Very little has been done to define the process of clinical learning in Malawi and yet anecdotal observations reveal that it is more challenging than classroom teaching and learning. This set the impetus for this hermeneutic phenomenological study, the aim being to gain an understanding of the nature of the clinical learning experience for undergraduate students in Malawi and to examine their clinical experiences against some experiential learning models (Kolb 1984; Jarvis et al 1998). The study setting was Kamuzu College of Nursing (KCN) and the sample was selected purposively and consisted of 30 undergraduate students who were recruited through volunteering. Conversational interviews were conducted to obtain students’ accounts of their clinical learning experience and an eclectic framework guided the phenomenological analysis. The study raises issues which relate to nursing education and nursing practice in Malawi. From an experiential learning perspective, the study reveals that clinical learning for KCN students is largely non-reflective. The study primarily reveals that the clinical learning experience is enormously challenging and stressful due to structural problems prevalent in the clinical learning environment (CLE). In some clinical settings the CLE appears hostile and oppressive due to negative attitudes which some of the clinical staff display towards KCN students. Consequently, students’ accounts depict emotionally charged situations which confront them and this illustrates that clinical learning for KCN students is an experience suffused with emotions. In literature issues on emotions are commonly discussed under emotional labour (Hochschild 1983) and I used the concept as a basis for my pre-understandings and interpreted the students’ accounts of their clinical learning experience against such a conceptual framework. What resonated from their narratives was the depth of the emotion work they engage in. This enabled me to arrive at a new and unique conceptualisation of clinical learning redefined in terms of emotional labour within the perspective of nurse learning in Africa. The findings are a unique contribution to the literature on emotions and provide essential feedback which forms the basis for improving clinical learning in Malawi.

Faculty of Health Sciences School of Physiotherapy 9303432y goundes@therapy.wits.ac.za / Orthopaedic manipulative therapy (OMT) like other areas of physiotherapy, is a rapidly advancing field. To keep abreast of changes, curricula need regular evaluation and updating. The curriculum consists of many components that may vary from content to timetabling. The aim of this study was to determine how past graduates from the University of the Witwatersrand perceived the OMT curriculum with regards to content, teaching methods and clinical learning. This information will contribute to an overall evaluation of the present OMT curriculum. The sample consisted of graduates from 1997-1999. Questionnaires and interviews were used to gather the information. Some interviews were carried out following analysis of answers to the questionnaire to clarify issues or gain additional information. Results indicated that eighty one percent of the sample found the content relevant to clinical practice, but forty two percent found certain aspects of the content inadequate. The following areas of content were deficient: sixty percent found information on patient education, advice and counseling related to OMT inadequate. Fifty five percent would have liked to be more exposed to research in this area. Sixty seven percent felt that teaching of clinical reasoning skills was lacking. Ninety four percent would have liked information on other joint mobilization concepts. It was perceived that active learning methods were more effective than passive learning methods. Fifty eight percent found tutorials, sixty eight percent found practical sessions, and fifty eight percent found workshops very effective. With regards to clinical learning, seventy seven percent found supervision very helpful in clinical placements. Eighty one percent found patient presentations helpful, and seventy one percent found discussion of patients with lecturers very helpful. Most responses indicated that the OMT curriculum was relevant to current practice in South Africa but inadequate in certain specific areas.

The clinical experience prepares nursing students to become competent and professional practitioners. Therefore, it is important to identify the key characteristics of a positive and constructive clinical learning environment. This cross-sectional study assessed undergraduate nursing students. (n=61; response rate of 38%) perceptions of their clinical learning environment and their suggestions to enhance it. The participants were fourth year nursing students enrolled in the Faculty of Nursing at the University of Manitoba who were doing their senior practicum (NURS 4290). Participants were invited to complete anonymously the actual and preferred versions of the Clinical Learning Environment Inventory (CLEI) (Chan, 2001). It was found that there were significant differences between students. perceptions of the actual and the preferred CLEI they desired. Participants also responded to two open-ended questions related to obstacles or things that would enhance their learning experience. Nine categories were identified that added to an understanding of the quantitative findings. The study indicated that there is still work to be done to provide a healthy clinical learning environment for nursing students and this task belongs to nursing researchers, educators, and health care organization preceptors and leaders.

