Magister Curationis - MCur / Background: Nursing as a profession is based on firm knowledge, values, clinical skills and attitudes. In the current dynamic healthcare system nursing students are challenged to be insightful and have clinical reasoning and psychomotor skills in order to apply theory to practice. Clinical teaching is therefore considered an essential part of the undergraduate nursing curriculum, as it provides the opportunity for students to apply theory to practice in the skills laboratory and then to transfer it into real life situations. Nursing students spend time in the clinical practice environment learning the skills and values of the nursing profession, with the goal of achieving the clinical learning outcomes, as prescribed by their nursing education institution and the South African Nursing Council. During this time nursing students depend on the support of clinical supervisors and nursing staff in the clinical practice environment to meet their learning outcomes. Clinical supervisors for the undergraduate nursing programme, at the university included in the study, are tasked with clinical teaching in the skills laboratory, supervision of nursing students in clinical practice and assessment of learning. Nonetheless, there are challenges ascertained by the clinical supervisors, which inhibits students from achieving their learning outcomes. Purpose of the study: The purpose of the study was to explore and describe the clinical supervisor’s perception of students’ skills transfer from skills laboratory to the clinical environment.

With the movement of nurse education into the higher education sector, the role of student nurses has moved from that of apprentices to learners with full student status on placement. Although supernumerary status is key to current nursing training, not much attention has been paid to its influence on student participation in the community of practice of the workplace. This thesis has set out to address this research gap. A qualitative dominant mixed methods study closely examined student participation on placement by comparing and contrasting students’, mentors’ and clinical instructors’ clinical learning and mentoring experiences and their perceptions of supernumerary status was carried out. Data were collected in a nursing college in Macau. In the qualitative part, a sample of seven third year and six fourth year student nurses were recruited to participate in a focus group interview corresponding to their year of study. In addition, five mentors and five clinical instructors were interviewed individually. Views from participants were compared and contrasted. For the quantitative part, all second to fourth year students were invited to respond to a questionnaire after placement. One hundred and fifty-one questionnaires were returned. Descriptive and inferential statistics were used to analyse the quantitative data. This study revealed that there is a lack of clarity about supernumerary status among student nurses. However, students’, mentors’, clinical instructors’ and nurses’ perceptions of clinical learning and supernumerary status exert an impact on student participation on placement. Although students were temporary peripheral participants of the workplace, they had to be engaged in the clinical environment and authentic practice in order to create connections with the workplace and develop nurse identities. It was found that students who were facilitated by mentors, who were drawn from ward staff, had more opportunities to participate in qualified nurses’ work and work with the nursing team on placement than those supported by university-based clinical facilitators.

The number of new graduates greatly affects the existence of any profession and for the nursing profession this rings very true. However, in this caring and nurturing profession many undergraduate nursing students indicate that they consider leaving the profession due to exposure to intra-professional violence. Intra-professional violence may take many forms, is perpetrated by different individuals and have negative effects on patients, staff and institutions therefore it should be identified and managed. In South Africa it has, so far, been a topic which has not received much attention. Purpose Determine the presence of intra-professional violence experienced by undergraduate nursing students in South Africa and then create an awareness of intra-professional violence to eliminate the occurrence thereof. Design A quantitative, non-experimental, explorative and descriptive design was used. Methods The data was collected by means of a questionnaire. The questionnaire was distributed to undergraduate nursing students at nine NEI in South Africa. Findings Although characteristics of oppressed group behaviour are present in undergraduate nursing students it to a low extent. Undergraduate nursing students are experiencing intra-professional violence in the clinical learning environment from different perpetrators. The most likely perpetrator is the registered nurse. The intra-professional violence does cause stress but are deemed controllable according to the undergraduate nursing students. Furthermore the results show that the presence of stress results in an increased control of intra-professional violence. The most likely coping mechanism for intra-professional violence is to do nothing. Conclusion The findings correlated with international results and indicate that intra-professional violence is experienced by undergraduate nursing students in South Africa. Oppressed group behaviour is a contributing factor, but is not the sole cause. Undergraduate nursing students do need education about intra-professional violence and engaging coping mechanisms. Clinical relevance If intra-professional violence is controlled, interpersonal relationships can improve. This would create an environment in which learning can be promoted and undergraduate nursing students will be able to develop their clinical skills with confidence. Furthermore, attrition will decline and nursing shortages can be countered. / Dissertation (MCur)--University of Pretoria, 2012. / Nursing Science / unrestricted

