Abstract The purpose of this study was to describe perceptions and explain background factors relating to the clinical learning environment and mentoring of culturally and linguistically diverse nursing students. The study included two phases: instrument development and a cross-sectional study. The instrument development phase consisted of a conceptualization process, which included two systematic reviews with thematic synthesis; generation of items for two new instruments, Cultural and Linguistic Diversity scale and Cultural and Linguistic Diversity in Mentoring scale, and psychometric testing of these newly developed scales. The cross-sectional phase was completed by collecting data from: (a) students (n = 329) studying in English-language nursing degree programmes from eight Finnish universities of applied sciences during autumn 2015 and spring 2016; and (b) mentors (n = 323) of culturally and linguistically diverse students from five Finnish university hospitals during spring 2016. In addition to the two newly developed instruments, two commonly used instruments Clinical Learning Environment, Supervision and Nurse Teacher scale and Mentors’ Competence Instrument were used for the main data collection. The data was analyzed using descriptive statistics, a nonparametric test and a binary logistic regression analysis. The psychometric properties of the instruments had good validity and reliability. Students’ perceptions on the level of their clinical learning environment and mentoring were lower than their mentors’ perceptions of their own mentoring competence. The level of language was the most common factor relating to the outcomes of culturally and linguistically diverse students’ clinical learning environment and mentoring. Future studies on culturally and linguistically diverse nursing students in the clinical environment should have a marked emphasis on improving proficiency in the native language, which should be implemented in the organizational structure of the clinical placements. This should include providing additional education for clinical mentors to enhance their mentoring competence with culturally and linguistically diverse students. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli kuvata ja selittää eri kulttuureista ja kielellisistä taustoista tulevien hoitotyön opiskelijoiden kliinistä oppimisympäristöä ja ohjausta. Tutkimuksessa oli kaksi vaihetta: mittarin kehittäminen ja poikkileikkaustutkimus. Mittarin kehittämiseksi ilmiö käsitteellistettiin, mikä toteutettiin kahtena systemaattisena katsauksena. Katsausaineistot analysoitiin temaattisella synteesillä. Tämän jälkeen muodostettiin mittarit operationalisoimalla käsitteet väittämiksi. Mittareita kehitettiin kaksi: Kulttuurinen ja kielellinen monimuotoisuus- mittari sekä Kulttuurinen ja kielellinen monimuotoisuus opiskelijaohjauksessa -mittari. Mittareiden kehittämisvaiheessa niiden psykometriset ominaisuudet testattiin. Poikkileikkaustutkimus toteutettiin keräämällä kyselyaineisto (a) opiskelijoilta, jotka opiskelivat englannin kielellä opetettavissa sairaanhoidon tutkinto-ohjelmissa kahdeksassa suomalaisessa ammattikorkeakoulussa syksyn 2015 ja kevään 2016 aikana (n = 329); sekä (b) eri kulttuureista tulevien opiskelijoiden ohjaajilta viidestä suomalaisesta yliopistosairaalasta kevään 2016 aikana (n = 323). Aineistot kerättiin ensimmäisessä vaiheessa kehitetyillä mittareilla sekä kahdella yleisessä käytössä olevalla mittarilla, Terveysalan koulutukseen liittyvän harjoittelun ohjauksen laatu -mittarilla sekä Opiskelijanohjausosaaminen -mittarilla. Aineisto analysoitiin käyttämällä kuvailevaa tilastoanalyysiä, ei-parametrisiä testejä ja binääristä logistista regressioanalyysiä. Tutkimuksessa kehitettyjen mittareiden psykometriset ominaisuudet olivat hyvät. Opiskelijoiden ohjaajat arvioivat oman osaamisensa korkeammalle kuin opiskelijat. Opiskelijat arvioivat sekä heidän kliinisen oppimisympäristönsä että ohjauksensa tason ohjaajien arvioita alhaisemmaksi. Kielitaito oli yleisin tekijä, joka vaikutti opiskelijoiden näkemyksiin kliinisestä oppimisympäristöstä ja ohjauksesta. Englannin kielellä opetettavissa tutkinto-ohjelmissa tulisi painottaa opiskelijoiden riittävää paikallisen kielen kielitaitoa. Tämän lisäksi kliinisen harjoittelun ohjaajien tulisi saada koulutusta eri kulttuurillisista taustoista tulevien opiskelijoiden ohjaukseen.

