram during placement
21 It improved my interpersonal relationship and skills
22 Clinical learning environment was conducive in all clinical settings.
23 The nurses at the clinical setting were friendly and easy to approach throughout the period of posting and rotation.
Views about Clinical Teaching (Instruction)/learning
24 The clinical instruction was student centered
25 The instruction was stimulating 26 The clinical teaching contents were well organized.
27 The instructor challenged me to understand ideas and
131
concepts
SA A D SD 4 3 2 1 28 The instructor encouraged me to ask questions
29 The instructor communicated concept clearly
30 The procedure and log books were accurate and useful during the teaching
31 There was a good coverage of the clinical instruction curriculum.
32 The teaching and learning materials were always provided.
33 The facilities were always in good working condition (adequate).
34 The clinical instructors were adequate in number 35 Varied teaching tips like preparation introduction,
interaction and summarization were used by the clinical instructor.
36 Varied clinical teaching styles (methods) were used by the instructors.
37 I was taught by a number of different clinical instructors.
38 The clinical teachers had good bedside manner.
39 Patients were involved during clinical teaching when necessary.
40 In my opinion, all the clinical instructors were capable of integrating theoretical knowledge and practical knowledge.
41 I felt socially comfortable in teaching sessions.
42 Opportunities are given to express my opinion and develop interpersonal skills during teaching sessions.
43 I was encouraged and allowed to participate actively in the teaching and learning sessions.
44 Opportunities were given to me for demonstration of clinical skills learnt like carrying out basic nursing tasks.
45 I was able to constantly use the learning materials provided for practical demonstration.
46 I was able to participate in the clinical professional development events like research.
47 I was opportuned to develop collaboration and communication skills with members of other disciplines during the teaching.
48 In my opinion the quality of clinical teaching and learning was good.
Views about clinical supervision 49 The clinical instructor and supervisors have adequate training,
knowledge and skills to supervise.
50 The supervisors were transparent. 51 The supervisors were friendly.
52 The supervisors evidenced personal interest in my success. 53 The clinical supervisors do not belittle and intimidate students.
132
SA
A
D
SD
4 3 2 1 54 The supervisor takes responsibility for students learning. 55 Supports from clinical supervisors during supervision were
adequate.
56 Supports of teachers from the school during clinical experiences were adequate.
57 There was good support system for student who encountered difficulties.
58 The supervisory relationship was characterized by a sense of trust and mutual relationship.
59 The staff was generally interested in student’s supervision. 60 I received group supervision which was adequate.
61 I received individual supervision which was adequate. 62 The supervisors were always available.
63 The supervisors were always accessible.
64 The supervisors show respect for students.
65 The supervisors had good rapport with students. Perception of Clinical Evaluation
66 I was evaluated in each unit of practice. 67 My clinical performance was evaluated only at the end of each
semester.
68 I was given opportunity for self assessment.
69 The clinical evaluators were able to use assorted techniques (strategies) like continuous assessment, assignment and examination.
70 The clinical evaluators were good at providing constructive criticism and feedback
71 Through the feedback, my strengths were reinforced and errors corrected.
72 The faculty informed me of the grading methods in practical exam 73 I was duly informed of the duration and period of clinical
evaluation.
