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FACTORS AFFECTING CLINICAL TRAINING OF NURSING
STUDENTS IN SELECTED NURSING EDUCATIONAL
INSTITUTIONS IN ENUGU AND EBONYI STATES OF NIGERIA
BY
AGU GRACE UCHECHUKWU
PG/MSC/07/46796
M.SC DISSERTATION
THE DEPARTMENT OF NURSING SCIENCES,
FACULTY OF HEALTH SCIENCES AND TECHNOLOGY,
UNIVERSITY OF NIGERIA,
ENUGU CAMPUS.
JANUARY, 2014.
2
FACTORS AFFECTING CLINICAL TRAINING OF NURSING
STUDENTS IN SELECTED NURSING EDUCATIONAL
INSTITUTIONS IN ENUGU AND EBONYI STATES OF NIGERIA
BY
AGU GRACE UCHECHUKWU
PG/MSC/07/46796
M.SC DISSERTATION
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 OF
MASTER OF SCIENCE DEGREE
IN NURSING EDUCATION
SUPERVISOR: DR. (MRS.) ANARADO, A. N.
JANUARY, 2014.
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CERTIFICATION
This is to certify that this dissertation was originally carried out by Agu
Grace Uchechukwu in the Department of Nursing Sciences, University of
Nigeria, Enugu Campus.
___________________ ___________________
Agu Grace Uchechukwu Date PG/MSc./07/46796
_______________________ ____________________
Dr. (Mrs) A. N. Anarado Date Dissertation Supervisor
4
Approval page
This dissertation, “Factors Affecting Clinical Training of Nursing Students in
selected Nursing Educational Institutions in Enugu and Ebonyi States of
Nigeria” has been approved for the award of Master of Science Degree in
Nursing Education in the Department of Nursing Sciences, Faculty of Health
Science and Technology, College of Medicine, University of Nigeria Enugu
Campus.
By
Dr. (Mrs) Anarado A. N. Date
Dissertation Supervisor
Dr. (Mrs) Uche Okolie Date
Head of Department
Prof. Obinna Onwujekwe Date
Dean FHST UNEC
External examiner Date
This day of 2013
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DEDICATION
This project is dedicated to God Almighty who protected and guided me
throughout this course of study and also to the Blessed Virgin Mary, my
Mother. It is also dedicated to all lovers of Nursing Education and Practice.
6
ACKNOWLEDGEMENTS
To God Almighty who protected and carried me along throughout this
study period belongs all Glory, Honour and Kingship. This research work
could not have been a successful study without the help of many people. In this
regard, I sincerely thank Dr. (Mrs) A.N. Anarado, the dissertation supervisor
for her unalloyed and meticulous way in handling this work. Her
resourcefulness, patience and motherly advice made this final work what it is.
Many thanks go also to all the lecturers in the Department of Nursing Sciences,
UNEC for the exposure and enlightenment given to me during the course of
this study. My gratitude goes to the Catholic Bishop of Abakaliki Diocese, his
Vicar General and to our Mother General for the opportunity, care and
financial support given to me during this study. My unreserved gratitude goes
to all my Sisters and friends especially Rev. Sr. Mary Paul Odey, for
typesetting this work and also for their spiritual and moral support towards the
success of this research work.
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TABLE OF CONTENT
CONTENT PAGE
Title Page i
Certification ii
Approval Page iii
Dedication iv
Acknowledgement v
Table of Content vi
List of Tables ix
List of Figures xi
List of Appendices xii
Abstract xiii
CHAPTER ONE: INTRODUCTION
Background to the Study 1
Statement of the Problem 6
Purpose of the Study 8
Objectives of the Study 8
Research Questions 9
Hypotheses 9
Significance of the Study 10
Scope of the Study 11
Operational Definition of Terms 11
CHAPTER TWO: REVIEW OF LITERATURE
Conceptual Review 13
� Concept of Nursing Education 13
� Concept of Clinical Nursing Training 16
Objectives of Effective Clinical Nursing Education 19
CONTENT PAGE
Approaches to Clinical Skill development in Nursing Education 21
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Factors affecting Clinical Nursing Training 28
Factors associated with Students themselves 37
Constraints/Challenges of Clinical Nursing Training 42
Theory underlying the Study 46
Model of the Study 49
Empirical Studies 51
Summary of Literature Review 55
CHAPTER THREE: RESEARCH METHODS
Research Design 57
Area of Study 57
Population of Study 60
Target Population 61
Instrument for Data Collection 62
Validity of the Instrument 63
Reliability of the Instrument 63
Ethical Consideration 64
Procedure for Data Collection 64
Method of Data Analysis 65
CHAPTER FOUR: ANALYSIS AND PRESENTATION OF RESULTS
Demographic Characteristics of Students 67
Demographic Characteristics of Teachers 68
Part one, School (A) 70
Research Question 1 70
Research Question 2 75
Research Question 3 77
CONTENT PAGE
Part Two, School (B) 79
Research Question 1 79
Research Question 2 84
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Research Question 3 87
Testing of Hypothesis 88
Hypothesis one 89
Hypothesis two 92
Hypothesis three 95
Summary of the Findings 97
CHAPTER FIVE: DISCUSSION OF FINDINGS
Administrative Factors that affect Clinical Training 100
Training/Supervisory Factors that affect Clinical Training 103
The Students’ Factors that affect Clinical Training 107
Hypothesis one 109
Hypothesis two 113
Hypothesis three 118
Implications for Nursing 120
Recommendations 122
Limitations of the Study 125
Suggestions for further Studies 125
Summary of the Study 126
Conclusion 127
REFERENCES 128
APPENDICES 134
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LIST OF TABLES
TABLES PAGE
Table 1: Demographic Characteristics of Students 67
Table 2: Demographic Characteristics of Teachers 68
Table 3: Respondents (School A) views of Administrative Factors
(Staffing) affecting Clinical Training of Student Nurses 70
Table 4: Respondents (School A) views of Administrative Factors
(Staffing) continued. 72
Table 5: Respondents (School A) views of Administrative Factors
(Infrastructure/Equipment) 73
Table 6: Respondents (School A) views of Training/Supervisory
Factors affecting Clinical Training of Nursing Students 75
Table 7: Respondents (School A) views of Students’ Factors
affecting Clinical Training of Nursing Students 77
Table 8: Respondents (School B) views of Administrative Factors
(Staffing) affecting Clinical Training of Student Nurses 79
Table 9: Respondents (School B) views of Administrative Factors
(Staffing) continued. 81
Table 10: Respondents (School B) views of Administrative Factors
(Infrastructure/Equipment) 82
Table 11: Respondents (School B) views of Training/Supervisory
Factors affecting Clinical Training of Nursing Students 84
Table 12: Respondents (School B) views of Students’ Factors
affecting Clinical Training of Nursing Students 87
Table 13: Z- test Significance of Differences between the two
Institutions of Study with regard to the Administrative
Factors affecting Clinical Training of Nursing Students 89
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TABLES PAGE
Table 14: Z- test Significance of Differences between the two
Institutions of Study with regard to Training/Supervisory
Factors affecting Clinical Nursing Training 92
Table 15: Z- test Significance of Differences between the two
Institutions of Study with regard to Students’ Factors
affecting Clinical Training of Nursing Students 95
12
LIST OF FIGURES
FIGURES PAGE
Figure 1: Drefus Model of Skill Acquisition 139
Figure 2: Conceptual Model of the Study 49
13
LIST OF APPENDICES
APPENDICES PAGE
Appendix 1: Target Population of Academic Staff and Students
from both Nursing Institutions of Study 134
Appendix 2 Stages of Skill Acquisition 135
Appendix 3: Questionnaire 136
Appendix 4: Calculation of Reliability of the Questionnaire 141
Appendix 5: Administrative Letter to Nursing Sciences
Department UNEC 144
Appendix 6: Letter of Identification
Appendix 7: Letter of Administrative Approval of Research work
Appendix 8: Request for number of Students and Lecturers
Appendix 9-10: Administrative Letters to School of Nursing Afikpo 148-149
Appendix 11: Application for Ethical Clearance 150
Appendix 12: Ethical Clearance Certificate
Appendix 13 &14: Informed Consents
Appendix 15: Hypothesis one 154
Appendix 16: Hypothesis two 155
Appendix 17: Hypothesis three 156
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ABSTRACT
The purpose of this study was to identify the factors that affect clinical training
of nursing students in School of Nursing Afikpo in Ebonyi State and
Department of Nursing Sciences, University of Nigeria, Enugu Campus in
Enugu State. Four research questions and three null hypotheses guided the
study. The research design used was descriptive cross-sectional survey method.
A face and content validated questionnaire with 34 items was used for the
collection of data. Data derived from the questionnaire were analyzed
descriptively and Z- test used for the hypotheses was tested at significant level
of p < 0.05. The result of the study from both schools showed that: the schools
have practical laboratories and libraries; students attend clinical experiences
regularly; ward nurses were involved in students’ clinical training, (mean
scores ≥ 3.0 which is the mean decision point). The result further showed that
in both schools there were inadequate equipment in the clinical areas; teachers
were not involved in clinical supervision of students; teachers were not able to
finish teaching their courses; non participation of students in planning of their
programme and also supervisors’ were not able to give proper supervision to
the students, (mean scores < 3.0). Findings revealed that there were significant
statistical differences (P-value < 0.05) between the two nursing institutions as
regards the administrative, training/supervisory and students’ factors affecting
clinical training of nursing students. Based on the findings, it was
recommended that adequate experienced and qualified nurse educators and
clinical instructors should be employed and maintained by the competent
authorities. Proper supervision of students by experienced teachers, nurses and
clinical supervisors should be advocated. Nursing and Midwifery Council of
Nigeria should provide a clearly written standard guidelines and policies on
clinical training of nursing students to ensure proper acquisition of nursing
skills which will be inferred in nursing practice.
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CHAPTER ONE
INTRODUCTION
Background to the study
Learning is a change in behaviour over time that is brought about by
experience during training in educational encounter (Akubuiro and Joshua,
2003). Training as part of education, is the acquisition of knowledge, skills and
competence as a result of the teaching of practical skills and knowledge that
relate to specific useful competences (Angel, 2007). Training helps the learner
to acquire certain useful skills and develop critical mind for the learner’s self
development. Therefore, the knowledge that comes from training is more of
knowledge of how to do or perform specific tasks. Thus, the modification in
behaviour as the product of training can occur following newly acquired skills,
knowledge, perception, facts, principles and new information at hand
(Adeyanju, 2004).
Nursing education is a term used to describe the overall body of
knowledge that applies to nursing profession. It encompasses a variety of
knowledge, skills, concepts, and practices which revolve around the unique
concepts of nursing, health, the person and the environment (Melone, 2010).
Nursing education consists of acquisition of a body of knowledge that is partly
delivered in a classroom setting which forms the theoretical bases of nursing
knowledge and an organized and supervised clinical training experiences that
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take place in the clinical settings where the nurse- patient relationship is
experienced directly or indirectly (Shariff and Masoumi, 2005).
Sonwuttanayut (2003) noted that the training process in nursing
education should aim at enabling the students to gain skills and experiences up
to their highest potentiality. This shall focus on the learners as being the most
important in the process. In addition, basic knowledge, attitude, skills and the
ability to apply knowledge into the actual practice of nursing should be
developed and inculcated into the student nurses in these processes. Training
can be reinforced with learning aids and equipment of different varieties
simply because they stimulate, motivate as well as arrest learners’ attention for
a while during the instructional process.
Clinical training which is part of nursing education takes place in
hospitals, other health care institutions, communities and homes under the
direction and supervision of trained personnel in nursing profession. Clinical
training as an integral part of nursing education as identified by Smith and
Fifz-Patrick, (2006), prepares student nurses with the ability of “doing” as well
as “knowing” the clinical principles in nursing practice. The clinical
experience which is a vital part of nursing education stimulates students to use
their critical thinking skills for problem solving. It provides the students
opportunity for their active self-learning, self development and ability to apply
their knowledge from theoretical context situation to emergency and general
public health care.
17
In line with this therefore, clinical education must be to help the students
to acquire the necessary nursing skills and the ability to perform in order to
establish their capacity to handle changing realities and situations in nursing
practice, (Melone, 2010). The nursing skills to be acquired consist of series of
courses in the nursing curriculum and manuals. These are designed to equip
students with the required clinical nursing skills needed for optimal practice,
(Rennie, 2009). These include nurse-patient relationship skill, interactional
skills, basic physical examination skills, clinical encounter across the life span,
therapeutic communication skills, positive attitudinal skills etc. These courses
span throughout the years of studies. Students must successfully complete all
the components of the clinical courses to progress as nurses. Examining the
development of necessary nursing skills during training, Ericsson (2004)
indicates that nursing skill acquisition is a continuous learning process. This
indicates that extensive experiences and supervision from mentors, preceptors,
supervisors, teachers, considerable time on task and involvement of students
are necessary to achieve a considerable nursing skill performance. There is also
supporting evidence that the students’ interest and the practice environment
e.g. hospital, exert an influence on the development of nursing skill (Ericsson
2009). In this case, students’ goals should include increased self knowledge
and scientific awareness in addition to their gradual improvement in
professional nursing practice.
18
At the beginning of the last century, nursing training was based mainly
on clinical experiences whereby students do more of clinical experiences in the
wards and receive small sums of payment (Harrison, 2010). However, with
increased complexity in today’s nursing care playing a challenge to the
theoretical and clinical training of nursing students, it was realized that
theoretical studies are of great importance in nursing education and practice.
This then led to reduction of the proportion of time spent on clinical experience
while the time and courses in relation to theoretical studies was increased
(Harrison, 2010). Furthermore, Ehiemere (2009) had highlighted that the
clinical environment is complex and rapidly changing with a variety of new
settings and roles in which nurses must be prepared to practice. Such settings
include families, schools, community settings etc. Therefore, clinical training
should be aligned to meet the challenges facing nursing practice. Although
clinical training is still an essential part of student nurses’ education, its role
and application have changed in recent years. However, in nursing education,
the classroom and clinical environment are linked and students must apply in
clinical practice what they have learned in the classroom, online and through
other exposures.
Bevis (2000) noted that teaching in clinical settings now presents nurse
educators with challenges that are different from those encountered in the
classroom, because teaching in the clinical settings require different
approaches to teaching. This increased complexity, rapidly changing and
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challenging atmosphere in nursing practice according to Harrison (2010)
requires experienced nurse teachers, clinical supervisors, infrastructure,
equipment and capable students to meet up with the challenges in nursing
practice. Where these are deficient, there is bound to be lapses and
incompetence in nursing skill acquisition which will be inferred in practice.
Few previous researches done in this area seem to confirm these assertions.
An exploratory study of the clinical learning experience of nursing
students done by Warner et al (2010) indicated that the clinical placement
duration of 6-7 weeks at a stretch for each clinical period helped the students to
study more and follow up cases in the wards, thereby influencing the level of
the overall learning and students’ satisfaction. Students were also satisfied with
the level of supervision given to them in the wards and the atmosphere in the
wards, but they reported less supervision in the clinical areas by their teachers.
Another study by Shariff and Masoum (2005) identified that students
feel anxious in their initial clinical placement; students are worried about
giving wrong information to the patients and students lack integration of theory
into clinical practice. The study also identified that staff nurses are not aware
of the skills and strategies necessary in clinical education; ward staff nurses are
not concerned about what student nurses learn during clinical experiences and
also their supervisors’ role was seen as only an evaluative one than a teaching
role.
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A study in Tanzania done by Sumari-Ayo (2006) revealed that lack of
adequate supervision of students in the clinical areas; inexperienced teachers in
the schools; unconducive environment in the school and in the clinical areas
and lack of students’ involvement in planning their programmes hinder clinical
nursing skill acquisition. However, little has been done empirically to know the
factors affecting clinical training of student nurses in the nursing institutions in
Nigeria to help find out what are involved in the training of student nurses in
the clinical areas for efficient nursing practice. This informed the researcher’s
choice of the topic, “factors affecting clinical training of nursing students in
nursing institutions” that promote or hinder their acquisition of necessary
nursing skills for adequate nursing practice.
Statement of the problem
School of Nursing, Mater Misericordiae Hospital, Afikpo, (SON-A) in
Ebonyi State as one of the institutions of study was established in 1952. It
presented first candidates for the General Nursing Certificate Examinations in
1954. The school has consistently recorded between 90% to 100% success in
the General Nursing Council Examination with many students having credits
in practical nursing examinations. This trend remained thus until 1990 when a
decline was first noted. This decline reached its climax in the 2004 November
General Nursing Council Examination when the school recorded a 20% pass
with more students failing the practical nursing examination.
21
In line with this declining development, Usufu (2005) reported that the
Nursing and Midwifery Council of Nigeria (N&MCN) has observed with
dismay the general poor performance of students in the General Nursing
Council Examination especially in practical nursing examination. N&MCN
also summoned all the principals of such schools of nursing with poor result
for a conference on 20th April 2005. This was to critically review the reasons
for the poor performance in General Nursing Council Examination in order to
proffer solutions.
Also anecdotal reports from nurses in clinical arena indicated lack of
clinical skills among the graduates of the 5-year generic degree programme.
Hence between, 9th-10
th August 2011, a similar meeting of Heads of Nursing
Department with the N&MCN was held at Ibadan to discuss among other
things the BNSc graduate nurses’ poor performance in clinical practice.
N&MCN therefore, calls seriously for the adoption of a- one year internship
programme proposal for all BNSc graduate nurses before they are legible for
registration as qualified nurses to bridge their poor clinical practice
competence. This implies the inclusion of Department of Nursing Sciences,
University of Nigeria Enugu Campus (DNS-UNEC) in Enugu State as one of
the institutions of study. The two Nursing Institutions were used despite their
diversities in ownership and structure of their nursing programme because both
of them are guided by the same N&MCN Standard of Nursing Education and
Practice; also both Nursing Institutions are required to follow the same Nursing
22
Curriculum to impart the necessary nursing skills to the students; they partake
in the same General Nursing Council Examinations; are registered by the same
Professional body as Qualified Nurses and are required to render the same
quality nursing care to clients. The question is, what are the factors affecting
nursing students’ clinical training that could lead to poor performance in
clinical practice?
Purpose of the study
This study investigated factors affecting clinical training of nursing
students in two selected nursing institutions, in Ebonyi and Enugu states of
Nigeria.
Objectives of the study
The objectives of the study were to:
1. Identify the administrative factors that affect clinical training of nursing
students in the school laboratories and in the clinical areas.
2. Identify the training/supervisory factors that affect clinical training of
nursing students in the school and in the clinical areas.
3. Identify students’ factors that affect their clinical training in the two
nursing institutions.
4. Determine the differences in the factors that affect clinical training of
nursing students between the two nursing institutions.
23
Research questions:
As a guide to the researcher, the following research questions and hypotheses
were formulated:
1. What are the administrative factors that affect clinical training of nursing
students in the school laboratories and in clinical areas?
2. What are the training/supervisory factors that affect clinical training of
nursing students in the school and in the clinical areas?
3. What are the students’ factors that affect clinical training in the nursing
schools?
4. Are there differences in the factors that affect clinical training of nursing
students between the two nursing institutions?
Hypotheses:
Three hypotheses were tested at significant level of p< 0.05, they included:
Ho1: There is no significant statistical difference in the administrative factors
affecting clinical training of nursing students between the two schools
under study.
Ho2: There is no significant statistical difference in the training/supervisory
factors affecting clinical training of nursing students between the two
schools under study.
Ho3: There is no significant statistical difference in students’ factors affecting
clinical training of nursing students between the two schools under
study.
24
Significance of the study:
Studying the factors that might affect nursing students’ acquisition of
clinical skills in nursing care while in training will assist in identifying the
constraining factors for proper acquisition of such skills. Identifying such
factors will improve students’ training in the clinical areas. Findings will
inform the school administrators and N&MCN on new approaches to improve
the system by formulating appropriate curriculum and procedures for clinical
experiences and training. This will give the right direction to the nurse
educators and supervisors and will facilitate acquisition of nursing skills by the
students. It will widen the stake holders’ view on provision of adequate
personnel like nurse educators and supervisors in the schools and clinical
areas. It will also widen the stake holders’ view on provision of equipment and
enabling environment in order to motivate students’ learning and thereby
improve institutional efforts to improve nursing practice.
The findings will help the nurse educators, clinical supervisors and
preceptors, to review how they carry out the role of clinical training of the
students under their care for better nursing skill acquisition. It will help them to
use the appropriate measures/methods in teaching the students to achieve
clinical nursing skill acquisition. The findings will help the students to
understand and play their own roles in improving their practical performance
by putting in more effort and interest in their studies and clinical practice so as
to achieve success. This will enhance their future practice as skilful and
25
efficient nurses both in theory and practice. These findings could also stimulate
further study.
Scope of the study:
The study was de-limited to the students and teachers of School of
Nursing, Mater Misericordiae Hospital Afikpo in Ebonyi State and the students
and teachers in the Department of Nursing, University of Nigeria Nsukka in
Enugu State. The study addressed the institutional factors as staffing which
include teachers and supervisors, infrastructure/equipment, methods of
training/ supervising of students and students’ factors to clinical training.
Operational definition of terms
1. Clinical training: refers to how to assess clients/patients clinically, give
account of clinical health problems, prescribe and implement appropriate
nursing measures, eg through the use of thermometer to measure the
temperature of a patient and doing tepid sponging where necessary without
being told.
2. Administrative factors: refer to human and material resources needed in
proper clinical nursing training. These include provision of nurse educators and
clinical supervisors in the schools and clinical areas (e.g. nurse educators,
mentors, preceptors, clinical nurses and clinical instructors). Administrative
factors include also infrastructure/equipment in the schools and clinical
settings (e.g. adequate laboratory, library, equipment like oxygen cylinders,
26
clinical thermometers, forceps, models and objects for inculcating clinical
nursing skills to nurses).
3. Training/supervisory factors: These include the techniques or measures
used to drill students during clinical training in order for them to acquire the
necessary nursing skills, e.g. through giving assignments, field trips, practical
procedures demonstration, ongoing teaching and correction of students by their
supervisors during their clinical experiences.
4. Students factors: These include students’ interest and involvement in their
training such as attendance to clinical experiences, punctuality and active
participation in assigned tasks etc.
5. Nursing educational institution: This is a hospital or university based
nursing institution accredited by the N&MCN to offer three years diploma in
nursing or five years degree in nursing sciences.
6. Student nurse: A person enrolled for the 3years diploma in General
Nursing Education programme or 5years Degree Nursing programme, in an
accredited educational institution by the N&MCN.
27
CHAPTER TWO
LITERATURE REVIEW
This chapter presents related materials reviewed from books,
abstracts and articles from libraries, journals and internet materials. Discussion
is organized under the following headings;
� Conceptual review of nursing education
- Factors affecting training of clinical nursing skills
� Review of related theory
- Model of the study
� Empirical review
� Summary of literature reviewed
Concept of nursing education
Education in its broadest, general sense is the means through which the
aims and habits of a group of people live on from one generation to the next.
Generally, it occurs through any experience that has a formative effect on the
way one thinks, feels or acts, (Harrison, 2010). In its narrow, technical sense,
education is the formal process by which a profession or society deliberately
transmits its accumulated knowledge, skills, customs and values from one
generation to another, e.g., instruction in schools (Robert, 2009). Nursing
education is a term used to describe the overall body of knowledge that equips
people to practice nursing. Although nursing education encompasses a variety
of knowledge, attitude, skills, concepts and practice, the universally accepted
28
concept revolves around the unique concepts of nursing, health, the person and
the environment (Melone, 2010).
