Pre-registration student nurses perception of the hospital-learning environment during clinical placements

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Summary

If we subscribe to the notion that nursing is an action profession, that nurses learn by doing [Neary, M., 2000. Responsive assessment: assessing student nurses’ clinical competence. Nurse Education Today 21, 3–17], then the mastery of fundamental clinical skills must be a key component of courses leading to registration. The last two decades have seen widespread changes to nurse education but the clinical field remains an invaluable resource in preparing students for the reality of their professional role supporting the integration of theory and practice and linking the ‘knowing what’ with the ‘knowing how’. The clinical-learning environment represents an essential element of nurse education that needs to be measurable and warrants further investigation. This exploratory cohort study (n = 67) examined pre-registration student nurses’ perception of the hospital-learning environment during clinical placements together with the key characteristics of the students’ preferred learning environment utilising an established tool, the clinical-learning environment inventory (CLEI) tool [Chan, D., 2001a. Development of an innovative tool to assess hospital-learning environments. Nurse Education Today 21, 624–631; Chan, D., 2001b. Combining qualitative and quantitative methods in assessing hospital-learning environments. International Journal of Nursing Studies 3, 447–459]. The results demonstrated that in comparison with the actual hospital environment, students would prefer an environment with higher levels of individualisation, innovation in teaching and learning strategies, student involvement, personalisation and task orientation.

Introduction

A belief that ‘nurses are made on the wards not in the classroom’ (Cuthbertson, 1996) supports the ideal that students should learn as much from the clinical field as the classroom with theory integrated with practice (Davies et al., 1999). The clinical field is an essential and irreplaceable resource in preparing student nurse for their professional role (McAllister, 2001). Making a Difference (DoH, 1999) sought to strengthen UK nurse education and training, valuing the importance of working in a learning organisation, providing practice-based teaching with the aim to create more opportunities for experienced staff to combine teaching and patient care so that students can acquire better practical skills.

Section snippets

Literature review

Pivotal to many studies of nursing in the clinical arena is the concept of the ward-learning environment. The clinical placements provide student nurses with the opportunity to combine cognitive, psychomotor and affective and problem-solving skills developing competencies in the application of knowledge, skills, attitudes and values in clinical situations (Chan, 2001b).

Just over two decades ago three significant studies were undertaken examining the clinical-learning environment (CLE) (Orton,

Aims

The purpose of this exploratory study was to determine pre-registration student nurses’ perceptions of the hospital-learning environment during clinical placements and to identify the key characteristics of their preferred CLE.

Objectives

  • 1.

    To assess pre-registration student nurses’ perceptions of the hospital-learning environment during clinical placements in various acute hospital settings.

  • 2.

    To determine the key characteristics of pre-registration student nurses’ preferred clinical-learning environment.

  • 3.

    To

Methodology and study design

For the purpose of this exploratory study it was considered that a quantitative approach would yield the most unambiguous and meaningful results. To obtain this quantitative data a questionnaire was used.

A questionnaire focuses on obtaining information considering the state of affairs of some situation often via direct questioning of a sample of respondents (Polit-O’Hara et al., 2001). Despite there being much comment regarding the CLE in the nursing education literature there had been no

Sampling decisions

For the purpose of this study, eligibility criteria were set to ensure a population relevant to the research question (see Box 1) of the cohort was selected partly on the grounds of convenience. However, the selection parameters also ensured all participants had a construct for reference having undertaken other hospital placements in their training programme and each respondent had an equal opportunity of inclusion. There was a purposive element to this sampling strategy in that my knowledge

Data collection

The questionnaire was formatted in a list of preset statements that were generally closed-ended/fixed alternative in a rating form using a Likert scale, thus the response alternatives were designated by the researcher, which allows a high degree of structure ensuring comparable results and facilitates analysis.

The Likert scale is an ordinal scale (Jordan et al., 1998), thus incorporates the classifying and labelling function of the nominal scale, but in addition creates a sense of order (Fowler

Validity and reliability

It should be noted that the CLEI tool developed by Chan, 2001a, Chan, 2001b was a new tool, because although there are various instruments available for assessing classroom learning environments at different levels it was felt that there was no one universal instrument designed specifically for measuring the hospital-learning environment whilst student nurses are on clinical placement (Fishser and Camillus, 1998) which Chan sought to address.

The final version of the CLEI contains 42 statements

Access and distribution

A cohort in the second year of study undertaking their acute placement in over 100 different acute hospital areas were chosen as the sample population. This ensured that they would all be undertaking hospital based placements and that the placement was of a timely duration i.e., 16 weeks. The questionnaire was distributed by the myself. At this time the study was explained and students were given an information sheet outlining the research project. All students who attended their allocated

Data analysis

The Statistical Package for Social Science (SPSS) (Chicago, IL) was used to perform and facilitate statistical analysis. Prior to entering the results into SPSS the questionnaires were coded by hand and 5% of the submitted questionnaires were checked by an independent verifier prior to analysis to reduce errors and enhance validity. Positive statements were scored 5, 4, 2, 1, respectively, for the responses strongly agree, agree, disagree and strongly disagree, whilst negative statements were

Results

To facilitate a comparison between pre-registration student nurses’ actual and preferred perceptions of the hospital-learning environment to be made, the mean score for each of the six scales, which made up the CLEI questionnaire, was calculated. The scores for each scale ranged from one to five and each scale had seven statements thus the maximum score for each scale is 35. The results of the scale means showed that this cohort of pre-registration students perceived satisfaction and

Discussion

A fundamental principle and expectation of nurse education and training is the preparation of the learner for a professional role. The clinical field provides a unique and pivotal role in this preparation. Consequently both students, educators and service providers have expectations as to how and what the clinical field can and should provide, although undoubtedly these expectations differ.

Learning is an innate element of human development but the facilitator has a significant contribution to

Limitations

This study was an exploratory study, thus by its very nature it is limited. The study only investigated one cohorts’ perception of the CLE consequently is lacking in generalisability and representativeness, however, it is important to note that the results of this study do mirror the results of Chan’s (2001b) earlier work. To be able to provide a more representative viewpoint the study population would need to be expanded to include all students on clinical placements locally and perhaps use

Conclusion

The CLE is a vital and irreplaceable component in preparing the learner for the realities of professional practice, encompassing the acquisition of the knowledge, skills and attributes needed to become a safe competent professional practitioner (McAllister, 2001) and whilst unpredictable, is vital in the education of nursing students (Lowry, 1992, Craddock, 1993, Campbell et al., 1994). Thus, it is essential with the ever-increasing demands and expectations in healthcare and education that

Acknowledgements

Academic Supervisors: Hazel Rangeley, Lecturer, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH; Jon Blacktop, Lecturer, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH.

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