Perception regarding clinical learning environment among undergraduate nursing students

 

Shaveta Sharma1, Jogindra Vati2

1Professor, Narayan Nursing College, Gopal Narayan Singh University, Rohtas, Bihar, India.

2Professor Cum Principal, Sri Guru Harkrishan Sahib College of Nursing, Mohali, Punjab, India.

*Corresponding Author E-mail: shaveta322155@gmail.com

 

 

ABSTRACT:

Clinical experience is an integral aspect of nursing education as it transforms the theoretical knowledge into practice and the cornerstone of nursing as a health profession. The experience gained through a good and supportive clinical environment includes the atmosphere of the clinical placement unit, and the relationships shared with clinical staff supervisors (staff nurses) and mentors (Clinical instructors) that will affect the students learning. Elements like good teaching, relationship with the clinical staff and opportunity to practice, need to be assessed to have an understanding of the student’s perception regarding clinical learning environment. The aim of the present study was to assess the clinical learning environment among undergraduate nursing students of various colleges of Punjab. Materials and methods: A non experimental, descriptive research design was used to assess the perception regarding clinical learning environment among undergraduate nursing students. SECEE inventory (student evaluation of clinical education environment) by Kari Jecklin - Sand was used to determine the clinical learning environment. Five Nursing institutions were selected conveniently to select 500 under graduate nursing students randomly. Results and Major Findings: The findings of the study revealed that Majority (68%) of the study subjects were satisfied with their clinical learning environment followed by 30.8% who were moderately satisfied and only 1.2% were unsatisfied with their clinical learning environment. As per the Personal Profile of the study subjects, age and gender were found highly significant with the perceived clinical environment score at the 0.01 level of significance whereas no significant association was found out with the habitat, marital status, type of family, place of stay during study and financing during study. As per the family background, mother’s occupation was found highly associated with the clinical learning environment score whereas no association was found with the annual income of parents, education of mother, education of father, father’s occupation and number of siblings.

 

KEYWORDS: Perception, Clinical Learning Environment, Undergraduate Nursing Students.

 

 

INTRODUCTION:

Educational environment is very important in assessing the strengths and weakness of any educational organization. The entry of students in the changed educational environment either leads to fun and achievement or hinder their achievements and it can be affected by various cultures, facilities available in the institution, their expectations etc. Shenai et al. (2019).

 

The qualities and characteristics of a learning environment are determined by a wide range of factors comprising of school policies, governance structures, physical facilities and other features may also be considered important elements of a “learning environment”. Bakhshialiabad, Bakhshi, and Hassanshahi (2015)

 

There is an increasing interest and focus regarding the role of the learning environment in undergraduate medical education in recent years. The World Federation for Medical Education Karle H (2006) emphasized the learning environment as one of the objectives for the evaluation of medical education programmes. The quality of the learning environment has been identified to be very important for effective learning as stated by Genn J, 2001. Ugusman et. al. (2015)

 

The training of nurses is essential for this health initiative WHO (2009). Educational environment perceived via the students as well as by the teachers, their point of view are based on three important components: the physical environment, intellectual and emotional climate. Sayed and El-Sayed (2012)

 

Clinical experience is an integral aspect of nursing education as it transforms the theoretical knowledge into practice and the cornerstone of nursing as a health profession. Killam and Heerschap (2013) revealed that clinical experience gained through a good and supportive clinical environment, which includes the atmosphere of the clinical placement unit, and the relationships shared with clinical staff supervisors (staff nurses) and mentors (Clinical instructors) will be effective for the students learning. Elements like good teaching, relationship with the clinical staff and opportunity to practice were reportedly influential in students’ learning in the clinical area. The support given to students by the nursing staff in the clinical setting also plays an important role in the achievement of their learning outcomes. Lawal, Weaver, Bryan, and Lindo (2015)

 

Nursing students who engage in a wide range of clinical duties in their clinical learning share similar stressors as professional nurses’ experience. Nursing students also have stress related to their educational studies and personal or social experience. This psychological stress may hamper their academic performance and impede their pursuit of the nursing career temporarily or permanently that has to be taken care of Liu, Gu, Wong, Luo and Chan (2015)

 

The findings of this study will help to eradicate the factors that cause delay in learning at Clinical site and will also help the college administration to design and implement the policies to improve the students’ learning and the quality of education. Appropriate management of factors producing quality nurse and their performance at

Clinical site will be enhancing in the form of high quality of patient care. High quality of patient care will make the patient satisfied and hospital practice will be enhanced.

 

RESEARCH STATEMENT:

A study to assess the perceived Clinical learning environment among undergraduate nursing students of various colleges of Mohali (Punjab).

 

OBJECTIVES OF THE STUDY:

1.         To assess the clinical learning environment among undergraduate nursing students

2.         To associate the Clinical learning environment of the undergraduate nursing students with their selected socio demographic variables.

 

RESEARCH APROACH:

Quantitative research approach

 

RESEARCH DESIGN:

Descriptive (Non - experimental design)

 

Settings:

The data was collected from undergraduate nursing students of five selected nursing colleges of Mohali, Punjab.

 

POPULATION:

All the undergraduate nursing students who were studying in second, third and fourth year of B.Sc Nursing in various nursing colleges of Mohali, Punjab.

 

Sample and SAMPLING TECHNIQUE:

Non probability (convenience) sampling technique was used to first select the various nursing colleges.

 

From the selected nursing Colleges the students were selected from each class with the help of simple random sampling (lottery method without replacement) to recruit the study subjects.

DESCRIPTION OF THE TOOL:

Section1. Demographic data of the study subjects related to personal profile and family background.

Section2. Likert Scale to assess perceived clinical learning environment.

 

DATA COLLECTION METHOD:

·           Prior     permission     was     taken    from     concerned authorities.

·           500 nursing students were recruited as study subjects.

·           Purpose of the study was explained to the study subjects.

·           Data was analyzed by using descriptive and inferential statistical methods.

TOOLS OF DATA COLLECTION:

 

SECTION A: Socio-Demographic Profile of the study subjects:

The first part of the tool consists of 2 items describing the demographic variables of the study subjects related to personal profile and family background.

 

The variables included in the personal profile were Age, Gender, Habitat, Marital status, Type of family, Place of stay during study and financing during study.

 

The variables included in the profile related to family were Annual income of parents, education level of mother, Education level of father, Mother’s occupation, Father’s occupation, number of siblings.

 

This part includes the assessment of clinical learning environment by SECEE (student evaluation of clinical education environment) 32 inventory items given by Kari Sand- Jecklin. J Nurs Meas.2009.

 

It contains the items under the following aspects:

·                 Instructor’s facilitation of learning (IFL) 12 items

·                 Preceptors/ staff nurses facilitation of learning (PFL) 11 items

·                 Learning opportunities (LO) 9 items

 

The items were scored on 5 point Likert scale (strongly agree to strongly disagree).

 

The items were scored as 1=Strongly Disagree (SD), 2=Disagree (D),3=Neutral (N), 4=Agree (A),5=Strongly Agree.

 

All items were positive except items 10 and 21 that were reversely scored.

 

Scoring criteria used was:

 

S.No

Scores

Score interpretation

1

≤54

Unsatisfactory

2

55-105

Moderately satisfactory

3

≥106

Satisfactory

 

Domain wise interpretation of scores:

Domain

Level of perception (score)

Instructors facilitation of learning (IFL)

Unsatisfactory (0-20)

Moderately satisfactory (21-40)

Satisfactory (41-60)

Preceptors/Staff nurses facilitation of learning (PFL)

Unsatisfactory (0-18)

Moderately satisfactory (19-35)

Unsatisfactory (36-55)

Learning opportunities (LO)

Unsatisfactory (0-15)

Moderately satisfactory (16-30)

Satisfactory (31-45)

Major findings of the study:

 

 

Figure 1 Percentage distribution of undergraduate nursing students as per Age, gender, residence and marital status (N=500)

 

Figure 2 Percentage distribution of undergraduate nursing students as per type of family, place of stay and financing during study         (N=500)

 

Figure 3 Percentage distribution of undergraduate nursing students as per annual income, mother's education and father's education    (N=500)

 

Figure 4 Percentage distribution of undergraduate nursing students as per mother's occupation, father's occupation and number of siblings (N=500)

 

Above given Figures 1, 2, 3, 4 depicts the percentage distribution of study subjects on the basis of personal profile and family background.

Table 1 Frequency and Percentage distribution of undergraduate nursing students as per their perceived clinical Learning Environment (N=500)

Level of perception (score)

Frequency (f)

% age

Unsatisfactory (≤54)

6

1.2

Moderately satisfactory (55-105)

154

30.8

Satisfactory (≥106)

340

68.0

 

Figure 5 Frequency and Percentage distribution of undergraduate nursing students as per their perceived clinical Learning Environment (N=500)

 

Table 1 and figure 5 shows the:

the Frequency and Percentage of perceived clinical Learning Environment among undergraduate nursing students. Majority (68%) of the study subjects were satisfied with their clinical learning environment followed by 30.8% who were moderately satisfied and only 1.2% were unsatisfied with their clinical learning environment.

 

 

Table 2: Domain wise frequency and Percentage distribution of undergraduate nursing students as per their perceived clinical Learning Environment                                                                                                                                                                                       (N=500)

Domain

Level of perception (score)

Frequency (f)

% Age

Instructors facilitation of learning (IFL)

Unsatisfactory (0-20)

6

1.2

Moderately satisfactory (21-40)

155

31.0

Satisfactory (41-60)

339

67.8

Staff nurses/ perceptors facilitation of learning (PFL)

Unsatisfactory (0-18)

11

2.2

Moderately satisfactory (19-35)

168

33.6

Unsatisfactory (36-55)

321

64.2

Learning opportunities (LO)

Unsatisfactory (0-15)

24

4.8

Moderately satisfactory (16-30)

157

31.4

Satisfactory (31-45)

319

63.8

 

Table 2 shows: domain wise perception,: Majority 67.8% were satisfied with the Instructor’s facilitation of learning whereas 31% were moderately satisfied and only 1.2% was unsatisfied. Majority (64.2%) of the study subjects were satisfied with the staff nurses role in their learning followed by 33.6% who were moderately

satisfied and 2.2% who were unsatisfied with it. 63.8% of the study subjects were satisfied with the learning opportunities provided to them in the clinical environment followed by 31.4% who were moderately satisfied and only 4.8% were unsatisfied with it as depicted by table 4.7 and figure 4.9.

 

Table 3: Score data of undergraduate nursing students as per their perceived clinical Learning Environment                                  (N=500)

Score data description

N

Maximum

Range

Mean

Std. Deviation

Mean % age

Overall Clinical learning environment

500

160

39 - 156

111.77

21.67454

69.9

Domain wise score data

 

 

 

 

 

 

Instructors facilitation of learning (IFL)

500

60

13 - 49

42.056

8.42798

70.1

Staff nurses/ Preceptors facilitation of learning (PFL)

500

55

14 - 55

37.702

8.21317

68.5

Learning opportunities (LO)

500

45

9 - 45

32.01

7.51391

71.1

 

Table 3 shows:

The Mean, SD and range of study subjects as per their score in the clinical learning environment. The mean and SD for the total score was 111.7 and 21.6 followed by the mean score in the IFL, PFL and LO domain were 42, 37, 32 and SD 8.4, 8.2 and 7.5 respectively.

