Nursing Clinical Instructors' Perspectives on Clinical Learning Environment Challenges: A Qualitative Study | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mosul Journal of Nursing (Print ISSN: 2311-8784 Online ISSN: 2663-0311) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Article 22, Volume 11, Issue 1, January 2023, Pages 193-197 PDF (1.01 M) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DOI: 10.33899/mjn.2023.176995 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Authors | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Younes Khalaf Attia; Radhwan Hussein Ibrahim | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Department of clinical nursing sciences, College of Nursing, University of Mosul, City of Mosul, Iraq | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Abstract | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Background and Aim: The clinical instructorsplay an essential role in the clinical learning environment by providing students with the important nursing skills. Therefore, this study aims to discover clinical instructors’ perspective about the challenges in the clinical learning environment. Method: A qualitative descriptive content analysis study design and semi-structured interview tool was used; the participants were 12 clinical nursing instructors who were selected purposively with a work experience of 7 − 18 years , earned MSc and PhD degrees and recruited from Nineveh governorate colleges of nursing. The data transcripts were analysed by using qualitative content analysis. Results: Four challenges emerged: (i) Ineffective clinical instruction; (ii) Ineffective clinical administration; (iii) Ministerial challenges; and (iv) Student related challenges. These challenges revealed clinical nursing instructors' difficulties in balancing their competency, good administration, ministerial factors and student competency. Conclusion: The identified challenges reflect the need to improve the quality of education and to create qualified nurse professionals, it may be important for students to be properly prepared, to choose the optimal clinical setting that meets the purpose, and to receive adequate teaching, advice, and supervision. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Keywords | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Challenges; Clinical Instructors; Clinical Learning Environment | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Nursing Clinical Instructors' Perspectives on Clinical Learning Environment Challenges: A Qualitative Study Younes Khalaf Attia 1, Dr. Radhwan. H. Ibrahim2 * Department of clinical nursing sciences, College of Nursing, University of Mosul, City of Mosul, Iraq;
Corresponding author:Younes Khalaf Attia Email: younes.20nup32@student.uomosul.edu.iq ORCID ABSTRACT Background and Aim: The clinical instructorsplay an essential role in the clinical learning environment by providing students with the important nursing skills. Therefore, this study aims to discover clinical instructors’ perspective about the challenges in the clinical learning environment. Method: A qualitative descriptive content analysis study design and semi-structured interview tool was used; the participants were 12 clinical nursing instructors who were selected purposively with a work experience of 7 − 18 years , earned MSc and PhD degrees and recruited from Nineveh governorate colleges of nursing. The data transcripts were analysed by using qualitative content analysis. Results: Four challenges emerged: (i) Ineffective clinical instruction; (ii) Ineffective clinical administration; (iii) Ministerial challenges; and (iv) Student related challenges. These challenges revealed clinical nursing instructors' difficulties in balancing their competency, good administration, ministerial factors and student competency. Conclusion: The identified challenges reflect the need to improve the quality of education and to create qualified nurse professionals, it may be important for students to be properly prepared, to choose the optimal clinical setting that meets the purpose, and to receive adequate teaching, advice, and supervision. Keywords:Challenges, Clinical Instructors, Clinical Learning Environment. Received: 26July 2022, Accepted: 01 January 2022, Available online: 28 January 2023 INTRODUCTION Nursing clinical instructors play a vital role in providing students with the skills and knowledge needed to be effective and successful in their practice(Niederriter et al., 2017). Clinical instructors must be able to effectively assess student progress, provide effective feedback, and help students develop critical thinking and problem-solving skills(Berman, 2015). Additionally, clinical instructors must be able to effectively manage the clinical learning environment to ensure the safety of students and staff, as well as promote a meaningful learning experience(Soroush et al., 2021). The challenges faced by nursing clinical instructors in the clinical learning environment can be varied and complex, common issues include a lack of resources, a lack of support from administration, and an inability to effectively communicate with students(Addisie et al., 2022). Clinical instructors must also contend with the changing dynamics of the healthcare environment, as well as the need to remain current with changes in technology and medical practices(Dahlke et al., 2012). Furthermore, clinical instructors must juggle the demands of clinical teaching with the demands of their own clinical practice(Nazari & Mohammadi, 2015). All of these issues can make it difficult for clinical instructors to provide the best possible education to their students(Jamshidi et al., 2016). METHOD A qualitative descriptive content analysis study design was adopted for the period extended from the 21th of September, 2022 to the 25th of December, 2022 in the College of Nursing at Mosul. Participants are selected through purposive sampling because it gives a specific and more details about the study problem. Clinical instructors were selected non-randomly based on years of service, specialization and competence in clinical training. The total participants that were selected (12), from Mosul, Nineveh and Telafer Colleges of Nursing. Participants who are clinical instructors with a minimum of 7 years of experience and have a Doctorate’s or master’s degree were willing to participate. Semi-structured interviews were conducted for about 30 to 45 minutes. An interview guiding open-ended questions was used to collect the data, Participants were provided with a copy of the interview questions, in both Arabic and English language. All of the interviews were recorded with a digital voice recorder. At the end of each interview, all notes and audio of each interview, were typed word by word and handwritten and then were imported in MAXQDA software. To ensure the credibility, dependability, confirmability, and transferability of the findings the questions were open-ended and designed to elicit meaningful responses from the participants, a clear structure and timeline to the research process were provided, as well as detailed notes and recordings of the interviews. Furthermore, the researcher was familiar with the topics discussed to ensure that the data collected is accurate and of a high quality. RESULTS A total of 6 clinical instructors aged 31 − 47 years, among whom 8 male and 4 female, who had a work experience of 7 − 18 years and earned MSc and PhD degrees participated in the study (Table 1). After the analysis of 180 codes obtained from the interview, four main themes and fourteen categories were identified (Table 2). Ineffective clinical instruction The first theme emerging from participants’ statements was ineffective clinical instruction which included instructor incompetency and instructor unprofessionalism. Effective clinical education is largely dependent on clinical instruction, a significant part of the educational process. The experiences of the participants revealed that many clinical educators lack the requisite clinical knowledge and abilities and also fail to directly teach nursing techniques. One of the participants said: “In hospitals, the instructors does not have predetermined goals to teach to the students in the hospital, but relies on the nursing staff present in the hospital to teach the students” (participant#3). Ineffective clinical administration The second theme emerging from participants’ statements was ineffective clinical administration which included inaccurate evaluation, shortage of time and lack of coordination. Participants mentioned that one of the most important problems in clinical training is the evaluation of the student. The student is evaluated in many ways that differ from one instructor to another, and there is no clear evidence for evaluating the student in the practical environment. One of the participants said:” there is no unified guide for evaluating the student in the practical environment within the same specialty. The clinical instructor sometimes evaluates the student on the basis of his grade in theory, or on the basis of the relationship with the instructor, or on the basis of his attendance” (participant#8). Ministerial challenges The third theme emerging from participants’ statements was ministerial challenges which included shortage of staff, material resource shortage, large number of students, lack of student’s opportunity and physical space shortage. The small number of clinical instructors constitutes a great burden, especially in the new colleges. Therefore, these colleges resort to contracting with trainers from outside the Ministry of Education. One of the participants said: “the number of clinical trainers is very small and does not correspond to the number of students admitted annually, and therefore the practical training does not achieve all the pre-determined objectives” (participant#11). The large number of students is the main problem of the clinical training environment. One of the participants said: “that the number of students is very large and is constantly increasing, although the college has a specific capacity that is sent to the Ministry on an annual basis. However, the Ministry cannot be satisfied with this number only, due to the large number of students who graduated from middle school” (participant#6). Student related challenges The fourth theme emerging from participants’ statements was student related challenges which included lack of student interest, lack of student motivation, experiential learning and communication difficulties. Many of the participants emphasized the students' lack of motivation to learn. One of the participants said: “the students lack the internal motivation to learn. Students often focus on tangible skills such as suturing wounds and giving medicine, and they turn away from intangible skills such as skills of communication, critical thinking and problem solving” (participant#1).
Table 1. Demographic characteristics related to participants.
Table 2. Main unit of meaning, categories and themes related to the challenges of clinical learning environment.
