CHAPTER ONE
INTRODUCTION
Background to the Study
Nursing is a practice discipline that requires nurses to have sound clinical skills and knowledge for rendering nursing care to the public. Nursing education prepares nurses to be competent in nursing practice through classroom lectures and clinical posting. While theoretical elaborations in nursing classroom prepare nursing students’ affective and cognitive domain, clinical posting on the other hand prepares their psychomotor domain for nursing practice. Therefore, one of the main features of nursing both as a science and a profession is integration of theory and practice (Rajeswaran, 2016). Clinical training is an important component of nursing education that takes place in a complex social context of the clinical environment (Sharif and Masoumi, 2005). Learning in a clinical setting creates challenges that are absent in a classroom setting. Tutors have control of the environmental conditions in the classroom whereas in the clinical setting, the teaching and learning are modified according to the situation of the real environment (Peters, McInnes, and Halcomb, 2015). The safety of patients that the students are assigned to care for during clinical postings is a priority over their offered opportunity to learn and learning needs (Peasah, Sarfo, and Asamoah, 2013). Clinical experience prepares student nurses to be capable of knowing as well as doing the clinical principles in practice. In other word competence in nursing skills is a product of clinical experience. Moreover, the clinical practices experienced during clinical postings stimulate students to use their critical thinking skills in problem solving and prepares them to practice safe and effective nursing (Pearcey and Draper, 2008).
Nursing education programs in Nigeria (of which FCT Abuja is the Capital) include a three years basic nursing programme done in schools of nursing (or a five years baccalaureate programme, if done in the university) and post-basic programmes in various sub-specialties offered by post-basic schools attached to teaching hospitals. Both the basic and post-basic programmes are regulated by the Nursing and Midwifery Council of Nigeria (NMCN), the statutory regulating body for nursing education and practice in Nigeria (Afoi, 2015).
It has been reported that post-basic nursing students failed to integrate theory into practice and also lacked adequate supervision in the clinical area despite experience of clinical posting (Bayoumi, Elbasuny, Assiri, and Alfesal, 2012). Such has been blamed on the structure of nursing programmes. The programmes are structured in a way that those that direct teachings in the classroom are not involved in direct clinical teaching and evaluation of the post-basic students (Msiska, Smith, and Faecett, 2014). Preceptors from the clinical area contribute to the students’ learning but are not involved in their classroom teachings. Therefore lack of role integration and clarity of learning outcomes among lecturers and preceptors blur learning outcomes and hinder nursing students’ clinical learning (Nabavi, and Vanaki, 2010).
The ward learning environment has a lot of external stimuli which disadvantages the nursing students with respect to identifying the learning opportunities. Msiska, Smith, and Faecett (2014) asserts that the lack of equipment, lack of guidance, supervision, and negative attitude by the nurses influence the effectiveness of the clinical learning of nursing students during clinical postings. Anxiety, attitude, academic level, commitment to the work and use of mobile phones by the student nurses affect the quality of learning and compromises the patients’ care (Motiagh, Karimi, and Hasanpour, 2012). The workload, higher numbers of student teacher ratio in the clinical area, and in the classroom affect the lectures’ role in the clinical teaching (McSharry, McGloin, Frizzell, and O' Donnell, 2010).
Stress, anxiety, depression, and dejection have also been identified as an important psycho-social factor affecting the nursing students’ experience of clinical posting (Rajeswaran, 2016). According to the available literatures, academic workload, unfamiliar situations in the clinical area, handling clinical emergencies, and shortage of resources negatively impact on nursing students’ clinical learning (Magnussen, and Amundson, 2003). Clinical nursing education is in essence learning through experience (Mabuda, Potgieter, and Alberts, 2008). Yet, patient needs are a primary focus and sometimes compromise students’ learning, because students are exposed to a lot of complex and challenging situations (Rajeswaran, 2016).
