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 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.

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.

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.

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.

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

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.

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.

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

The concept ‘mentoring’ in nursing is not a new concept as such and has probably been used in a variety of situations and given many interpretations. In healthcare, mentoring is aimed at facilitating professional learning and it enables a student nurse to gain clinical skills during practice placements (Gopee 2008:7). In the psychiatric clinical learning environment, unit managers play a vital role regarding student nurses’ attainment of clinical skills during their practical placements. Lack of mentoring can adversely affect the student nurses’ ability to achieve clinical learning outcomes and this will affect their competency as professional nurses at the end of their training. The aim of this study was to explore and describe the perceptions of the student nurses and unit managers in a specific public psychiatric hospital regarding the mentoring role of unit managers within a psychiatric clinical learning environment. The objectives of the study were to explore and describe the perceptions of student nurses regarding the mentoring role of unit managers within the psychiatric clinical learning environment, to explore and describe the perceptions of unit managers regarding their mentoring role within the psychiatric clinical learning environment and to make recommendations to enhance the mentoring of student nurses by unit managers in a psychiatric clinical learning environment. A qualitative, exploratory and descriptive research design was utilized to address the aim and objectives outlined. Semi-structured focus group interviews were conducted separately with a purposefully selected sample of unit managers and student nurses. The data analysis was guided by the constant comparative method of qualitative data analysis of Tesch (1990:113). The process of transforming data into research results led to the emergence of the following themes for student nurses and unit managers: mentoring as a concept, expectations of the mentoring role, enabling factors of mentoring, disabling factors of mentoring and plans to enhance mentoring. Though the two groups of participants were interviewed separately common perceptions emerged in relation to the themes identified. Mentoring as a concept was viewed as a process of teaching, guiding, supporting, leading, supervision, role-modeling and assistance by an experienced, knowledgeable unit manager. Regarding expectations of the mentoring role, participants were of the opinion that unit managers were not prepared for this role through specific training, but used their experience, to guide student nurses. Furthermore, they perceived it as one of the unit manager’s responsibilities. Disabling factors of mentoring encompassed lack of student nurses’ theoretical background knowledge in psychiatric nursing science, unit managers’ lack of knowledge of advancement in the educational arena, the attitudes of student nurses and unit managers, lack of unit managers’ preparation for mentoring, organizational problems and lack of communication between nurse educators and unit managers. Enabling plans for mentoring encompassed training of unit managers for the mentoring role, theoretical preparation of student nurses prior to placement for psychiatric clinical learning experience, student nurses and unit managers to change their attitude addressing organisational problems and enhanced collaboration between educational and clinical facilities. Recommendations were made regarding nursing practice, nursing education and nursing research for future improvements on the mentoring role of unit managers in the psychiatric clinical learning environment. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted