Jss College of Nursing Saraswathipuram, Mysore-9

JSS COLLEGE OF NURSING – SARASWATHIPURAM, MYSORE-9

1. NAME OF THE CANDIDATE AND ADRESS :

SONIA ABRAHAM

1st YEAR MSC NURSING

JSS COLLEGE OF NURSING

SARASWATHI PURAM

MYSORE.

2. NAME OF THE INSTITUTION :

J S S COLLEGE OF NURSING

1ST MAIN SARASWATHIPURAM,

MYSORE-09

3. COURSE OF STUDY AND SUBJECT :

M. Sc. NURSING. MEDICAL SURGICAL NURSING

4. DATE OF ADMISSION TO COURSE : 15/05/2007

5. TITLE OF THE TOPIC:

AN EXPLORATORY AND COMPARATIVE SURVEY OF PERCEPTIONS OF BACCALAUREATE AND DIPLOMA NURSING STUDENTS REGARDING QUALITY OF CLINICAL LEARNING ENVIRONMENT AT A SELECTED NURSING INSTITUTION OF MYSORE. 5. BRIEF RESUME OF THE INTENTED STUDY

INTRODUCTION

Clinical learning has evolved significantly since Nightingales St

Thomas Hospital School of nursing of the last century. Effective clinical learning is a major objective in preparing students for the health care services. The opportunity to plan clinical learning enabled clinical educators to review not only what and how students learn, but importantly, the organization of activities which facilitates clinical learning .Learning in the classroom and in clinical put students under confusion when they try to reconcile the idea into real.

Always students have little hesitation in telling us what does and

what does not help them to learn in clinical setting. Student evaluations

of their clinical learning experience leave teachers in no doubt that their

involvement with students ,the support they give , the confidence that

they can engender , the clinical expertise they model and the knowledge

they share are important to students clinical learning . (1) 6.1 NEED OF THE STUDY

Clinical learning is an integral part of nursing education .Positive learning take place when it is related to cohesiveness, satisfaction, task orientation on the other hand levels of friction and disorganization can lead to negative learning climate. Major facilitating factors that promote clinical learning are the extent to which students are allowed to make decisions, teaching techniques , learning activities , opportunities for expressing opinions, clear and well organized activities.(2)

There are many factors which affect students learning, like heredity, environment, prior knowledge, genetic makeup, experience in their home, school and community .It is said that students who grow in a stimulated and supportive environment feel very positive about their learning. Some of the constraints in choosing learning activities among students include inability of equipment , lack of pre – requisites , knowledge skills, resistance to active participation, stress, anxiety, and too high student faculty ratio.(3) Synthesis of classroom theory occurs in the clinical setting. Four major problems in the clinical setting that hinder optimal learning are - High student to faculty ratio, increasing patient acuity, student anxiety and faculty concerns about patient safety. Literature supports as anxiety increases learning decreases. Major cause of student anxiety in clinical include - fear of making mistakes, the initial clinical experience in a unit and performing clinical procedures. (4)

Students and faculty both report the major factors which hinder effective learning is the inefficient use of student time and schedules. With increasing number of student’s clinical agencies makes the students work the same shift as regular nursing personals. As a result students spends most of their clinical time doing routine task repeatedly, this aspect does not contribute to their learning nor the development of clinical judgments.

Recently developed clinical educations are focusing on clinical outcomes like clinical judgment, ethical behavior, technical proficiency and new competencies. Eve3n research would guide the type preparation the students would do in anticipation of clinical learning. (5) Students and faculty both report that the major factors which hinder effective learning are the inefficient use of student time and schedules. With increasing number of student’s clinical agencies makes the students work the same shift as regular nursing personal. As a result student spends most of their clinical time doing routine task repeatedly. This aspect does not contribute to their learning or the development of clinical judgments. Recently developed clinical educations are focusing on clinical outcomes like clinical judgments, ethical behavior, technical proficiency and new competencies. (6)

Faculties have a significant influence in student’s success or failure of learning in clinical practice. The most successful relationship is those in which mutual respect and admirations exist between students and teachers.

Many studies have showed both teacher and students have reported experiencing constraint relationships results in failure and frustrating experiencing in clinical teaching and learning (7) The literature revealed the birth of literature in Indian setup. With increasing number of nursing institution leading to large number of nursing student’s population it is felt necessary to explore the quality of clinical learning environment which the students are provided with clinical practice. So that a student model for clinical lear5ning environment can be developed which can serve as guideline for providers of nursing education.

6.2 REVIEW OF LITERATURE

An extensive review of research and non research literature

relevant to the study was undertaken to develop deeper insight into the

problem and to built the foundation of the study .

