Clinical practice is a major component of nursing education wherein significant learning takes place. It is also a place where nursing students can experience stress which can have a negative impact on their learning. The purpose of this study was to explore nursing students’ perceptions of and experiences with their coping efforts as they face stress associated with clinical practice. Lazarus and Folkmans’ theory of stress and coping guided this study. Semi-structured interviews were conducted with 10 undergraduate nursing students. Qualitative thematic analysis was used to analyze the data. Four major themes emerged upon analysis: Learning about self, Social Support, Self-Care, and Clinical Instructors. Nursing students need clinical environments which let them face challenges and meet the responsibilities of nursing practice with support from clinical instructors (Emerson, 2007; Parker & Myrick, 2010). A non-punitive and respectful environment is essential for a student to learn and cope effectively with stressful situations. Clinical instructors play a significant role in the clinical practice of nursing students. Clinical instructors facilitate learning by helping students to overcome situational, knowledge-related or emotional stressors. Negative relationships with them can increase the amount of stress in students in their clinical practice. Whereas positive relationships with the instructors and the staff on the unit increase students’ comfort, decrease stress, and enhance learning. This study yielded qualitative data on nursing students’ views about and experiences with coping with the stress from their clinical practice. This study also provided valuable information regarding the clinical instructor’s role in the coping process. The findings have implications for improving the clinical instructor’s role in enhancing coping among nursing students with the stress that arises from clinical practice. / May 2016

Clinical instructors may have a negative or positive effect on student’s clinical practice. The behavioral characteristics of respiratory therapy clinical instructors are vital to the success of student’s clinical learning experience. Therefore, respiratory therapy student’s perception of the effectiveness of the clinical instructor’s behavior is an important indicator to modify and facilitate effective clinical instruction. PURPOSE: The purpose of this study was to identify the most effective clinical teaching behaviors (ECTB) perceived by undergraduate respiratory therapy (BSRT) and integrated graduate respiratory therapy (MSRT) students and to identify any similarities in their rankings. METHODS: The study used descriptive exploratory design with a self-reporting survey. The survey was administered to a convenience sample of first and second year BSRT and MSRT students attending an accredited respiratory therapy program at an urban university located in the southeastern United States. The survey consisted of 35 teaching behaviors presented on a five-point Likert scale according to importance. The collected data were analyzed using descriptive statistics. RESULTS: Seventy-two students were surveyed, more than two-thirds of the respondents were female. Seventy-five percent of respondents studied were BSRT, which females accounted for 78% and males 22%. Graduate MSRT studied were 25% of the total sample with females and males equally split at 50%. Two thirds of MSRT students reported previous education with BSRT students reporting less than one-quarter. The study findings indicate BSRT and MSRT students’ perceptions ranking of the most important behavioral characteristics hold similarities but both perceive the ordered rank of importance differently. Both BSRT and MSRT students ranked “be approachable” as the most important clinical behavioral characteristic with mean scores and S.D respectively (M 4.89, S.D ±0.37, and M 4.94, S.D ±0.24). Additionally, BSRT students rank the characteristic “respect student as an individual” (M 4.87, S.D ±0.34) next significant while MSRT students rank “demonstrate self-control & patience” (M 4.94, S.D ±0.23) the next highest. CONCLUSION: Although BSRT and MSRT students’ perceptions demonstrated similarities, mean scores data between first year and second year show a shift in ranking between characteristics. This may be because student’s perceptions could change as they advance in their clinical course work or their past educational experience. In addition, the results may assist respiratory therapy clinical instructors to appreciate students’ views and acknowledge areas of success as well as areas needing improvement.

Adjunct faculty members make up a growing proportion of nursing school clinical faculty in the United States due to a nurse educator shortage in higher education. Many of the nurses hired as clinical faculty members have years of experience providing patient care, but they lack experience in clinical instruction and assessment. At a state community college in the southeastern United States, nursing students have expressed dissatisfaction in their course evaluations with inexperienced faculty in clinical programs. The experiences of both nursing students under the guidance of novice clinical instructors and clinical faculty were examined in this case study. The National League for Nursing's (NLN) standards for practice for academic nurse educators served as the conceptual framework for this study and was used to develop research questions related to clinical practice and assessment. Data were collected from 9 students and 6 clinical nursing faculty members who participated in anonymous, open-ended electronic questionnaires regarding use of the standards in instruction and assessment. Student clinical experience collective evaluations from 3nursing programs across the state were also used for data collection and analysis. Data were coded and themes were identified and verified through triangulation. Themes were inconsistent with the NLN standards and included no formal orientation, no preparation for the clinical instructor role, use of subjective instructor evaluations, and lack of instructor feedback. Results were used to develop a professional development program to prepare novice clinical instructors for the clinical environment according to the NLN standards. This study may result in positive social change by improving clinical experiences for nursing students in community colleges, resulting in better patient care as they assume their roles in the larger medical community.

