Received on 10.05.2019 Modified on 13.06.2019

Int. J. Nur. Edu. and Research. 2019; 7(4): 463-466.

DOI: 10.5958/2454-2660.2019.00103.0

INTRODUCTION:

Clinical education is the most important part of nursing education and is considered as an inseparable component of it [1, 2, 3, 4]. In this case, in some sources, clinical education has been mentioned as the heart of professional training in this major [1]. A significant part of nursing students’ time is spent in clinical settings during their education [1]. Therefore, preparing them for their professional role has been widely considered, and the main focus of attention is on clinical education [5]. Nursing is always recognized as a profession-based practice, and clinical education is the main part of it [5, 6]. Training in clinical centers provides the students with opportunities to experience nursing in the real world and put theoretical knowledge into practice [7].

Given the importance of clinical education among nursing students, researchers and educational planners of nursing schools in Iran have shown great interest in recent years [8-14]. In Iran, this issue has been very much considered so that the most important part of which has been the changes in the educational curriculum of undergraduate nursing students. Since the beginning of 2015, a new curriculum for nursing education has been designed and announced, and one of the major changes in it was to pay more attention to the clinical education as well as the attendance of students in clinical settings. In the new regulations, last year nursing students should work in the same way as nursing staff of hospitals in accordance with the work plan of the departments in all three shifts (morning, evening and night). This matter has drawn a great attention to clinical education.

However, studies have shown that clinical education of nursing students is still facing serious challenges [3]. One of these challenges is the inadequate learning environment. The clinical learning environment is an interactive network of forces contributing to the learning outcomes of students [7]. Providing an appropriate learning environment for clinical education of nursing student is essential [15]. Nursing staff and their professional attitude are part of the learning environment [7]. However, searches showed limited studies in this regard. Therefore, in this study, we tried to measure the attitude of professional nurses regarding the attendance of nursing students in clinical settings.

METHODS:

The present study was conducted at Qazvin University of Medical Sciences in 2018-2019. The study setting was active departments of five teaching hospitals affiliated to the university. Currently nursing education in Iran is being developed in three (undergraduate, postgraduate and PhD) degrees. At undergraduate level, the course is 8 semesters (4 years) that the first semester consists of theoretical courses, while the second to sixth semesters includes both theoretical and practical courses. And finally, the last two semesters (7^th and 8^th) are only about practical lessons. Nursing education is mainly run by state-run medical universities, however, there are active nongovernmental universities as well. Clinical education of nursing students is mainly carried out at teaching hospitals affiliated to these medical universities. There are two groups of undergraduate and postgraduate nursing students at Qazvin University of Medical Sciences. The study population consisted of all the nurses with a at least an undergraduate degree working in hospitals affiliated to Qazvin University of Medical Sciences. Sampling was made through a convivence sampling method and all nurses who were willing to participate in the study were invited. Sampling was done by two researchers and after obtaining the necessary permissions. In order to do this, the researchers referred to the target settings during the morning and evening hours and asked nurses to participate in the study. If the nurses were willing, researchers explained the main objectives of the study to them and distributed the questionnaires between them. The nurses were asked to deliver the questionnaires to their head nurses after completing the questionnaires, and at the end, the head nurses delivered them to the researchers.

A researcher-made checklist and a standard questionnaire entitled "Nurses' attitudes towards nursing students" that its validity and reliability was determined to be desirable in previous studies, were used for data collection. The checklist of demographic variables included items about nurses’ age, gender, work experience, and degree. The "nurses' attitude towards nursing students" questionnaire consists of 41 items that measure nurses' attitude through seven subscales; items related to (1) time, (2) motivation, (3) knowledge, (4) professional issues, (5) background comparison, (6) instructor-student relationship and (7) personal issues. Items in this questionnaire are scored as follows: Agree (score 1), Undecided (score 2), and Disagree (score 3). Total score is within a range of 41 to 123. Scores 41 to 95 are indicative of negative attitude, while scores 96 to 123 are interpreted as positive attitude [16].

Ethical Considerations:

The present study is a student proposal approved by the research committee of Qazvin School of Nursing and Midwifery. This study also obtained the Ethics License for Biomedical Research from the Ethics Committee of the University. The researchers also asked the participants to sign the informed consent before entering to the study. The nurses, who participated in the study, were informed that no information would be obtained beyond the objectives set out in the study, and the information obtained would remain confidential.

Data Analysis:

Collected data were entered to the SPSS version 16 and then, analyzed using descriptive and inferential statistics.

RESULTS:

Totally, 89 nurses participated in this study that 81 of them were female and others were male. The mean age and work experience of nurses were 30.9 and 8.3 years, respectively. the majority of the nurses had a bachelor degree in nursing (n=83).