Introduction The purpose of this study was to enhance the prac experience of undergraduate nursing students and registered nursing staff. An innovative model of clinical education, the Clinical Education Unit (CEU) model was developed, implemented and evaluated. Background to the study Clinical education is a vital component of the undergraduate nursing curriculum. 'Real world' practice provides students with the opportunity to develop the knowledge, attitudes and skills needed to function effectively as a registered nurse. Despite the commitment of universities to produce competent graduates, there has continued debate regarding the preparedness of new graduates for practice as registered nurses. This has focussed continued attention on the adequacy of students' clinical education and, in particular, on the models used for clinical facilitation/supervision. There is little published evidence that clearly demonstrates the effectiveness of any of the current models of clinical education or that any particular model is better than any other in achieving quality outcomes (Wellard, Williams and Bethune 2000; Clare, White, Edwards and Van Loon 2002). Hence, as recommended in the recent National Review of Nurse Education (2002), ongoing evaluation of nursing curricula and teaching practice, including clinical education, is clearly warranted. Methods The study utilised action research methodology to examine the effects of the Clinical Education Unit (CEU) on the quality of clinical prac as experienced by undergraduate nursing students and registered nurses working with the students in wards where they were placed for their practicums. It was undertaken in two iterations or phases: Phase 1 - Development, implementation and initial evaluation of an innovative model of clinical education (the CEU model) and Phase 2 - Refinement and re-evaluation of the CEU model of clinical education. Using focus group discussions and survey questionnaires, qualitative and quantitative data were collected from undergraduate nursing students and clinical nursing staff in conjunction with each iteration of the study. Results Phase 1 results indicated that the CEU model was evaluated more positively by students and registered nurses than were the non-CEU models that were used for comparison. This result was demonstrated in the comments of students and registered nurses with regard to the respective models of clinical education and supported by their ratings of the quality of clinical experience through the QPE-Phase questionnaires. A similar trend was found in the results from Phase 2. The CEU-2 model was again evaluated more positively by students and registered nurses than were the non-CEU models that were used for comparison. Conclusion In summary, the results of this study indicate that the CEU model had a positive impact on the prac experience of students and registered nurses. In both phases of the study, students and registered nurses in wards where the CEU model was being used evaluated the prac experience more positively than did students and registered nurses in wards where non-CEU models were being used. Two key factors were found to be important in achieving this outcome: the collaborative nature of the CEU model and nursing staff ownership of students' clinical education. These factors provided an operating framework which enabled the development of positive learning environments in the wards where students were placed for prac. Equally important were arrangements for the supervision of students' practice which involved local clinical facilitation and the explicit inclusion of other nursing staff in the ward. Further, continued support from the university to allow the clinical facilitators to take a supernumary role when facilitating students, to provide staff development for clinical education and to support staff on a day-to-day basis during the prac was also important, if not essential. It is proposed that these factors, acting synergistically, promoted enhanced access to learning opportunities for students and improved learning outcomes for students and staff. The study makes an important contribution to nursing education by providing evidence that can inform future developments in the area of undergraduate clinical education. It has potential benefits for nursing education not only in the local context, but within the international arena as well.