Harrison (2010) affirmed that nursing education is the process of
preparing individuals for caring as nurses. Through nursing education, future
nurses learn the skills which are necessary to provide patient care, develop and
execute treatment, plan and teach clients how to take care of their medical and
other conditions. Nursing education consists of acquisition of a body of
knowledge that is partly delivered in a classroom setting which forms the
theoretical bases of nursing knowledge and an organized and supervised
clinical learning experience. This clinical training starts with practice in the
demonstration laboratory using dummies representing different areas of
nursing care. Areas where clinical training could be done include different
departments in a hospital clinics, homes, communities, psychiatric hospitals,
orthopaedic hospital, gynaecological section etc.
Nursing education takes cognizance of the national policy on education
in developing sound educational principles which are essential to the
preparation of nurses to function as members of interdisciplinary and
interdepartmental health teams (N&MCN, 2001). This programme develops
the students’ affective, cognitive and psychomotor skills in problem solving.
Active participation of nursing students in both the community and hospital
based services is essential for students sound clinical experience.
29
The goal of nursing education
The goal of nursing education over the years according to Searle (2000)
has been to contribute to the health of individuals and the entire society.
Initially, nursing had concentrated on the care and comfort of all the ill and
injured but as a result of advances in health sciences, the emphasis is now
placed on promotive, preventive and rehabilitative care. Therefore, nursing
education aims at preparing competent polyvalent nurse practitioners who will
use problem solving skills in providing safe, acceptable, effective and
affordable health services to meet the health needs of individuals, families and
the community at all levels of care (N&MCN, 2001).
To achieve the aim of nursing education, there should be a systematic
direction and guidance of the students. This is to ensure that adequate nursing
knowledge is imparted to the students both theoretically and practically to
achieve proper skill and problem solving skills acquisition which will lead to
efficient nursing care (Quinn 2001).
Forms of nursing education in Nigeria:
Currently the N&MCN Standard of Nursing Education, (2010), consists of:
1. Non university based programmes such as,
(a) Basic General Nursing Certificate programme. This is done in hospital
based schools of nursing and it lasts for three (3) years.
30
(b) Advanced Post Certificate Diploma. This is done in post basic schools
of nursing, e.g. school of midwifery, school of psychiatric Nursing etc
and each lasts for eighteen (18) months.
2. University based programmes
(a) Baccalaureate programme –Generic programme, consisting of
candidates coming through direct entry and those coming through
Universal Tertiary Matriculation Examination (UTME) in pursuit of
Bachelor of Nursing Science (BNSc) done for five (5) years.
UTME and Direct entry students with no professional qualifications take
N&MCN examinations and qualify as registered nurses and midwives as
part of the five year programme.
(b) Higher degree programmes –Masters Degree in Nursing Sciences (MSc
Nursing), with specialization in Maternal and Child health, Nursing
Education, Medical- Surgical Nursing, Mental Health Nursing,
Community Health Nursing and Nursing Administration and
management.
(c) Doctorate Degree in Nursing Sciences (PhD. Nursing), e.g. PhD. Nursing
Education etc.
Concept of clinical nursing training
Clinical nursing is the process through which student nurses are exposed
to real life situations in order to acquire the skills inherent in nursing
profession for effective nursing practice. It provides the students with the
necessary opportunity to acquire knowledge and skills that help in critical
31
thinking and performance of needed client’s/ patient’s care. According to
Smith et al (2006), clinical nursing training plays an important role in teaching
learning process. It provides nursing students the development and acquisition
of nursing skills, self clinical experience and the ability to apply the knowledge
gained from the theoretical context to any emergency situation or in general
public health care. It is only in the clinical situations that nursing care becomes
a reality and the student nurse can observe the responses of patients to the care
given (Melone, 2010). The overriding purpose of clinical education in nursing
is to prepare nurses to meet the health care needs of the public; therefore,
clinical nursing programme must be well aligned with the changes arising from
health care reforms, (Ehiemere, 2009).The purpose of clinical nursing is to
promote client/patients well being and help to ease suffering and discomfort in
a manner that is legal, ethical and respectful, (Melone, 2010).
The correlation of theory and practice and the building of meaningful
experiences must take place in the field of clinical practice, whether in the
school laboratory, hospital wards, clinic, or a patient’s home. The nurse learns
to interact skillfully with these people and other members of the health team.
Ehiemere (2009) affirmed that the health practice environment is becoming
complex and health care is dramatically evolving to address the quality
changes. It then demands new competencies of nursing skills and practices.
This in turn demands transformation of clinical educational programmes and
educational practices to meet up with the transformation. According to Shariff
32
et al (2005), the primary drivers of transformation in nursing clinical education
are society’s need, societal demand with 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. Therefore, good clinical training based on sound nursing
education is the only option to equip nurses with the current trend in nursing
practice (Ehiemere, 2009). Mellish et al (2000) emphasizes the following
principles with regard to clinical nursing training:
• Clinical training occurs in the real-life situations: it translates theory into
practice.
• The student nurse is an active participant.
• It should be a small group activity. Physical limitations make the number of
nurses who can be involved at a stretch very small. It may even occur on
the basis of one patient, one teacher and one student.
• The student nurse is given the opportunity to develop self-confidence by
performing under expert guidance and supervision.
• It affords the student opportunities for observation and decision-making.
• It allows assessment of the degree to which educational objectives have
been attained.
• It centres on patient/client care.
33
• It is an invasion of the privacy of patients and therefore can be carried out
only with their consent except in cases where there is difficulty in doing
this. In this case patient’s relatives can be consulted.
In line with this, N&MCN stipulated that the ratio of registered nurse
educators to students in the classroom and in the clinical setting should be
1: 10, (Curriculum for General Nursing Education in Nigeria, 2001).This is for
efficient training and supervision.
The goals of clinical nursing training
The ultimate goal of clinical nursing education as indicated by Sumari-
Ayo (2006) is to prepare the students to think critically, communicate
accurately and perform indicated therapeutic nursing interventions in patient
care situations and exhibit the caring behaviours inherent in nursing actions.
They are also to apply an ethical perspective in clinical decision making and
function effectively as a team member within the organizational structures
surrounding the delivery of patient care.
Objectives of clinical nursing education
Clinical nursing education is said to be effective when the clinical
teaching and learning objectives have been achieved. According to Quinn
(2001), successful clinical teaching and learning depend on accomplishment of
the set objectives. The clinical learning objectives are:
• Provision of orientation, accessible and appropriate learning opportunities,
and adequate length of placement periods, appropriate care models, staff
34
commitment, ethics and accompaniment approaches such as preceptor
ship/mentorship system for the students to enhance learning.
• Appropriate academic staff perspectives, which involve the role of nurse
educators and their knowledge and experience, the attitude and skills which
they bring to the relationship among themselves, the student nurses and
supervisors as well as how clinical accompaniment of the students are done.
These include commitment to the relationship with placement staff,
maintenance of clinical competence, application of theory to practice,
monitoring placement evaluation, ward/unit staff development,
consideration of student nurses learning styles and the use of effective
methods for enhancing clinical learning experiences.
• Appropriate service provider/ward staff perspectives: This includes the type
of interactions that occur between the nurse educators or other
accompaniers/ward supervisors and student nurses. It involves commitment
to individualised care, a team approach, multidisciplinary teamwork,
communication with the school, commitment by service managers and
appraisal systems.
• Provision of quality assurance mechanisms. These include congruence of
curriculum and placement method, monitoring and annual review
mechanism, adequate clinical teaching and supervision of students and
maintenance of clinical practice standards and quality care (Daft 2000).
35
• Good interaction between the service provider/ward staff, educators and
students to maintain a conducive atmosphere for learning.
Approaches to clinical skill development in nursing education
Rennie (2009) asserts that while many health care institutions provide
formal nursing clinical skill training, it is difficult to determine whether it is
training or the clinical environment that informs practice. However, formal
clinical skill training limits learning only to when the resource is available
rather than what an authentic learning experience presents in the clinical area.
Clinical skill training needs to be grounded into the students with clinical
experiences and exposures to encourage incremental skill development.
Clinical skills are defined by Rennie (2009) as any action performed by
a student nurse involved in direct patient care which impacts on clinical
outcome in a measurable way. These include:
(1) Technical skills such as, taking clinical examinations and taking part in
invasive procedures during clinical experience.
(2) Non technical skills such as team working and communication.
(3) Cognitive skills such as clinical reasoning and decision making.
This implies that every action, behaviour, decision with patient/ client as
motivation is a clinical skill. Therefore, skill acquisition should be encouraged
and importantly valued more than transmission of knowledge through formal
clinical programmes. Knowles (1990) identified that the volume and
complexity of skill and knowledge of current modern technical equipment and
36
procedures is evolving at such a pace that it is no longer safe to teach students
a skill and assume the knowledge will last for their life time. Therefore, the
learning that should be encouraged in our schools of nursing should be a
lifelong learning process. This involves a process of enquiry and gathering of
information/ data rather than relying on transmission of information from
experts to learners.
In nursing education, it is traditional to prepare learners to perform in
the work place by delivering information in a class- room type environment,
and then assume that they can apply the knowledge in the clinical areas.
Superficially, this seems to be a reasonable approach. However, the shift from
modular model to this academic approach has resulted in some nurses who
qualify but are not fit for practice, (N&MC, 2005). Gallagher et al (2005)
stated that delivering information in a classroom rarely develop decision
making, attitude and retrieval. Also people have a limited attention, so
information may not be retained. However, combining this knowledge to
practical life situation helps in concretization and quick retrieval of such
information.
Patterns of clinical training in nursing education
Patterns of clinical training in nursing refer to the ways in which
programmes for clinical experiences or practical experiences are organized.
This is to meet up with integration of classroom theoretical studies with
clinical experiences which occur outside the classroom. The patterns for
37
clinical training differ from one school of nursing to another depending on the
schedule adopted by each school of nursing or each department of nursing in
the university. According to each pattern, the school, college or department of
nursing must adhere to the stipulated hours for clinical experience per session
and also for the whole course of study years according to Nursing and
Midwifery Council of Nigeria (N&MCN). N&MCN stipulated that the clinical
experience period for hospital based schools of nursing in the course of three
years programme is a minimum of 4,400 hours (Curriculum for General
Nursing Education in Nigeria 2001) which includes all the internal and
external clinical experiences. Each student must attain the number of hours for
clinical experience so as to be qualified for sitting for the profession nursing
examination.
The patterns adopted for clinical education include:
1. Training in the demonstration room
2. Block study clinical training
3. Study day’s clinical training
4. Consolidated clinical training
(1) Training in the demonstration room.
Demonstration laboratory is an apartment in the school set aside for
demonstration of procedures after the normal classroom teaching of the
theoretical bases of such procedures. It is also a place where equipment like
models, skeleton, forceps, beds, oxygen cylinders etc are kept and used to teach
38
students and also for the students to practice with first before going into the
hospital for real life practice.
Clinical training starts in the demonstration room and forms the first point
for practical experience which each school schedules to fit into their own
curriculum. It cuts across all nursing training schools as the first point of
contact between the students and the clinical instructors, teachers and
supervisors. According to Lohor (2005) clinical training in the demonstration
room takes place mainly during the early part of the training for a sufficient
period of time as is contained in the school curriculum. This is done before the
students go into the hospital wards or other places for practice. This is also
done intermittently as students are taught in the classroom.
(2) Block study type of clinical training
This pattern of clinical nursing training is one of the oldest methods of
clinical nursing training. It involves planning the yearly school programme to
indicate the specific periods when students are to go for clinical experience and
the periods they are to be in the classroom. This means that the time students
are on clinical experience areas are different from the classroom teaching
learning periods. Students are assigned to a different specific area of clinical
experience during each experience period, while classroom learning may
consist of four or six weeks at a stretch. This is mainly used in schools of
nursing.
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(3) Study day’s clinical training pattern
Studies days clinical training pattern is scheduled in such a way that
students are allowed to attend classes on certain days of the week and also go
for clinical experience some other days in the same week. It may be planned to
be three days classroom studies alternated with two days clinical experiences
or vice versa. This is also one of the oldest patterns of clinical training in
nursing
4) Consolidated clinical training pattern
This pattern of clinical training is used in the universities and can also be
used in schools of nursing. Here the clinical experience period is normally
scheduled to be at a lengthy period at a stretch, which is six months. This is
scheduled normally towards the end of the semester, so that the students may
utilize what they have learnt in the classroom to the clinical experience areas.
Any pattern of clinical training adopted by any nursing institution should
fulfill the following three requirements as adopted by Nursing and Midwifery
Council of Nigeria (N&MCN):
a. Students must complete at least 4,400 hours of clinical experiences.
b. Students must complete a defined number of clinical learning activities
as contained in their record of classroom instruction and clinical
experience schedule books.
40
c. Students must have their schedule books signed by their preceptors or
supervisors, which show that they are functioning at their appropriate
level as first beginning level clinician.
Each school also develops their own procedure manuals which the
students and school teachers use to teach and demonstrate procedures
according to the school’s philosophy for care.
Actions to ensure effective clinical nursing training
The contextual elements of clinical nursing training as identified by
Iwasiw (2009) which serve as a guide to action for the clinical teachers in
nursing include the following:
1) The language of clinical teaching: The use of well worded, simple and
clear language will go a long way in helping the teacher to convey the message
to the students and also make it easier for the students to understand the topic
better.
2) Clinical training is as important as the classroom teaching. Nursing is a
professional practice discipline, where clinical training provides real life
experiences and opportunities for transfer of knowledge to practice situations.
Therefore, clinical training should be giving adequate time and concern.
3) Clinical education should reflect the nature of professional practice. A
professional is an individual who possesses expert knowledge and skill in a
specific domain, acquired through formal education in an institution of higher
learning and through experience. The professional uses that knowledge and
41
skill on behalf of the society by serving specific clients. Therefore, as practice
in clinical setting exposes students to realities of professional practice that
cannot be covered by a text book or a simulation, teaching should reflect the
nature of professional practice. Also clinical practice requires critical thinking
and problem solving abilities, specialized psychomotor and technological skills
and a professional value system.
4) The nursing students in the clinical areas are learners not qualified
nurses. The role of the student in nursing education should be primarily that of
a learner not a qualified nurse. Students should not practice without a
supervisor.
5) Sufficient learning time should be provided before performance is
evaluated. It should be known that skill acquisition is a complex process that
involves making mistakes and learning how to correct and then prevent those
mistakes in future. Therefore, clinical teachers should give adequate learning
time with ample opportunities for feedback before evaluating students’
performance summatively.
6) Clinical teaching is supported by a climate of mutual trust and respect:
Another element as a guide to action is the importance of creating and
maintaining a climate of mutual trust and respect between the staff and the
students to support learning and students growth.
7) Clinical teaching and learning should focus on essential knowledge,
skills and attitude. Teaching and learning time should be used to maximum
42
advantage by focusing most of the time and effort on the most common
practice problems that students and staff members are likely to face.
8) The espoused curriculum may not be the curriculum in- use. Argyris
and Schon (1994) proposed that human behaviour is guided by operational
theories of action that operate at two levels. The first level, espoused theory
(the paper curriculum) is what individuals say that they believe and do. The
other level, theory in use (the practice theory curriculum) guides what
individuals actually do in spontaneous behaviour with others. Similarly, the
espoused curriculum is the one that is used for accreditations or state approval
but the curriculum in-use is what actually happens. This disparity happens
often when clinical teachers do what seem right to them which are not in the
curriculum. Incongruity between espoused theory and theory in use can result
in ineffective individual practice as well as discord within a school system.
Factors affecting clinical nursing training
The major determinants of the effectiveness of clinical training are the
context in which they occur. According to Smedley and Penney (2010),
clinical training in nursing is performed in response to the professional,
societal and educational demands using available human intelligence, physical
and financial resources as the context of the curriculum. As far as the
curriculum context is different for each nursing program, so also the practice of
clinical training should differ from one nursing programme to another. This
infers that there should be differences in the factors that affect clinical training
43
of nursing students. This implies that some of the factors that could affect
clinical training in nursing include the curriculum philosophy, the context for
clinical nursing training and resources needed for effective clinical training in
nursing. Therefore each school must make decisions that are congruent with
their planned curriculum for a successful acquisition of skill. The factors are:
1) The curriculum philosophy: The curriculum is a systematic plan of
activities which is made according to each school philosophy and mission in
response to the professional, societal and educational needs. This includes
statement of belief about the goals of nursing education, the nature of teaching
and learning and the role of the teachers and learners (Iwasiw, Goldenberg,
Andrusyszyn, 2009). The values and beliefs included in a curriculum
philosophy provide structure and coherence for a curriculum and provide clear
actions to be followed. Statements of curriculum are meaningless if they are
contradicted by actual nursing educational practices. Although traditionally,
philosophy is viewed as essential tool in building a curriculum, some nursing
education leaders have suggested that a set of assumptions or one or more
theories could be used in planning the nursing curriculum, (Bevis, 2000).
When used as a curriculum foundation, learning theories such as behaviorism,
cognitive theories etc, reflect faculty belief about learning, teaching, student
characteristics and the educational environment. Iwasiw et al (2009) indicated
that nursing theories such as Rogers’ unitary person model, Newman’s model
of health and Watson’s theory of human caring may also serve as both
44
theoretically and philosophically according to the context of each curriculum.
Therefore, the contemporary nursing curriculum philosophies often are a blend
of philosophy, nursing theory and learning theory. The curriculum provides a
framework that shows educational and clinical activities to be followed in
clinical training. Incongruity between the curriculum and the actual activities
of the school can result in ineffective individual learning/practice as well as
discord within a school system.
2) The context for clinical nursing training: This includes the medium or the
actual practical application of the training process. Those are the measures or
actions involved in the clinical training. Oermann and Gaberson (2009)
asserted that every clinical teacher has a philosophical approach to clinical
training whether or not the teacher realizes it. The context determines what the
teacher understands as his role, approaches to clinical training, selection of
teaching and learning activities, use of evaluation process and relationship with
learners and others in the environment. It includes also how the students play
their own roles in the teaching learning process. These beliefs serve as a guide
to action and they affect how clinical teachers practice, how students learn and
how learning outcome are evaluated. Inadequacy in the context jeopardizes the
acquisition of required nursing skills.
3) Resources needed for effective clinical training in nursing.
For efficient and effective clinical training aimed at ensuring quality
care, theoretical nursing taught in the classroom must be repeated and in
45
congruence with what the students practice in the clinical areas (Oermann and
Gaberson, 2009). To maintain this fact, there must be competent personnel in
the schools and the wards to supervise and handle the clinical aspect of nursing
effectively. The resources needed are:
A) Qualified and experienced nurses:
There should be qualified and experienced nurses and clinicians,
mentors, preceptors, link teachers and teacher- lecturers in the schools and
hospitals or other places where the students go for their clinical training. These
nurses must be conversant with the new innovations in nursing research,
education and practice, so that they may be able to help the students under their
care. These human resources employed in clinical training of students help the
students to enhance the practical learning process and ensure production of
qualitative, critical thinking and benevolent nurses who will engage in decision
making and evidence based nursing care based on research findings.
B) Nurse educators and supervisors:
These are professional nurses acting as teachers, mentors, preceptors,
clinical instructors and clinicians involved in planning, facilitating and
supervising of clinical training of nurses to ensure adequate nursing skill
acquisition.
It is a well known fact that teachers and supervisors are crucial factors in
students’ school achievement. Some nurse educators and researchers like
Usufu (2005), Shariff and Masoumi (2005) seem emphatic that students’
46
academic performance does to a large extent depend on the quality, adequacy
and dedication of teachers and their supervisors. It is also identified that
expensive laboratories, nursing equipment, costly reference libraries, superior
text books, extensive clinical experience areas and skillfully arranged courses
of study are of little value in the teaching of nursing science subjects unless
they are presided over and administered by the mind of an individual who
knows and loves nursing profession and who has acquired some nursing skills
and the art of impacting this knowledge to others, (Hopkins, 1994). This
clearly shows that the role of qualified and experienced teachers and
supervisors in the teaching and learning of any skill or subject cannot be
underestimated. Commenting on the need and use of professionally trained
teachers and supervisors, Akambi (1998), said that they will ensure efficiency
and make sure that they impart the right knowledge, develop the needed skills
and mental faculty of the students they are teaching. He further stated that a
professionally prepared teacher can use even an inadequately structured
curriculum to build a structured programme of significant merit. Lohor (2005),
cries out that in the many states of the country, 40% and 50% of nurse
educators and clinical supervisors needed are lacking. One resultant effect in
this respect is that few available ones are faced with the problems of coping
with a large class of students for the classroom work and clinical training. In a
paper presented to the principals of schools of Nursing in Nigeria, Usufu
(2005) stated in line with the teachers’ factors that to some extent, the teacher
47
judges his/her performance from the performance of the students. Where the
students perform poorly both the students and the teachers should have cause
to give serious consideration about their teaching and learning.
C) Infrastructure/equipment in the schools and clinical settings
Items or equipment used in the schools and clinical areas are regarded as
the life wire of any nursing school and for there to be a meaningful nursing
education, (Melone, 2010). There must be that conscious effort to direct
sufficient resources to such areas that will ensure drawing maximum benefit
from the equipment and infrastructure available.
For standard nursing education, lack of equipment sets back students’
performance and creates a lot of tension and anxiety on the students because of
poor performance. Cannon (1997) emphasized strongly the unavoidable needs
for adequate equipment, noting that, “at all stages of skill acquisition, good
demonstration with adequate equipment is important and often a vital part of
teaching in acquiring a skill we learn by imitation”. Accordingly, Tonne (1999)
observed that the most effective device for the teaching of skill is teacher
demonstration with appropriate equipment. For example, a teacher who shows
to students how to type using a computer saves time and presents these
students with useful tips more than he can give by merely talking. It is
therefore, a right deduction that no nursing school can function well without
proper and adequate equipment in the school and in the clinical areas. The
schools should have adequate and up to date text books in the library which
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will serve as reference materials for both the teachers and the students.
Knowles (1990) and the WHO (1999) indicated that appropriate clinical
learning facilities such as laboratory, library, equipment and supplies should
always be made available and maintained regularly to make learning concrete
and easier to reproduce when needed.
D) Measures /designs for teaching clinical nursing skills include:
(i) Preparation and Planning
Planning for clinical accompaniment of students is a prior activity which
should be done by involving all key players. Gerrish (1992) (in Quinn 2001)
maintains that teaching in practice placement areas requires a commitment by
the teachers, collaboration between education and service staff and staff
development for teachers in their new role in relation to practice. The
accompanists and the student nurses should participate in planning and
preparation for clinical accompaniment. The key features of effective clinical
education are that it is designed and conducted according to the learner’s
characteristics and the use of appropriate teaching and learning strategies.
Several factors need to be considered when drawing up a plan.
According to (Quinn, 2001), the curriculum has an influence on clinical
nursing education by accommodating the essential principles and features for
an educational proposal in such a form that it is capable of effective translation
into practice. Therefore, the planning team should consider what has been
described in the curriculum in fulfilling clinical teaching and learning. The
49
planning team includes nurse educators, clinical instructors, preceptors, ward
supervisors and nursing students.