Objetivo: Describir y hacer un análisis crítico de los casos clínicos que formaron parte significativa del aprendizaje obtenido como interno de medicina durante los meses de rotación en el Centro de Salud Gustavo Lanatta Luján y el Hospital Nacional Dos de Mayo, durante el periodo de junio 2021 a febrero 2022, los cuales contribuyeron a mi formación como futuro médico cirujano. Metodología: Se realizó un estudio observacional, de tipo descriptivo y analítico de los casos que consolidaron la experiencia clínica obtenida durante el internado médico Resultados principales o hallazgos: Recopilación de 30 casos clínicos, que fueron presentados de manera descriptiva. Los cuales evidencian de forma global los principales aprendizajes obtenidos en la práctica clínica, tales como: comunicación oral, pensamiento crítico y analítico, manejo de información y profesionalismo. Conclusiones: El internado médico es una etapa fundamental en la formación de todo profesional del campo de la salud, en el cual se sintetizan, integran y aplican los conocimientos adquiridos durante los años previos. Actualmente, el contexto de pandemia nos ha permitido ser parte del desarrollo de la ciencia, experimentando de primera mano la evolución de una enfermedad, la cual generó cambios a los que se debió adaptar, no solo el personal de salud, sino también la población en general; asimismo atravesamos una etapa en la cual día a día se emitían nuevos avances científicos, los cuales debíamos analizar y aplicar en los diferentes campos con la finalidad de lograr el bienestar de nuestros pacientes. Finalmente, se obtuvo un aprendizaje íntegro, enfocado en el paciente, respetando y considerando sus creencias y culturas; fortaleciendo la relación médico paciente y la comunicación activa, puesto que en nuestra profesión se trata personas, no solo patologías. / Objective: To describe and make a critical analysis of the clinical cases that formed a significant part of the learning obtained as a medical intern during the months of rotation at Gustavo Lanatta Luján Health Center and Dos de Mayo National Hospital, during the period of June 2021 to February 2022, which contributed to the training as a future physician. Methodology: An observational, descriptive and analytical study of the cases that consolidated the clinical experience obtained during the medical internship. Main results or findings: Compilation of 30 clinical cases, which were presented using descriptive instruments. Which evidence the main learning obtained in clinical practice, such as: oral communication, critical and analytical thinking, information management and professionalism. Conclusions: The medical internship is a fundamental stage in the training of all professionals in the health field, in which the knowledge acquired during the previous years is synthesized, integrated and applied. Currently, the pandemic context has allowed us to be part of the development of science, experiencing first-hand the evolution of a disease, which generated changes to which not only health personnel had to adapt, but also the population in general; Likewise, we went through a stage in which new scientific advances were issued day by day, which we had to analyze and apply in the different fields in order to achieve the well-being of our patients. / Trabajo de Suficiencia Profesional

One of the major challenges associated with nursing education in this 21st century is the practice preparation of student nurses in this complex healthcare environment to ensure their fitness to practice. Practice training relies largely on mentoring which is central to the professional development of student nurses. In the local context of Mauritius, the clinical mentoring of students is service-led rather than education-driven. In the context of the current debate, it is becoming evident that the clinical mentoring system in Mauritius needs rethinking in order to respond to the emerging training and education needs of nurses. The aim of the study was to develop a contextually relevant clinical mentoring framework for student nurses in Mauritius in order to enhance the standard of student nurses’ training during clinical placements. A descriptive exploratory sequential mixed method with a cross-sectional design was used in this study. The sample for the qualitative phase consisted of eight nurses, while there were 255 nurses and 115 students in the quantitative phase. Data were collected through face-to-face semi-structured interviews and a self-administered questionnaire, respectively. The findings were synthesised using Dickoff et al’s (1968) survey list to develop the clinical mentoring framework for student nurses. The findings of the qualitative phase indicated that the current learning support system for students in the clinical settings did not reflect what mentoring should be about. Mentoring per se was not practiced, but rather a form of clinical accompaniment resulting in the practice being less effective for its purpose. A variety of activities/roles were described that nurses fulfil in everyday clinical practice that included some aspects of a mentoring approach. Participants provided a number of pre-requisites needed for the mentoring process. The results of the quantitative phase revealed that both students and nurses recognised that the mentoring system was informal. They also shared the same views regarding barriers to mentoring, such as staff shortage, lack of resources, and inadequate support from management and the Central School of Nursing (CSN). Along with mentoring competencies, teaching, assessing, communication, managerial and leadership skills, were identified as core competencies for mentors. Effective clinical mentoring requires an understanding of the mentoring process from a broader perspective. Mentors should be equipped with core competencies. Successful mentoring outcomes are dependent on a conducive clinical learning environment (CLE) and the approach used to mentor. The framework on mentoring could guide and provide a holistic approach to mentoring students in CLEs. However, emphasis must be placed on the collaboration between the management, the clinical setting and the CSN. The clinical framework developed from this study can be tested for its effectiveness. / Health Studies / Ph. D. (Nursing)

The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.

Text in English / The purpose of this study, was to identify and describe factors, which facilitate or impede learning in clinical learning settings. The study adopted an exploratory descriptive approach, incorporating both quantitative and qualitative designs. Data collection tool, comprised of two sections: Section 1 focused on demographic characteristics. While section 2 addressed study variables of clinical setting, staffing, patient care/ practice standards, nurse manager's commitment and interpersonal relationships. The last section had two parts; part 1 being close ended Likert type scale ranging from strongly agree to strongly disagree. Part 2, was open ended, and solicited respondents' feelings opinions and experiences on factors they perceived to facilitate or impede clinical learning. The findings indicate that the majority of settings studied did not provide adequate factors to facilitate clinical learning. Factors such as availability of learning experiences, acceptable unit organization, space and resource availability, and accessibility to students, adequate staffing with qualified staff who actively participate in teaching, appropriate and quality patient care role modelled, lecturer availability and involvement in clinical teaching, team building and inclusion of students in the team, committed nurse managers involved in students' learning, conducive relationships among staff, students and patients, comfort relationships, advocacy and creating conducive relationship by the nurse manager, were identified as necessary for learning. These factors however, were found to be either lacking, inadequate or inaccessible to students. Findings were based on data from a quota sample of 202 participants proportionately drawn from students, nurse managers and nurse lecturers. The study made recommendations to improve and enhance the conduciveness of clinical practice settings used for learning in Botswana. / Health Studies / D.Litt. et Phil. (Advanced Nursing Science)