Clinical learning experiences form an integral part of the student nurse's training, for it is in the clinical setting that students acquire the knowledge, skills and values necessary for professional practice. The purpose of this research was to explore student nurses experiences during clinical practice. A qualitative, exploratory, descriptive and contextual design was utilised, employing the phenomenological method. Unstructured interviews were conducted with student nurses in their final year of the four year nursing programme at a nursing college campus in the Limpopo Province. Tesch's method of data analysis was used. The findings indicate that there are aspects which impact negatively on student nurses' clinical learning experiences, such as lack of teaching and learning support, lack of opportunities for learning, poor theory-practice integration, and poor interpersonal relationships between the students, college tutors and ward staff. Recommendations to enhance the clinical learning experiences of student nurses were made. / Health Studies / M.A. (Health Studies)

Clinical learning experiences form an integral part of the student nurse's training, for it is in the clinical setting that students acquire the knowledge, skills and values necessary for professional practice. The purpose of this research was to explore student nurses experiences during clinical practice. A qualitative, exploratory, descriptive and contextual design was utilised, employing the phenomenological method. Unstructured interviews were conducted with student nurses in their final year of the four year nursing programme at a nursing college campus in the Limpopo Province. Tesch's method of data analysis was used. The findings indicate that there are aspects which impact negatively on student nurses' clinical learning experiences, such as lack of teaching and learning support, lack of opportunities for learning, poor theory-practice integration, and poor interpersonal relationships between the students, college tutors and ward staff. Recommendations to enhance the clinical learning experiences of student nurses were made. / Health Studies / M.A. (Health Studies)

Published Article / The aim of the study on which this article is based was to reflect on the learning experiences of students during integrated management of childhood illness (IMCI) training in an undergraduate programme. IMCI is a set of guidelines that was established by the World Health Organisation (WHO) for cost-effective quality care for children younger than five to prevent diseases and death (WHO, 2004). Skilled primary healthcare workers are required to provide quality care at first contact with these children. The IMCI package was presented as an integral part of the second-year module that focuses on primary healthcare. In order to improve the quality of health services and refocus the health system on primary health-care (South Africa Department of Health, 2010), students have to demonstrate that they have achieved competence. According to Killen (2000:188), competence is a holistic term and focuses on knowledge, skills and values instead of competencies, which refer to specific capabilities. Primary health-care workers who act competently will integrate foundational IMCI knowledge with skills and values as well as with the ability to verify their decisions (Killen, 2000:188). Aqualitative, exploratory and descriptive research design was used to investigate the IMCI learning experiences. Such experiences are one of the indications whether training has been successful and how it can be improved (Suski, 2004:222). Data was collected by means of nominal-group technique (NGT) interviews with second-year nursing students of the training school who complied with the criteria for inclusion. NGT interviews were used effectively to evaluate clinical interaction, education and training.The findings reflected the different emotions experienced during teaching and learning as having been positive, negative or neutral. The consideration of negative emotions will assist with the improvement of IMCI teaching and learning, but all these findings can be useful for other higher-education institutions that present or plan to present IMCI training.