The clinical training objectives should be taken into account when
practicing. Chun-Heung and French (1997) cautioned about students spending
most of their time doing routine work and menial tasks thus wasting time for
clinical learning. Nursing educators, preceptors and other clinical supervisors
should select and agree on appropriate methods and materials, ensuring that
they are available and relevant to learning outcomes. Planning should be
systematic and realistic to ensure that students know what is expected of them
and when. The plan should allow for flexibility in order to meet unforeseen
eventualities. Quinn (2001) suggests that in order to select strategies that
enable deep holistic learning to take place, nurse educators and supervisors
should be aware of students’ differences, ways that keep students motivated
and interested.
Daft (2000) stresses the value of maintaining a good working
relationship with ward personnel, expertise like medical and paramedical in a
formal clinical education programme, so that they can be consulted when there
is a need.
Division of the time available and allocation of personnel so that all
students have an equal opportunity to benefit is essential (Quinn, 2001).
Specific times should be set aside when students are released from the wards
for formal activities, such as demonstrations of procedures.
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(ii)Techniques/ measures used for effective clinical training in nursing
One of the most important responsibilities of a clinical teacher is
selecting and giving clinical assignments that are related to desired outcome to
students. This should be appropriate to students’ levels of knowledge and skill
and challenging enough to motivate learning. Directing a learner to provide
comprehensive nursing care to one or more patients is a typical possible
clinical assignment and not always the most appropriate choice.
The techniques include:
• Giving assignment to students and correcting them
• Ongoing assessment in the clinical areas for early detection of lapses
• Proper supervision and prompt correction.
• Mentoring as students learn by imitation
• Motivation of students by encouraging their little efforts
• Evaluation to elicit learning outcome
Evaluation techniques in clinical training
Evaluation is the process of eliciting the extent to which learners have
achieved the educational objectives. It is used also for assessment of both the
teacher and the students and its outcome helps both the teacher and the
students to know areas of their deficiencies and areas of strength. Evaluation
can be formative or summative. Some of the evaluation strategies in clinical
51
nursing training according to Oermann et al (2009) include written and oral
assignments.
i) Written assignment: Written assignments should build on one another to
progressively develop student’s skills. It should be used to promote
understanding, develop higher level thinking skills, examine feelings, beliefs
and value, develop writing skills, etc.
Examples of written assignments are:
• Use of case method and case study
• Evidence- based practice papers
• Development of teaching plan and nursing care plan
• Writing journals
• Giving tests and examinations
ii) Oral practice assessment (practicum) or clinical evaluation. This means
testing the students’ ability to do the activities which they learnt during the
clinical training. It can be done formatively or summatively as is scheduled in
the school’s programme following the procedure and the schedule books.
Factors associated with students
In a study done by Baillie (1993) on the importance of showing an
interest and taking initiative by students, student nurses recognized that their
own approach to placements areas affected their learning. They also found that
students prefer active participation to observation. Furthermore, they suggested
that good mentor, communication and organizational environment were good
52
for learning. According to Sims (1997) students get satisfaction in doing things
that interest them which promote better learning. Consequently, better learning
gives higher satisfaction and this cycle continues.
In a study by German (1994), it was observed that students’ attitude
towards school subjects can directly or indirectly influence their performance
in those subjects. Those that have positive attitude towards Biology were
expected to be interested in doing Biology and science like activities. This was
proved to be true from using path analytic model. He hypothesized that attitude
towards Biology in schools would influence students’ performance in biology
because the students would dread the subject they dislike.
Students’ performance in nursing clinical experiences depends on
whether the student likes nursing science subjects’ classes, feels that nursing
science will be useful and is not afraid to ask questions during clinical
experiences (Meloni, 2010). Osang (1990) tried to find out the relationship
between students’ self concept and performance and noted that students’
performance in nursing clinical training depended much on what the student
thought of or believed about him or herself with reference to nursing science.
This result shows that self concept is positively related to achievements by
students. Gardnerr & Supplee (2010), noted in their study that interest is a key
factor for effective teaching and learning. It has been recognized that where
interest is manifested adequately, the inhibiting influence of the limited
background and ability of the student is reduced to manageable proportions.
53
It is then important to help students establish and develop scientific spirit
and experimental attitude needed in nursing to enhance practice, (Ricks, 1999).
Ricks (1999) stated also that effective nursing science programme makes room
for students to discover solutions to problems themselves and not make them
mere speculators.
Other things that influence students’ attitude and performance are
students’ home environment, background knowledge of the subject and
motivation by the teachers and peers. In planning clinical activities for the
students, their learning styles should be considered to help them participate and
learn better, (Billings and Halstead, 2005).
Student nurses’ learning styles
The level of independent learning depends much on the course planners
who identify what and how it should be learned with the availability of
required resources. During clinical experiences, student nurses get a chance to
utilize their preferred learning styles to achieve the clinical learning objectives.
Billings and Halstead (2005) emphasized the need for teachers to utilize the
different learning cognitive styles in ward-based practice to ensure effective
clinical learning. According to Bastable (2003) and Hinchliff (2005), students
perceive and process information using different learning styles. These
learning styles are biologically or sociologically acquired by the students. It
holds that the teachers and supervisors should use the styles in handling the
students. Bastable (2003) identified four learning styles used by students,
54
namely diverger, assimilator, converger and accommodator, based on Piaget’s
and Guilford’s theories of thinking, creativity and intellect. These learning
styles are briefly discussed below.
• Accommodators are active in experimentation (busy “doing”) and engage
in concrete experience (“feelings”). Such learners are good at carrying out
plans and getting things done. They are people-oriented, see and exploit
opportunities and are committed to meeting objectives. They rely on other
people for information rather than use their own analytical ability. They are
more inpatient and bold than other types. According to Killen (2000), they
benefit from teaching strategies such as problem-solving and ward
placement. Writing reports of case studies can be stimulating to such
students during clinical experiences.
• Convergers learn better by active conceptualisation (theorists) (“thinking”)
and active experimentation (“doing”). They are good at problem-solving,
making decisions, setting goals and selecting the best solutions. Killen
(2000) describe them as being less oriented to people. The teaching
strategies that benefit convergers include problem solving, demonstration
and ward placement.
• Divergers (reflectors) are good at learning through concrete experiences
and reflective observation (“watching”). According to Killen (2000),
teaching strategies such as group discussion and brainstorming are
beneficial to student nurses with this type of learning style.
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• Assimilators (pragmatists) learn through active conceptualisation,
reflective observation, theory building and inductive reasoning. They are
also good at designing experiments, analysing quantitative data and
organising information. They benefit from teaching strategies like formal
lectures, writing papers, and seminars.
The different learning styles show that students benefit from teaching
strategies such as ward placement, problem solving, role-play, small group
discussion, audio-visual simulation, and demonstrations in which they have
personal encounters. Billings and Halstead (2005) emphasized that student
nurses should be guided to learn and to perform practical skills in
demonstration laboratory before they encounter real patients. According to
Hallet (1997), student nurses should be accompanied during clinical learning
so that opportunities are provided for them to gain experience, permitting them
to progress gradually from dependency to independency.
Facilitating student learning in clinical practice:
Within the changing health climate, clinical training has become a large
part of the nurse's role, including the facilitation of student learning. Yet there
is still a lack of clarity with regard to the person that should be responsible for
the clinical teaching of students on a daily basis and what the role entails
(Waldock, 2010). From an international perspective, Pellatt (2006) noted that
supervision of students in the clinical areas appears to have been left to the
clinical nurses who are always with the students. This has created a degree of
56
discomfort for many students and nurses, as students believe they lack the
preparation and/or experience in student supervision, particularly through
clinical teaching. Given this situation, it is not surprising that the quality of
student supervision and role satisfaction for both nurses and students cannot be
assured through current practices.
According to Waldock (2010) registered nurses (RNs) working with
student nurses in the clinical setting have a major influence on student
performance as they are more with the students than their other supervisors.
They have the ability to promote and facilitate student learning or cripple the
students' ability to apply knowledge and skills and accommodate new learning
in clinical practice. Some of the identified factors that affect student nurses in
clinical practice include: support provided by the education faculty and health
provider, preparing the nurses for the supervision role, time and workload
allocation and the nurse/student relationship. The quality of clinical placements
as perceived by students in terms of support, clinical teaching and learning,
and the integration of theory into practice vary considerably from one
experience to the next. Harrison (2010) advocated for an on-going training,
seminars and conferences for these nurses in the clinical areas. This is to
update and equip them with the current nursing skills.
Constraints/ challenges of clinical training in nursing:
Although a lot of positive changes have occurred in modern clinical
nursing training as indicated by Baker (2000) such as improvement in the
57
pattern of clinical training, some factors still act as constraints to the effective
clinical training in nursing. Some of the constraints noted by Searle (2000)
are:
• Lack of clearly written standard guidelines and policies on clinical training
of student nurses.
• Lack of time on the part of nurse educators or the supervising persons due
to workload or other commitments.
• Personnel who are concerned with clinical supervision not interested in
clinical teaching and learning.
• Inappropriate curriculum and reference materials for teachers and students.
Others include:
(1) Lack of theory- practice integration: The gap between theory and
practice in nursing has posed a lot of confusion to the student nurses, in that
what they learnt in the classroom is different from what is obtainable in the
clinical areas. Wallin, Wikblad and Ewald (2003) indicated that research has
shown also that one of the contributing factors to lack of theory practice
integration is the sequence in which the theory is taught and implemented. The
gap created may be due to certain factors such as lack of experience and
knowledgeable teachers to supervise and teach the students in the clinical
areas, limited procedures in the hospitals for students to practice what they
learnt in the classroom and also inexperienced nurses working in the hospitals
who are not updated with the current trends in nursing practice.
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(2) Inadequate trained and experienced nurses. Lohor (2005) emphasized
that inadequate number of trained and experienced nurses jeopardize the
process of nursing education both in the classroom and in the clinical settings
especially in the clinical areas. This makes it difficult for students to be guided
well in the clinical areas where the ratio of students per a practical teacher will
be very large for the teacher to handle. Also, inadequate number of preceptors
and supervisors in the clinical areas posed a lot of constraints. Nursing
curriculum stipulates a ratio of 1:10 as the adequate teacher/student ratio for
clinical training, (N&MCN General Nursing Curriculum 2001).
(3) Lack or inadequate funding: Funding goes a long way to help in
clinical training of nurses. Lack of fund affects every other aspect in the
training such as adequate staffing, students’ motivation, provision of
equipment etc. Therefore, lack of fund for the provision of the materials
necessary for clinical training will jeopardize the training.
(4) Inadequate length of time for clinical practice: The time allocated for
clinical practice goes a long way in promoting practical learning skills. The
length of time for clinical experience helps to determine how well they may
learn the skills. Inadequate length of time does not help the students to learn
much before leaving the clinical area.
(5) Lack of patients or client to practice with: Nursing profession is a
practice dominated service profession. Therefore, it requires that the student
nurses need to do a lot of practice under guidance to enable them to learn the
59
art of nursing. Lack of patients does not provide opportunities for real life
practice.
(6) Lack of equipment: Clinical nursing training need varieties of
equipment such as models, beds, oxygen cylinders, machines of different
types, etc to practice with to gain knowledge and mastery. In recent time, with
the technological boom, more sophisticated equipment should be needed also
to meet up with the current global trend in nursing.
(7) Inadequate supervision: This is as a sequence of lack of enough
supervisors, preceptors and clinical teachers who are supposed to guide, teach,
supervise and assess the students in their clinical areas. Inadequate supervision
leads to lack of students’ assessment and evaluation to elicit the extent of
knowledge and practice gained by the students.
(8) Limited procedures for nurses: Nurses have limited procedures to
practice with in the clinical arena compare to the procedures they learnt in the
classroom, for example, giving an intravenous line medication. This does not
give room for them to practice all the procedures learnt in the classroom
thereby leading to poor performance in those aspects of nursing practice, e.g.
some training hospitals do not allow nurses to carry out procedures like
intravenous medications etc.
(9) Lack of collaboration between the nurses in the hospital and
teachers in the classroom. It is said that training of students should include
mutual understanding and trust between the teachers in the school, the
60
supervisors in the clinical areas and the students to motivate both parties to
action. Where this is lacking, it brings ill feelings and lack of interest on the
students and the nurses who teach and supervise them.
(10) Selection of wrong candidates for training: Wrongly selected
candidates for nursing training pose a lot of problems in the clinical training
because the students may lack interest in the studies and practice. These
candidates can be “untrainable” students who lack interest in nursing
profession but want to be nurses because of other interests such as economic or
interest in traveling oversea (Lohor, 2005). This makes teaching and learning
very tedious for both the teachers and the students because they lack the ability
and interest to study nursing.
(11) Lack of incentive to teachers and supervisors: Lack of incentives to
the teacher, supervisors and nurses in the clinical areas affect clinical training
of students and pose a lot of constraints to clinical training. These incentives
include opportunities for attending workshops, conferences and seminars etc
especially in research and new technological approaches in nursing which are
widely in use today.
Theory underlying the study:
Theory underlying factors that affect clinical training of nursing students
in nursing schools is the Dreyfus model of skill acquisition as developed by
Benner (2004). This model contains a systematically planned process for
teaching students to acquire the required clinical skills for nursing practices.
61
The Dreyfus model of skill acquisition is a model of how students acquire
nursing skills through formal instruction and practical experiences. It has
originally five steps such as novice stage, advanced beginner, competent stage,
proficiency stage and expert stage.
(1) Novices’ stage: This being the first step, orientations and instructions on
the subject matter are given to the students. Rigid adherence to taught rules,
plans of actions, procedures of doing things are advocated by the trainer. The
students have no sense of responsibility beyond following the rules and
procedures exactly. In this stage, good orientation and practical demonstrations
of nursing skills by a professional is advocated.
(2)Advanced beginners: With the teacher’s drilling of instructions,
demonstrating and students practicing procedures with adequate equipment
and adequate supervision of students, students leave the former stage. Here
individual students develop organizing principles to quickly access the
particular rules or procedures that are relevant to the specific task at hand.
Students also have limited situational perception and treat all aspect of work
separately with equal importance. Students’ participation in practicing the
things they have been taught help them to understand the nursing skills
involved well.
(3) Competent stage: With much exposure and practice, training becomes
more concrete. Students now are engaged in active decision making in
choosing a course of action, e.g. coping with crowded activities, accumulation
62
of information, some perception of actions in relation to goals, deliberate
planning execution of action under supervision and can formulate and carry out
routines.
(4) Proficient stage: With active participation in clinical experiences, students
have learnt some nursing skills. Also with much clinical nursing practice,
individual student nurse develops intuition to guide his/her decisions and
develops the ability to formulate nursing plans according to the profession.
Candidate now has holistic view of situations, can prioritize important aspects
of activities, perceives deviations from the normal pattern and employs
maxims for guidance with meanings that adapt to the situation at hand.
(5) Expert stage: Candidates here transcend reliance on rules, guidelines and
maxims. They have intuitive grasp of situations based on deep, tacit
understanding. They have vision of what is possible and use analytical
approaches in new situations or in cases of problems.
63
Fig. 2: Model of the study of factors affecting clinical training of nursing
students. (Application of Dreyfus’s skill acquisition model)
The Dreyfus skill acquisition model as propounded by Benner (2004)
can be utilized to explain clinical training of students in nursing profession.
This training theory views each student and their stages of performance
uniquely and helps the teachers/ supervisors to attend to their needs
Clinical training of
students
Skill acquisition
Quality nursing care
(Independent variable)
Model of the study
(Intervening variables)
− teachers/supervisors,
− equipment/materials,
− techniques/measures
used for training,
− Students’ attitude.
(Study variables)
Proficient stage
Competent stage
Expert stage
Advanced Beginner
Novice’s stage
(Dependent variables)
64
individually and appropriately. It aims at upgrading the students from novice to
expert nurses by identifying the training needs at each stage and drilling the
students to acquire those needed skills before stepping forward to the next
stage.
In the model of study, the dependent variables are the stages of skill
acquisition which are novice stage, advanced beginner, competent stage,
proficient and expert stage. The intervening variables are the study variables
which include factors of adequate teachers/supervisors, equipment,
techniques/measures used for training and students attitude towards training.
The intervening variables are the factors that may affect clinical training of
nursing students either positively or negatively depending on the adequacy of
the intervening variables. The independent variable is the clinical training
offered to nursing students which involves skill acquisition that manifests in
the quality of nursing care rendered by students.
The model shows that adequacy and competency of the intervening
variables using the five stages approach of the model will affect clinical
training of nursing students. This is because at each stage, the students will be
drilled properly on the skills to be learnt before moving up to the next stage. In
other words, it is hypothesized that with experienced teachers and supervisors
using appropriate equipment with right training techniques and students being
interested in clinical experiences, students will acquire adequate and
appropriate nursing skills necessary for practice. Also, lack or
65
inappropriateness in any of the intervening variables or lack of proper
utilization of the stages of the model will result to poor acquisition of the
necessary nursing skills thereby leading to poor clinical nursing practice. The
model also showed that acquisition of nursing skill is a continuous process that
never ends but needs regular updating in order to remain relevant and
proficient in nursing profession.
Empirical review
A descriptive study done by Wuthiphong, Somsri and Suthineum (2009),
on factors influencing clinical learning behaviour of nursing students revealed
that students’ paying attention to clinical orientations, seminars/conferences
given to them before each clinical experience period and also that students
reporting when they noticed abnormal signs or symptoms in a patient to the
teachers or nurses around them helped them to learn better. The result also
indicated that inadequate number of experienced educators/clinical supervisors
were a negatively influencing factor to the clinical learning behaviour of
student nurses. This study showed also that motivating students and teachers to
act as role models to each other enhanced nursing skill acquisition.
A quantitative study done by Sumari-Ayo (2006) on factors influencing
clinical teaching of midwifery students in Tanzania, using three schools of
midwifery revealed that both the professional and educational qualification of
the tutors were low, tutors and the preceptors were overworked due to shortage
of staff, the schools’ clinical skill laboratory and the hospital wards lack basic
66
equipment and necessary supplies, there were no clinical accompaniment
guidelines. Also teachers in the classroom and supervisors in the clinical areas
do not cooperate with each other in training the students.
An exploratory study by Warner, et al (2010) showed that the clinical
experience placement duration of 6 weeks at a stretch for each clinical
experience period allowed students to learn better; supervisory relationship
between students and their supervisors was cordial and motivating; students
experienced conducive atmosphere in the wards while the role of their nurse
educators were not perceived in the clinical areas. Majority of their supervisors
were staff nurses in the wards while few were specialist nurses, 73% of the
students had schedule supervision sessions with their supervisors without their
nurse teachers. Also, 75% of the students recorded satisfaction with the
successful mentorship experiences they observed in the wards which enhanced
skill acquisition. They noted that their teacher’s role was mainly evaluative
role than supervisory roles. This implies that their teachers’ role did not
motivate them.
A qualitative study of nursing students experiences of clinical practice
done by Shariff and Masoum (2005) revealed that almost all the students
identified feeling anxious in their initial clinical placement; were worried about
giving the wrong information to the patients; lacked integration of theory into
clinical practice because of lack of clinical supervisors; ward staff nurses are
67
not concerned about what students learn and that staff nurses were not aware
of the skills and strategies necessary in clinical education.
A quantitative, descriptive, survey by Salmon and Gutema (2004) on
examining the experiences of student nurses on community based experience
(CBE) revealed that students’ participation and mentors’ willingness to answer
questions and the relevance of the placement areas were factors that facilitated
learning. While students reported that the factors that hindered learning were
difficulties of self-expression in a group, mentors emphasizing only mistakes
and weaknesses and the short time-frame for clinical experience due to
ongoing lectures during clinical experience periods.
Meechan, Jones, & Valler-Jones (2011) investigated on students'
perspectives of their clinical skills acquisition and knowledge during the
foundation year of their nursing programme, and whether this improved
students' levels of competence and confidence. Findings showed that students
identified that the curriculum supported the acquisition of clinical skills. This
indicates that the introduction of clinical skills teaching and assessment within
a university's simulation laboratory augmented with structured assessment
within the clinical environment improved the acquisition of clinical skills.
A descriptive study done by Williams & West (2011) titled,
“Approaches to nursing skills training in three countries” showed that the
central role of the clinical instructors is clinical training of students, the relative
freedom given to nursing students to participate in their own learning needs
68
helped their self confidence, interest and it increased learning. Also the
academic qualification and educational methodologies that were required for
clinical instructors helped them in drilling and concretizing nursing skills
taught to the nursing students during clinical training. It showed that the large
number of patients they took care of during their clinical experience helped
them to acquire nursing skill. In all the studied countries, the clinical
supervisors were large in number in the wards to ensure adequate control
teaching of students.
Study done by Dorthe and Regner (2011) on the practical skills of newly
qualified nurses showed that the newly qualified nurses do not feel equipped
when they finished their training as a direct consequence of the decrease in
practical training hours. The study also identified that the way nursing theory is
perceived and taught is problematic. The interviews done also revealed that the
nurses think that nursing theories should be applied directly in practice. This
misunderstanding is probably also applicable to the teachers of the theories.
Focus groups and questionnaires used for the study done by Bray, Flynn,
and Sanders (2011) aimed to explore the factors which influence student
nurses' ability to pass urethral catheter in children during their care. This aimed
at informing current pre-registration students’ clinical skill training and
education. The results showed that the students identified that their inability to
competently carry out urethral catheterization was influenced by lack of
exposure to the clinical skill and a need for specific paediatric focused training.
69
Evaluation of current catheterization training highlighted that, even after
training, only a small proportion of the student nurses felt confident to
catheterize children in practice because of lack of competence in that nursing
skill.
Summary of literature reviewed
Conceptual review of nursing education shows that nursing education
consist of acquisition of a body of knowledge which is partly delivered in a
classroom setting and an organized and supervised clinical training done in
different areas where student nurses do their clinical experiences. While
clinical training as part of nursing education consist of acquisition of
knowledge, skills and competences useful for rendering quality nursing care.
The patterns adopted for clinical training in Nigeria include, training in
the demonstration room, block study clinical training, study days clinical
training and consolidated clinical training. Some of the factors that affect
clinical training are the curriculum philosophy, the context for clinical training
and the human and material resources needed for effective clinical training.
Some of the challenges of clinical training in nursing include:
inadequate trained and experienced nurse educators, clinical nurses, clinical
supervisors etc both in the schools and in the clinical areas. There are also
theory- practice gap, inadequate funding, inadequate supervising of students
during their clinical experiences etc.
70
From the empirical review, it was observed that some studies had been
done on clinical training experiences of student nurses. The findings revealed
that a good orientation of the student nurses about what is expected of them
before the commencement of any clinical practice and enough period of time
for practice helped them to understand the clinical issues easily and better
when taught. Also, that good and experienced clinical teachers and preceptors,
conducive environment and adequate equipment are needed in the schools and
clinical areas to help the students integrate knowledge into clinical practical
skills. However, little has been done empirically in Nigeria to find out the
factors that do affect clinical training of nursing students. This is considered a
serious gap as identifying the factors that are involved in the training of student
nurses will help to acknowledge the necessity of providing those human and
material resources needed for adequate training of nursing students to enhance
nursing skill acquisition. It is this gap that informed the researcher’s choice of
the topic, factors affecting clinical training of nursing students. The model on
which the study was based is the Dreyfus model of skill acquisition as
developed by Benner (2004).