The purpose of this qualitative study was to explore students’ perceptions and experiences of feeling confident in some clinical areas and not in others and to explore how clinical teachers may increase students’ feelings of self-efficacy during clinical practice. Using Bandura’s (1997) theory of Self-efficacy as a framework three major themes and several subthemes emerged from the data as important influences to student learning. Clinical Education facilitator (CEF) was the term used in this study for clinical teacher (CT)and was considered by students to be the most important influence to clinical learning.The CEF was the most developed theme followed by the theme of the environment and the theme of the student. The findings of this research were found to be consistent with the literature related to self-efficacy and student learning in the clinical setting. Implications for nursing education and recommendations for further research were discussed.

The clinical experience prepares nursing students to become competent and professional practitioners. Therefore, it is important to identify the key characteristics of a positive and constructive clinical learning environment. This cross-sectional study assessed undergraduate nursing students. (n=61; response rate of 38%) perceptions of their clinical learning environment and their suggestions to enhance it. The participants were fourth year nursing students enrolled in the Faculty of Nursing at the University of Manitoba who were doing their senior practicum (NURS 4290). Participants were invited to complete anonymously the actual and preferred versions of the Clinical Learning Environment Inventory (CLEI) (Chan, 2001). It was found that there were significant differences between students. perceptions of the actual and the preferred CLEI they desired. Participants also responded to two open-ended questions related to obstacles or things that would enhance their learning experience. Nine categories were identified that added to an understanding of the quantitative findings. The study indicated that there is still work to be done to provide a healthy clinical learning environment for nursing students and this task belongs to nursing researchers, educators, and health care organization preceptors and leaders.

The purpose of this qualitative study was to explore students’ perceptions and experiences of feeling confident in some clinical areas and not in others and to explore how clinical teachers may increase students’ feelings of self-efficacy during clinical practice. Using Bandura’s (1997) theory of Self-efficacy as a framework three major themes and several subthemes emerged from the data as important influences to student learning. Clinical Education facilitator (CEF) was the term used in this study for clinical teacher (CT)and was considered by students to be the most important influence to clinical learning.The CEF was the most developed theme followed by the theme of the environment and the theme of the student. The findings of this research were found to be consistent with the literature related to self-efficacy and student learning in the clinical setting. Implications for nursing education and recommendations for further research were discussed.

Magister Curationis - MCur / An increasing number of males is entering the nursing profession. The researcher in his position as a clinical supervisor at the School of Nursing at the University of the Western Cape (UWC), through informal ward rounds with student nurses in the wards, has received concerns raised by male student nurses regarding their dissatisfaction with their clinical learning. Given the paucity of literature about the experiences of males working in a profession dominated by females, the researcher embarked on this study to understand how male student nurses experienced the clinical learning environment. The aim of the study was to explore and describe the lived clinical learning experience of male student nurses during their experiential learning in the clinical setting. A descriptive phenomenological design was used. Purposive sampling was used to select participants from the second, third and fourth year of their study. Three focus group discussions, consisting of six participants per group were used to collect data. One open-ended question guided the interviews. Focus group discussions were audio-recorded and transcribed verbatim. Data analysis was conducted by means of Colaizzi`s (1978) seven steps method of qualitative analysis. Three major themes identified focused on the experiences regarding the constraints in the learning environment, the impact on the self and social support of students working in a female dominated profession. The participants in this study were male students only, but after looking at the findings and literature, the problem of not being given opportunities to practise clinical skills in a clinical learning environment, particularly according to their level of study, is a problem that faces both male and female students. The findings indicate that male nurses do have different experiences compared to female nurses because of their masculinity, hence they are limited in the care that they can provide to female patients.