 

Figure 6: Mean percentage of undergraduate nursing students as per their perceived clinical Learning Environment (N=500)

 

Table 4: Association of perceived clinical learning environment score with selected demographic variables related to personal profile of undergraduate nursing students                                                                                                                                                             (N=500)

Demographic variables

N

Clinical learning environment perception level

Chi Square

Unsatisfactory (≤54)

Moderately satisfactory (55-105)

Satisfactory (≥106)

Value df p-value

Personal profile

Age (in completed years)

≤19

66

2

31

33

17.28

20-21

289

4

73

212

6

22-23

113

0

39

74

0.008**

>23

32

0

11

21

 

Gender

Male

20

0

13

7

11.50

Female

480

6

141

333

2, 0.003**

Habitat

Rural

300

3

100

197

2.41

Urban

200

3

54

143

2, 0.299

Marital Status

Married

18

0

5

13

0.33

Unmarried

482

6

149

327

2, 0.849

Type of family

Nuclear

390

4

121

265

0.48

Joint

110

2

33

75

2, 0.787

Place of Stay during study

Hostel

323

3

96

224

4.04

Home

126

3

44

79

4

Outside stay/ Paying guest

51

0

14

37

0.401

Financing during study

Fee loan

41

2

10

29

6.33

Scholarship

24

0

8

16

6

Self

377

3

119

255

0.387

Any other

58

1

17

40

 

Table 4 shows:

that the age and gender were found highly significant with the perceived clinical environment score at the 0.01 level of significance whereas no significant association

was found out with the habitat, marital status, type of family, place of stay during study and financing during study.

 

Table 5: Association of perceived clinical learning environment score with selected demographic variables related to family background of undergraduate nursing students (N=500)

Demographic variables

N

Clinical learning level

Chi Square

Unsatisfactory (≤54)

Moderately satisfactory (55-105)

Satisfactory (≥106)

Valuedf p-value

Related to family

Annual income of parents (in rupees)

<50,000

126

1

47

78

8.35

50,000-1,00,000

230

4

66

160

6

1,00,000- 2,00,000

105

1

25

79

0.214

>2,00,000

39

0

16

23

 

Education level of Mother

No formal education

40

0

13

27

14.02

Upto Matric

193

1

50

142

10

10+2

151

1

50

100

0.172

Graduation

90

3

30

57

 

Post-graduation

21

1

10

10

 

Any other

5

0

1

4

 

Education level of Father

Matric

121

1

37

83

18.26

10+2

175

1

45

129

10

Graduation

135

1

48

86

0.051

Post-graduation

55

3

22

30

 

No formal education

4

0

1

3

 

Any other

10

0

1

9

 

Mother’s Occupation

Home maker

411

4

120

287

24.28

Government employee

38

1

14

23

8

Private employee d

26

0

10

16

0.002**

self employed

21

0

8

13

 

Any other

4

1

2

1

 

Father’s Occupation

Government employee

252

4

85

163

9.46

Private employee

87

0

31

56

6

Self employed

124

2

26

96

0.149

Any other

37

0

12

25

 

Number of siblings

Nil

47

0

15

32

4.14

1

190

3

65

122

6

2

164

2

42

120

0.658

> 2

99

1

32

66

 

* significant difference ( p<0.05) * highly significant difference ( p<0.01)

 

Table 5 shows:

That mother’s occupation was found highly associated with the clinical learning environment score whereas no association was found with the annual income of parents, education of mother, education of father, father’s occupation and number of siblings.

 

DISCUSSION:

The findings of the present study revealed that majority 68% of the study subjects were satisfied with their clinical learning environment followed by 30.8% who were moderately satisfied with it whereas only 1.2% were unsatisfied with it. The findings of the study contradicted the findings of the study conducted by (Bifftu et al., 2016) which revealed that more than half of the study participants perceived themselves as incompetent regarding their clinical learning environment.

 

A similar study conducted by (Liu et al., 2015) supported the findings of the present study that suggests that workload of the nursing students , teaching and learning modalities should be reviewed.

 

The findings of the present study also favor the findings of a study conducted by (D’Souza et al., 2015) which revealed that the satisfaction of the students with the clinical learning environment was highly significant and positive.

 

MAJOR FINDINGS:

1.               Frequency and % age of perceived clinical Learning Environment among undergraduate nursing students was revealed as majority (68%) of the study subjects were satisfied with their clinical learning environment followed by 30.8% who were moderately satisfied and only 1.2% were unsatisfied with their clinical learning environment.