71
CHAPTER THREE
RESEARCH METHODS
This chapter presents the research design, area of the study, study
population, sample size and instrument for data collection, validity and
reliability of instrument, ethical consideration, procedure for data collection
and method of data analysis.
Research design
Descriptive cross-sectional survey design was used for the study. This
design was considered adequate because it has the ability to describe the
existing practice and reveals areas that need change. It also yields current and
prevailing information about the situation under study as it exists. Polit and
Beck (2003) in supporting this line of thought noted that, the descriptive
survey design involves a systematic collection, analysis, interpretation and
reporting of important facts about the existing event.
Area of study
The two areas of study were School of Nursing Afikpo (SON-A) in
Ebonyi State and Department of Nursing Sciences University of Nigeria Enugu
Campus (DNS-UNEC) in Enugu State of Nigeria. Ebonyi State with Abakaliki
as its capital has a land mass approximated at 5932km2. The State has
boundaries in the North with Benue State, East with Cross River, South with
Abia state and West with Enugu State. According to records from the ministry
of information Abakaliki, Ebonyi State has a population of 3 million people
and 13 Local Government Areas. These include, Afikpo North local
72
government area where the school for the study is situated (Ebonyi State
Ministry of Information, 2009). There is only one school of nursing in the State
which is, School of Nursing, Mater Misericordiae Hospital, Afikpo in Afikpo
North local government area. The school was selected and designated as
School (A) for the study. The school was established by the Roman Catholic
Mission in 1952 and it has been functioning since then. It is located along
Afikpo Ozizza road and is 75 kilometers from Abakaliki which is the capital of
Ebonyi State. This school was used for the study because of the decline in
practical performance of students in General Nursing Council Examination
especially in practical section.
The other area of study is Department of Nursing Sciences, University
of Nigeria Enugu Campus designated as school (B), in Enugu State with Enugu
as its capital. It has a land mass approximated at 7,161km2 (Enugu State,
Ministry of Information, 2007). The State has boundaries in the North with
Benue and Kogi States, East with Ebonyi State, South with Abia and Imo
States and West with Anambra State. It has a population of 5,590,513 people
and seventeen (17) local government areas, (Nigeria National Bureau of
statistics, Enugu 2005).
There are three Schools of Nursing and one University based
Department of Nursing in Enugu State namely: School of Nursing, Enugu
State University Teaching Hospital, Parklene, School of Nursing University of
Nigeria Teaching Hospital, Enugu, School of Nursing, Bishop Shanahan
Hospital, Nsukka and Department of Nursing Sciences, Faculty of Health
73
Sciences and Technology in University of Nigeria Nsukka, Enugu Campus
(UNEC).
This University was established in 1955 but was officially opened on 7th
October 1960 as the climax to the Nigerian independence celebration in the
Eastern region of Nigeria by her Royal Highness, the Princess Alexandra of
Kent who represented Her Majesty, Queen Elizabeth the second.
Department of Nursing Sciences UNEC came into existence during the
1982/ 83 academic session of the University. The department started with a 3-
year degree programme for registered nurses in three major areas namely,
Public Health Nursing, Nursing Education and Nursing Administration. Later
during the 2003/2004 academic session, the department started a 5-year
generic degree programme in Nursing Sciences for secondary school certificate
holders leading to the award of B.N.Sc degree. Department of Nursing
Sciences UNEC was used because of the reports from nurses in the clinical
areas indicating lack of clinical skills among the graduates of generic degree
programme.
These two schools for the study offer a three year higher diploma
General Nursing Education and a 5 year Generic Nursing degree programme
respectively. Nursing and Midwifery Council of Nigeria registers and issues
successful candidates that pass their professional qualifying examinations with
a professional nursing certificate and license to practice nursing in Nigeria.
School of Nursing Afikpo was chosen because it is the only school of nursing
in Ebonyi State offering a 3 year basic general nursing education while the
74
Department of Nursing Sciences is the only department offering a 5 year
Generic Nursing Programme in Enugu State. These two Institutions were
chosen to elicit the differences in the factors that affect clinical training of
nursing students in these institutions despite the diversities in ownership and
structure of their nursing programmes. The two nursing institutions were used
despite the diversities in ownership and structure of their nursing programmes
because of the following reasons: both Nursing Institutions are guided by the
same N&MCN Standard of Nursing Education and Practice; they use a similar
pattern of clinical training schedule which aims at imparting proper nursing
skills to the students; students from both institutions receive their clinical
training at the same type of clinical areas/settings e.g. hospital clinics etc; both
face the challenges of General Nursing Council Examination in which the
successful candidates are registered to practice as nurses by N&MCN;
candidates are also controlled after graduation by the same N&MCN and are
expected to render the same quality nursing care to clients in their different
areas of nursing practice.
Population of study
The total population for the study included all the academic staff and all
the students of the two institutions of study. The teachers’ total number was:
School of Nursing Afikpo, fourteen (14) and Department of Nursing Sciences
Enugu Campus, twenty (20). The students’ total number was: School of
Nursing Afikpo, two hundred and twenty eight (228) and Department of
75
Nursing Sciences Enugu Campus, four hundred and forty six (446). The total
population of teachers and students for the study from both schools were six
hundred and seventy four (674).
Target population
The target population constituted of all the academic staff of both
institutions and all the students in their second and third year of nursing
training in School of Nursing Afikpo and students in their 4th and 5
th year in the
Department of Nursing Sciences, UNEC. These cadres of students were
selected because they have had clinical exposures for more than one year,
therefore, they can give an experiential account of their clinical learning. The
target population of study was three hundred and thirty (330) comprising of
teachers and students from both nursing institutions. They were all considered
as eligible respondents, but inclusion and exclusion criteria were applied in
selecting the actual respondents. The reason for using all the respondents of the
study was because the number of the academic staff and the students’
population from both institutions were not too large to be managed for the
study.
76
Inclusion criteria: Respondents were:
- Teachers and students physically present in the schools during the study
period
- Students in the second and third years of nursing education in the nursing
school and students in their fourth and fifth years of study in the nursing
department of the university.
- Willingness to participate in the study.
Instrument for data collection
The instrument used for collection of relevant data from the respondents
was a researcher developed questionnaire titled: Questionnaire on factors
affecting clinical training of nursing students (QFACTNS). Items in the
questionnaire were generated from literature reviewed based on the objectives
set for the study. The questionnaire has thirty four (34) items in four sections
(A-D). Section A with seven (7) items dealt with the demographic data of the
respondents; section B with twelve (12) items sought information on the
administrative factors in relation to human resources and
infrastructure/equipment in the schools and clinical areas; section C with
eleven (11) items elicited information on the training/supervisory measures
used for clinical training of nursing students, while section D with four (4)
items dealt with the students’ factors affecting clinical nursing training.
Items thirteen (13) to thirty four (34) of the questionnaires were
constructed on a five-point likert scale which the respondents rated according
77
to their own dispositions. The items were rated by using 5, 4, 3, 2, and 1 which
were interpreted as follows:
5 - Strongly agree
4 - Agree
3 - Disagree
2 - Strongly disagree
1 - No opinion
Validity of the Instrument
A researcher-developed questionnaire, face and content validated by the
project supervisor and three other lecturers in the Nursing Sciences
Department were used for the study. The unsatisfactory items were either
restructured or deleted. Their modifications were reflected on the final draft of
the instrument.
Reliability of the instrument
The reliability of the questionnaire was established by test-retest
technique. Copies of the respective instrument were administered to twenty
five students and five teachers from School of Nursing, Our Lady of Lourdes
Hospital, Ihiala in Anambra State. The instrument was re-administered to the
same students and teachers after two weeks interval. Using the Pearson’s
product moment correlation (r), the test-retest scores were analyzed and the
coefficient of statistics reliability was 0.96 which indicated a high value. This
led to the conclusion that the instrument was reliable.
78
Ethical considerations
Ethical clearance was obtained from the Health Research Ethics
Committee of University of Nigeria Teaching Hospital Ituku- Ozalla in Enugu
state.
Administrative permission was obtained from the proprietor of the
School of Nursing Afikpo and the Head, Department of Nursing Sciences
University of Nigeria, Enugu Campus. The purpose of the study was explained
to the respondents and a signed informed consent was obtained from them.
Assurance was also given to them of the confidentiality of the information
given by them.
Procedure for data collection:
The researcher with the help of two trained research assistants
administered the copies of the questionnaire to the academic staff and the
students of both schools on different days. Copies of the questionnaire were
administered to the students in groups when they were in the classroom while
the teachers received their own questionnaire individually in their offices. The
administration and collection of the questionnaire lasted for three weeks.
Three hundred and thirty (330) questionnaires were administered while three
hundred and eleven (311) were duly completed and returned given a return rate
of 94.2%.
79
Method of data analysis
The data gathered were cleaned and analyzed with the help of software
SPSS version 17 using frequencies, percentages, standard deviation and mean
scores with a mean decision point of ≥ 3.0 for accepting a factor as promoting
students’ clinical training. While Z- test was used as inferential statistics. The
z- test was used to identify the differences with regard to the factors affecting
clinical training of nursing students between the two institutions at significant
level of p < 0.05. All the hypotheses were verified using Z- test tested at level
of significance of p < 0.05. Decision rule for testing of the hypotheses was Z-
test score > P-value which indicated rejection of the null hypothesis, where as
Z-test score < P-value indicated acceptance of the null hypothesis.
The five-point rating scale of Strongly Agree (SA), Agree (A), Disagree
(D), Strongly Disagree (SD) and no opinion (NOP) with values of 5, 4, 3, 2
and 1 respectively were used in scoring the items. This gave a total of 15 and a
mean of 3.0 when divided by 5. This was taken as the mean decision point. All
the items that attained mean scores of ≥ 3.0 were accepted by the respondents,
while mean scores < 3.0 were rejected by the respondents.
80
CHAPTER FOUR
ANALYSIS AND PRESENTATION OF RESULTS
This chapter dealt with the analysis and presentation of the results from
the data collected with the questionnaire and summary of the findings. The
results were presented using the research questions and hypotheses.
Out of the three hundred and thirty (330) copies of the questionnaire
administered, three hundred and eleven (311) were duly completed and
returned, giving a return rate of 94.2%. The two nursing institutions’ results
from section (B) were presented differently and titled:
Part one: School (A) --- School of Nursing, Afikpo (SON-A).
Part two: School (B) ---Department of Nursing Sciences, (DNS-UNEC).
Out of (311) respondents, 115 (36.9%) were from School of Nursing,
Afikpo, (School A), while 196 (63%) were from the Department of Nursing
Sciences University of Nigeria Enugu Campus (UNEC), (School B). Majority
of the respondents 283 (90.9%) were students while 28 (9%) were teachers.
Decision rule for the items which were constructed on a five-point likert
scale was based on mean score ≥ 3.0. Mean scores ≥ 3.0 were accepted as
positive responses while mean scores < 3.0 were accepted as negative
responses.
SECTION A: The responses to items 1-2 in the questionnaire were analyzed
to answer questions on Demographic factors of the students and presented in
table one.
81
Table 1: Demographic characteristics of the students
n = 283
Table 1 showed that, 177 (62.5%) students were from school (B) while
106 (37.4%) were from school (A). From both schools majority, 246 (74.6%)
were females, while the males were 37 (25.4%).
The responses to items 1, 4 - 6 in the questionnaire were analyzed to
answer questions on Demographic factors of the teachers and presented in
table 2.
Items School A School B f Percentage
Gender
Males
Females
Year of study
Year 2
Year 3
Year 4
Year 5
f
12
94
58
48
-
-
%
11.3
88.7
54.7
45.3
-
-
f
25
152
-
-
43
134
%
14.1
85.9
-
-
24.3
75.7
37
246
58
48
43
134
25.4
74.6
20.4
16.9
15.1
47.3
Total 106 37.4 177 62.5 283 100
82
Table 2: Demographic characteristics of the teachers:
n = 28
Out of the 28 teachers from both schools as displayed in Table 2, 6
(21.2%) were males while 22 (78.5%) were females. The highest educational
qualifications’ result revealed that school (A) has 2 (22.2%) teachers with RN
certificate only, 5 (55.5%) with B.Sc. Nursing, 2 (22.2%) with B.Sc. Anatomy
and no teacher with M.Sc. or PhD.
Items School A School B f Percentage
f % f %
Gender
Males
Females
3
6
33.3
66.7
3
16
15.8
84.2
6
22
21.4
78.5
Highest educational
qualification
RN only
B.Sc Nursing only
B.Sc Anatomy only
M.Sc. only
PhD
2
5
2
-
-
22.2
55.5
22.2
-
-
-
6
-
4
9
-
31.5
-
21.0
47.3
2
11
2
4
9
7.1
39.2
7.1
14.2
32.1
Years of teaching
experience
1-5
6-10
10 years – above
7
1
1
77.8
11.1
11.1
9
4
6
47.4
21.1
31.6
16
5
7
57
17.8
25.2
Teachers status
Lecturer
Clinical instructor
7
2
77.8
22.2
15
4
78.9
21.1
22
6
78.6
21.4
Total 9 32.1 19 67.8 28 100
83
While school (B), has 6 (31.5%) teachers with B.Sc. Nursing, 4 (21.0%)
with M.Sc. and 9 (47.3%) teachers with PhD.
In school (A), 7 (77.8%) of their teachers had 1-5 years of teaching
experience, 1 (11.1%) had 6-10 years of teaching experience and also only 1
(11.1%) teacher had 10-above years of teaching experience. While in school
(B), 9 (47.4%) of their teachers had 1-5 years of teaching experience, 4
(21.1%) had 6-10 years and 6 (31.6%) of their teachers had 10 years and above
teaching experience.
The result also showed that school (A) had 7 (77.8) lecturers and 2
(22.2%) clinical instructors. While school (B), had 15 (78.9%) lecturers and 4
(21.1%) clinical instructors. It was also noted from the Table that 22 (78.6%)
of the teachers from both schools were predominantly lecturers while clinical
instructors were 6 (21.4%).
84
SECTION B
PART ONE: SCHOOL (A) SON-A
SECTION B: Research question one: what are the administrative factors
that affect clinical training of nursing students?
The responses to items 7- 11 in the questionnaire were analyzed to
answer questions on administrative factors, (staffing) and presented in Tables 3
and 4.
Table 3: Respondents (School A) views on administrative factors (staffing)
affecting clinical training of nursing students
n = 115
Items Teachers Students Total %
The Number of teachers in this school is:
< 4
4 to 6
7 to 10
11 and above
Total
f % f %
1
97
14
3
115
.9%
84.3%
12.2%
2.6%
100%
0
1
5
3
9
0
11.1
55.6
33.3
1
96
9
0
106
9%
90.6
8.5
0
Which of these act as clinical supervisors in your
school: clinical instructors only
preceptors only
staff nurses in the clinical areas only
students are not being supervised
both clinical instructors and ward staff nurses
Total
0
0
4
0
5
9
0.
0
44.4
0
55.6
22
0
48
9
27
106
20.8
0
45.3
8.5
25.5
22
0
52
9
32
115
19.1%
0%
45.2%
7.8%
27.8%
100%
If you are supervised in the wards, how many of
the following staff supervises the students during
each shift in the wards?
Clinical instructors only 1
2
3
4
Total
2
2
1
0
5
40.0
40.0
20.0
0
49
0
0
0
49
100
0
0
0
51
2
1
0
54
44.3%
1.7%
0.8%
0%
46.8%
Preceptors only: 1 Total
0
0
0
0
0
0%
Staff Nurses in the wards or clinical areas only: 1
2
3
4
Total
8
1
0
0
9
88.8
11.1
0
0
75
0
0
0
75
100
0
0
0
83
1
0
0
84
72.1%
0.8%
0%
0%
72.9%
Table 3 showed that, 5 (55.6%) out of the 9 teachers indicated that the
number of their teachers were 7-10, 1 (11.1%) of them indicated that they had
85
4-6 teachers, while 3 (33.3%) teachers accepted that they had 11 and above
teachers in their school. While majority, 96 (84.3%) of their students indicated
that they had 4-6 teachers in their school.
The result showed also that 4(44.4%) of their teachers indicated that it
is only the clinical instructors that supervise the students, while 5 (55.6%)
teachers agreed that it was both the clinical instructors and the ward staff
nurses that supervise students during their clinical experiences. Forty eight
(45.3%) students indicated that it was only the ward staff nurses that
supervised them during clinical experiences, 22(20.8%) said that it was only
the clinical instructors, 9 (8.5%) stated that the students were not supervised,
while 27 (25.5%) of the students indicated that it was both the clinical
instructors and the ward staff nurses that supervised them during their clinical
experiences.
On the number of clinical instructors that follow students at each shift, 2
(40%) teachers answered that it was one clinical instructor, 2 (40%) indicated
that it was 2 clinical instructors and 1 (20%) teacher stated that it was 3 clinical
instructors that follow students at each shift during their clinical experience.
While all 49 (100%) of the students that answered in support of the clinical
instructors indicated that it was only one clinical instructor that supervised
them at each shift. The result showed also that the school had no preceptor
since nobody agreed to that statement. The Table further showed that 8
(88.8%) teachers stated that it was only 1 staff nurse that supervises students,
while only 1 (11.1%) teacher agreed that it was 2 staff nurses that supervise
students during each shift. On the other hand, all the 75 (100%) students that
86
answered in support of the staff nurses indicated that it was only one staff
nurse that supervise the students at each shift during their clinical experience.
Table 4: Respondents (School A) views on administrative factors, (staffing)
affecting clinical training of nursing students continued.
n = 115 Items Respondents NOP
1
SD
2
D
3
A
4
SA
5
Mean
Score
SD Decision
Teachers in this
school are enough
to handle the
subjects in the
school.
Teachers
Students
0
1
1
27
7
78
1
0
0
0
3.00
2.73∗∗∗∗
.500
.469
accepted
rejected
Teachers in this
school are
involved in
supervision of
students in the
clinical areas.
Teachers
Students
1
1
1
76
2
3
5
26
0
0
3.22
2.51∗∗∗∗
1.093
.876
accepted
rejected
Group mean score = 2.8
Decision mean =≥≥≥≥ 3.0, NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected
The result in Table 4 showed that only the teachers accepted that
teachers are enough to handle the subjects in the school and also that teachers
are involved in supervision of students in the clinical areas with mean scores of
3.00 and 3.22 respectively. While the students did not accept both statements
with mean scores of 2.73 and 2.51 respectively which are less than the
accepted decision mean score (≥ 3.0). Group mean is 2.8, which is < 3.0.
87
The responses to items 12-18 in the questionnaire were analyzed to
answer questions on administrative factors, (Infrastructure/Equipment) and
presented in Table 5.
Table 5: Respondents (School A) views on administrative factors,
(infrastructure/equipment) affecting clinical training of nursing students.
n= 115
Items Respondents NOP
1
SD
2
D
3
A
4
SA
5
Mean
Score
SD Decision
This school has practical
laboratory for students’
clinical practice.
Teachers
Students
0
0
0
0
0
0
4
52
5
54
4.56
4.51
.500
.469
accepted
accepted
The laboratory has a large
space for all the students
to observe what is being
thought.
Teachers
Students
0
0
1
0
1
2
1
30
6
52
4.33
4.26
1.118
.808
accepted
accepted
The school laboratory has
enough equipment that can
enable many students to
practice procedures during
the same period.
Teachers
Students
0
0
0
0
2
1
0
77
7
28
4.33
4.25
1.323 accepted
.496 accepted
The hospital has enough
needed equipment for the
number of students on
each shift to practice with
while on clinical
experience.
Teachers
Students
0
1
4
72
5
33
0
0
0
0 2.56∗∗∗∗
2.30∗∗∗∗
.527 rejected
.481 rejected
Students/clients ratio in
each ward during clinical
periods was enough for
students practice.
Teachers
Students
0
1
5
10
0
4
4
0
0
0
1 2.44∗∗∗∗
2.06∗∗∗∗
.527 rejected
.361 rejected
The school has a library
with current nursing text
books for references.
Teachers
Students
0
1
2
2
3
3
4
24
0
72
3.22
4.58
.833 accepted
.729 accepted
Teachers and students use
the library.
Teachers
Students
0
0
0
99
1
7
3
0
5
0 2.56∗∗∗∗
2.07∗∗∗∗
.726 rejected
.250 rejected
Group mean score = 3.4
Decision mean = ≥≥≥≥ 3.0
NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected
88
Table 5 showed that both the teachers and the students are in agreement
with the following statements: that their school has practical laboratory for
students’ clinical practice, (mean scores 4.56 and 4.51respectively), that the
laboratory has a large space for all the students to observe what is being taught,
(mean scores 4.33 and 4.26respectively), that the school laboratory has enough
equipment that can enable many students to practice procedures during the
same period ( mean scores 4.33 and 4.25 respectively) and that the school has a
library with current nursing text books for references, (mean scores 3.22 and
4.58 respectively). The mean scores are ≥ 3.0 which is the decision mean
score.
Also both respondents did not accept that the hospital has enough needed
equipment for the number of students on each shift to practice with while on
clinical experience, (mean scores 2.56 and 2.30 respectively), that students/clients
ratio in each ward during clinical periods is enough for students practice, (mean
scores 2.44 and 2.06 respectively) and that teachers and students use the library,
(mean scores 2.56 and 2.07 respectively). The mean scores are less than the
decisions mean score of ≥ 3.0. The Table showed that the respondents accepted 4
items and rejected 3 items with group mean score 3.4 which is ≥ 3.0.
89
Research question two: what are the training/supervisory factors that
affect clinical training of nursing students?
The responses to items 19-29 in the questionnaire were analyzed to
answer questions on training/supervisory factors, and presented in Table 6.
Table 6: Respondents (School A) views on training/supervisory factors that
affect clinical training of nursing students
n= 115 Items Respondents NOP
1
SD
2
D
3
A
4
SA
5
Mean
Score
SD Decision
The school authority does the
following to ensure that students
acquire the required nursing skills:
Organize clinical conferences
/seminars for the students.
Teachers
Students
0
0
1
27
3
53
4
26
1
0
3.56
2.99∗∗∗∗
.882
.710
accepted
rejected
Encourage students to participate in
planning of clinical teaching
programmes.
Teachers
Student
0
0
2
28
4
77
2
1
1
0
3.22
2.75∗∗∗∗
.972
.459
accepted
rejected
Provide mentors and preceptors in
each shift to coach the students on the
nursing skills.
Teachers
Students
0
0
5
98
4
7
0
1
0
0 2.44∗∗∗∗
2.08∗∗∗∗
.527
.312
rejected
rejected
Give students assignments during
clinical periods at least once a week.
Teachers
Students
0
0
3
74
5
7
1
25
0
0 2.78∗∗∗∗
2.54∗∗∗∗
.667
.853
rejected
rejected
Teachers do finish teaching their
courses and practical before students
go to the clinical areas.
Teachers
Students
0
0
6
99
3
6
0
0
0
1 2.33∗∗∗∗
2.08∗∗∗∗
.500
.368
rejected
rejected
Students do repeat demonstration
after teacher’s own teaching during
each procedure.
Teachers
Students
0
1
0
0
0
0
4
28
1
0
4.56
4.70
.527
.572
accepted
accepted
Clinical orientations are given to the
students at the beginning of each
clinical posting.