Review of lete4rature is a process of familiarizing oneself with the

knowledge collected and assimilated which will generate a picture of

what is known and what is unknown. Clinical learning environment is an important part of clinical education. This learning environment should provide student nurses a positive learning environment. A study was conducted to assess pre- registration nursing student’s perceptions of hospital learning environment. Both quantitative and qualitative methodology was used.

A semi structured interview conducted for 21 nursing students and the data were obtained through a clinical learning environment inventory from 108 nursing students. Results showed there was significant difference in the actual and preferred perception of clinical learning.(8)

The quality of learning environment is an essential factor in determining the quality of nursing student’s clinical experience. Stress and anxiety usually affects clinical learning. A study conducted for the development and testing from clinical learning environment diagnostic inventory for Bsc nursing students. This instrument assessed affective, perceptual, symbolic, behavioral clinical learning environment. Finding yielded acceptable estimates of reliability and validity of instrument and it was found useful for assessing clinical learning environments in clinical setting. (9)

Clinical learning environment is an integral aspect which influences students learning outcome. A qualitative study was conducted to elicit the perception of clinical learning environment among 229 nursing students in 2nd or 3rd year of their course. An in-depth interview was conducted and the data obtained. The 5 subscales of clinical learning environment scale include staff-students relationships, nurse manager commitment, patient relationship student satisfaction, hierarchy and rituals. The finding revealed that the interpersonal relationship between the participants in the clinical learning environment were found to be crucial in the development of a positive learning environment. A positive learning environment also found be resulting in students satisfaction with clinical learning environment as well as the students influenced the quality of clinical learning environment. The finding suggested that Nurse educators, clinical venues and all other participating in the undergraduate nursing students clinical education, must collaborate in order to create a clinical learning environment which promotes the development of well- educated registered nurses capable providing safe, cost- effective patient care.(10)

A good co-operation is needed between school or college and the staff nurses in order to provide a better clinical learning environment. A phenomenological study was conducted to describe the student’s perception on clinical environment as a learning environment. An unstructured interview was conducted among 16 student nurses regarding their learning experience. Major elements identified which help student nurses to grow up as a nurse include the appreciation and the support student received , the quality of mentoring and the patient care and students self – directedness.(11)

Students are posted in various health care programmes in order to have positive learning. Clinical student’s placement also influences the extent of learning in clinicals. A longitudinal study was conducted on 4- year part time physiotherapy students. In this qualitative phenomenological study a semi structured interview was conducted for

17 students from the 2000 cohort. Through the interview, factors which have least and most facilitating learning were found, among those factors some were identified as positive and some are negative as factors like direct involvement with patients, educator student interaction with the degree and nature of context deciding on the direction of participant’s perception. The effective strategies to overcome the negative aspect was identified ie. Effective communication skills. (12)

Clinical learning is always affected by various factors and nursing students use coping strategies to overcome the difficulties. A study was conducted to identify the student’s conceptualization of their clinical role and issues affecting clinical learning. Data were collected through interviewing 22 students. Data were analyzed and the finding showed clinical students perceived them self as learners. Clinical learning is affected by unconducive ward environment, negative inter/intrapersonal relationships, inadequately structured clinical activities, anxiety, shortage of both human and material resources. These factors made the students to have maladaptive coping strategies. (13)

For an exploratory qualitative study on the nursing student’s perception of learning in the clinical setting a convenient sample of 23 ,

2nd and 3rd year nursing students was selected and the data were collected by open ended question and perception of learning in clinical setting was evaluated. According to students major elements identified were acceptance of nursing students by other clinician, importance of peer learning, reciprocity and accountability. Study also recommends it is important to adopt alternative approaches. (14)

A study was conducted to investigate approaches to study and learning of nursing and midwifery students in Iran. Generally students approach their studies in surface, deep or strategic manner. Student approaches to study have significant impact on academic success. A cross section design with samples from all the 3 batches of nursing students at one university in Iran was adopted that 64% of nursing and 63% of midwifery students adopted deep approach. Significant positive correlation was found between interests in study and use of strategic approach for both the student’s group. Grade point average for nursing students adopting strategic approach was significantly higher than those who adopted deep or surface approach. The grade point average for midwifery students adopting strategic approach was statistically significantly higher than that for those adopting deep approach, but not different from the grade point average of those adopting surface approach. (15)

A study conducted to determine whether Australian undergraduate nursing curriculum incorporate the necessary skills and knowledge to prepare graduates for current health care. By evaluating 26 Australian curriculums, it was found that hoe each curriculum balance various aspect of course like recent advancement in society, education, and health care industries overall evaluation revealed that graduates were well prepared for practice. However questions of quality and coordination of clinical learning were highlighted for future focus and it was expressed that challenges lie in addressing excessive workload and assessment. (16)