74 The evaluator consistently informed me of my progress.
75 Assignment that required critical and creative thinking were provided or given.
133
APPENDIX II
CALCULATION OF RELIABILITY OF QUESTIONNAIRE
Respondent Pre-Test Scores (X) Post-Test Scores (Y) XY X2 Y2
1 178 180 32040 31684 32400
2 201 204 41004 40401 41616
3 222 221 49062 49284 48841
4 198 200 39600 39204 40000
5j 176 178 31328 30976 31684
6 200 198 39600 40000 39204
7 245 243 59535 60025 59049
8 101 120 12120 10201 14400
9 99 110 10890 9801 12100
10 219 224 49056 47961 50176
11 156 175 27300 24336 30625
12 143 165 23595 20449 27225
13 138 143 19734 19044 20449
14 178 180 32040 31684 32400
15 188 183 34404 35344 33489
16 167 154 25718 27889 23716
17 127 129 16383 16129 16641
18 187 185 34595 34969 34225
19 199 201 39999 39601 40401
20 201 209 42009 40401 43681
21 220 225 49500 48400 50625
22 264 264 69696 69696 69696
23 243 245 59535 59049 60025
24 189 190 35910 35721 36100
25 178 180 32040 31684 32400
26 99 104 10296 9801 10816
27 110 112 12320 12100 12544
28 152 145 22040 23104 21025
29 139 140 19460 19321 19600
30 140 141 19740 19600 19881
31 165 152 25080 27225 23104
32 178 154 27412 31684 23716
33 192 189 36288 36864 35721
34 204 202 41208 41616 40804
35 239 211 50429 57121 44521
36 218 201 43818 47524 40401
37 169 172 29068 28561 29584
38 159 165 26235 25281 27225
39 178 170 30260 31684 28900
40 165 154 25410 27225 23716
Total 7124 7118 1325757 1332644 1322726
134
APPENDIX III
135
APPENDIX IV
CORRELATION FOR RELIABILITY OF INSTRUMENT (USING SPSS 17.0 OUTPUT)
Correlations
Pre Test Post Test
Pre Test Pearson Correlation
1 .970"
Sig. (2-tailed) .000
N 40 40
Post Test Pearson Correlation
' .970" 1
Sig. (2-tailed) .000
N 40 40
Correlation is significant at the 0.01 level (2-tailed). From the above Tables, the Spearman's rank correlation coefficient is 0.97. This indicates a strong positive correlation. Therefore, the research instrument is very reliable.
136
APPENDIX V
INFORMED CONSENT Introduction: My name is Ugwu Stella Ngozika, a post graduate student of Department of Nursing Science, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus. Voluntary nature of participation: Subjects participation in this study is entirely voluntary. You have the right to withdraw consent and discontinue participation in the study at any given time. Study procedure: I am carrying out a study on nursing students’ perceptions of clinical nursing training in selected schools in Enugu State. In this study, you will be required to fill the questionnaire. Please feel free to ask for clarification on any question you do not understand. Risk: The process of filling the questionnaire will not cause you any harm or injury. Confidentially: Please note that information you give will be kept confidential. Your name will never be used in connection with any information you give. Feed back: In case of any clarification, you can contact me: 07032361295 Response: The study has been explained to me and I understood the consent of the study process. I will be willing to participate in the study described above. …………………………….. ………………………… ………………………….. Signature of participant signature of witness signature of researcher
…………………………… ………………………… …………………………… Date Date Date In case of enquiries/complaint, contact Dr. Okolie Uche HOD Department of Nursing Sciences Faculty of Health Sciences & Technology University of Nigeria, Enugu Campus
137
APPENDIX VI
138
APPENDIX VII
Department of Nursing Sciences, Faculty of Health Sciences & Technology, University of Nigeria, Enugu Campus, 28th July, 2014 The Principal, School Nursing, Bishop Shanahan Hospital, Nsukka, Enugu State. APPLICATION FOR ADMINISTRATIVE PERMISSION TO USE SECOND AND THIRD YEAR STUDENT NURSES FROM YOUR SCHOOL FOR RESEARCH STUDY I wish to apply for your permission to use the second and third year student nurses from your school for my research study. I am a post graduate student of the above department carrying out a research study on nursing students’ perceptions of clinical nursing training in selected schools in Enugu State. The research project is under the supervision of Dr. Mrs. N.P. Ogbonnaya of Department of nursing Sciences. Information obtained would be treated with utmost confidentiality. Thank you. Yours sincerely, Ugwu Stella Ngozika
139
APPENDIX VIII
1
APPENDIX IX
Means and standard deviation of the 70 items of the SPCNTQ
n = 441
Subscales S/N ITEMS SA A D SD n Sum Mean
Stdev
Nursing students’