Teachers
Students
0
1
1
53
3
50
4
2
1
0
3.56
2.50∗∗∗∗
.882
.556
accepted rejected
The ward staff nurses follow the
correct procedure in carrying out their
job to enable students to learn and do
the right thing.
Teachers
Students
0
1
1
25
0
74
7
6
1
0
3.89
2.80∗∗∗∗
.782
.542
accepted rejected
The ward staff nurses do supervise the
students during each procedure.
Teachers
Students
0
1
1
24
0
55
7
26
1
0
3.89
3.00
.782
.717
accepted
accepted
Supervisors do evaluate students’
clinical experience at the end of each
clinical period.
Teachers
Students
0
1
2
47
6
57
1
1
0
0 2.89∗∗∗∗
2.55∗∗∗∗
.601
.537
rejected
rejected
The school provides field
trips/excursions as varied teaching
and learning opportunities.
Teachers
Students
0
1
1
1
2
29
1
71
5
4
4.11
3.72
1.167
.598
accepted
accepted
Group mean score = 3.0
Decision mean = ≥≥≥≥ 3.0
NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected
90
Responses on Table 6 showed that only the teachers accepted that the
school authority organizes clinical conferences/seminars for the students,
(mean score 3.56), and that the school authority encourages students to
participate in planning of clinical teaching programmes, (mean score 3.22),
while the students rejected both statements with mean scores of 2.99 and
2.75respectively. The result showed also that only the teachers indicated that
clinical orientations are given to the students at the beginning of each clinical
posting, (mean score 3.56) and that the ward staff nurses follow the correct
procedure in carrying out their job to enable students to learn and do the right
thing, (mean score 3.89). On the other hand, students did not accept both
statements with mean scores of 2.50 and 2.80 respectively.
Both teachers and students did not accept the following statements: that
the school authority provides mentors and preceptors in each shift to coach the
students on the nursing skills, (mean scores 2.44 and 2.08 respectively); gives
students assignments during clinical periods at least once a week, (mean scores
2.78 2.54 respectively) and that the teachers do finish teaching their courses
and practical procedures before students go to the clinical areas, (mean scores
2.33 and 2.08 respectively). It is noted also that both teachers and students did
not accept that supervisors evaluate students’ clinical experience at the end of
each clinical period with mean scores of 2.89 and 2.55 respectively.
Both the teachers and the students in school (A) also accepted that,
students are allowed to repeat demonstration after teacher’s own teaching
during each practical procedure, (mean scores 4.56 and 4.70 respectively), that
the ward staff nurses do supervise the students during each procedure, (mean
scores 3.89 and 3.00 respectively) and that the school provides field
91
trips/excursions as varied teaching and learning opportunities (mean scores
4.11 and 3.72 respectively). The group mean is 3.0 which correspond with the
decision mean score ≥ 3.0.
Research Question three: what are the students’ factors that affect clinical
nursing training?
The responses to items 30-34 in the questionnaire were analyzed to
answer questions on students’ factors and presented in Table 7.
Table 7: Respondents (school A) views on students’ factors affecting
clinical training of nursing students
n= 115
Items Respondents NOP
1
SD
2
D
3
A
4
SA
5
Mean
Score
SD Decision
Every student attended
clinical experiences
regularly as scheduled.
Teachers
Students
0
1
1
0
4
2
4
7
0
96
3.33
4.86
.707
.786
accepted
accepted
Every student attempted the
clinical assignments/ texts
given to them.
Teachers
Students
0
1
1
1
4
25
4
52
0
27
3.33
3.97
.707
.786
accepted
accepted
The students make use of
the equipment in the school
laboratory for clinical
practice on their own.
Teachers
Students
0
2
2
4
5
76
2
23
0
1
3.00
3.16
.707
.588
accepted
accepted
Students do the following
during clinical experiences:
Self assessment of their
clinical performance.
Teachers
Students
0
1
1
5
6
94
1
2
1
4
3.22
3.03
.833
.506
accepted
accepted
Accepts corrections and ask
their ward staff nurses
questions during clinical
experience.
Teachers
Students
0
1
0
0
5
2
1
26
3
77
3.78
4.68
.610
.972
accepted
accepted
Students use the nursing
care procedures book during
clinical experience as a
guide for practice.
Teachers
Students
0
1
0
1
5
2
1
75
3
27
3.78
4.19
.972
.603
accepted
accepted
Group mean score = 3.6
Decision mean = ≥≥≥≥ 3.0
NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected
92
Table 7 showed that both the teachers and the students are in agreement
that, every student attends clinical experiences regularly as scheduled, (mean
scores 3.33 and 4.86 respectively), every student attempts the clinical
assignments/ texts given to them, (mean scores 3.33 and 3.97 respectively) and
that the students make use of the equipment in the school laboratory for
clinical practice on their own, (mean scores 3.00 and 3.16 respectively). The
result showed also that the respondents accepted that, Students do self
assessment of their clinical performance, (mean scores 3.22 and
3.03respectively), that the students accept corrections and ask their ward staff
nurses questions during clinical experience with mean scores of 3.78 and 4.68
respectively and that students use the nursing care procedures book during
clinical experience as a guide for practice with mean scores of 3.78 and 4.19
respectively. The group’s mean score for students’ factors is 3.6. The research
question three is accepted because the group’s mean score is 3.6 and is greater
than the accepted benchmark of 3.0.
93
PART TWO, SCHOOL (B):
Research question one: what are the administrative factors (staffing) that
affect clinical training of nursing students?
The responses to items 7-11 in the questionnaire were analyzed to
answer questions on administrative factor, (staffing) and presented in Tables 8
and 9.
Table 8: Respondents (School B) views on administrative factors (staffing)
affecting clinical training of nursing students
n = 196
Items Teachers Students Total %
The Number of teachers in this school is:
< 4
4 to 6
7 to 10
11 and above
Total
f % f %
1
5
63
127
196
0.5%
2.6%
32.1%
64.8%
100%
1
1
3
14
19
5.3
5.3
15.8
73.7
0
4
60
113
177
0.0
2.3
33.9
63.8
Which of these act as clinical supervisors in your school:
clinical instructors only
preceptors only
ward staff nurses only
students are not being supervised
both clinical instructors and ward staff nurses
Total
7
0
2
2
8
19
36.8
.0
10.5
10.5
42.1
75
1
14
84
3
177
42.4
0.6
7.9
47.5
1.7
82
1
16
86
11
196
41.8%
0.5%
8.2%
43.9%
5.6%
100%
If you are supervised in the wards, how many of the
following staff do supervise the students during each shift
in the wards?
Clinical instructors only
1
2
3
4
Total
9
6
0
0
15
60
40
.0
.0
22
52
3
1
78
28.2
66.7
3.8
1.3
31
58
3
1
93
33.3%
62.4%
3.2%
1.1%
100%
Preceptors only: 1 Total
0 0
1 100
1
100%
Staff Nurses in the wards or clinical areas only: 1
2
3
4
Total
8
1
1
0
10
80
10
10
.0
8
4
2
3
17
47.1
23.5
11.8
17.6
16
5
3
3
27
59.3%
18.5%
11.1%
11.1%
100%
94
Table 8 showed that majority, 14 (73.7%) out of the 19 teachers stated
that the number of their teachers were 11 and above, while only 3 (15.8%)
indicated that teachers are 7-10 in number. On the other hand majority, 113
(63.8%) out of the 177 students noted that they had 11 and above teachers in
their school. While 60 (33.9%) indicated that they were 7-10 teachers in their
school.
The result showed also that 7(36.8%) of their teachers indicated that it
was only the clinical instructors that supervise the students, while 8 (42.1%)
teachers agreed that it was both the clinical instructors and the ward staff
nurses that supervise students during their clinical experiences. While 75
(42.4%) of the students noted that it was only the clinical instructors that
supervise the students, 14 (7.9%) indicated that it was only the ward staff
nurses that supervised them during clinical experiences but 84 (47.5%) stated
that the students were not supervised during clinical experiences.
On the number of clinical instructors that follow students at each shift, 9
(60%) teachers out of the 15 teachers that answered this item indicated that it
was one clinical instructor while 6 (40%) indicated that it was 2 clinical
instructors that follow students at each shift during their clinical experience.
While majority 52 (66.7%) of the students that answered clinical instructors
indicated that it was only two clinical instructors that supervised them at each
shift. The result showed also that the school may not have any preceptor since
only one student agreed to that statement.
95
The table further showed that 8 (80%) teachers out of the 10 teachers
that answered for number of nurses in the wards stated that it was only 1 staff
nurse that supervise students. On the other hand, out of the 17 (100%) students
that answered in support of the staff nurses, 8 (47.1%) students indicated that it
was only one staff nurse that supervise students during each shift while 4
(23.5%) indicated that it was two staff nurses that supervise the students at
each shift.
Table 9: Respondents (School B) views on administrative factors (staffing)
affecting clinical training of nursing students continued.
n = 196 Items Respondents NOP
1
SD
2
D
3
A
4
SA
5
Mean
score
SD Decision
Teachers in this
school are enough
to handle the
subjects in the
school.
Teachers
Students
1
6
5
5
9
118
1
34
3
14
3.00
3.25
1.106
.782
accepted
accepted
Teachers in this
school are involved
in supervision of
students in the
clinical areas.
Teachers
Students
1
7
9
104
5
15
3
41
1
10
2.68∗∗∗∗
2.68∗∗∗∗
1.003
1.052
rejected
rejected
Group mean score =2.9
Criterion mean = ≥≥≥≥ 3.0
NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected
Table 9 showed that both the teachers and the students are in
agreement that the teachers in the school are enough to handle the subjects
in the school with mean scores of 3.00 and 3.25 respectively. While they
did not accept that teachers in the school are involved in supervision of
students in the clinical areas with mean scores of 2.68 and 2.68
respectively. The group mean is 2.9 and is < 3.0.
96
Research question one continued: what are the administrative factors
(Infrastructure/Equipment) that affect clinical training of nursing
students?
The responses to items 12-18 in the questionnaire were analyzed to
answer questions on (Infrastructure/Equipment) and presented in Table 10.
Table 10: Respondents (School B) views on administrative factors
(Infrastructure/Equipment) affecting clinical training of nursing students
n = 196
Items Respondents NOP
1
SD
2
D
3
A
4
SA
5
Mean
Score
SD Decision
This school has practical
laboratory for students’
clinical practice.
Teachers
Students
1
0
0
9
2
2
13
138
3
28
3.89
4.05
.875
.611
accepted
accepted
The laboratory has a large
space for all the students
to observe what is being
thought.
Teachers
Students
1
6
8
66
9
89
1
14
0
2 2.53∗∗∗∗
2.66∗∗∗∗
.697
.722
rejected
rejected
The school laboratory has
enough equipment that
can enable many students
to practice procedures
during the same period
Teachers
Students
1
3
12
61
4
98
1
12
1
3
2.42*
2.72∗∗∗∗
.902
.689
rejected
rejected
The hospital has enough
needed equipment for the
number of students on
each shift to practice with
while on clinical
experience.
Teachers
Students
2
2
3
31
6
119
7
21
1
4
3.11
2.97∗∗∗∗
1.100
.656
accepted
rejected
Students/clients ratio in
each ward during clinical
periods is 1:5 for practice
under supervision.
Teachers
Students
1
8
2
19
7
59
7
85
2
6
3.37
3.35
1.012
.886
accepted
accepted
The school has a library
with current nursing text
books for references.
Teachers
Students
1
9
1
44
7
23
9
92
1
9
3.42
3.27
.902
1.053
accepted
accepted
Teachers and students use
the library. Teachers
Students
2
17
0
5
1
12
16
135
0
8
3.63
3.63
.955
.980
accepted
accepted
Group mean score = 3.1
Decision criterion mean = ≥≥≥≥ 3.0, NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected
97
Result in Table 10 showed that teachers and students in school (B) are in
agreement that their school has practical laboratory for students’ clinical
practice, (mean scores 3.89 and 4.05 respectively), that students/clients ratio in
each ward during clinical periods were enough for practice under supervision,
(mean scores 3.37 and 3.35 respectively), that the school has a library with
current nursing text books for references, (mean scores 3.42 and 3.27
respectively) and that teachers and students make use of the library, (mean
scores 3.63 and 3.63 respectively).
The table showed also that both respondents did not accept that the
laboratory has a large space for all the students to observe what is being taught,
(mean scores 2.53 and 2.66 respectively) and that the school laboratory has
enough equipment that can enable many students to practice procedures during
the same period with mean scores 2.42 and 2.72 respectively. But only the
teachers accepted that the hospital has enough needed equipment for the
number of students on each shift to practice with while on clinical experience
with mean score of 3.11 while the students rejected that statement with mean
score of 2.97.The group mean for administrative factors
(infrastructure/equipment) is 3.1 and is ≥ 3.0 which is the decision mean.
98
Research Question two: What are the training/supervisory factors used
for clinical training of nursing students?
The responses to items 19-29 were analyzed to answer questions on
training/supervisory factors in Table 11.
Table 11: Respondents (School B) views on training/supervisory factors affecting
clinical training of nursing students n = 196
Items Respondents NOP
1 SD
2
D
3
A
4
SA
5
mean
Score
SD Decision
The school authority does the
following to ensure that students
acquire the required nursing
skills:
Organize clinical conferences/
seminars for the students.
Teachers
Students 1
4
2
8
4
59
10
91
2
15
3.53
3.59
1.020
.800
accepted
accepted
Encourage students to participate
in planning of clinical teaching
programmes.
Teachers
Students 1
5
6
47
8
78
3
33
1
14 2.84∗∗∗∗
3.02
.958
.941
rejected
accepted
Provide mentors and preceptors
in each shift to coach the
students on the nursing skills.
Teachers
Students 1
4
10
108
5
35
2
27
1
3 2.58∗∗∗∗
2.53∗∗∗∗
.961
.840
rejected
rejected
Give students assignments
during clinical periods at least
once a week.
Teachers
Students 1
2
8
53
7
80
2
38
1
4 2.68∗∗∗∗
2.94∗∗∗∗
.946
.806
rejected
rejected
Teachers do finish teaching their
courses and practical before
students go to the clinical areas.
Teachers
Students 1
4
8
118
8
30
0
21
2
4 2.68∗∗∗∗
2.45∗∗∗∗
1.003
.818
rejected
rejected
Students do repeat
demonstration after teacher’s
own teaching during each
procedure.
Teachers
Students 1
3
0
5
1
33
11
74
6
62
4.11
4.06
.937
.896
accepted
accepted
Clinical orientations are given to
the students at the beginning of
each clinical posting.
Teachers
Students 1
4
0
3
1
6
11
137
6
27
4.11
4.02
.937
.678
accepted
accepted
The ward staff nurses follow the
correct procedure in carrying out
their job to enable students to
learn and do the right thing.
Teachers
Students 1
4
1
31
10
71
6
69
1
2
3.26
3.19
.872
.817
accepted
accepted
The ward staff nurses do
supervise the students during
each procedure.
Teachers
Students
2
3
1
14
8
11
1
7
39
1
10
3.21
3.22
1.032
.740
accepted
accepted
Supervisors do evaluate
students’ clinical experience at
the end of each clinical period.
Teachers
Students
1
6
4
47
9
73
4
38
1
13
3.00
3.03
.943
.956
accepted
accepted
The school provides field
trips/excursions as varied
teaching and learning
opportunities.
Teachers
Students
2
8
0
15
1
22
11
124
5
8
3.89
3.62
1.150
.879
accepted
accepted
99
Respondents’ views as shown in Table 11 revealed that both teachers
and students accepted that, the school authority organizes clinical
conferences/seminars for the students, (mean scores 3.53 and 3.59
respectively), that students are allowed to repeat demonstration after teacher’s
own teaching during each procedure, (mean scores 4.11 and 4.06 respectively),
that clinical orientations are given to the students at the beginning of each
clinical posting, (mean scores 4.11 and 4.02 respectively) and that the ward
staff nurses follow the correct procedure in carrying out their job to enable
students to learn and do the right things,( mean scores 3.26 and 3.19
respectively).
It is also noted from the table that both respondents are in agreement that
the ward staff nurses do supervise the students during each procedure, (mean
scores 3.21 and 3.22 respectively), that the supervisors do evaluate students’
clinical experience at the end of each clinical period, (mean scores 3.00 and
3.03 respectively) and that the school provides field trips/excursions to the
students as varied teaching and learning opportunities, (mean scores 3.89 and
3.62 respectively).
The table showed also that both teachers and students did not accept the
following: that the school authority provides mentors and preceptors in each
shift to coach the students on the nursing skills, (mean scores 2.58 and 2.53
respectively), that supervisors give students assignments during clinical
periods at least once a week, (mean scores 2.68 and 2.94 respectively) and that
100
the teachers do finish teaching their courses and practical before students go to
the clinical areas, (mean scores 2.68 and 2.45 respectively).
Only the teachers did not accept that the school authority encourage
students to participate in planning of clinical teaching programmes, (mean
score 2.84), while the students accepted that the school authority encourage
students to participate in planning of clinical teaching programmes, with mean
score 3.02. The group mean for training/supervisory factors is 3.2 and is ≥ 3.0
which is the decision mean.
101
Research Question three: what are the students’ factors that affect clinical
nursing training?
The responses to items 30-34 in the questionnaire were analyzed to
answer questions on students’ factors and presented in Table 12.
Table 12: Respondents (school B) views on students’ factors affecting clinical
training of nursing students n= 196
Items Respondents NOP
1
SD
2
D
3
A
4
SA
5
mean
score
SD Decision
Every student attends
clinical experiences
regularly as scheduled.
Teachers
Students
1
2
1
0
8
113
7
46
2
16
3.42
3.42
.961
.703
accepted
accepted
Every student attempts
the clinical assignments
/texts given to them.
Teachers
Students
1
5
1
3
5
18
10
137
2
4
3.58
3.86
.961
.697
accepted
accepted
The students make use
of the equipment in the
school laboratory for
clinical practice on their
own.
Teachers
Students
1
8
8
104
9
36
1
25
0
4
2.53∗∗∗∗
2.51∗∗∗∗
.697
.873
rejected
rejected
Students do the
following during
clinical experiences:
Self assessment of their
clinical performance.
Teachers
Students
2
16
3
93
9
13
3
41
2
14
3.00
2.68∗∗∗∗
1.106
1.159
accepted
rejected
Accepts corrections and
ask their ward staff
nurses questions during
clinical experience.
Teachers
Students
2
16
0
3
3
3
10
45
4
110
3.74
4.30
1.147
1.199
accepted
accepted
Students use the
nursing care procedures
book during clinical
experience a s a guide
for practice.
Teachers
Students
2
18
0
2
8
2
7
137
2
18
3.35
3.76
1.065
1.011
accepted
accepted
Group mean score =3.3
Decision criterion mean = ≥≥≥≥ 3.0,
NOTE: ∗∗∗∗ indicates mean score <<<< 3.0 and rejected
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Table 12 showed that both teachers and students in school (B) accepted
that every student attends clinical experiences regularly as scheduled, (mean
scores 3.42 and 3.42 respectively) and that every student attempts the clinical
assignments/texts given to them with mean scores of 3.58 and 3.86
respectively. Both respondents are also in agreement that students accepted
corrections and ask their ward staff nurses questions during clinical experience,
(mean scores 3.74 and 4.30 respectively) and that students use the nursing care
procedures book during clinical experience as a guide for practice with mean
scores of 3.35 and 3.76 respectively.
The result showed also that both teachers and students did not accept
that the students make use of the equipment in the school laboratory for
clinical practice on their own with mean scores of 2.53 and 2.51 respectively.
Only the teachers indicated that the students do self assessment of their clinical
performance, mean score 3.00 while the students did not accept that they do
self assessment of their clinical performance with mean score of 2.68. The
group mean for the students’ factors is 3.3 and is ≥ 3.0 which is the decision
mean.
Testing of hypotheses:
The decision rule: If Z- test score > P-value (critical value), the null
hypotheses is rejected which showed that there is significant statistical
difference on the item between the two schools. But if the Z-test score is < P-
103
value (critical value), the null hypothesis is accepted which shows that there is
no significant statistical difference on the item between the two schools
Hypotheses one: There is no significant statistical difference in the
administrative factors affecting clinical training of nursing students
between the two schools under study.
The responses for items 10-18 in the questionnaire were tested to verify
this hypothesis and presented in Table 13.
Table 13: Z- test significance of difference between the two institutions of study as
regard the administrative factors affecting clinical nursing training
n = 311
Items Z – test
scores
P- value Decision
Teachers in this school are enough to handle the
courses in the school.
- 5.766 .000∗∗∗∗ rejected
Teachers in this school are involved in
supervision of students in the clinical areas.
-.968 0.334 accepted
This school has practical laboratory for students’
clinical practice.
6.930 .000∗∗∗∗ rejected
The laboratory has a large space for all the
students to observe what is being thought.
18.120 .000∗∗∗∗ rejected
The school laboratory has enough equipment that
can enable many students to practice procedures
during the same period.
19.757 .000∗∗∗∗ rejected
The hospital has enough needed equipment for
the number of students on each shift to practice
with while on clinical experience.
-8.805 .000∗∗∗∗ rejected
Students /clients ratio in each ward during
clinical experience is enough for students
practice.
-14.359 .000∗∗∗∗ rejected
The school has a library with current nursing text
books for references.
10.540 .000∗∗∗∗ rejected
Teachers and students use the library. -16.241 .000∗∗∗∗ rejected
Level of significance = P <<<< 0.05
NOTE: ∗∗∗∗ indicates significance difference at P <<<< 0.05
Z - test score >>>> P- value (critical value) = reject the hypothesis
104
The result in Table 13 showed that significant statistical differences exist
between the schools with regard to administrative factors affecting clinical
training of nursing students. In all the nine items on administrative factors
affecting clinical nursing training, statistical significance mean differences
exist between the schools except in one (item 2). But both schools had average
mean scores < 3.0 in item 2, which implies that both disagreed that the teachers
are involved in clinical supervision of the students. There is no significant
statistical mean difference between the schools in item number 2, (Z=.968,
P=0.334).
For items 1, 6, 7&9, school (A) had mean scores < 3.0, therefore,
rejected all the assertions while school (B) had mean scores ≥ 3.0, so agreed
with the statements. There were significant statistical differences between the
schools in these items, so the null hypothesis is rejected. The alternative being
that school (A) do not have enough teachers to handle school courses, not
enough equipment for students clinical practice in the hospital, inadequate
number of clients for students practical training and that teachers and students
do not make use of the school library.
School (B) had mean scores < 3.0 in items 4 & 5, while school (A) had
mean scores ≥ 3.0 in those items. There were significant statistical mean
differences between the schools, so the null hypothesis is rejected. The
105
alternative is that school (B) did not have a large practical laboratory and not
enough equipment for students practice in the laboratory.
For item 3 and 8, both schools had mean scores ≥ 3.0, therefore they
agreed with the assertions that they have practical laboratory and library with
current nursing text books for students use. However, school (A) mean scores
on the two items (4.54; 3.85) were significantly higher than that of school (B),
(3.97; 3.35). The z-test scores were z = 6.932, p= 0.000; z = 10.540, p = 0.000
respectively. Therefore the null hypothesis is rejected and the alternate
hypothesis is accepted. School (A) agreement is stronger.
106
Hypotheses two: There is no significant statistical difference in the
training/supervisory factors affecting clinical training of nursing students
between the two schools under study.
The responses for items 19-29 in the questionnaire were tested to verify
hypothesis 2 in Table 14.
Table 14: Z- test significance of differences between the two institutions with
regard to the training/supervisory factors affecting clinical nursing training
n = 311
Items Z – test P- value Decision
The school authority does the following:
organize clinical conferences/seminars for the
students
-5.940 .000∗∗∗∗ rejected
Encourage students to participate in planning of
their clinical training programmes
-2.328 .021∗∗∗∗ rejected
Provide mentors and preceptors in each shift to coach
the students on the nursing skills.
-5.092 .000∗∗∗∗ rejected
Give students assignments during clinical periods at
least once a week.
-3.667 .000∗∗∗∗ rejected
Teachers do finish teaching their courses and clinical
procedures before students go to the clinical areas.
-4.468 .000∗∗∗∗ rejected
Students are allowed to demonstrate after teachers’
own teaching during each procedure.
6.723 .000∗∗∗∗ rejected
Clinical orientation is given to the students at the
beginning of each clinical posting.
-17.942 .000∗∗∗∗ rejected
The ward staff nurses follow the correct
Procedures in carrying out their job to enable
students to learn and do the right thing.
-3.512 .001∗∗∗∗ rejected
The ward staff nurses do supervise the students
during each procedure.
-1.666 .097 accepted
Supervisors do evaluate students’ clinical experiences
at the end of each clinical period.
-4.653 .000∗∗∗∗ rejected
The school provides field trips/ excursions as varied
teaching and learning aid.
1.083 .280 accepted
Level of significance = P <<<< 0.05
NOTE: ∗∗∗∗ indicates significance difference at P <<<< 0.05
Z- test score >>>> P- value (critical value) = reject the hypothesis
107
The result in Table 14 showed that significant statistical differences
existed between the schools with regard to training/supervisory factors
affecting clinical training of nursing students. In all the eleven items on
training/supervisory factors affecting clinical nursing training, statistical
significance mean differences existed between the schools except in two items
(items 9 & 11) but both schools had average mean scores ≥ 3.0 which implies
that both schools agreed that the ward staff nurses do supervise students during
each procedure in the clinical areas and that the school provide field
trips/excursions as varied teaching and learning aid. There is no significance
statistical mean difference between the schools, (z = -1.666, p = 0.097 &
z = 1.082, p = .280).
For items 3, 4& 5, both schools had mean scores < 3.0, therefore they
disagreed with the following statements: that the school authority provides
mentors and preceptors in each shift to coach students, gives students
assignments at least once a week and that teachers finish teaching their courses
before students go to the clinical areas. However, school (B) mean scores in the
three items (2.54, 2.91 & 2.47) were a bit higher, (z = -5.092, p= .000;
z = -3.667, p= .000; z = -4.469, p= .000), than that of school (A) (2.11, 2.56 &
2.10). Therefore the null hypothesis is rejected and the alternate hypothesis is
accepted.
For items 1 & 6, both schools had mean scores > 3.0, therefore they
agreed with the statements that the school authority organize clinical
108
conferences/seminars for the students and that students do repeat
demonstration after teachers’ own teaching during each procedure. However,
school (B) mean score in item 1 (3.59) is a bit higher than the mean score of
school (A) 3.03, (z = -5.940; p = .000). Also, school (A) mean score in item 6
(4.69) is a bit higher than the mean score of school (B) 4.06, (z = 6.723; p =
.000). Therefore, the null hypothesis is rejected and the alternate hypothesis is
accepted.
For items 2, 7, 8 & 10, school (A) had mean scores < 3.0, therefore
rejected all the assertions while school (B) had mean scores ≥ 3.0, therefore,
accepted the statements. There were significant statistical differences (z =
-2.328, p = .021; z = -17.942, p = .000; z = -3.512, p = .001 & z = -4.653,
p = .000) between the schools in these areas. So the null hypothesis is rejected.
The alternative being that in school (A), the school authority do not encourage
students to participate in planning of their clinical training programmes,
clinical orientation are not given to the students at the beginning of each
clinical posting, ward staff nurses do not follow the correct procedures in
carrying out their job and also that the supervisors do not evaluate students
clinical experiences at the end of each clinical period. Therefore, the null
hypothesis is rejected and the alternate hypothesis is accepted.
109
Hypotheses three: There is no significant statistical difference in students’
factors affecting clinical training of nursing students between the two
institutions under study.
The responses for items 30-34 in the questionnaire were tested to verify
this hypothesis 3 in Table 15.
Table 15: Z- test significance of differences between the two institutions of
study with regard to the students’ factors affecting clinical nursing training
n = 311 Items Z – test
score
P- value Decision
Every student goes for his/her clinical experiences
regularly as scheduled.
15.832 .000∗∗∗∗ rejected
Every student attempts the clinical assignments /
tests given to them.
1.017 .310 accepted
Students make use of the equipment in the school
laboratory for clinical practice on their own.
7.045 .000∗∗∗∗ rejected
Students do the following during their clinical
experience: Self assessment of their clinical
performance.
2.879 .004∗∗∗∗ rejected
Accept corrections and ask ward staff questions. 2.927 .003∗∗∗∗ rejected
Students use the nursing care procedure book during
clinical experience as a guide for practice.
4.084 .000∗∗∗∗ rejected
Level of significance = P <<<< 0.05
NOTE: ∗∗∗∗ indicates significance difference at P <<<< 0.05
Z- test score >>>> P- value (critical value) = reject the hypothesis
The result in Table 15 showed that significant statistical differences exist
between the schools with regard to the students’ factors affecting clinical
training of nursing students. In all the six items on the students’ factors
110
affecting clinical nursing training, statistical significance mean differences
exist between the schools except in one (item 2) but both schools had average
mean scores ≥ 3.0 which implies that both schools agreed that every student
attempts the clinical assignments/tests given to them. There is no significant
statistical mean difference between the schools, but (z = 1.017, P = .310).
For items 3 & 4, school (B) had mean scores < 3.0, while school (A) had
mean scores ≥ 3.0. There are significant statistical mean differences
(z = -5.092, p = .000 & z = -3.667, p = .000) between the schools, so the null
hypothesis is rejected. The alternative is that in school (B), students do not
make use of the equipment in the school laboratory for clinical practice by
themselves and students do not perform self assessment of their clinical
performance.
For item 1, 5 and 6, both schools had mean scores ≥ 3.0, therefore they
agreed with the assertions that every student goes for his/her clinical
experiences regularly as scheduled, students accept corrections and ask ward
staff nurses questions and that students use the nursing care procedure book
during clinical experience as a guide for practice. However, school (A) mean
scores on the three items 4.74; 4.61 & 4.16 were significantly higher than that
of school (B), 3.42; 4.24 & 3.72, the z-test is (z= 15.832, p = 0.000; z =2.927,
p = .003 & z = 4.084, p = 0.000). Therefore the null hypothesis is rejected and
the alternate hypothesis is accepted. School (A) agreement is stronger.
111
Summary of the Findings
The following were the major findings from both nursing institutions
which contributed positively or negatively to acquisition of nursing skills.
In school (A), respondents accepted that the following factors contributed
positively to students’ clinical training:
- Provision of practical laboratory with enough equipment for students
use for practice,
- Practical laboratory with large space for all the students to observe what
is being thought,
- Library with current nursing text books for references,
- Students repeat demonstration of practical procedures after teachers own
teaching,
- Provision of field trips/excursions as training opportunities,
- Involvement of ward nurses in students’ clinical training,
- Students’ attendance of clinical experiences regularly and doing
assignments given to them,
- Students’ ability to practice on their own and using their procedure
manual as a guide for practice (mean scores ≥3.0).
In school (A), respondents accepted that the following factors contributed
negatively to nursing students’ clinical training:
- Inadequate number of teachers to handle subjects in the school,
- Teachers’ non involvement in clinical supervision of students,
112
- Teachers’ inabilities to finish teaching their courses before students go to
the clinical areas,
- Inadequate equipment in the clinical areas for students practice,
- Students’ non usage of the school library,
- Insufficient client in the clinical areas for students practice
- Inadequate number of supervisors for clinical training of students,
- Non provision of mentors and preceptors to coach nursing students,
- Supervisors’ inability to give proper supervision and evaluation of clinical
performance of students
- Students’ non participation in planning their clinical programme (mean
scores < 3.0).
In school (B), factors that contributed positively to nursing students’ clinical
training are:
- Adequate number of teachers to handle the subjects in the school,
- Provision of practical laboratory for students use,
- Provision of library with current nursing text books,
- Teachers and students usage of the school library,
- Sufficient client in the clinical areas for students practice
- Organizing clinical conferences/seminars for students,
- Involvement of ward nurses in students training,
- Students repeat demonstration of procedures,
- Students’ attendance of clinical experiences regularly
113
- Students’ usage of their procedure manual as a guide for practice
In school (B), factors that contributed negatively are:
- Teachers’ non involvement in clinical supervision of students,
- Teachers’ inabilities to finish teaching their courses before students go to
the clinical areas,
- Small spaced practical laboratory that do not allow students to observe
what is being thought,
- Inadequate equipment in their school laboratory and in the clinical area,
- Inadequate number of nursing text books in their library,
- Inadequate number of supervisors for clinical training of students,
- Non provision of mentors and preceptors to coach nursing students,
- Supervisors’ inability to give proper supervision and evaluation of clinical
performance of students
- Students’ non participation in planning their programme,
- Students’ inability to practice on their own and to do self assessment of
their clinical performance (mean scores < 3.0).
- Findings revealed that there were significant statistical differences between
the two nursing institutions as regards the administrative,
training/supervising and students’ factors affecting clinical training of
nursing students as evidenced by the Z-test score > P-values in most items
tested in the three hypotheses.
114
CHAPTER FIVE
DISCUSSION OF FINDINGS
This chapter presents discussion of major findings, implications for
nursing education and practice, recommendations, limitations to the study,
suggestions for further studies, summary and conclusion.
Administrative factors that affect clinical training of nursing students in
the schools’ laboratory and in the clinical areas
The findings of this study showed that the number of students (283)
outweighed that of the teachers (28) with ratio as 1: 10; (school (A) 1: 6 and
school B 1: 5) when considered that only a section of the students were used
for the study. This implies that the teachers will find it difficult to manage the
students both in the schools and in the clinical areas. This finding can be
considered as one of the constraining factors to appropriate acquisitions of
nursing skills because the teachers may not finish the course work on time and
the students may not be adequately supervised during clinical experiences.
This affirms the statement made by Lohor (2005) that where the number of
nurse teachers is inadequate, the few available ones are faced with the
problems of coping with a large class of students for the classroom work and
clinical supervision. Also, the study done by Withiphong et al (2009) revealed
that inadequate number of teachers/supervisors were a significantly influencing
factor to the clinical learning behaviour of student nurses.
115
The findings also showed that the students were not properly supervised
during clinical experience; that it was mainly one or two clinical instructors
that supervise students, (school (A) 44.3%, school (B) 62.4%), for both the
teachers and students. Although the ward staff nurses are there, few
occasionally do supervise the students. This may be due to shortage of these
nurses or overloaded work. Lack of proper supervision will lead to wrong
learning of nursing skills, laziness and non motivation on the part of the
students. This leads to truancy during clinical experiences. This finding is in
line with some of the findings identified in the studies done by Sumari-Ayo
(2006) and Sharif and Masoum (2005). They reported overwork of teachers
and preceptors due to shortage of staff and that the ward staff nurses were not
concerned about what students learn. Staff nurses were busy with their duties
therefore not able to assume both educational and service role while on duty.
The situation where there is inadequate supervision of students implies that the
students are on their own without guidance. This poses serious danger to both
the patients and the students and also hinders learning/acquisition of required
nursing skills which are needed for quality nursing care.
Although the study revealed that only the respondents in school (B)
accepted that their teachers were enough to handle the subjects in the school,
(mean score 3.23), both schools rejected the issue of their teachers being
involved in supervision of students in the clinical areas, (mean scores, school
A= 2.57, school B= 2.68). This implies that what the students learnt in the
116
classroom are not made concrete in real life situations in the wards, thereby
creating theory–practice gap and poor nursing skill learning. This study
supported some of the findings in the studies done by Warner et al (2010) and
that of Sharif and Masoum (2005) which showed that majority of the
supervisors were ward staff nurses without the nurse teachers. Their teachers
acted mainly as practical examination evaluators but not as clinical
facilitators/supervisors. Also, in the study the students were confused because
what they learnt in the classroom were different from what was done in the
clinical areas, leading to lack of integration of theory into clinical practice.
In relation to the items on infrastructure/equipment, the respondents
accepted that both schools had practical demonstration laboratory, (mean
scores, 4.51 and 4.03) but only school (A) had a large spaced practical
laboratory and enough equipment needed for practice, (mean scores, 4.27 and
2.65). They also accepted that both schools had a library each, (mean scores,
4.48 and 3.29) but only the teachers and students in school (B) made use of
their library, (mean scores, 2.10 and 3.63 respectively). But they rejected the
statement that the hospitals had enough needed equipment for students
practice. Also, only school (B) had enough clients for students practice under
supervision, (mean scores, 2.09 and 3.35). Where nursing schools have enough
of these items, it showed that students can participate actively using the
equipment when procedures are being taught. Where there are lacks of
equipment in the wards, this makes what is learnt in the school not to be put
117
into practice in real situations in the wards. This jeopardizes learning and skill
acquisition because practice makes perfect and better nursing care delivery.
This supported the report from Sumari-Ayo (2006) and Bray et al (2011)
studies which indicated that the school skill laboratory and the hospital wards
lacked equipment and other necessary supplies, which do not help students to
practice and concretize what they learnt in the classroom. They noted also that
student’s inability to competently carry out urethral catheterization after their
graduation was influenced by lack of exposure to the clinical skills. Also
Searle (2000) identified lack of equipment/infrastructure as one of the
constraining factors affecting clinical training of students in nursing
profession.
Training/supervisory factors that affect the clinical training of students in
the schools and in the clinical areas
This study revealed that respondents from both institutions accepted that
the school authority organized clinical conferences/seminars for the students,
(mean scores, 3.03 and 3.59), but school (A) rejected the issue of encouraging
students to participate in planning their programmes, (mean scores, 2.78 and
3.01). By organizing conferences and seminars for the students, they expose
the students to varieties of knowledge and experience which helped them to
interact with other people, develop critical thinking skills and also up date
them with current issues in nursing and other professions. Wuthiphong et al
(2009), Career et al (2012) and Williams et al (2011) observed that when
118
students paid attention to orientations, seminars and conferences they learned
better and acquire more knowledge and skills. However, when students are not
involved in planning of their programme, it decreases their zeal and interest in
their affairs. Students become dependent on the planners and are uninterested
in such programme. This finding is contrary to the assertions of Quinn (2001)
that supervisors and the student nurses should participate in the planning and
preparation of the programme for clinical training so as to foster their interest
and active involvement in the activities.
The findings also revealed that the respondents rejected the statement
that the school authority provides mentors and preceptors to coach students
while on clinical experience, (mean scores, 2.11 and 2.54); that supervisors
give students clinical assignments during clinical periods, (mean scores, 2.56
and 2.91) and also that their teachers finish teaching their courses and practical
teaching before the students go to the clinical areas, (mean scores, 2.10 and
2.47). This confirms that there is not much supervision and assessment of
students’ clinical training. It showed also that due to lack of mentors and
preceptors in the clinical areas, there will not be ongoing assessment and direct
correction of students during nursing procedures in the clinical areas. The
students do not have mentors to imitate and be motivated to work. There is no
individual student follow up, proper drilling and on the spot correction and
guidance as can be given by the preceptors. Not given assignment to students
will not help to identify the weak points and strengths of the students learning
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so as to know how to help each student. Inability of the teachers to finish
teaching their courses before students go for clinical experience may be due to
overload of work; lack of motivation of the teachers or nonchalant attitude of
the teachers. This will not help to concretize the skills since students had no
prior knowledge of the topic in theory. The findings are contrary to the
assertions of Shariff et al (2005) that provision of professional nurses such as
mentors, preceptors and clinical instructors as supervisors of students during
clinical experience periods ensure efficiency and make sure that supervisors
impart the right knowledge, develop the needed nursing skills and mental
faculty of the students they supervise. The findings also differ from the
findings of Warner et al (2010) which noted that 75% of the students recorded
satisfaction with the successful mentor ship experience they observed in the
wards which enhanced nursing skill acquisition. Findings differ from the result
of the study done by Meechan et al (2011) which identified that the
introduction of clinical skills teaching and assessment within a university’s
simulation laboratory and augmented with structured assessment within the
clinical environment improved the acquisition of clinical skills.
The study further showed that the respondents from both schools
accepted that the students repeat demonstration after the teachers own
teaching, (mean scores, 4.69 and 4.06), that in school (B), clinical orientations
were given to the students at the beginning of each clinical posting, (mean
score, 4.03) and that the ward staff nurses followed the correct procedure in
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carrying out procedures, (mean score, 3.20), while these were not done in
school (A), (mean scores, 2.58 and 2.89). Both schools accepted that the ward
staff nurses supervise the students during each procedure. In line with the
above statement, giving of clinical orientation to students before each clinical
posting gives a clear knowledge and direction to the students and minimizes
the tension or fear of making mistakes; that the ward staff nurses’ followed the
correct procedures; made it easier for the students to imitate and learn better
and faster. These findings support the findings in the study done by Career et al
(2012), that allowing students to participate during clinical procedures
facilitates concreteness of skills. Also, that students paying attention to the
clinical orientations given to them help the students to learn better as identified
in a study done by Wuthiphong et al (2009). Ward nurses following the correct
procedure promoted the assertion posited by Waldock (2010) which stated that
registered nurses working with student nurses in the clinical settings have a
major influence on the students’ performance. This is because they are more
with the students than their other supervisors. They can promote and facilitate
students learning or cripple them.
The result that staff nurses supervise students in the wards is in line with
what Warner et al (2010) identified in their study, that majority of their
supervisors were staff nurses in the wards while few were specialist nurses.
But the finding is not in agreement with the study done by Shariff et al (2005)
121
which stated that the ward staff nurses were not concerned about what students
do or learn.
The respondents from both schools rejected the idea that their
supervisors do evaluate students’ clinical experiences at the end of each
clinical period. This may be due to lack of supervisors or overload of the few
available ones. This will not give clue to students’ performance and areas of
deficiencies. Inability of the supervisors to evaluate students’ clinical
experiences goes contrary to the findings in the study carried out by Warner et
al (2010) where students rated the supervisory relationship between them and
their supervisors very high because of the mutual relationship between them. It
is also not in line with the assertions of Oermann et al (2009) which advocated
evaluation technique as a toll for identifying the deficiencies and areas of
weakness and strength in clinical training.
The respondents accepted that the schools provide field trips/ excursions
as a means of exposing the students to other learning opportunities in other to
fortify learning, (mean scores, 3.75 and 3.64). This is in line with the
objectives of clinical nursing education as identified by Quinn (2001) and it
includes provision of orientation to students, provision of accessible and
appropriate varied training opportunities.
The students’ factors that may affect clinical training of nursing students
Findings of this study, suggested that teachers and students from both
schools identified less problems on students factors affecting clinical training
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of nursing students. This may be due to the students’ interests and likeness of
nursing profession or may be to avoid being reprimanded by the school
authorities. Attending clinical experiences as scheduled, (mean scores, 4.74
and 3.42) is in line with the stipulations of the N&MCN concerning minimum
hours for clinical experiences, (4,400 hours) which qualifies students for taking
the professional examinations, (Curriculum for General Nursing Education in
Nigeria 2001). Students attempting clinical assignments/tests given to them
form part of the formative and summative evaluation of their clinical
experiences, as noted by Oermann et al (2009).
The findings of this study also identified that students in school (B) do
not use equipment in the laboratory to practice on their own and also that they
do not do self assessment of their clinical performance, (mean scores, 2.51 and
2.71). This may be due to lack of interest or lack of motivation of the students.
The rejection of these assertions do not support the finding in the study done
by William et al (2011) which indicated that a relative freedom to students and
motivation for students to pursue their own learning needs and practices on
their own helped their self confidence and increased nursing skill acquisition.
Also the findings are contrary to what Gardner and Supplee (2010) noted in
their study that interest in ones training is a key factor for effective teaching
and learning.
Result of this study showed that the respondents from both schools
agreed that students do accept corrections and ask questions to their ward staff
123
nurses, (mean score, 4.61 and 4.24). Also they accepted that students use the
procedure book during clinical experiences, (mean score, 4.16 and 3.72). This
may be due to their interest in clinical training and motivation given to them by
their supervisors in the wards. The results are in support with what
Wuthiphong et al (2009) reported in their study, that students reporting
immediately when they notice abnormal signs and symptoms in a patient to
their supervisors or ward nurses around them, helped students to learn better.
Also Carer et al (2012) noted in their study that mentors’ willingness to answer
students’ questions facilitated learning. The findings are also in line with the
assertions of Melone (2010) that students’ performance in nursing clinical
experiences depends on the students’ interest in the course. Accepting the
usage of procedure books during clinical experience as a guide for practice is
in line with the N&MCN mandate to each nursing school. It serves as
directives or patterns of carrying out nursing care procedures, (Curriculum for
General Nursing Education in Nigeria, 2001).
Hypotheses one:
There is no significant statistical difference in the administrative factors
affecting clinical training of nursing students between the two nursing
institutions under study?
The null hypothesis one (Ho1) was rejected indicating that there are
significant statistical differences between the two schools as regards the
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administrative factors affecting clinical training of nursing students and
alternate hypothesis accepted.
In testing hypothesis one, the results showed that there were significant
statistical differences between the schools in all the items of the administrative
factors affecting clinical training of nursing students except in one item, item
2, (z = -.968, p = 0.334).This result implies that the result is similar in both
schools, because their teachers are not involved in supervision of students in
the clinical areas with mean scores, school (A) = 2.57 and school (B) =2.68.
Findings showed that there were significant statistical differences
(z = - 5.766; p = 0.000) between the two schools of study as regards whether
the schools have enough teachers to handle the subjects in the schools. School
(A) had not enough teachers compared to school (B). Nursing schools not
having enough teachers to teach in the schools leads to poor quality nursing
education and practice because of poor nursing knowledge and nursing skills
acquisition.
The result also showed that there is no significant statistical difference
(z = -.968, p = 0.334) between both schools as regards teachers being involved
in supervision of students. Both schools had mean scores < 3.0 in that item.
This implies that the teachers in both schools do not supervise their students
while on clinical experience, thereby creating theory practice gap. This is in
line with what Sharif et al (2005) described as lack of integration of theory into
clinical practice. These findings agreed with the findings of Sumari-Ayo
125
(2006) and Warner et al (2010), which indicated that the teachers were
overworked due to shortage of teachers and that the students rated their nurse
teachers role of supervision low during clinical experiences because of the
teachers non involvement in their clinical supervision. Also Lohor (2005)
emphasized that one of the constraints of clinical training of nursing students is
inadequate number of trained teachers both in the classroom and in the clinical
areas where students do their experiences.
The result indicated that in school (B), the size of the school practical
laboratory is not large enough to accommodate their students’ population and
there is also not enough equipment for practice in the practical laboratory.