Introduction Saudi Arabia is the largest country in the Middle East occupying the majority of the Arabia Peninsula. In 1934 the exploration of oil propelled this country from one of the poorest to one of the highest in per capita income. Islamic law forms the basis of Saudi Arabia's constitution, its civil and penal codes and guides the Saudis in their daily and family lifestyles, governing morals, dress, eating habits and business dealings. Between 1970 and 1980, there was a sharp increase in the rate of population. Currently the population is estimated at 20.8 million with a projected increase to 44.8 million by the year 2025, with approximately 49% under the age of 20. This rise in population has implications for the health care industry, of which expatriates make up more that 85% of the country's health care system. Purpose The purpose of the study was to examine the social and cultural experiences associated with living and working as a registered nurse in a major teaching hospital in Saudi Arabia and to identify and understand how to develop critical thinking skills in Saudi nurses during a nursing education/intervention program in Saudi Arabia. Methodology The researcher reviewed the literature on critical thinking, which allowed the construction of a conceptual model (Appendix 1) to guide teaching and evaluation of critical thinking skills and maintained the focus on dialogue to stimulate interaction and participation in order to promote critical thinking abilities in Saudi nurses. This study adopted ethnography as a methodology and utilised Spradley's (1979)ethnographic research cyclical tasks for data collection and analysis, which are explained in the exploratory, descriptive and explanatory phases of the research. The researcher was a participant observer and collected ethnographic data in the social situation. A variety of data collection methods were employed, which included observation of students and clinical instructors, evaluation of clinical instructors teaching techniques in utilising critical thinking strategies, evaluation of students' responses in the use of critical thinking strategies, focus group interviews of students and clinical instructors and informal interviews conducted within the hospital setting with relevant informants. The use of multi-methods provided the opportunity to examine more fully the richness and complexities of the culture, by gathering data from various sources to validate the consistency of information to reflect the multiple realities of this cultural group. Cultural domains were identified after examining field notes and interviews for terms and clues repeatedly verbalised by informants, in particular students. The researcher organised the domains to formulate taxonomies, leading to cultural themes, which are answered within the research questions in Chapter 8. The research questions for this study are as follows: Research questions 1. What are the issues related to the implementation of critical thinking in a Professional Development Program to improve critical thinking in Saudi nurses? 2. What major elements are involved in creating and sustaining the Saudi Arabian nursing profession? 3. How might Saudi culture be used to support the development of professional nursing identity? Implications for the study This study has the potential to make a significant contribution to nursing education in Saudi Arabia in promoting critical thinking in nurses and in curriculum development for the following reasons. First, didactic instruction was replaced with an interactive approach by utilising critical thinking strategies and devices to facilitate the development of critical thinking abilities. Second, working with a conceptual framework or model made it easier to manage complex multifaceted concepts, such as critical thinking. The model maintained the focus on dialogue and experiential learning thereby assisting students and staff to integrate theory and practice. This model was effective for the program and if duplicated by other programs, could create a learning environment that would allow the effective development and evaluation of critical thinking. The model is reflected in Appendix 1. Recommendations for the nursing profession in Saudi Arabia * To establish the Nursing Practice Act which subsequently leads to the formation of a National Nursing Registration Board. * To transfer nursing into the higher education sectors, to be on par with their Western counterparts. To foster career incentives for men to meet the cultural needs of the people, increase Saudi nurses in the workforce and to raise the image of nursing. * To enact Saudiisation policy. * To incorporate Islamic nursing history into diploma nursing and other nursing educational programs and implemented into the workplace, government policy and the media. * To construct separate male and female hospitals to solve the gender issues. * To systematically collect, collate and analyse nursing data. * To develop continuing education programs to meet educational needs of nurses.

BACKGROUND: Clinical facilities are essential components not only for health care delivery systems but also for health care education programs. The clinical learning environment is important in training the future workforce in healthcare. Respiratory therapy education programs face several issues with the need to prepare a proper learning environment in different clinical settings. PURPOSE: The purpose of this study was to determine the perceptions of respiratory therapy students on the learning environment of clinical facilities affiliated with a respiratory therapy program at an urban state university. METHODS: This study used an exploratory research design to evaluate the essential aspects of a clinical learning environment in respiratory therapy education. A self-reporting survey was utilized to gather data from 34 respiratory therapy students regarding their perception about the effectiveness of clinical facilities in respiratory therapy education. The researcher utilized The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale that was developed by Sarrikoski et al. (2008). The CLES+T evaluation scale was adapted and modified after a written agreement from the author. The survey included three main domains, which are the clinical learning environment (18 items), the supervision relationship (15 items), and the role of clinical instructors (9 items). Thirty-two students participated in the survey with a response rate of 94.1%. RESULTS: Responses included two groups of students: the second year undergraduate (68.8%) and graduate students (31.3%), with 75% being female participants. The results obtained from the study indicated that both graduate and undergraduate respiratory therapy students gave high mean scores to the learning environment of the clinical facilities, supervisory relationship and the roles of clinical instructors. A statistically significant data was obtained pertaining to the difference of perceptions regarding the multi-dimensional learning between the graduate and undergraduate students. The graduate students evaluated that “the learning situation are multi-dimensional” more than the undergraduate students (p = 0.03). Findings of this study showed that female students had higher ratings than male students in all evaluations of clinical facilities. However, only one dimension of leadership style stating that “the effort of individual employees was appreciated” was statistically significant (p=0.03). The results stating, the presence of a significant percentage of the students with lack of successful private supervision and high percentage of failed supervisory relationship, are in contrast with the fact that clinical learning plays a vital role in the respiratory therapy education. It is also contrasting that majority of the students experienced team supervision, which is against the philosophy and principles of individualization. CONCLUSION: Since respiratory therapy is a practice-based profession, it is essential to integrate clinical education to respiratory care education. Gender and education level may impact students’ perceptions about the learning environment of clinical facilities. This study provides information about areas for improvement in clinical facilities affiliated with a respiratory care education program at an urban university.