DISCUSSION The findings obtained from the study demonstrated that Ineffective clinical instruction, Ineffective clinical administration, Ministerial challenges, and Student related challenges are the challenges in the clinical learning environment in the Nineveh governorate colleges of nursing. The first theme gathered in this study agreed with the previous study(Sadeghi et al., 2019),that point to subjectivism, a lack of scientific and nursing practice expertise, a lack of dedication to teaching, and a focus on routine learning were all evident indications of low clinical competence, which hampered students' ability to develop their clinical competence. The second theme of our study consistent with those(Achempim-Ansong et al., 2022), that mentioned, there are numerous challenges of clinical administration . These include a lack of authority, poor communication, time constraints, interpersonal conflicts with coworkers, a rise in workload, exhaustion, a shortage of employees, a lack of enthusiasm on the part of supervisees, and a lack of trust. Another study(Gülten Sucu et al., 2019) agreed with the third theme of this study, there are a variety of circumstances, including an excessive number of students, insufficient hospital patient capacity, and a dearth of unique cases, that contribute to conditions in the clinical setting that are viewed negatively by instructors.There is also the issue of clinics and hospitals having inadequate infrastructure, including inadequate clinical practice rooms and lab facilities. In addition finding of (Jamshidi et al., 2016) agreed with fourth theme of this study and suggest that many students lack the communication skills necessary for effective communication in the clinical environment, lack of theoretical knowledge and practical skills as well as presence of stress and inferiority complexes in students in confronting the clinical environment. CONCLUSIONS It was determined that nursing clinical learning envirinment had many challenges include, instructor incompetency and unprofessionalism, inaccurate evaluation, shortage of training time, lack of coordination between instructors, shortage of faculty, material resource shortage, large number of students, lack of students opportunity, physical space shortage, lack of student interest , lack of student motivation, students experiential learning and communication difficulties of students. ETHICALCONSIDERATIONSCOMPLIANCEWITHETHICALGUIDELINES Ehical approval was obtained to conduct the study from the collegiate committee for medical research ethics at the University of Mosul. The study's purpose and steps were explained and emphasized the study participant's right to self-determination, confidentiality, and anonymity, lastly, written consent was taked from participant. FUNDING AUTHOR’SCONTRIBUTIONS Study concept; Writing the original draft; Data collection; Data analysis and Reviewing the final edition by all authors. DISCLOSURESTATEMENT: The authors report no conflict of interest. ACKNOWLEDGEMENTS We thank the nursing colleges at the University of Mosul, Nineveh and Telafer for their support and facilitation of the research task. We also thank the participants in the study for their acceptance to participate. REFERENCES Achempim-Ansong, G., Kwashie, A. A., & Ofei, A. A. (2022). Exploring the benefits and challenges of administrative clinical supervision in nursing and midwifery. Journal of Nursing Education and Practice, 12(1). Addisie, A., Cherie, A., Gela, D., & Ataro, B. A. (2022). Challenges faced during clinical placement among nursing students. A mixed study conducted at highest institutions in Addis Ababa city, Ethiopia, 2020. Berman, A. C. (2015). Good teaching is good teaching: A narrative review for effective medical educators. Anatomical sciences education, 8(4), 386-394. Dahlke, S., Baumbusch, J., Affleck, F., & Kwon, J. Y. (2012). The clinical instructor role in nursing education: a structured literature review. J Nurs Educ, 51(12), 692-696. https://doi.org/10.3928/01484834-20121022-01 Gülten Sucu, D., Hülya Fırat, K., & Refia Selma, G. (2019). Difficulties in Clinical Nursing Education: Views of Nurse Instructors'. International Archives of Nursing and Health Care, 5(1). https://doi.org/10.23937/2469-5823/1510114 Jamshidi, N., Molazem, Z., Sharif, F., Torabizadeh, C., & Najafi Kalyani, M. (2016). The challenges of nursing students in the clinical learning environment: A qualitative study. The Scientific World Journal, 2016. Nazari, R., & Mohammadi, E. (2015). Characteristics of competent clinical instructors: a review of the experiences of nursing students and instructors. Journal of Nursing and Midwifery Sciences, 2(2), 11-22. Niederriter, J. E., Eyth, D., & Thoman, J. (2017). Nursing students’ perceptions on characteristics of an effective clinical instructor. SAGE Open Nursing, 3, 2377960816685571. Sadeghi, A., Oshvandi, K., & Moradi, Y. (2019). Explaining the inhibitory characteristics of clinical instructors in the process of developing clinical competence of nursing students: a qualitative study. Journal of family medicine and primary care, 8(5), 1664. Soroush, A., Andaieshgar, B., Vahdat, A., & Khatony, A. (2021). The characteristics of an effective clinical instructor from the perspective of nursing students: a qualitative descriptive study in Iran. BMC nursing, 20(1), 1-9. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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