Master of Public Health - MPH / Background: Globally there is an urgent requirement for skilled nurses. For this reason, interventions in nursing education need to be carefully assessed and strategically planned and coordinated. In order to establish an effective clinical learning environment at education institutions, it is strongly recommended that one should gain insights from the perceptions of students, regarding their experience of their learning environment. Aim: The aim of the study was to investigate the undergraduate nursing students’ perceptions of the psychosocial clinical learning environment in a Higher Education Institution. Methodology: A quantitative descriptive survey design was used for this study in the form of questionnaires. The study utilized the pre-existing Clinical Learning Environment Inventory (CLEI) instrument developed by Chan (2001). The study utilised third year and fourth-year undergraduate nursing students. The target population comprised third year undergraduate nursing students (n=250), and fourth year undergraduate nursing students (n=248). The total target population was (n=498) undergraduate nursing students. A random sampling technique was used to select the study sample size of n=218. Self-administered questionnaires were distributed to two hundred and eighteen (218) respondents during class time and two hundred and eighteen (218) completed questionnaires were returned. The data was analysed using the Statistical Package for Social Science version 25. Descriptive statistical analysis was used to generate frequencies, mean values, median and standard deviation of observations. Reliability and validity of the study was ensured as described in the methodology section. Permission to use students for the study was sought from the registrar of the University. Informed written 3 consent was sought from all the participants in this study. The ethical principles were adhered to ensure confidentiality and anonymity of the participants throughout the study and beyond. Results: The fourth year respondents, 64.7% (n=90) agreed that their facilitators often think of interesting activities compared to their third-year counterparts, 35.3% (n=49); whereas, 63.6% (n=77) agreed that the facilitator thinks up innovative activities for students as compared with 36.4% (n=44) third years. This significant difference between the year levels cannot be justified from the study findings. However, it can be attributed to an underestimation of the impact of innovation and its impact on teaching and learning. The perception of fifty percent (50%) each for both year levels reported that the clinician talks more, rather than listening to the students. These findings indicate that communication between students and their clinical facilitator is hindering the clinical learning experience. There was a significant difference found between the groups (t=1.1, p=.027), as the average opportunities for interaction between students and clinical facilitators were lower for third year [2.3(±0.4)], compared with the average participation score for the fourth year 2.4 (±0.4). Most of the respondents, 81.2% (n=177) reported that clinical placement was a waste of time. The findings showed that the degree of satisfaction declined as students progressed from third to fourth year. There was a significant difference between the groups with 91.1% (n=102) fourth years reporting that clinical placement was a waste of time compared to 70.8% (n=75) of their third-year counterparts. A probable explanation for this might be the fact that the learning objectives and activities differed in the academic progression. The extent to which students are allowed to make decisions and are treated fairly was found to be more favourable by fourth years than third years, with mean scores of 2.7±0.4 and 2.6±0.4 respectively; thus highlighting a greater level of independence at the more senior 4 level. Study findings reported that 47% (n=102) agreed that the preceptor/clinician often became side-tracked instead of sticking to the point and only 45.9% (n=100) stated that clinical placements were disorganized. The findings from this study indicated that half of the students did experience a certain level of clarity and organization across their classes, while others did not consistently receive this level of clarity. Conclusion: The findings of the study indicates that there was inadequate supervision, poor student-mentor interaction, a lack of clarity and organization and ineffective teaching methods that impacted negatively on their decision making skills and revealed the need for new strategies to be implemented in the nursing education system, in order to ensure a successful CLE. Recommendations: This study demonstrated that students perceive the CLE as a place to learn and obtain skills for the nursing profession, yet their perceptions of how they were taught did not reflect their enjoyment of learning, and showed room for improvement in how clinical facilitators used different teaching methods, interacted with learners, and allowed them to make decisions, all the while ensuring that the lines of communication were kept open. Clarity and an organizational culture were lacking in the students learning environment which impacted negatively on their perception of learning. It is imperative that clinical facilitators evaluate their behavior with students consistently, be aware of their behavior and be open to suggestions and recommendations on how to improve their teaching.

