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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.

Magister Curationis - MCur / 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. / South Africa

Introduction: A trusting relationship between medical learners and clinical teachers is vital for educational and clinical productivity. Perceptions of a trusting relationship are influenced by the learner’s perception of the interpersonal risk (i.e. being humiliated) for engaging in learning behaviours (e.g. asking questions, seeking feedback, learning from mistakes). Perceptions of low interpersonal risk are linked to learners feeling comfortable engaging in learning behaviours. What is less clear is how the clinical environment may influence a medical learner’s perception of trust. Methods: Using constructivist grounded theory, we conducted semi-structured interviews with 19 medical clerks and 10 clinical educators affiliated with a single institution. Interviews explored participants’ personal experiences of positive, negative or challenging learner-teacher relationships in the clinical environment. Results: Through qualitative analysis, we developed a theory of Co-Navigation which describes how teachers and learners have common points of interaction to solidify or diminish trust as they navigate the dynamics of the clinical environment. These points in the relationship that each must co-navigate include: preparing to work together; asking questions; engaging in clinical work; and addressing learner mistakes. Perceptions of whether the opportunity solidified or dissolved trust, arose from learners’ perception of the amount of effort their teacher made to mitigate stress learners experienced in the learning environment. Limitations: Our interview participants were recruited as individuals; we did not examine their perceptions of their relationships with each other. Co-recruitment of teacher-learner dyads may be a strategy to further refine this theory in future research. Conclusion: The Co-Navigation theory helps teachers and learners identify key opportunities in the relationship and suggests approaches to solidifying trust at these critical junctures. It highlights the role the clinical environment plays in facilitating and constraining opportunities to establish trust. / Thesis / Master of Health Sciences (MSc) / This thesis project aimed to understand how the clinical environment shapes the way medical learners interact and build relationships with their clinical teachers. We interviewed medical students and clinical teachers who worked together during the medical learner’s clerkship year of clinical training in various healthcare specialties. In the interviews, we discussed learner experiences of positive and negative relationships with clinical teachers. We developed a theory which describes four opportunities that medical learners and clinical teachers will encounter that can support the development of a trusting relationship. This thesis project will contribute insight into types of interactions that can be highlighted as strategic points for educational interventions and administrative reform, to support the development of trusting learner-teacher relationships during clerkship.

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)

The purpose of the study was to determine and understand the challenges that student nurses encounter in the clinical learning environment (CLE) in Limpopo Province, South Africa and how these challenges can be addressed. A quantitative, descriptive, cross-sectional survey was used. The population consisted of levels 2, 3 and 4 year student nurses from three campuses of Limpopo College of Nursing. The researcher used a self- developed questionnaire for data collection. Out of 206 questionnaires, 152 were returned fully completed, yielding 74% effective response rate. The study revealed some of the challenges which negatively affect students’ education and clinical learning and strategies were devised to address these challenges / Health Studies / M.A. (Nursing Science)

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.

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 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.