The nursing students prepared at a post-basic level are expected to be evaluated on wide range of clinical procedures during their practicum in the course of the program and during the end stage nursing and midwifery council exam (Killam and Heerschap, 2012; Afoi, 2015). Studies have identified Lack of clarity of learning outcome, lack of synergy between classroom learning and clinical practice, unfamiliar areas, difficult patients, fear of making mistakes and being evaluated as incompetent by examiners as sources of stress during the clinical posting and accompanying exams. In other words, existing empirical opinions point to existence of theory-practice gap despite that embedment of clinical posting in nursing education was aimed to close this gap (Rajeswaran, 2016).
Theory- practice gap is a cog in the wheel of progress of nursing education because nursing education is meant to produce safe and effective nurses that have both sound clinical knowledge and skills to serve the public (Hickey, 2007). Where clinical experience acquired via clinical posting, which is supposed to blend theory and practice, is reported to be impoverished by some factors that render it ineffective it means that the key goals of nursing education are not being adequately met (Hathorn, Machtmes, and Tillman, 2009). This is especially as clinical experience is an integral part of nursing education that prepares student nurses to be able of "doing" as well as "knowing" the clinical principles in practice, and as well stimulates students to use their critical thinking skills for problem solving for enhanced competency and clinical skills (Guzman, Ormitta, Palada, Panganbana, and Pristina, 2006).
The current study, therefore, seeks to unravel if the above scenarios reported by previous studies are also the case with the post-basic nursing programmes in Nigeria as there are no existing published studies on experiences of clinical posting of post-basic nursing students in Nigeria as evidenced by goggle search that produced no result on the subject matter. Because FCT Abuja is the capital of Nigeria, the Post-Basic schools located therein are likely than post-basic schools located in other areas to have students of diverse ethnicity, religion, cultural and tribal inclinations that reflect the diversity of the country’s geographical space. Against this background, the current study seeks to assess, through qualitative approach, the experience of clinical posting of post basic nursing students in FCT, Abuja
Statement of the Problem
Nursing education is meant to produce safe and effective nurses that have both sound clinical knowledge and skills to serve the public (Hickey, 2007). Clinical experience, which is supposed to balance theory and practice, has been reported to be impacted by some factors that render it ineffective making the goals of nursing education to be unmet or underachieved (Hathorn, Machtmes, and Tillman, 2009). Lack of clarity of learning outcome, lack of synergy between classroom learning and clinical practice, unfamiliar areas, difficult patients, fear of making mistakes and being evaluated as incompetent by examiners has been reported to impact on experience of clinical posting and thus, clinical nursing practice (Sharif and Masoumi, 2005; Rajeswaran, 2016). This is further compounded by the fact that the safety of patients that the students are assigned to care for is a priority over their offered opportunity to learn and learning needs during clinical postings (Peasah, Sarfo, and Asamoah, 2013)
Because clinical experience is an integral part of nursing education that prepares student nurses to be able of "doing" as well as "knowing" the clinical principles in practice and as well stimulates students to use their critical thinking skills for problem solving (Guzman, Ormitta, Palada, Panganbana, and Pristina, 2006), it is imperative that its patterns of influence and how it is influenced is understood (Dinmohammadi, Peyrovi, and Mehrdad, 2013). The existing literatures reflect nursing students’ experience of clinical postings in other climes of the world outside Nigeria as goggle search showed no existing published work on the subject matter in Nigeria. Therefore, a probe into the pattern and challenges of nursing students’ experience of clinical posting in Nigeria is imperative to provide the nursing authorities, decision makers and nursing stakeholders in the country with information useful for informed policy choices on nursing students’ clinical experience.
Since Abuja, the Federal Capital Territory (FCT) of Nigeria, harbours Nigerians of diverse background vis-à-vis ethnicity, culture, religion, socio-economic status so on, the Post-Basic schools located therein are likely than post-basic schools located in other areas to have students of diverse ethnicity, religion, cultural and tribal inclinations that reflect the diversity of the country’s geographical space. The current study therefore, seeks to evaluate the experience of clinical posting of post basic nursing students in FCT, Abuja.