opinion of their
placement into the
clinical learning
environment /setting
6 Students are actively involved in planning for the clinical placement
63 102 135 141 441 969 2.20 1.04
7 The orientation I received for the placement was adequate
69 196 141 35 441 1181 2.68 0.83
8 The duration for each clinical placement and exposure was adequate
88 151 130 72 441 1137 2.58 0.99
9 All the placements were timetabled
152 174 86 29 441 1331 3.02 0.90
10 The placement period was put to good use
111 195 97 38 441 1261 2.86 0.89
11 The placement gave me the opportunity to learn with students from other discipline
134 187 91 29 441 1308 2.97 0.88
12 Rotation to necessary specialist clinical units were adequate e.g theatre, obstetric and gynae, med-surg, etc.
108 151 123 59 441 1190 2.70 0.98
13 Clinical setting (environments) were well organized
81 165 132 63 441 1146 2.60 0.95
14 Reasonable accommodation was 60 108 147 126 441 984 2.23 1.01
126
2
made available for the student during outstation posting
15 Transport arrangements during the placement were adequate
68 125 125 123 441 1020 2.31 1.04
16 Aesthetic aspects of the physical infrastructure were adequate
43 167 149 82 441 1053 2.39 0.90
17 Access to leisure activities during the clinical posting was always allowed
50 134 151 106 441 1010 2.29 0.96
18 Reasonable steps were taken to ensure that the health of the students were not jeopardized during placement
56 159 134 92 441 1061 2.41 0.96
19 There was a positive atmosphere for learning throughout the period of the posting
57 194 130 60 441 1130 2.56 0.88
20 The clinical sites and faculty provide me with procedure book and movement scattergram during placement
62 187 131 61 441 1132 2.57 0.90
21 It improved my interpersonal relationship and skills
113 229 65 34 441 1303 2.95 0.84
22 Clinical learning environment was conducive in all clinical setting
58 153 187 43 441 1108 2.51 0.84
23 The nurses at the clinical setting were friendly and easy to approach throughout the period posting and rotation
47 184 159 51 441 1109 2.51 0.83
subscale mean 2.57 0.51
Nursing students’ views about clinical teaching (instruction)
24 The clinical instruction was student centered
54 176 164 47 441 1119 2.54 0.84
127
3
25 The instruction was stimulating 56 203 135 47 441 1150 2.61 0.84
26 The clinical teaching contents were well organized
47 157 178 59 441 1074 2.44 0.85
27 The instructor challenged me to understand ideas and concept
54 201 128 58 441 1133 2.57 0.87
28 The instructor encouraged me to ask questions
105 236 67 33 441 1295 2.94 0.83
29 The instructor communicated concept clearly
68 191 139 43 441 1166 2.64 0.86
30 The procedure and log books were accurate and useful during the teaching
81 181 119 60 441 1165 2.64 0.93
31 There was a good coverage of the clinical instruction curriculum
56 161 155 69 441 1086 2.46 0.90
32 The teaching and learning materials were always provided
36 115 183 107 441 962 2.18 0.89
33 The facilities were always in good condition (adequate)
43 118 180 100 441 986 2.24 0.91
34 The clinical instructors were adequate in number
44 116 186 95 441 991 2.25 0.90
35 Varied teaching tips like preparation introduction, interaction and summarization were used by the clinical instructor.