Students consider ward as a learning environment and staff nurses have very important role as mentor. A study was conducted to explore the characteristics of a ward and its evaluation as a learning environment by students. Using structured questionnaire data was collected from 162,

2nd and 3rd year nursing students. Data was analyzed and results showed that quality of nursing care is highly correlated with the quality of the nursing environment. Supervisory relationship followed in the ward is an important factor which makes the students to assess ward as a learning environment. (17)

6.3 STATEMENT OF THE PROBLEM

AN EXPLORATORY AND COMPARATIVE SURVEY OF THE

PERCEPTIONS OF BACCALAUREATE AND DIPLOMA NURSING

STUDENTS, REGARDING QUALITY OF CLINICAL LEARNING

ENVIRONMENT AT SELECTED NURSING INSTITUTIONS OF

MY SORE. OBJECTIVE

 To assess the perception of baccalaureate nursing students

regarding quality of clinical learning environment.

 To assess the perception of Diploma nursing students regarding

quality of clinical learning environment.

 To compare the perception of baccalaureate and diploma

nursing students regarding quality of clinical learning

environment.

 To find the association of the perception of baccalaureate and

diploma nursing students regarding quality of clinical learning

environment with their selected personal variable. ( age ,

gender, year of study , place of residence, academic stream at

10+2 level and purpose of choosing nursing as their carrier,

duration of clinical setting)

CONCEPTUAL FRAMEWORK

Kings goal attainment theory OPERATIONAL DEFINITION

1. Clinical learning environment

In this study it refers to the learning climate provided to the

nursing students in the clinical field which is the combination of

physical, human, interpersonal and organizational properties as

well as mutual respect and trust among teachers and students and

it also refers to the learning climate which provides and facilitate

the students to utilize the opportunity to combine their cognitive,

psychomotor, and affective skills and problem solving abilities.

2. Quality of clinical learning environment

Refers to the extent to which the quality of clinical learning

environment has been able to facilitate the nursing students to

achieve their set goals and objective. 3. Perception of quality of clinical learning environment.

Refers to how much helpful the nursing students perceive their

clinical learning environment has been in achieving their goal, to

be checked through clinical learning environment inventory.

4. Baccalaureate nursing students

It refers to the Baccalaureate nursing students studying in 2nd and

4th year of their course at the time of data collection.

5. Diploma nursing students

It refers to students in their Diploma in nursing and midwifery

studying in their 2nd and 3rd year of their course at the time of data

collection.

HYPOTHESIS

There will be significant difference in the mean perception score of

Baccalaureate and Diploma nursing students with regarding quality

of clinical learning environment. There will be significant association between Baccalaureate

nursing students’ perception of quality of clinical learning

environment and their selected personal variable viz. age, gender,

year of study, place of residence, academic stream at 10+2 level,

purpose of choosing nursing as their carrier and duration of clinical

setting.

There will be significant association between Diploma nursing

student’s perception of quality of clinical learning environment and

their selected personal variable viz. age, gender, year of study,

place of residence, academic stream at 10+2 level ,purpose of

choosing nursing as their carrier and duration of clinical setting .

ASSUMPTION

- Nursing students will have the capacity to perceive the

quality of clinical learning environment. DELIMITATION

The study is limited to Baccalaureate nursing students (2nd & 4th

years) and Diploma nursing students (2nd & 3rd years) of

selected nursing institutions in Mysore.

7. MATERIAL AND METHOD

Research design

Exploratory and comparative survey

Variable

-Perceptions of Baccalaureate nursing & Diploma nursing

students regarding Quality of clinical learning environment

-Age, year of study, place of residence, academic stream at

10+2 level, purpose of choosing nursing as their carrier and

duration in clinical setting.

Source of data

Setting

- Nursing institution which provides Baccalaureate and Diploma

nursing in the city of My sore and are attached to the parent

hospital. Population

-All 2nd year and 4th year Baccalaureate nursing students and 2nd

year and 3rd year Diploma nursing students comprises the

population

7.2 METHOD OF DATA COLLECTION

Sample and sampling criteria

Sample

-2nd and 4th year Baccalaureate nursing students.

- 2nd and 3rd year Diploma nursing students.

Inclusion criteria

-Those 2nd year, 4th year Baccalaureate nursing students and 2nd,

3rd year Diploma nursing students who have had clinical

exposure of more than 3 months in their parent hospital.

-Students those who are willing to participate Exclusion criteria

Nursing students who have not had clinical exposure in

the parent hospital due to any reason.

Sampling techniques

Convenient sampling.