Practical laboratory without a large space will make it difficult for the students
to observe the teacher clearly during demonstration of practical procedures and
this hinders nursing skill acquisition. This is in line with the finding of Sumari-
Ayo (2006) who found that the school practical laboratory was small and lack
basic equipment for practice thereby hindered most of the students from
observing what the teacher demonstrated and led to lack of nursing skill
acquisition. WHO (1999) indicated that appropriate clinical learning facilities
such as spacious practical laboratory should always be made available to make
learning concrete and easier to reproduce when needed.
There is also a significant statistical difference (z = 8.805, p = 0.000)
between the schools in the aspect of having enough needed equipment in the
hospital wards. School (A) does not have enough equipment in the hospital for
126
practice. The implication is that even if the students do the practice in the
school, it cannot be repeated in the hospital wards because of lack of
equipment and lack of clients in the wards so as to concretize the procedures
learnt theoretically. This finding is in line with that of Sumari-Ayo (2006) who
reported that the hospital wards lack basic equipment and necessary supplies
leading to lack of skill acquisition. This finding is one of the constraints of
clinical nursing training identified by Searle (2000) which indicated that
clinical nursing training need varieties of equipment for students’ practice.
This helps learning to be concrete and enhances nursing skill acquisition.
There is significant statistical difference (z = -14.359, p = 0.000)
between the schools on the statement of student/clients ratio. The deficiency
was reported in school (A). This lack of clients hinders students from the use
of life objects to practice with under supervision so as to concretize theories
learnt in the classroom. The finding is against N&MCN educational standard
for student /clients’ ratio to ensure adequate training of students (Curriculum
for General Nursing Education, in Nigeria, 2001). Williams and West (2011)
stated that the number of patients which students took care of during their
clinical experiences help them to acquire the required nursing skills.
Although there is a significant statistical difference (z=10.540, p=.000)
between the schools on whether the two institutions have libraries, the
difference is not much as seen in the mean scores of school (A) = 4.48 and
school (B) = 3.29 which are above mean decision point. But there is an
127
outstanding difference in the usage of the library, because teachers and
students in school (A) do not make use of their own library, (mean score 2.10).
The finding indicated that School (A) has a library with current nursing text
books but both the teachers and the students do not make use of the library.
While as school (B) respondents reported that they have a library and they
make use of the books as references. None usage of the school library is not in
line with the assertion of Melone (2010) which stated that good library and
equipment used in the nursing schools and clinical areas are regarded as the
life wire of any nursing school to achieve a meaningful nursing education.
Also WHO (1999) indicated that appropriate clinical learning facilities such as
laboratory, library, equipment and supplies should always be made available
and maintained regularly to make learning concrete and easier to reproduce
when needed.
Hypotheses two:
There is no significant statistical difference in the training/supervisory
factors affecting clinical training of nursing students between the two
nursing institutions under study?
In nine out of the eleven items on training/supervisory factors,
significant statistical differences exist between the institutions. Therefore, the
null hypothesis two (Ho2) was rejected in these and alternate hypothesis
accepted as regards to the training/supervisory factors affecting clinical
training of nursing students.
128
Significant differences between the schools were noted in the aspects of
organizing clinical conferences/seminars for the students and encouraging
students to participate in planning their clinical teaching programmes as
presented in Table 14, (z = -5.940, p = .000 & z = -2.328, p = .021). When
students partake in making decisions concerning them, they have great interest
in the programme and also achieve self worth or self confidence which
motivates learning. Gardner et al (2010) noted that involvement of nursing
students from the onset of planning any programme enable them to discover
solutions to problems by themselves and not to be mere speculators. This
heightens their interest in such endeavor. Salmon and Gutema (2004) asserts
that students’ participation and mentors willingness to answer questions are
some of the factors that facilitate nursing skill acquisition.
There is also significant statistical difference, (z = -5.092, p = .000)
between the schools on the item of provision of mentors and preceptors in both
schools. Lack of or inadequate number of these personnel hinders direct
teaching and supervision of students during their clinical experience. This
leads to poor nursing skill acquisition and is inferred in nursing practice. This
is in line with the findings of Wuthiphong et al (2009) which indicated that
inadequate number of experienced teachers, mentors, preceptors and
supervisors were a significantly influencing factor to the clinical training
behaviour of student nurses. This is an opposite of what Warner et al (2010)
identified in their study where 75% of the students recorded satisfaction with
129
the successful mentorship experiences they observed in the wards which
enhanced skill acquisition.
Findings revealed significant statistical differences (z = -3.667, p = .000
& z = -4.468, p = .000) between the schools on the item of supervisors giving
assignments to students during clinical experience periods and on whether
teachers do finish teaching the courses before students proceed for clinical
experience. However, both schools failed in fulfilling both items as both
schools scored below the mean decision point, (school (A) =2.56 &2.10,
school (B) 2.91&2.47). Inability of the supervisors to give students
assignments will not allow the supervisors to identify the weak points in each
student’s skill acquisition, leading to poor learning and practice. Also, where
teachers do not finish teaching the courses before students proceed for clinical
experiences, leaves the students ignorant of that knowledge and needed nursing
skills. This leaves students to learn on the job, students lack interest in the
work and play truancy during clinical experiences. Inability of the teachers to
finish their courses before clinical experiences kept the students feeling
anxious in their initial clinical placement, worried about giving wrong
information to the clients and lacks integration of theory into clinical practice
as identified by Sharif et al (2005) in their qualitative study.
Result showed that School (A) students were allowed to repeat
demonstration after teachers own teaching more than students from school (B),
mean scores 4.69 & 4.06. When students repeat what the teacher has
130
demonstrated, students learn better and the teacher has the opportunity to
correct mistakes on the spot to prevent students from learning wrongly. But
where this is not done, students stick to the wrong procedures they may have
learnt from anybody. When students demonstrate after teachers own teaching,
it forms part of the advanced beginners’ stage of the Dreyfus model of skill
acquisition which propels students up to the next level of skill learning,
(Benner, 2004). Teachers’ drilling of instructions, demonstrating and
practicing procedures with adequate equipment and supervision of students,
helped the students to leave the former stage of novices’ stage to advanced
beginner’s stage, (Benner 2004).
The results of the items about giving clinical orientation to students and
whether the ward staff nurses follow the correct procedures, indicated
significant statistical differences (z = -17.942, p = .000 & z = -3.512, p = .001)
between the schools. In school (A), students score of 2.89 in item (8) implies
that ward staff nurses do not follow the correct procedure in doing their jobs.
Students learn by imitation, therefore where the ward staff nurses who are
more with the students do not follow the correct procedures while doing their
jobs, students learn the wrong procedures. Not giving clinical orientation
before students proceed for clinical experiences, make students to be ignorant
of the learning expectations in the wards, hence the students are not motivated
and they lack interest. These results differed from the findings of Wuthiphong
et al (2009) which indicated that students were given orientation and that
131
students paying attention to orientation before clinical practical experience
helped them to learn better. Also Quinn (1996) highlighted that one of the four
key elements that affect clinical training of students is that they learn also by
imitation as the teaching learning support from their ward staff nurses.
In both schools the ward staff nurses supervise the student nurses in the
clinical areas. This is an asset and an observation of the ethical legal duty of
accountability by the trained nurses. This is in line with the findings of Warner
et al (2010) where students identified that majority of their supervisors were
staff nurses in the wards while few were specialist nurses. On the contrary
Sharif et al (2005) found out that the ward staff nurses were not concerned
about what the students learn. They are busy with their duty schedule and
cannot combine supervisors’ role with their duty. Waldock (2010) asserted that
registered nurses working with student nurses in the clinical settings have a
major influence on students’ performance as they are more with the students
than their other supervisors.
There is significant differences (z score = -4.653, p-value =.000)
between the two schools on whether the supervisors evaluate students during
clinical experiences. School (A) rejected that statement. Lack of evaluation of
students’ performance may be due to shortage of supervisors or inexperience
or both. This does not reflect proper evaluation of students clinical
performance, teaching and prompt correction of students. Evaluation helps to
132
elicit the extent to which learners have achieved the educational objectives,
(Dermann et al 2009).
There is no significant differences (z = 1.082, p = .280) between the two
schools as regards providing field trips/excursions for the students. Both
schools provide this experience as both had mean scores of 3.75 & 3.64. Field
trips/excursions provide students with more avenues of learning and makes
knowledge more concrete as they see, touch or work with concrete objects. It
provides interactive medium for students as they chat and interact with other
people not from their locality or school. Providing field trips/excursions for the
students is in line with the objectives of clinical nursing education as identified
by (Quinn 2001). The provision of orientation to students, accessible and
appropriate varied training opportunities helped to concretize learning, (Quinn
2001).
Hypotheses three:
There is no significant statistical difference in students’ factors affecting
clinical training of nursing students between the two nursing institutions
under study?
In five out of the six items in students’ factors affecting clinical training
of nursing students, significant statistical differences were observed between
the schools. Therefore the null hypothesis three (Ho3) was rejected indicating
that there are significant statistical differences between the two schools as
regards to the students factors affecting clinical training of nursing students.
133
Table (15) showed significant statistical difference (z = 15.832,
p = .000) between the schools on the statement that students go for their
clinical experiences as scheduled. This also showed that School (A)
respondents attended clinical experience regularly more than students from
school (B). This may be due to the location of the clinical area of students in
school (B) which is far from the university. There is no significant statistical
difference (z = 1.017, p = 0.310) between the two schools on the item of
whether every student attempts the clinical assignment or test given to them.
Students attempting clinical assignments/tests given to them form part of the
formative and summative evaluation of their clinical experiences, as noted by
Oermann et al (2009).
The results showed that School (A) students make use of the equipment
in the laboratory on their own while those from school (B) do not make use of
the equipment in the laboratory on their own, (z =7.045, p =.000). This may be
for fear of the equipment been lost when students use them alone. Where
students repeat procedures on their own, it helps them to learn the skills better.
There is Significant statistical differences (z = 2.879, p = .004;
z = 2.927, p = .003 &z = 4.084, p = .000) between the schools as noted on the
items of whether the students do self assessment of their performance, accept
corrections and ask questions to their ward staff nurses and also use their
procedure books as a guide for practice. The difference is more pronounced on
the item about students doing self assessment of their performance with mean
134
scores of, school (A) 3.04 and school (B) 2.71 respectively. While other items
implied greater magnitude of agreement as both schools scored above 3.0
mean decision point. Melone (2010) asserted that students’ performance in
clinical experience depended on the interest and importance which the students
attach on it and are not afraid to ask questions during clinical experiences due
to attitude of the ward staff nurses that supervise and teach them in the clinical
areas. These staff nurses may not know what to teach them, the students also
react by not asking those nurses questions. In school (B), their school
procedure manual differs from that of their hospital which is the same with that
from school of Nursing, University of Nigeria Teaching Hospital (UNTH).
Students may be confused on the requirement of each manual. Students’ use of
the procedure book during their clinical experiences as a guide for practice is
in line with N&MCN requirements. Each training school should develop their
procedure manual for clinical training based on N&MCN curriculum of
nursing education, (curriculum for General Nursing Education in Nigeria,
2001).
Implications for Nursing
The implications of the findings to nursing education and practice are:
− High teacher-student ratio (above 1:10), in the nursing schools creates
over load of work to the teachers and will lead to improper attendance to
students’ learning needs
135
− Large space in the schools’ practical laboratory will enable the students
to have a clear view of what the teacher is demonstrating thereby students
learn the required skills better.
− Lack of adequate equipment in the nursing school practical laboratory and
in the clinical areas jeopardizes psycho-motor skill development.
− Library with adequate nursing text books in the schools helps both the
students and teachers as a reference base when they make use of them.
− None involvement of teachers in the supervision of students in their
clinical areas creates theory- practice gap leading to poor or wrong
learning of nursing skills.
− Students not supervised during their clinical experience expose both
students and patients to serious dangers leading to poor acquisition of
nursing skills and poor quality nursing care.
− Not giving students assignments/tests and also not evaluating students
during their clinical experience period do not give room for proper
evaluation of the students’ strengths and weaknesses during training.
− Lack of mentors and preceptors in the clinical areas leads to poor drilling
or coaching of students on the required nursing skills.
− Inadequate number of clients in the wards restricts students’ actual
practice with real life objects which hinders proper skill acquisition.
136
− None involvement of students in planning their activities leads to lack of
interest in actual carrying out of the plan.
− Students’ attendance to their clinical experiences as scheduled exposes
them to many real life situations which will help them to concretize what
they learnt in the classroom.
− Students doing practice on their own helps them to learn better and
remember easily what they have been taught.
− Using the procedure book helps the students and teachers to follow each
nursing procedure as programmed and helps one to be acquainted with the
nursing knowledge and skills.
− The significant statistical differences identified in this study showed that
procedure for clinical training in schools of nursing is different from that
of the university based nursing programme. This calls for a way of
resolving the issues identified by N&MCN.
Recommendations
It is evidenced that some factors affecting clinical training of nursing
students in School of Nursing, Afikpo (SON-A) and Department of Nursing
Sciences, Enugu Campus (DNS-UNEC) are poor and inadequate therefore,
may hinder nursing skill acquisition. It is therefore recommended that:
1. Adequate, experienced and qualified nurse educators and clinical
instructors are necessary in any nursing institution and such should be
employed and maintained by the competent authorities.
137
2. School authority should plan and follow their curriculum based on
N&MCN programme in such a way that teachers can finish their courses
earlier before students go for such clinical experience so as to be equipped
with enough knowledge and information.
3. The school authority should realize that the duration of clinical experience
period at each session at a stretch influences the level of overall students’
clinical skill acquisition. Therefore, clinical experience period should not
be too short a period.
4. Nurse educators should teach and follow up students to the clinical areas
using the set up guidelines for theory and clinical teaching to prevent
theory- practice gap and not go there to police the students.
5. All involved in the training and supervision of students should be updated
with current trends in nursing and research through seminars/conferences
so that they can impart such knowledge to the students.
6. Qualified preceptors and clinical instructors should be employed and
motivated for clinical facilitation/supervision of students during their
clinical experiences.
7. Adequate number of qualified nurses should be employed to work in
different places where student nurses do their clinical experience to
facilitate supervision and teaching in the clinical areas.
138
8. Adequate and spacious practical laboratories should be constructed and
equipped with enough equipment to enhance skill acquisition in school
(B).
9. Provision of adequate equipment and supplies in the wards are important
to facilitate competent teaching and learning in the clinical areas.
10. Enough clients are needed in the clinical areas to facilitate and concretize
knowledge and nursing skills in school (A).
11. Behaviour modification to change inferiority complex, bias and other
negative attitudes that hinder students, teachers and clinical staff nurses
interactions and communication in the clinical areas should be taught
during training.
12. Supervisors should evaluate students’ performance regularly to elicit areas
of weakness and give proper corrections and directions.
13. Mentorship relationship help students in their professional development
and skill acquisition, therefore such people should be provided in the
clinical areas.
14. Nursing students should be involved actively in planning their
programmes to ensure their active participation and interest in such
activities.
15. Clinical orientation of students before clinical practice should be
organized in such a way that all the students should participate actively.
139
16. N&MCN to provide a clearly written standard guidelines and polices on
clinical training of student nurses.
Limitations to the Study
One of the constraints in this study is lack of co-operation from some of
the respondents in giving answers to the questionnaire items. This is because
they see it as exposing the activities in their schools. Some of the students were
fearful as they do not know how the school authority will see some of their
answers. Some students were on clinical experience which has different time
schedules. While some of the lecturers were very busy and needed to be given
more time to attend to the questionnaire.
Suggestions for Further Studies
Further studies could be carried out in the following areas:
- Factors affecting student nurses behaviour during their clinical training
could be studied by other researchers.
- Exploration of the practical skills of newly qualified nurses in Nigeria can
also be researched.
- Study on approaches to nursing skills training in Nigeria can be done.
- Longitudinal study using more number of schools on the same topic is
encouraged for a better generalization.
140
Summary
This study assessed the factors affecting clinical training of nursing
students in School of Nursing, Afikpo and Department of Nursing Sciences,
University of Nigeria, Enugu Campus. It was designed to determine the:
- Administrative factors that could affect the clinical training of nursing
students in the schools and in the clinical areas.
- Training/Supervisory factors that could affect the clinical training of
nursing students in the schools and in the clinical areas.
- Students’ factors that may affect clinical training in nursing institutions.
- Whether there are significant statistical differences in the factors affecting
clinical training of nursing students between the two nursing institutions of
study.
Literature was reviewed according to the objectives of the study. The
research design used was a descriptive cross-sectional survey design. 311
respondents (teachers and students) were recruited for the study. A validated
questionnaire constructed by the researcher was used for the collection of data.
Data derived from the study was subjected to descriptive statistics and Z- test
for inferential statistics. Major findings of the study were: teachers were not
enough to handle the courses in school (A), mean score 2.75, teachers do not
supervise students in the clinical areas in both schools mean scores < 3.0 which
is below the mean decision point and both schools have only one or two
clinical instructors that supervise students during their clinical experience.
141
Both schools have practical laboratories but school (B) does not have enough
equipment and space in the practical laboratory, (mean scores = 2.69 & 2.65)
while school (A) has enough equipment in the school, (mean score 4.25) but do
not have enough equipment in the wards (mean score 2.32). Their supervisors
do not evaluate students during clinical period. Students attend clinical
experiences regularly and attempt clinical assignments/texts given to them,
(mean scores, school (A) = 3.33 & 3.33; school (B) = 4.86 & 3.97). Findings
revealed that there were significant statistical differences (p-value < 0.05)
between the two nursing institutions as regards the administrative,
training/supervisory and students’ factors affecting clinical training of nursing
students. Based on the findings, it was recommended that adequate
experienced and qualified nurse educators and clinical instructors should be
employed and maintained by the competent authorities. Proper supervision of
students should be advocated. N&MCN to provide a clearly written standard
guidelines and polices on clinical training of nursing students.
Conclusion
The study was to determine the factors that affect clinical training of
nursing students in School of Nursing Afikpo in Ebonyi State and Department
of Nursing Sciences, University of Nigeria, Enugu Campus in Enugu State.
Three research questions and three null hypotheses were formulated to guide
the study. The result of the findings showed that there were administrative,
training/supervisory and students’ factors that can adversely affect clinical
training of nursing students in both nursing institutions.
142
REFERENCES
Adeyanju, J. L. (2004), Teachers’ perception of the effects and use of
instructional materials in teaching. Nigeria: OAU press.
Akambi, K. (1998), Selection, utilization and evaluation of instructions.
Ibadan: Y- Books.
Akubuiro, I. and Joshua M. (2003), Self concept, attitude and achievement of
secondary school students in science subject: Calabar: University press.
Angel, B. (2007), Clinical skills. USA: Michigan state University press.
Argyris, C. and Schon, D. (1994), Theory in practice: increasing professional
effectiveness. USA: Jossey – Bass Company.
Baillies, (1993), Factors affecting students nurse learning in community
placement. Journal of Advanced Nursing; 18, (7) 1043-1053.
Baker, C. (2000), Problem based learning for nursing: integrating lessons for
other disciplines with nursing experience. Journal of Professional
Nursing, 16 (5) 258-266.
Bastable, B. (2003), Nurses as educators: principle of teaching and learning of
nursing practice. London: Addison Wesley.
Benner, P. (2004), Judgment in nursing practice and education. Bulletin of
Science Technology and Society; 24 (3) 188-190.
Bray, L. Flynn, A. & Sanders, C. (2011), The experiences of children’s nursing
students: learning urethral catheterization. Nurse Education in Practice,
11, (3) 168-172.
Bevis, E. (2000),Towards a caring curriculum: A new pedagogy for nursing.
Boston: Jones and Bartlett Company.
Billings and Halstead, (2005), Teaching in nursing: a guide for faculty
teaching. USA: Elsier Saunders.
Cannon, B.W. (1997), Teaching office skills. USA: Pitman Publication
Company.
143
Chun-heung, L. and French, P. (1997), Education in the practicum: a study of
the ward learning climate in Hong Kong. Journal of Advanced
Nursing, 26 (3): 455 – 462.
Daft, R.L. (2000), Nursing management. Philadelphia: Dryden press.
Dorthe, B, and Regner, B, (2011), The practical skills of newly qualified
nurses. Nurse Education Today, 31 (2): 168- 172.
Ehiemere, I.O. (2009), Current trends in Nursing Education, Research and
Practice. West African Journal of Nursing, 53, 87 – 93.
Enugu State Government, Ministry of Information, (2007), People, Population,
and Settlement. Enugu. http://www.enugustate.gov.ng/
Ericsson, K.A. (2009) Deliberate practice and the acquisition and maintenance
of expert performance in medicine and related domain. Academic
Medicine, 79 (10): 1-12.
Gallagher, A. G. (2005) Virtual reality simulation for the operation room:
proficiency based training as a paradigm shift in surgical skill training.
Annals of Surgery, 241 (2): 364- 372.
Gardner and Supplee, (2010) Handbook of clinical teaching in Nursing and
Health science. New York: Jones and Bartlett Company.
Gerrish, K. (1992) The nurse teacher’s role in the practice setting. Nurse
Education Today, 12, 227-232.
German, I. (1994), Influence of students’ attitude toward science subject in
schools. Nigeria Medical Association, News Letter. 10, 5-7.
Hallet, C. (1997), Learning through reflection in the community. Journal of
Advanced Nursing, 31(5): 100 – 109.
Harrison,H. (2010), Meaning of Nursing Education. USA: Jones & Bartlett co.
http//www.onsbag.com/qview2029033
Heitman, B. (2006) The development of expert performance in nursing.
Tanzania: University press.
Hinchliff, S. (2005), The practitioners’ teacher. USA: Elsevier Churchill.
144
Hoel, P. G. (2006), Introduction to business statistics. USA: John Wiley and
sons.
Hopkins, J. (1994), Learning and Performance supports. New York: Hopkins
University press.
http//www.nurseducationtoday./com./article/80260-6197 (99)
http://en.wikipedia.org/wiki/enugu_state#education
Iwasiw, C. Goldenberg D. and Andrusyszyn M.(2009),Curriculum
Development in Nursing Education. USA: Jones and Barthlett
Company.
John, S. (2003), A B C of learning and teaching in Medicine. Bio- Medical
Journal, 8: 30-32
Karen, S, & Gutema K, (2012) Students nurses learning on community based
education in Ethiopia. Education for health, 17, (2): 172- 182.
Kendra, C. (2010), An overview of Bandura’s social learning theory: Journal
of Educational Psychology. 56 (23): 38-42.
Killen, R. (2000), teaching strategies for outcome based education.
Lansdowne: Justas publications.
Kirschner, P.,Sweller, J.& Clark, R. (2006), Why minimal guidance during
instruction does not work. Journal of Educational Psychology, 41 (2):
75-86.
Knowles, M. (1990),The adult learner: a neglected species. USA: Gulf
publications.
Kohn, (2000), To err is Human: building a safer health system. USA: Springer
publishing company.
Lohor, D. (2005), Assessing students’ poor performances in General Nursing
Certificate Examination (A paper presented at the National conference
of the Principals of schools of Nursing in Nigeria. Airport Hotel Lagos,
20th April, 2005).
Lohor, D. (1998), The use of instructional material in teaching learning
situation. (A paper presented at the National Conference of the
145
principals of schools of Nursing in Nigeria. Airport Hotel, Lagos, 15th
June, 1998).