Purpose of the Study
The main purpose of this study is to assess the post basic nursing students’ experience of clinical posting in FCT, Abuja. Specific Objectives of the study are to
- assess post basic nursing students’ experience of clinical posting in relation to what are outstanding, what are pleasant, what are anxiety-provoking and what are most challenging.
- explore what were helpful during post basic nursing students experience of clinical posting.
- assess if post basic nursing students’ experience of clinical posting translates into learning new things or not.
- assess post basic nursing students’ opinion on whether nursing practice in the hospital is different from what is taught in the classroom.
- explore whether the post basic nursing students’ expectation of experience of clinical practice is met or not.
- assess how post-basic nursing students think their experience of clinical posting can be improved.
Research Questions
The study will provide answers to the following questions:
- What do post basic nursing students find outstanding, pleasant, anxiety-provoking or most challenging in their experience of clinical posting?
- What did post basic nursing students find helpful during their experience of clinical posting?
- Does post basic nursing students’ experience of clinical posting translates into learning new things or not?
- What is post basic nursing students’ opinion on whether nursing practice in the hospital is different from what is taught in the classroom?
- Is the post basic nursing students’ expectation of experience of clinical practice being met or not?
- How do post-basic nursing students think their clinical experiences can be improved?
Significance of the Study
The result of this study will be useful to nursing authorities, decision makers and nursing stakeholders in the country. Nursing students especially, those at post-basic levels will also find it useful.
To the nursing authorities, decision makers and nursing stakeholders [such as the Nursing and Midwifery Council of Nigeria (NMCN), the National Association of Nigerian Nurses and Midwives (NANNM), the University Graduates of Nursing Science Association (UGONSA), and professional associations of the post-basic sub-specialties], when the work is published, it would provide them with knowledge that would help them have greater insight into the nursing students’ experience of clinical practices vis-à-vis empirical facts on the strength, weakness and improvement prospects of the current instructional method employed in students’ clinical teaching. This will enable them to make informed policy choices in developing effective clinical teaching strategies that will have the capacity of achieving or improving on the nursing educational mandate of providing safe and effective nursing care to the public via knowledgeable, competent and skilled nursing workforce. To this end, no gap should be allowed between theory and practice through reinforced and repositioned clinical posting. This can be achieved by continually consolidating the strength of the current clinical instructional methodology and improving on its weakness by implementing far-reaching empirical recommendations of studies on the subject matter such as the current study.
To nursing students, it will provide information on factors influencing their experience of clinical posting and performances. Through these information students would become more competent in evaluating and managing problems and difficulties of clinical experience to their advantage. When students learn what constitute impediments to their having qualitative and impactful clinical experience, they will make concerted effort to support the authorities find solutions or address the challenges. Being aware of the challenges and the way forward will promote behavioural changes among the students which will make them “part of the solutions” rather than “part of the problems”. It will make them to be supportive of efforts at reformation by the authorities to improve on the existing methodology of clinical instruction.
Scope of the Study
The study will be delimited to only post-basic nursing students schooling in FCT, Abuja. In addition, it will equally be delimited to the following post-basic nursing schools located in Abuja: Post-basic school of Intensive Care Nursing Gwagwalada Teaching Hospital, and the Post-basic Schools of Oncology and Nephrology Nursing of the National Hospital, Abuja.
Operational Definition of Terms
- Clinical Experiences: The exposure a nursing student gets from interacting with and helping manage patients’ condition under the supervision of qualified nurses.
- Post-basic nursing student: A student that is studying to get licensed from the Nursing and Midwifery Council of Nigeria to practice a clinical nursing specialty. In the current study, post-basic schools are the Post-basic school of Intensive Care Nursing Gwagwalada Teaching Hospital and the Post-basic Schools of Oncology and Nephrology Nursing of the National Hospital, Abuja.
- Theory-practice gap: Inability to match classroom descriptions and illustrations of clinical situations with reality of practice.