Sample size

2nd year Baccalaureate nursing students - 35

4th year Baccalaureate nursing students - 35

2nd year Diploma nursing students -35

3rd year Diploma nursing students - 35

Data collection technique

Structured clinical learning environment inventory. Method of data collection

-Approval from authority, select sample as per criteria.

- Structured clinical learning environment inventory will be administered to a sample of 140 nursing students and the data will be collected.

Plan of data analysis

Descriptive and inferential statistics used.

 Mean, Median, SD, and Range will be calculated for quality

of clinical learning environment scores.

 Frequency and percentage distribution will be computed to

analyze the selected personal variable and clinical learning

environment.

 ‘t’ test will be used to compare the perception score of

Baccalaureate and Diploma nursing students.  Chi- square will be computed to analyze the association

between perception of Baccalaureate and Diploma nursing

and their selected variable.

7.3 Does the study require any intervention or investigations to be conducted on patient or other humans or animals?

7.4 Has ethical clearance been obtained from your institution in

case of 7.3

NOT APPLICABLE

8 List of References

1. Ruth white, Christine Evan, Clinical teaching in nursing,

1st edition, 2002, stanly throns publishers. P- 2-6 , 17-19. 2. Dominic Chan. Development of the clinical learning environment inventory, Journal of nursing education, Feb

2002, 41(2); p -69-75.

3. Pamela Ironside. Students voices:Listening to their experiences in practice education.Journal of nursing educatition. February 2005 44(2):p-49-52.

4. Amanda Henderson, Michalle Twentymann, Alison,

Belinda .students perception of the psycho0social clinical learning environment:An evaluation of clinical placement.

2007 26(7): p- 564-571.

5. Mary key bekker , Jenet M Neuwrith. Teacheing stratergies to maximize clinical experience with beginning students. Journal of nursing education. Februvary2002 41(2): p- 89-91.

6. Christine A Tanner, Journal of nursing education,

2006, 45(4); p-9

7. Ming-Tsai and Ling- Long Tsai. The critical success factors and impact of prior knowledge to nursing students when transferring nursing knowledge during nursing clinical

practice. Journqal of nursing management. 2005 13:p-459-466.

8.Dominic chan. Nursing students perception of hospital

learning environment- an Australian perspective. International

journal of education scholarship. Januvary 2007 6(4):p- 213-219.

9. Yasuko Hosado. Development and testing of a clinical learning

environment diagnostic inventory for baccalaureate nursing

students, Journal of Advanced nursing, July 2006, 56(5); p-480- 490.

10.Dunn SV Hansford. Undergraduate nursing students perceptions of

their clinical learning environment. Journal of Advanced nursing .

June 1997 25(6): p- 1299-1306.

11.Inker papp,Marjatha Markkanen, Mikaele Von Bonsdorff. Clinical

environment as a learning environment : student nurses perceptions

concerning clinical learning experiences. Nurse education today.

May 2003 23(4)p- 262- 268. 12Jenny morris. Factors influencing the quality of students learning on

practice placement. Learning in health and social care. December

2007 6(4): p- 213 -219.

13S.I. Silthole. The clinical area placement experiences and coping

stratergies of first year general nursing students. Final reported

funded by UNISWA research board , 2000 to 2004. www.

Google.com . Acesessed on 24- 11- 2007 .

14. Kristien Ranse, laurie grealish. Nursing student’s perception of

learning in the clinical setting of the dedicated education unit.

Journal of Advanced nursing. 2007 58(2):p-171-179.

15. Parisa et al. A nursing and midwifery student’s approaches to study and

learning. Journal of Advanced nursing. 2006 54(3): p-351-352.

16. Lara leibbrant,Diane Brown and JillWhite. National comparative

curriculum evaluation of Baccalaureate nursing degree:A

framework for the practices based profession. Nursing education

today. August 2005 25(6): p- 418- 429. 17 Mikko Saarikoski, Helena Leino- Kilpi. Association between qualities of

ward nursing care student’s assessment of the ward as a learning

environment.www.google.com.Accessed on 24.11.2007

9 Signature of candidate

10 Remarks of the guide

RECOMMENDED AND FORWARDED

11 Name and Designation

11.1 Guide

Dr. BHARTI. M PROFESSOR AND PRINCIPAL JSS COLLEGE OF NURSING MYSORE

11.2 Signature

11.3 Co guide

NOT APPLICABLE 11.4 Signature

11.5 Head of the department

Dr. BHARTI. M PROFESSOR AND PRINCIPAL JSS COLLEGE OF NURSING MYSORE

11.6 Signature

12. 12 .1 Remarks of the chairman and principal

RECOMMENDED AND FORWARDED

12.2 Signatures