Marylyn, H. & Oermann, (2011). Toward evidence based nursing education:
deliberate practice and motor skills learning. Journal of Nursing
Education, 50 (2): 63- 64.
Mellish, M.J. & Brink, H. (2000), Teaching the practice of Nursing. Durban:
Heinemann.
Melone, S. (2010), Basic Nursing skills and concepts. Nursing times T.M
Magazine. www.nursingtimes.net.
Meechan, R, Jones, H. & Valler- Jones T, (2011), Students’ perspectives on
their skill acquisition and confidence. British Journal of Nursing, 20 (7):
445- 450.
Ministry of information, (2009), Abakaliki, Ebonyi State.
Nelson, Linda & Burzotta, (2010), Teaching at its best: a research based
resource for instructors. San Francisco: John Wiley and sons.
Nigeria National Bureau of statistics, (2005), Enugu state.
Nursing and Midwifery Council of Nigeria (2001), Curriculum for General
Nursing Education in Nigeria.
Nursing and Midwifery Council of Nigeria (2005), Rules and regulations
governing General Nursing Examinations.
Nursing and Midwifery Council (NMC) (2005) Consultations on proposals
arising from a review of fitness for practice at the point of registration.
London: NMC.
Nursing and Midwifery Council of Nigeria (2010), Standard of Nursing
Education.
Oermann, M.H. & Gaberson, K.R.(2009),Clinical teaching strategies in
Nursing. New York: Springer publishing company.
Osang, G. (1990), Relationship between students performance in science
subject in schools and self concept. National Newsletter of Nigeria
Medical Association, 10, (7), 10.
146
Pellatt, G.(2006),The role of mentors in supporting pre-registration nursing
students. British Journal of Nursing, 15 (6) 336-340.
Polit, F.D & Beck, T.M. (2003), Nursing research principles and methods.
Philadelphia: Lippincott, Williams and Wilkins.
Preskill, & Torres, (2009) Preceptorship and interpersonal conflit: a
multidisplinary study. Journal of Advanced Nursing, 43 (2) 188- 189.
Quinn, F.M. (2001), The principles and practice of nurse education.
Cheltenham: Nelson Thornes.
Rennie, I, (2009) Exploring approaches to clinical skills development in
nursing education. Nursing Times, 105 (3) 20- 22.
Rick, S. (1999), Steps in the performance improvement process. New York:
Hopkins University press.
Robert, L. (2009), What is education. USA: John Wiley and sons.
http://www.motivation-tools.com/youth/what-is-education.htm
Rogers, A. (2003), Learning theory. Bio- Medical Journal, 8: 26.
Salmon, K. & Gutema, K. (2004), Experiences of student nurses on
community based experience. Education for health magazine, 17 (2)
172- 182.
Searle, C. (2000), Professional Practice: a South African Nursing Perspective.
Durban: Heinemann.
Shariff, F. & Masoumi, S. (2005), a qualitative study of nursing students
experiences of clinical practice. Bio-Medical Central Nursing Magazine,
4: 6.
Sims, (1997) Community based education in the Zambian experience.
Education for health change in learning and practice, 10, (3) 301- 310.
Smedley, & Penney, (2010), A Partnership Approaches to the Preparation of
preceptors. Nursing Education Perspectives Magazine, 30. 31 – 36.
Smith, J.M & Fitz-Patrick, J.J. (2006), Best practices in nursing education.
New York: Springer publishing company.
147
Sonwuttanayut, .P. (2003) The influence of personal factors, teachers
characteristics, intuitional environment on self directed learning
readiness of nursing students, Practiomklao College of Nursing.
Sumari- Ayo, E. (2006), Factors influencing clinical teaching of midwifery
students in a selected clinical setting in Tanzania, University of South
Africa.
Tonne, H. (1999), Principles and practice of education. London: McGraw Hill
book company.
Usufu, Z. (2005) Students’ poor performance in nursing examination: A cause
for alarm, (A paper presented at the National conference of the
principals of schools of Nursing in Nigeria. Airport Hotel Lagos, 20th
April 2005).
Waldock, J, (2010) Facilitating students learning in clinical practice. New
Zealand. Kaitiaki Press.
Wallin, Wikblad & Ewald (2003) Clinical efficiency and safety in managing
cardio-vascular risk. Vasc Health Risk Management. 2008;4(2):341–
353.
Warner, T., Johansson, U.B, Papastavrou, E., Tichelaar, E., Tomietto, M,
Bossche, K., Moreno, M. & Saarikoski, M. (2010), An exploration of the
clinical learning experience of nursing students in nine European
countries. Nurse Education Today, 7. Doi:10.1016/j.nedt.2010.03.003
William, K, & West, E, (2011), Approaches to nursing skills training.
International Nursing review, 18, 132- 134.
World health organization, (1999), Nursing practice around the world:
Nursing/Midwifery health system development programme. Geneva:
WHO.
Wuthiphong, J., Somsri, D. & Suthineum, U. (2009), Factors influencing
clinical learning behaviour of Nursing Students in Boromerajonani
college of nursing, Chon Buri. Thailand: Nursing Education, 20:17.
148
APPENDIX (1)
Target population of academic staff and students from both nursing
institutions of study
NURSING INSTITUTIONS STUDENTS ACADEMIC
STAFF
YR 2 YR3 YR4 YR5
School of Nursing, M.M.H.
Afikpo, Ebonyi state.(School A)
Department of Nursing Sciences
UNEC, Enugu State.(School B)
53
42
94 107
14
20
Total 95 201 34
Source: Records department of the institutions
Total students = 296
Total Academic Staff = 34
Total target population = 330 subjects
149
APPENDIX (2)
Stages of skill acquisitions
Expert stage
Proficient stage
Competent stage
Advanced beginners
Novice’s stage
Fig. 1: Dreyfus’s model of skill acquisition
Source: Benner P. (2004), Judgment in nursing practice and education.
Bulletin of Science Technology and Society, 24 (3): 188- 190.
150
APPENDIX (3)
QUESTIONNAIRE ON FACTORS AFFECTING CLINICAL
TRAINING OF NURSING STUDENTS (QFACTNS)
I am a post graduate student of the department of Nursing Sciences,
University of Nigeria, Enugu Campus and I am carrying out a study on factors
affecting clinical training of nursing students in selected educational
nursing institutions in Ebonyi and Enugu states. A questionnaire will be
issued to each respondent for this study. There are no correct answers to the
questions. Your honest opinion to each question will help me to establish the
training needs of student nurses.
All the information you give will be held confidential and will be used
purely for academic purpose. Your sincere opinion on each question will be
highly appreciated.
Thanks for your anticipated co-operation.
AGU Grace U. (Rev. Sr.)
Department of Nursing sciences
Faculty of Health Sciences &Technology
College of Medicine, University of Nigeria
Enugu Campus.
151
APPENDIX (3) continued
QUESTIONNAIRE ON FACTORS AFFECTING CLINICAL
TRAINING OF NURSING STUDENTS (QFACTNS)
FOR BOTH TEACHERS AND STUDENTS
Please observe the following:
a. Tick only the correct answers to all the questions in sections A-D
b. Tick only the correct answers in the blank spaces provided.
SECTION A
Instruction: Tick the correct and the one related to you in the blank
spaces provided.
Name of Nursing Institute
a. School of Nursing, Afikpo
b. Department of Nursing, UNEC
Biodata
1. Gender: (a) Male (b) Female
2. Year of study: (a) year 2 (b) year 3
(c) year 4 (d) year 5
3. Designation: (a) Teacher (b) Student
4. Highest educational Qualification: (a) RN only
(b)B.Sc Nursing only (c) BSc. Anatomy only
(d) M.Sc. only (e) PhD
(f) Others indicate
152
5. Years of Teaching Experience
(a) 1 – 2 years (b) 3 – 5 years (c) 6 – 10 years
(d) 10 years & above
6. Teachers status: lecturer supervisor clinical instructor
SECTION B: Select the most appropriate answer to each statement from the
five (5) options of Strongly Agree (SA), Agree (A), Disagree (D), Strongly
Disagree (SD) and no opinion (NOP). Tick in the column of the item of
your choice.
SECTION B: Administrative factors:
Staffing:
7. The number of teachers in this school is:
< 4
4 -6
7-10
11 and above
8. Which of these act as clinical supervisors in your school?
Clinical instructors only
Preceptors only
Nurses working in the clinical areas only
Students are not supervised
Both clinical instructors and staff nurses
9. If you are supervised in the wards, how many of the following
staff do supervise the students during each shift in the wards?
Tick the no. 1 2 3 4 5 6 and above
Clinical instructors only
Preceptors only
Staff nurses in the wards or clinical areas only
√
153
ADMINISTRATIVE FACTOR (STAFFING) CONTD RESPONSES OPTIONS
ITEMS SA A D SD NOP
10. Teachers in this school are enough to handle the
subjects in the school.
11. Teachers in this school are involved in supervision of
students in the clinical areas.
Infrastructures/equipment:
12. This school has practical demonstration
laboratory for students clinical practice.
13. The laboratory has a large space for all the
students to observe what is being thought.
14. The school laboratory has enough equipment
that can enable many students to practice
procedures during the same period.
15. The hospital has enough needed equipment for
the number of students on each shift to practice with
while on clinical experience.
16. Students/ clients ratio in each ward during
clinical periods is enough for students’ practice
under supervision.
17. The school has a library with current nursing text
books for references.
18. Teachers and students make use of the library.
Measures used for clinical training of students.
The school authority does the following to ensure
that students acquire the required nursing skills:
19. Organize clinical conferences/ seminars
for the students.
20. Encourage students to participate in
planning of their clinical training programmes .
21. Provide mentors and preceptors in each shift to
coach the students on the nursing skills.
22. Give students assignments during clinical
periods at least once a week.
23. Teachers do finish teaching their courses and
clinical procedures before students go to the clinical
areas.
154
Measures used for clinical training of students RESPONSE
OPTIONS
SA A D SD NOP
24. Students do repeat demonstration after
teacher’s own teaching during each procedure.
25. Clinical orientation are given to
the students at the beginning of each
clinical posting.
26. The ward staff nurses follow the correct
procedures in carrying out their job to enable
students to learn and do the right thing.
27. The ward staff nurses do supervise the
students during each procedure.
28. Supervisors do evaluate students’ clinical
experiences at the end of each clinical period.
29. The school Provide field trips/excursions, as
varied teaching and Learning opportunities.
Students’ factors towards clinical training
30. Every student attends clinical
experiences regularly as scheduled.
31. Every student attempts the clinical
assignments/tests given to them.
32. The students make use of the equipment in
the school laboratory for clinical practice
on their own.
33. Students do the following during
clinical experience:
- Self assessment of their clinical
performance,
- Accept corrections and ask their ward
staff questions during clinical experience.
34 Students use the nursing care procedure
book during clinical experience as a guide
for practice.
155
APPENDIX (4)
CALCULATION OF RELIABILITY OF QUESTIONNAIRE
(QFACTNS)
ITEM
NO.
TEST
X
RE-TEST
Y
XY
X^2
Y^2
1 23 23 529 529 529
2 20 18 360 400 324
3 24 24 576 576 576
4 10 5 50 100 25
5 20 20 400 400 400
6 4 4 16 16 16
7 8 10 80 64 100
8 3 3 9 9 9
9 0 3 0 0 9
10 21 21 441 441 441
11 23 23 529 529 529
12 24 24 576 576 576
13 16 16 256 256 256
14 23 23 529 529 529
15 22 22 484 484 484
16 19 19 361 361 361
17 20 15 300 400 225
18 15 20 300 225 400
19 20 22 440 400 484
20 22 20 440 484 400
21 22 21 462 484 441
22 18 18 324 324 324
23 0 2 0 0 4
24 25 21 525 625 441
25 13 13 169 169 169
26 23 23 529 529 529
27 22 22 484 484 484
28 20 20 400 400 400
29 22 22 484 484 484
SUM 502 497 10053 10278 9949
156
APPENDIX (4) continued
PEARSON CORRELATION COEFFICIENT ® FOR
QUESTIONNAIRE
(QFACTNS)
n = 29 ΣX = 502 ΣY = 497 ΣXY = 10053
ΣX2 = 10278 ΣY
2 = 9949
( ) ( )
( ) ( )
× −=
× − × −
2 2
29 10053 502 497
29 10278 502 29 9949 497
r
= 0.962r (For questionnaire items)
Hoel, P. G. (2006), Introduction to Business Statistics, seventh edition. John
Wiley & Sons, Inc. USA
157
APPENDIX (4) continued
CORRELATIONS FOR RELIABILITY OF INSTRUMENT
Using Statistical package for social sciences (SPSS)
Correlationsa
Test Re-test
Test Pearson
Correlation
1.000 .962**
P-value .000
N 29.000 29
Re-test Pearson
Correlation
.962**
1.000
P-value .000
N 29 29.000
**. Correlation is significant at the 0.01 level
(2-tailed).
158
APPENDIX (5)
Department of Nursing
Faculty of Health Science and Technology
University of Nigeria
Enugu Campus.
10th October, 2012.
The Head of Department,
Nursing Sciences
FHST
UNEC
Ma,
APPLICATION FOR ADMINISTRATIVE
APPROVAL OF RESEARCH WORK
I, Agu Grace Uchechukwu, a post graduate student of the Department
of Nursing Science, University of Nigeria Enugu Campus with registration
number PG/MSC/07/46796, wish to carry out a study on factors affecting
clinical training of nursing students in selected educational nursing institutions
in Ebonyi and Enugu states. I wish to use the Department of Nursing Sciences,
University of Nigeria Enugu Campus. I humbly solicit for your permission to
undertake the above research in the mentioned school using the teachers and
students nurses. Attached is the ethical clearance giving to me by the Ethical
Committee of UNTH Itukku Ozalla. The result of the research will be treated
with confidentiality and for the purpose of this research only.
Thanks for your co-operation.
Yours faithfully,
Agu Grace Uche (Rev. Sr) PG/MSC/07/46796
0706691465
159
160
161
162
APPENDIX (9)
Department of Nursing
Faculty of Health Science & Technology
University of Nigeria, Enugu Campus
10th October, 2011.
The Hospital Administrator
Mater Misericordiae Hospital
Afikpo
Ebonyi State.
Sir,
APPLICATION FOR ADMINISTRATIVE APPROVAL OF
RESEARCH WORK
I, Agu Grace Uche, a post graduate student of the Department of
Nursing Science, University of Nigeria Enugu Campus with registration
number PG/MSC/07/46796, wish to carry out a study on factors affecting
clinical training of student nurses in selected educational nursing institutions in
Ebonyi and Enugu states. I wish to use School of Nursing, Mater Misericordiae
Hospital Afikpo of which you are the administrator. I humbly solicit for your
permission to undertake the above research in the mentioned school using the
teachers and the student nurses. The result of the research will be treated with
confidentiality and for the purpose of this research only. I promise to abide by
the ethics of the profession.
Thanks for your co-operation.
Yours faithfully,
Agu Grace Uche (Rev. Sr) PG/MSC/07/46796
07066914650
163
APPENDIX (10)
Department of Nursing
Faculty of Health Science and Technology
University of Nigeria
Enugu Campus
10th October, 2011.
The Principal
School of Nursing
Mater Misericordiae Hospital
Afikpo
Ebonyi State.
Sir,
APPLICATION FOR ADMINISTRATIVE APPROVAL OF
RESEARCH WORK
I, Agu Grace Uche, a post graduate student of the Department of
Nursing Science, University of Nigeria Enugu Campus with registration
number PG/MSC/07/46796, wish to carry out a study on factors affecting
clinical training of student nurses in selected educational nursing institutions in
Ebonyi and Enugu states. I wish to use School of Nursing, Mater Misericordiae
Hospital Afikpo which you are the principal. I humbly solicit for your
permission to undertake the above research in the mentioned school using the
teachers and students nurses. The result of the research will be treated with
confidentiality and for the purpose of this research only. I promise to abide by
the ethics of the profession.
Thanks for your co-operation.
Yours faithfully,
Agu Grace Uche (Rev. Sr) PG/MSC/07/46796
07066914650
164
APPENDIX (11)
Department of Nursing Sciences,
Faculty of Health Sciences and Technology,
University of Nigeria,
Enugu Campus.
10th September, 2012.
The Chairman,
Health Research Ethical Committee,
University of Nigeria Teaching Hospital,
Ituku-Ozalla.
Sir,
APPLICATION FOR ETHICAL CLEARANCE
I, Agu Grace U. am currently carrying out a research project in partial
fulfillment for M.Sc. programme in the Department of Nursing Sciences.
The topic of the research is “Factors Affecting Clinical Training of Nursing
Students”. The research project is under the supervision of Dr. Mrs. Anarado A.N.
in the Department of Nursing Sciences University of Nigeria Enugu Campus.
About 340 copies of questionnaire would be shared out for responses on the
Factors Affecting Clinical Training of Nursing Students. Informed consent would
be sought from these respondents and information obtained would be treated with
utmost confidentiality.
I hereby humbly apply for an approval to enable me proceed and
accomplish this project within the time frame, October, 2012.
Attached are the project proposal and the copy of the questionnaire and
respondent consent form. Thanks in anticipation for the quick response.
Yours faithfully,
Agu, Grace U. (Rev. Sr.) PG/MSC/07/46796
07066914650
165
166
167
168
APPENDIX (15)
Hypothesis one: There is no significant statistical difference in the
administrative factors affecting clinical nursing training.
Table 13: Z-test of significance of differences between the two institutions of study
with regard to the administrative factors affecting clinical nursing training
n = 311
Items Schools n weighted
X score
Std
deviation
Z-test
score
P-value Decision
Teachers here are enough to
handle the courses in the
school
(A)
(B)
Total
115
196
311
2.75
3.23
2.64
.475
.819
.747
-5.766 .000* reject
Teachers are involved in
supervision of students in
the clinical areas.
(A)
(B)
Total
115
196
311
2.57
2.68
2.64
.909
1.045
.997
-.968 0.334 reject
This school has practical
demonstration laboratory
for students clinical practice
(A)
(B)
Total
115
196
311
4.51
4.03
4.21
.502
.640
.636
6.930 .000* reject
The laboratory has a large
space for all the students to
observe what is being
taught.
(A)
(B)
Total
115
196
311
4.27
2.65
3.25
.831
.719
1.092
18.120 .000* reject
The school laboratory has
enough equipment that can
enable many students to
practice procedures during
the same period.
(A)
(B)
Total
115
196
311
4.25
2.69
3.27
.590
.715
1.009
19.757 .000* reject
The hospital has enough
needed equipment for the
number of students on each
shift to practice with while
on clinical experience.
(A)
(B)
Total
115
196
311
2.32
2.98
2.74
.488
.709
.710
-8.805 .000* reject
Students / patients ratio in
each ward during clinical. (A)
(B)
Total
115
196
311
2.09
3.35
2.88
.388
.896
.967
-14.359 .000* reject
The school has a library
with current nursing text
books for references.
(A)
(B)
Total
115
196
311
4.48
3.29
3.73
.820
1.038
1.121
10.540 .000* reject
Teachers and students use
the library
(A)
(B)
Total
115
196
311
2.10
3.63
3.07
.334
.975
1.089
-16.241 .000* reject
Level of significance = P<<<<0.05
NOTE: ∗∗∗∗ indicates significance difference at P<<<<0.05
Z- Score >>>> P- value (critical value) = reject the hypothesis
169
APPENDIX (16)
Hypothesis two:
Table 14: Z-test of significance of differences between the two institutions of study with
regard to training/supervisory factors affecting clinical nursing training
n = 311
Items Schools N weighted
X score
Std
deviation
Z- test
score
P-value Decision
The school authority does the
following:
-organize clinical conferences/
seminars for the students
(A)
(B)
Total
115
196
311
3.03
3.59
3.38
.737
.821
.834
-5.940 .000* reject
-Encourage students to
participate in planning of their
clinical training programmes
(A)
(B)
Total
115
196
311
2.78
3.01
2.92
.526
.942
.819
-2.328 .021* reject
-Provide mentors and
preceptors in each shift to coach
the students on the nursing
skills.
(A)
(B)
Total
115
196
311
2.11
2.54
2.38
.345
.850
.734
-5.092 .000* reject
-Give students assignments
during clinical periods at least
once a week.
(A)
(B)
Total
115
196
311
2.56
2.91
2.78
.840
.821
.845
-3.667 .000* reject
Teachers do finish teaching
their courses and clinical
procedures before students go to
the clinical areas.
(A)
(B)
Total
115
196
311
2.10
2.47
2.34
.383
.838
.726
-4.469 .000* reject
Students are allowed to
demonstrate after teachers’ own
teaching during each procedure.
(A)
(B)
Total
115
196
311
4.69
4.06
4.29
.568
.898
.847
6.723 .000* reject
Clinical orientations are given
to the students at the beginning
of each clinical posting.
(A)
(B)
Total
115
196
311
2.58
4.03
3.49
.649
.705
.977
-17.942 .000* reject
The ward staff nurses follow the
correct Procedures in carrying
out their job to enable students
to learn and do the right thing.
(A)
(B)
Total
115
196
311
2.89
3.20
3.08
.632
.820
.770
-3.512 .001* reject
The ward staff nurses do
supervise the students during
each procedure.
(A)
(B)
Total
115
196
311
3.07
3.22
3.16
.758
.770
.768
-1.666 .097 reject
Supervisors do evaluate
students’ clinical experiences at
the end of each clinical period.
(A)
(B)
Total
115
196
311
2.57
3.03
2.86
.547
.952
.853
-4.653 .000* reject
The school provides field trips/
excursions as varied teaching
and learning aid.
(A)
(B)
Total
115
196
311
3.75
3.64
3.68
.660
.909
.826
1.082 .280 reject
NOTE: ∗∗∗∗ indicates significance difference at P<<<<0.05
Z- Score >>>> P- value (critical value) = reject the hypothesis
170
APPENDIX (17)
Hypothesis three:
Table 15: Z- test of significance of differences between the two institutions of
study with regard to students’ factors affecting clinical nursing training
n = 311
Items Schools n weighted
X score
Std
deviation
Z-test
score
P-value Decision
Every student goes for
his/her clinical experiences
regularly as scheduled.
(A)
(B)
Total
115
196
311
4.74
3.42
3.91
.677
.677
15.832 .000* reject
Every student attempts the
clinical assignments / tests
given to them.
(A)
(B)
Total
115
196
311
3.92
3.83
3.86
.791
.728
.754
1.017 .310 reject
Students make use of the
equipment in the school
laboratory for clinical
practice on their own.
(A)
(B)
Total
115
196
311
3.15
2.51
2.75
.596
.829
.829
7.045 .000* reject
Students do the following
during their clinical
experience:
Self assessment of their
clinical performance.
(A)
(B)
Total
115
196
311
3.04
2.71
2.84
.536
1.155
.985
2.879 .004* reject
Accept corrections and ask
ward staff questions. (A)
(B)
Total
115
196
311
4.61
4.24
4.38
.684
1.203
1.05
2.927 .003* reject
Students use the nursing
care procedure book during
clinical experience as a
guide for practice.
(A)
(B)
Total
115
196
311
4.16
3.72
3.88
.643
1.021
.923
4.084 .000* reject
Level of significance = P<<<<0.05
NOTE: ∗∗∗∗ indicates significance difference at P<<<<0.05
Z- Score >>>> P- value (critical value) = reject the hypothesis
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