2.               The domain wise frequency and percentage of clinical learning environment perception depicted that majority 67.8% of the study subjects were satisfied with the Instructor’s facilitation of learning whereas 31% were moderately satisfied and only 1.2% was unsatisfied. Majority (64.2%) of the study subjects were satisfied with the staff nurses role in their learning followed by 33.6% who were moderately satisfied and 2.2% who were unsatisfied with it. 63.8% of the study subjects were satisfied with the learning opportunities provided to them in the clinical environment followed by 31.4% who were moderately satisfied and only 4.8% were unsatisfied with it.

3.               The mean, SD and range of study subjects as per their score in the clinical learning environment were calculated and were as follows: the mean and SD for the total score in the clinical learning environment were 111.7 and 21.6 followed by the mean score in the Instructors facilitation of learning (IFL), Staff nurses/ Preceptors facilitation of learning (PFL) and Learning opportunities (LO) domain were 42, 37, 32 and SD 8.4, 8.2 and 7.5 respectively.

 

RECOMMENDATIONS:

·                 The study can be replicated on a larger sample to generalize the findings.

·                 The comparative study can be conducted for assessing the learning environment of undergraduate and post graduate students.

·                 The comparative study can be conducted for assessing the learning environment of basic and post basic B.Sc. Nursing students.

·                 Similar study can be conducted in private and government institutions to see the difference in the perceptions of the students.

·                 Similar study can be conducted as experimental in nature as the teachers can be given knowledge regarding the various strategies to improve the learning

 

REFERENCES:

1.                Bakhshialiabad, H., Bakhshi, M., and Hassanshahi, G. (2015). Students’ perceptions of the academic learning environment in seven medical sciences courses based on DREEM. Advances in Medical Education and Practice, 6, 195–203. Retrieved from https://doi.org/10.2147/AMEP.S60570

2.                Bifftu B. B, Dachew B . A. Perceived clinical competence among undergraduate nursing students Advances in Nursing Volume 2016 (2016), Article ID 9294673, 7 pages

3.          D souza M.S., Subrahmanya 2015 .Perception of and satisfaction with the clinical learning environment (CLE) among nursing students. Nurse Education today June 15 volume 35 Issue 6 pages 833-40

4.          Kari Sand – Jecklin. Refinement and testing of the student evaluation of clinical education environment inventory(SECEE). Southern online journal of nursing research issue 4, vol 1.2000

5.          Lawal, J., Weaver, S., Bryan, V., and Lindo, J. L. (2015). Factors that influence the clinical learning experience of nursing students at a Caribbean school of nursing. Journal of Nursing Education and         Practice,              6(4).      Retrieved from https://doi.org/10.5430/jnep.v6n4p32

6.          Liu. M, S, T. K., Wong, Luo, M. Z., and Chan, M. Y. (june2015). Perceived stress among Macao nursing students in the clinical learning environment. International Journal of Nursing Science, 2(2), 128-133.

7.          Sayed, H. Y., and El-Sayed, N. G. (2012). Students’ perceptions of the educational environment of the nursing program in Faculty of Applied Medical Sciences at Umm Al Qura University, KSA.8(4), 7.

8.          Shenai, N. A. S., George, A. M., Mariyam, A. M., Abraham, A. P., Balakrishnan, A., and Scaria, A. (2019). Perception of educational environment among Bsc nursing students. International Journal of Nursing Education, 11(1), 109. Retrieved from https://doi.org/10.5958/0974-9357.2019.00021.7

9.          Ugusman A,Othman N A, Razak Z N A. Assessment of learning environment among the first year Malaysian Medical students. Journal of taibah university Medical sciences. Vol 10. Issue 4. dec 2015 P 454- 460.

 

 

 

 

Received on 15.07.2021                Modified on 03.08.2021

Accepted on 18.08.2021            © AandV Publications all right reserved

Int. J. Nur. Edu. and Research. 2021; 9(4):451-457.

DOI: 10.52711/2454-2660.2021.00104