42 173 150 76 441 1063 2.41 0.88
36 Varied clinical teaching styles (methods) were used by the instructors
51 165 158 67 441 1082 2.45 0.89
37 I was taught by a number of difference clinical instructors
69 187 115 70 441 1137 2.58 0.94
38 The clinical teachers had good bedside manner
47 195 139 60 441 1111 2.52 0.86
128
4
39 Patients were involved during clinical teaching when necessary
59 199 112 71 441 1128 2.56 0.92
40 In my opinion, all the clinical instructors were capable of integrating theoretical knowledge and practical knowledge
44 176 157 64 441 1082 2.45 0.86
41 I felt socially comfortable in teaching sessions
55 211 119 56 441 1147 2.60 0.86
42. Opportunities are given to express my opinion and develop interpersonal skills during teaching sessions
60 207 117 57 441 1152 2.61 0.88
43 I was encouraged and allowed to participate actively in the teaching and learning activities
110 218 75 38 441 1282 2.91 0.87
44 Opportunities were given to me for demonstration of clinical skills learnt like carrying out basic nursing tasks
120 202 81 38 441 1286 2.92 0.89
45 I was able to constantly use the learning materials provided for practical demonstration
90 183 128 40 441 1205 2.73 0.89
46 I was able to participate in the clinical professional development events like research
76 159 141 65 441 1128 2.56 0.94
47 I was opportuned to develop collaboration and communication skills with members of other disciplines during the teaching
71 193 122 55 441 1162 2.63 0.90
48 In my opinion the quality of clinical teaching and learning
66 196 134 45 441 1165 2.64 0.86
129
5
was good
Subscale mean 2.56 0.53
Nursing students views about clinical supervision
49 The clinical instructor and supervisors have adequate training knowledge and skills to supervise
82 217 95 47 441 1216 2.76 0.88
50 The supervisors were transparent
51 198 149 43 441 1139 2.58 0.82
51 The supervisors were friendly 53 177 161 50 441 1115 2.53 0.85
52 The supervisors evidenced a personal interest in my success
47 176 163 55 441 1097 2.49 0.85
53 The clinical supervisors do not belittle and intimidate students
73 123 163 82 441 1069 2.42 0.97
54 The supervisor takes responsibility
67 197 128 49 441 1164 2.64 0.87
55 Supports from clinical supervisors were adequate
38 174 177 52 441 1080 2.45 0.81
56 Supports from teachers from the school were adequate
58 177 144 62 441 1113 2.52 0.89
57 There was good support system for student who encountered difficulties
51 147 168 75 441 1056 2.39 0.90
58 The supervisory relationship was characterized by a sense of trust and mutual relationship
47 146 176 72 441 1050 2.38 0.88
59 The staff were generally interested in students supervision
59 172 140 70 441 1102 2.50 0.91
60 I received group supervision which was adequate
47 150 177 67 441 1059 2.40 0.87
61 I received individual supervision which was adequate
54 149 155 83 441 1056 2.39 0.93
130
6
62 The supervisors were always available
48 110 193 90 441 998 2.26 0.91
63 The supervisors were always accessible
44 153 165 79 441 1044 2.37 0.89
64 The supervisors show respects for students
39 150 175 77 441 1033 2.34 0.87
65 The supervisors had good rapport with students
51 171 151 68 441 1087 2.46 0.89
Subscale mean 2.46 0.54
Nursing students’ perceptions of clinical evaluation.
66 I was evaluated in each unit of practice
60 172 140 69 441 1105 2.51 0.91
67 My clinical performance was evaluated only at the end of each semester
79 191 121 50 441 1181 2.68 0.90
68 I was given opportunity for self assessment
71 160 138 72 441 1112 2.52 0.95
69 The clinical evaluators were able to use assorted techniques (strategies) like continuous assessment, assignment and examination
110 182 95 54 441 1230 2.79 0.96
70 The clinical evaluators were good at providing constructive criticism and feedback
71 184 146 40 441 1168 2.65 0.86
71 Through feedback, my strengths were reinforced and errors corrected
81 182 125 53 441 1173 2.66 0.91
72 The faculty informed me of the grading methods in practical exam
75 165 121 80 441 1117 2.53 0.98
73 I was duly informed of the 130 182 87 42 441 1282 2.91 0.93
131
7
duration and period of clinical evaluation
74 The evaluator consistently informed me of my progress
47 131 180 83 441 1024 2.32 0.90
75 Assignment that required critical and creative thinking were provided or given
92 180 108 61 441 1185 2.69 0.95
Subscale mean 2.63 0.54
132