Clinical learning is regarded as a vital component in nursing programmes and students need to work in various clinical environments. In the emergency nursing programme presented at a tertiary nursing education institution, the pre-hospital environment is used as a clinical learning environment in which students rotate for approximately eight weeks. The clinical experience that they gain may assist in them developing the necessary knowledge and skills. It also assists in theory-practice correlation. The purpose of this study was to evaluate the value of the pre-hospital environment utilised as part of the clinical learning component of the emergency nursing programme. A qualitative approach was utilised since the researcher wanted to study a particular phenomenon, namely the pre-hospital learning environment. Therefore, the research design was a descriptive design whereby the researcher could describe the real life situation in the pre-hospital learning environment as experienced by the emergency nurse students. The target population for the study was emergency nurses who had already obtained their qualification as a registered emergency nurse, as well as emergency nurse students that had completed their rotational period in the pre-hospital learning environment. For the purpose of this study the identified sample consisted of students enrolled for the emergency nursing programme at a tertiary nursing education institution in Gauteng. The sample was adequate to provide the researcher with sufficient in-depth data and was also representative of the accessible population. The final sample size was 45 emergency nurse students who had completed the pre-hospital rotational period between 2008 and 2011. Data collection was done by means of Appreciative Inquiry, a method used that not only focuses on the positive, but which is also a stimulating way of looking at organisational change. Stories (narratives) were shared by the emergency nurse students pertaining to their real life experiences. Initially stories were shared in writing on an Appreciative Inquiry interview schedule. For the purpose of data saturation, individual Appreciative interviews were conducted by an independent interviewer, utilising the Appreciative Inquiry interview schedule as a guide. Data analysis was conducted by the interviewer, supervisors and an independent data analyser to ensure trustworthiness. Four themes were identified, namely clinical exposure, competencies, team work and future recommendations. From the data analysis and the four themes recommendations could be made with regard to programme refinement. Copyright / Dissertation (MCur)--University of Pretoria, 2013. / Nursing Science / unrestricted

Student Number : 0317159E - MSc(Nursing) research report - School of Therapeutics - Faculty of Health Sciences / The learning environment and supervision in clinical placement play an important role in nursing education. The purpose of this study was to describe the opinions of student nurses with regard to the clinical learning environment and supervision at Malamulo Hospital, Malawi. A quantitative descriptive design was used. Data were collected from nursing students at Malamulo College of Health Science using the Clinical Learning Environment Scale (CLES) comprising structured questions. The questionnaire was administered to the total population of students (N=84) and the response rate was 87% (n=73). Descriptive statistics were used to analyze data. Relationships between variables were determined by using Fisher’s exact test and the t-test. The findings revealed that the majority of the participants were satisfied with their clinical learning environment and supervision in their latest clinical placement. Particularly, they were satisfied with the relationship that prevailed between students and members of nursing staff, feedback they received from their supervisors, the nursing care given to patients and the quality of learning opportunities. However, it was determined that nurse teachers did not regularly supervise students and also that some students were not clear about the nursing philosophy of their wards. Ward familiarization processes were not well planned as indicated by about a third of the participants. More than one third also indicated that the learning situations were not sufficient and not meaningful. While 73.98 % indicated that they received constructive feedback from their supervisors, about half of the participants indicated that the feedback was not given continuously.The majority (67.76%) of the participants experienced team supervision as opposed to individual supervision. Therefore it is recommended that nurse teachers increase the number of visits to the wards when students are in clinical placement to improve quality of clinical learning. The nursing college may need to have specific clinical instructors who are trained in clinical supervision and who will be available for students in the clinical placements regularly. The ward managers and the nursing staff need to clarify and display their ward nursing philosophy so that both nurses and students can have a common understanding and common goal in the provision of nursing care. It is also recommended that feedback be given to students continuously to enhance learning.