Although I was trained as a nurse, I became curious about the views of psychiatric nursing staff as to what they feel would create a clinical learning environment for them. This was as a result of having my dearly beloved father admitted to a medical ward, and being on the receiving side of care. This created a fear in me that surprised me. I was scared at how my father would be treated if I was not present to witness his care. As a nurse, strangely, I felt that I could not trust the nurses to provide safe clinical care for/with my father. I began to feel concerned about the competencies of nurses as I observed the care that was being offered to him. My observation and experience was that the ward environment generated an atmosphere that needed a form of nursing care that was collaborative and transparent where the hand-over between professionals communicated the needs of the patients in their care – from making sure that patients’ bedding is comfortable, to checking whether they are trying to communicate something, to being sure that their medication has been properly given. This aroused my curiosity as to whether nursing staff themselves had views as to what is needed to have, or to create, an environment that sustained their original urge to take up nursing in the first place. I thus became curious to investigate the views and experiences of both qualified and non-qualified psychiatric nurses with the aim of improving the clinical learning environment within acute adult inpatient wards, as well as secure adult and male adolescent mental health inpatient wards, as these wards raise crucial issues to do with control, power, seclusion, rights and responsibilities, issues that are not easy for nurses to learn to deal with in their classroom training. For this study I interviewed sixteen staff members of wards within the National Health Service and the private sector. The staff varied in their experiences and qualification, from qualified mental health nurses to non-qualified nurses. My findings show that: (1) Nurses often felt the ward organisation had hindered their learning through the way in which it worked to organise them. (2) Nurses would have liked to experience a different kind of learning. However they were not sure in what way or how they would like the learning experience to be. (3) The expert nurses were able to work in a competent manner despite the sense of the organisation organising their practices, as they were able to sense which of the limited number of organisational possibilities were open to them so that their choices allowed for their practices to be learning experiences as well as providing sound clinical care. (4) Learning dialogues happen in contexts where nurses feel supported and where the episode of care in which they are engaged is also supported by a team approach and resourceful pulling together of skills and abilities. (5) There was a lack of space(s) for the nurses to use for reflection. (6) Nurses also expressed the need for supervision after an episode or critical event had taken place. (7) Throughout all the areas I inquired into, what was strongly echoed was that the psychiatric nurses all felt that they needed a voice within the organisation and its hierarchy of team structures within these wards. There was a felt sense that the nurses wanted and at times needed more expert nurses working in the teams. Overall, I was struck by the abilities which were brought to the forefront as the nurses shared their views and experiences of how they felt organised by the organisation. They were able to explore the factors that they felt would improve the quality of care that nurses provide and were able to share what they believe will help them in co-creating standards for how the clinical environment could become a learning environment for the nurses.

This research explores how experienced nurses perceive their role as clinical teachers in an environment that is challenged not only with on-going changes in healthcare delivery, but also by the expectation that it will continue to provide positive clinical learning opportunities for undergraduate student nurses. Schools of nursing in Australia have undergone rapid and far-reaching change as a consequence of the legislated transfer of nursing eduction to the tertiary sector. Expectations that nurse academics will possess higher degrees and be actively involved in research mean that faculty members have less time to be directly involved in their students’ learning during clinical practice placements. The literature indicates that the responsibility for moment to moment teaching and learning thus appears to have been implicitly given to clinical staff who may not possess any formal qualifications for teaching, yet are largely responsible for students’ learning through clinical placements. Indeed some clinicians report a worrying lack of knowledge of clinical supervision models giving cause for further concern about the nature of the clinical learning environment. Schools of nursing expect that clinical practica will provide opportunities for students to learn how to be a nurse through guided questioning, analysis and critical thinking. It is evident that in some settings, this represents an ideal situation and not the reality. Critical reflection on these issues has informed the purpose of this research and helped to shape the following questions that focus the conduct of the study: Research Question One. How do experienced nurses create positive clinical learning environments for student nurses? Research Question Two. How do experienced nurses resolve the often-contradictory demands of nursing students and those of the practice setting? Research Question Three. How do changes in the healthcare environment impact on the experienced nurse's role as a clinical teacher? The theoretical framework for this study was underpinned by the interpretive philosophies of hermeneutic phenomenology and symbolic interactionism, because they acknowledge the personal experiences and meanings of the participants. A case study approach was utilised because it acknowledges the given context of the participants. Data were collected from six experienced nurses through a series of semi-structured interviews, informal interviews and periods of participant observation supported by field notes and the researcher’s diary. Participants identified that their perception of their role as clinical teachers was constructed of three intersecting roles: that of facilitator of learning, assessor and socialiser. This study concludes that several factors influence these nurses’ perception of their role as clinical teachers. In particular, the positivist work culture of the clinical setting and nurses’ own past experiences and world view of nursing combine to shape these nurses’ perception of their role as clinical teachers. The research concludes that the expectations that students will be supported in their endeavours to be critically thinking, problem solving and reflective practitioners may, in fact, be unrealistic in the current, economically constrained, clinical environment. It is evident that experienced nurses, despite being willing to be involved with clinical teaching, have to function in rapidly changing environments that do not always offer opportunities for nurses to reflect on their practice. However, the creation of positive clinical learning environments in these circumstances requires an increased understanding and appreciation by both schools of nursing and their students of the impact of change on these nurses and their clinical environment. This appreciation may result in more effective collaboration between nursing education and nursing service to assist student nurses to learn not merely through repetitive practice and busywork, but also through opportunities to observe, question and understand their nursing practice.