Text in English / The purpose of this study, was to identify and describe factors, which facilitate or impede learning in clinical learning settings. The study adopted an exploratory descriptive approach, incorporating both quantitative and qualitative designs. Data collection tool, comprised of two sections: Section 1 focused on demographic characteristics. While section 2 addressed study variables of clinical setting, staffing, patient care/ practice standards, nurse manager's commitment and interpersonal relationships. The last section had two parts; part 1 being close ended Likert type scale ranging from strongly agree to strongly disagree. Part 2, was open ended, and solicited respondents' feelings opinions and experiences on factors they perceived to facilitate or impede clinical learning. The findings indicate that the majority of settings studied did not provide adequate factors to facilitate clinical learning. Factors such as availability of learning experiences, acceptable unit organization, space and resource availability, and accessibility to students, adequate staffing with qualified staff who actively participate in teaching, appropriate and quality patient care role modelled, lecturer availability and involvement in clinical teaching, team building and inclusion of students in the team, committed nurse managers involved in students' learning, conducive relationships among staff, students and patients, comfort relationships, advocacy and creating conducive relationship by the nurse manager, were identified as necessary for learning. These factors however, were found to be either lacking, inadequate or inaccessible to students. Findings were based on data from a quota sample of 202 participants proportionately drawn from students, nurse managers and nurse lecturers. The study made recommendations to improve and enhance the conduciveness of clinical practice settings used for learning in Botswana. / Health Studies / D.Litt. et Phil. (Advanced Nursing Science)

Workplace violence directed at student nurses in training in psychiatric institutions is a significant concern as it negatively affects the quality of learning and causes the students to have a negative perception of nursing as a profession. The absence of scientific data describing the perceptions of student nurses about workplace violence and their clinical learning outcome motivated the researcher to conduct the study. Quantitative, descriptive research was conducted to explore the influence that workplace violence will have on clinical learning outcomes of student nurses who are studying psychiatric nursing at psychiatric institutions in KwaZulu-Natal, in South Africa. Data was gathered using a 71 question questionnaire, which was adapted from the one used by Hewett (2010). With the necessary permission from the health authorities, the campus principals and the nursing students, a group of 4th year student nurses (n=163) from 6 campuses of the KwaZulu-Natal College of Nursing (KZNCN) who have worked in psychiatric units for at least 3 months and longer participated in the study. The study highlighted the types of workplace violence encountered by student nurses, the effects of workplace violence on students’ academic performance and the barriers to the reporting of workplace violence encountered by the student nurses. The study revealed that there is a large amount of non-physical, some physical and a few incidents of sexual violence directed towards the student nurses at the psychiatric institutions, and that it has a negative impact on student learning. The recommendations emanating from the study support the idea of a shared responsibility between healthcare and education institutions and the focus is on preparing and equipping the student psychiatric nurses to confront, withstand and break the cycle of workplace violence. / Health Studies / M.A. (Nursing Science)

The purpose of this qualitative explorative study is to explain individualized lived experiences of registered nurses working and participating in clinical supervision for nursing students within the clinical environment at selected hospitals. The study explores the challenges faced by registered nurses on a daily basis on how to structure clinical activities for the nursing students and provide high quality care to patients.

The purpose of this qualitative explorative study is to explain individualized lived experiences of registered nurses working and participating in clinical supervision for nursing students within the clinical environment at selected hospitals. The study explores the challenges faced by registered nurses on a daily basis on how to structure clinical activities for the nursing students and provide high quality care to patients.

Text in English / This study explores and describes the perceptions of student nurses regarding professional nurses as role models in the clinical learning environment. An exploratory-descriptive qualitative approach was followed. The population for this study was the final year students in the programme: Bridging course for enrolled nurses leading to registration as a general nurse. Nonprobability, quota sampling was done. The study was conducted at two Gauteng campuses of a private nursing education institution. Two “World Café” conversations were conducted where after data saturation was achieved. The three major themes that emerged were professionalism of the professional nurse, the need for student support and the teaching and learning environment. From the students’ feedback it was evident that professional nurses should be aware of the important role they play in the professional and personal development of students. Professional nurses as role models should portray the professional behaviours and attitudes required by the profession. Students have a vision of how they expect to be when they qualify as professional nurses. Recommendations from this study relate to the three themes identified and clearly indicate that students have a realistic expectation of and a need for visible role models in the clinical learning environment. / Health Studies / M.A. (Health Studies)