The overall score of nurses’ attitude was 74.2 with a standard deviation of 8.4. The mean score in the subscale of "time" was 9.7 with a standard deviation of 1.7. The highest and lowest scores in this part were related to the items "Nursing students cause more trouble than help" and "A lot of work had to be done to improve the educational status of nursing students", respectively. The mean score in the subscale of "motivation" was 6.8 with a standard deviation of 1.8. The highest and lowest scores in this part were related to the items "Nursing students willingly help nursing staff to fulfill their duties" and "Nursing students do only what they are assigned", respectively. The mean score in the subscale of "knowledge" was 16.1 with a standard deviation of 2.7. The highest and lowest scores in this part were related to the items "You cannot tell nursing students anything because they know everything" and "Nursing students seem to have no common sense", respectively. The mean score in the subscale of "professional issues" was 11.9 with a standard deviation of 2.2. The highest and lowest scores in this part were related to the items "Nursing students are too intimate with the physicians" and "I believe that nursing students respect nurses as practitioners", respectively. The mean score in the subscale of "background comparison" was 10.3 with a standard deviation of 2.2. The highest and lowest scores in this part were related to the items "Nursing students are well prepared for clinical practice" and "We were all students once, so we should be tolerant with nursing students", respectively. The mean score in the subscale of "instructor-student relationship" was 5.1 with a standard deviation of 1.5. The highest and lowest scores in this part were related to the items "Nursing students are too intimate with instructors" and "Nursing students often rely on instructors rather than nurses", respectively. The mean score in the subscale of "personal issues" was 14.3 with a standard deviation of 2.6. The highest and lowest scores in this part were related to the items "Nursing students are too dependent on the nursing staff" and "Nursing students become overwhelmed if they have to provide care for more than one or two patients", respectively. Among demographic variables, age was the only variable that had a significant relationship with nurses' attitude. As their age increased, their attitude towards the attendance of nursing students in the clinical settings was more positive (p=0.033, rr=0.244).

DISCUSSION:

Considering the important role of nursing staff in clinical education of nursing students, this study aimed to study the attitude of nurses working in hospitals affiliated to Qazvin University of Medical Sciences regarding the attendance of nursing students in clinical settings. In general, the results showed that nurses did not have a positive attitude towards the attendance of nursing students in clinical settings.

Our searches in this regard showed 3 studies that measure the attitudes of nurses working in hospitals regarding the attendance of nursing students in clinical settings [16, 17, 18]. Two studies were conducted in Iran and the other study was conducted among Palestinian nurses. Similar to the results of the present study, the results of all three studies showed that clinical nurses did not have a positive attitude toward the attendance of nursing students in clinical settings. In the subscale of "time", nurses reported that nursing students cause more trouble than help during their attendance in clinical settings. They also stated that a lot of work has to be done to improve the educational status of nursing students. In a study by Aghamohammadi-Kalkhoran et al., a high percentage of nurses reported that nursing students cause more trouble than help during their attendance in clinical settings [16]. This issue should be carefully studied. Perhaps the reason for this matter is related to a large crowd of students of different majors simultaneously in one department. In some cases, it is seen that a large number of nursing and non-nursing students are present at the same time in one department. Therefore, it is necessary for nursing and non-nursing educational planners to pay a great attention to this matter. In the subscale of "motivation", nurses fairly scored high on all items, indicating a positive attitude in this subscale. For instance, a high percentage of nurses mentioned that nursing students willingly help nursing staff to fulfill their duties. In this regard, in the study of Aghamohammadi-Kalkhoran et al., nurses reported exactly the same attitude. In this subscale, many nurses said that students do not usually do things according to what they have been assigned [16]. This matter should be taken into consideration by the educators and the necessary measures must be taken. In this regard, instructors can use experienced students alongside novice students. In the subscale of "knowledge", most nurses believed that students have good information and knowledge about relevant topics that it can reflect the proper education of students during their training in the university. In this regard, in the study of Aghamohammadi-Kalkhoran et al., nurses reported exactly the same attitude. In the subscale of "professional issues", few nurses believed that nursing students respect nursing staff [16]. In this subscale, nurses also reported that nursing students are more intimate with other members of the medical team, including the physicians. This issue is very important and should be considered by the planners. In addition to further studies, in order to examine the issue in greater details, it seems that interventions such as inter-sectoral meetings between instructors, nursing students and nurses can help improve the existing status of the hospital as the entrance of students to different departments of the hospital. In the subscale of "background comparison", a high percentage of nurses reported that nursing students are well prepared for clinical practice which this can be a positive point. In this regard, in the study of Aghamohammadi-Kalkhoran et al., nurses reported exactly the same attitude. In the subscale of "instructor-student relationship", nurses believed that nursing students have a good relationship with their instructors [16]. In recent years, discussions on clinical education of nursing students was very important and some measures have been taken in this regard, which it can result in better communication between clinical instructors and students. In the subscale of "personal issues", the responses showed that students are highly dependent. In this regard, in the study of Aghamohammadi-Kalkhoran et al., nurses reported exactly the same attitude [16]. In this regard, the existing situation can be improved by creating a supportive atmosphere, as well as establishing a better relationship between nursing staff and students.

CONCLUSION:

A significant part of nursing students' education is done in clinical settings and the cooperation of nursing personnel in this regard is essential. However, the findings of the present study showed that the nurses, who participated in the study, did not have a positive attitude towards the attendance of students in the hospitals. This issue should be addressed by the nursing educational planners and the necessary measures be considered in this regard, especially since the new curriculum of nursing education in Iran has paid great attention to the attendance of nursing students in the clinical settings. Given the lack of studies, it is recommended that similar studies be carried out in this regard. It is also recommended that the topic be examined with qualitative research methods for further details.

LIMITATION:

A large number of nurses were unwilling to participate in the study, and therefore the sample size was slightly lower than expected. This issue should be considered by readers when using results.

ACKNOWLEDGMENTS:

The authors would like to thank all the nurses participating in this study as well as the Research and Technology department of Qazvin University of Medical Sciences.

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Received on 10.05.2019 Modified on 13.06.2019

Int. J. Nur. Edu. and Research. 2019; 7(4): 463-466.

DOI: 10.5958/2454-2660.2019.00103.0