Bakgrund: Under senare år har allt fler kliniska träningscentra för färdighetsträning etablerats för att möjliggöra en trygg och säker lärandemiljö med simuleringsmöjligheter för studerande och personal. Klinisk färdighetsträning är en viktig del i sjuksköterskeutbildningen vid Högskolan Dalarna (HDa) där lärandemiljön på Kompetenscentrum (KC) kan bidra till en förbättring av lärandemiljön i den kliniska färdighetsutbildningen. Syfte: Syftet med denna studie var att undersöka sjuksköterskestudenters upplevelser via skattning av lärandemiljön för klinisk färdighetsutbildning före och efter inrättandet av Kompetenscentrum. Metod: Studien genomfördes som en enkätundersökning med kvasiexperimentell design. Enkätens baserades på Saarikoski och Leino-Kilpis mätinstrument CLES där frågeställningar om lärandemiljön modifierades med hjälp av Delphimetoden utifrån de tre olika dimensionerna: utbildningsmiljö, relation och lärarens roll. Mätningen före inrättandet genomfördes under hösten 2010 och mätningen efter inrättandet genomfördes hösten 2011. Totalt ingick 266 sjuksköterskestudenter i studien varav 198 (74 %) besvarade enkäten. Resultat: Sjuksköterskestudenter skattade upplevelsen av lärandemiljön mer positiv efter inrättandet av Kompetenscentrum där resultatet visar en signifikant högre skattning i 8 de av de 16 frågorna. Sjuksköterskestudenterna skattade att de upplever att utbildningsmiljön är mer verklighetstrogen, de är mer nöjda med färdighetsträningen samt att den inspirerar dem till att arbeta som sjuksköterska. Att relationen mellan dem och läraren bygger på respekt och att det är en mer positiv atmosfären under färdighetsträningen. Däremot påvisades ingen signifikant skillnad i studenternas upplevelse av den kliniska lärarens roll. Slutsats: Det är uppenbart att lärandemiljö har betydelse för sjuksköterskestudentens integration av såväl teoretiska som praktiska kunskaper vilket medför att färdigheterna förbättras och ger en bra grund för arbetet som sjuksköterska. Strategier bör vidtas för att vidmakthålla och utveckla lärandemiljön på KC samt fokusera ytterligare på integrering av teori och praktik. / Background: In recent years, an increasing number of clinical training centers for skill training is available to allow for a safe and secure learning environment with simulation opportunities for students and staff. Clinical skill training is an important part of nursing at University College of Dalarna (HDa) where learning environment at the center of excellence (KC) can contribute to an improvement in this part of the training. Aim: The aim of this study was to investigate the nursing students ' experiences through the estimation of learning environment of clinical skill training before and after the establishment of center of excellence. Method: The study was conducted as a survey with quasiexperimental design. The questionnaire was based on Saarikoski and Leino-Kilpis gauges CLES where questions were modified with the help of Delphi method based on the three different dimensions: educational environment, relationship and the teacher's role. The measurement before the establishment was carried out during autumn 2010 and the measurement after establishment occurred in autumn of 2011. A total of 266 students were included in the study, of which 198 (74%) responded to the questionnaire. Result: Nursing students estimated the experience of learning environment more favorable after the establishment of center of excellence where the results show a significantly higher estimate in 8 of the 16 questions. Nursing students´ believe that the training environment is more realistic, they are more satisfied with skill training and that inspires them to work as a nurse. The relationship between them and the teacher is based on respect and that opens up to a more positive atmosphere during skill training. On the other hand, no significant difference in the student’s experience of the clinical teacher's role was noticed. Conclusion: It is clear that the learning environment is important for nurse student's integration of theoretical as well as practical knowledge and skills improvement and provides a good basis for work as a nurse. Strategies should be taken to maintain and develop the learning environment at KC and focus more on the integration of theory and practice.