Official Journal of the College of Nursing, University of Mosul

Authors

Department of clinical nursing sciences, College of Nursing, University of Mosul, City of Mosul, Iraq

Abstract

Background and Aim: The clinical instructorsplay an essential role in the clinical learning environment by providing students with the important nursing skills. Therefore, this study aims to discover clinical instructors’ perspective about the challenges in the clinical learning environment.
Method: A qualitative descriptive content analysis study design and semi-structured interview tool was used; the participants were 12 clinical nursing instructors who  were selected purposively  with  a work experience of 7 − 18 years , earned MSc and PhD degrees and recruited from Nineveh governorate colleges of nursing. The data transcripts were analysed by using qualitative content analysis.
Results: Four challenges emerged: (i) Ineffective clinical instruction; (ii) Ineffective clinical administration; (iii) Ministerial challenges; and (iv) Student related challenges. These challenges revealed clinical nursing instructors' difficulties in balancing their competency, good administration, ministerial factors and student competency.
Conclusion: The identified challenges reflect the need to improve the quality of education and to create qualified nurse professionals, it may be important for students to be properly prepared, to choose the optimal clinical setting that meets the purpose, and to receive adequate teaching, advice, and supervision.

Keywords

Nursing Clinical Instructors' Perspectives on Clinical Learning Environment Challenges: A Qualitative Study

Younes Khalaf Attia 1, Dr. Radhwan. H. Ibrahim2 *

 Department of clinical nursing sciences, College of Nursing, University of Mosul, City of Mosul, Iraq;

  1. Department of clinical nursing sciences, College of Nursing, University of Nineveh, City of Mosul, Iraq;

 Corresponding author:Younes Khalaf Attia

Email: younes.20nup32@student.uomosul.edu.iq

ORCID

ABSTRACT

Background and Aim: The clinical instructorsplay an essential role in the clinical learning environment by providing students with the important nursing skills. Therefore, this study aims to discover clinical instructors’ perspective about the challenges in the clinical learning environment.

Method: A qualitative descriptive content analysis study design and semi-structured interview tool was used; the participants were 12 clinical nursing instructors who  were selected purposively  with  a work experience of 7 − 18 years , earned MSc and PhD degrees and recruited from Nineveh governorate colleges of nursing. The data transcripts were analysed by using qualitative content analysis.

Results: Four challenges emerged: (i) Ineffective clinical instruction; (ii) Ineffective clinical administration; (iii) Ministerial challenges; and (iv) Student related challenges. These challenges revealed clinical nursing instructors' difficulties in balancing their competency, good administration, ministerial factors and student competency.

Conclusion: The identified challenges reflect the need to improve the quality of education and to create qualified nurse professionals, it may be important for students to be properly prepared, to choose the optimal clinical setting that meets the purpose, and to receive adequate teaching, advice, and supervision.

Keywords:Challenges, Clinical Instructors, Clinical Learning Environment.

Received: 26July 2022, Accepted: 01 January 2022, Available online: 28 January 2023

INTRODUCTION

 Nursing clinical instructors play a vital role in providing students with the skills and knowledge needed to be effective and successful in their practice(Niederriter et al., 2017). Clinical instructors must be able to effectively assess student progress, provide effective feedback, and help students develop critical thinking and problem-solving skills(Berman, 2015). Additionally, clinical instructors must be able to effectively manage the clinical learning environment to ensure the safety of students and staff, as well as promote a meaningful learning experience(Soroush et al., 2021). The challenges faced by nursing clinical instructors in the clinical learning environment can be varied and complex, common issues include a lack of resources, a lack of support from administration, and an inability to effectively communicate with students(Addisie et al., 2022). Clinical instructors must also contend with the changing dynamics of the healthcare environment, as well as the need to remain current with changes in technology and medical practices(Dahlke et al., 2012). Furthermore, clinical instructors must juggle the demands of clinical teaching with the demands of their own clinical practice(Nazari & Mohammadi, 2015). All of these issues can make it difficult for clinical instructors to provide the best possible education to their students(Jamshidi et al., 2016).

METHOD

A qualitative descriptive content analysis study design was adopted for the period extended from the 21th of September, 2022 to the 25th of December, 2022 in the College of Nursing at Mosul.

Participants are selected through purposive sampling because it gives a specific and more details about the study problem. Clinical instructors were selected non-randomly based on years of service, specialization and competence in clinical training. The total participants that were selected (12), from Mosul, Nineveh and Telafer Colleges of Nursing. Participants who are clinical instructors with a minimum of 7 years of experience and have a Doctorate’s or master’s degree were willing to participate.

Semi-structured interviews were conducted for about 30 to 45 minutes. An interview guiding open-ended questions was used to collect the data, Participants were provided with a copy of the interview questions, in both Arabic and English language. All of the interviews were recorded with a digital voice recorder. At the end of each interview, all notes and audio of each interview, were typed word by word and handwritten and then were imported in MAXQDA software. To ensure the credibility, dependability, confirmability, and transferability of the findings the questions were open-ended and designed to elicit meaningful responses from the participants, a clear structure and timeline to the research process were provided, as well as detailed notes and recordings of the interviews. Furthermore, the researcher was familiar with the topics discussed to ensure that the data collected is accurate and of a high quality.

RESULTS

A total of 6 clinical instructors aged 31 − 47 years, among whom 8 male and 4 female, who had a work experience of 7 − 18 years and earned MSc and PhD degrees participated in the study (Table 1). After the analysis of 180 codes obtained from the interview, four main themes and fourteen categories were identified (Table 2).

Ineffective clinical instruction

The first theme emerging from participants’ statements was ineffective clinical instruction which included instructor incompetency and instructor unprofessionalism. Effective clinical education is largely dependent on clinical instruction, a significant part of the educational process. The experiences of the participants revealed that many clinical educators lack the requisite clinical knowledge and abilities and also fail to directly teach nursing techniques. One of the participants said: “In hospitals, the instructors does not have predetermined goals to teach to the students in the hospital, but relies on the nursing staff present in the hospital to teach the students” (participant#3).

Ineffective clinical administration

The second theme emerging from participants’ statements was ineffective clinical administration which included inaccurate evaluation, shortage of time and lack of coordination. Participants mentioned that one of the most important problems in clinical training is the evaluation of the student. The student is evaluated in many ways that differ from one instructor to another, and there is no clear evidence for evaluating the student in the practical environment. One of the participants said:” there is no unified guide for evaluating the student in the practical environment within the same specialty. The clinical instructor sometimes evaluates the student on the basis of his grade in theory, or on the basis of the relationship with the instructor, or on the basis of his attendance” (participant#8).

Ministerial challenges

The third theme emerging from participants’ statements was ministerial challenges which included shortage of staff, material resource shortage, large number of students, lack of student’s opportunity and physical space shortage. The small number of clinical instructors constitutes a great burden, especially in the new colleges. Therefore, these colleges resort to contracting with trainers from outside the Ministry of Education. One of the participants said: “the number of clinical trainers is very small and does not correspond to the number of students admitted annually, and therefore the practical training does not achieve all the pre-determined objectives” (participant#11). The large number of students is the main problem of the clinical training environment. One of the participants said: “that the number of students is very large and is constantly increasing, although the college has a specific capacity that is sent to the Ministry on an annual basis. However, the Ministry cannot be satisfied with this number only, due to the large number of students who graduated from middle school” (participant#6).

Student related challenges

The fourth theme emerging from participants’ statements was student related challenges which included lack of student interest, lack of student motivation, experiential learning and communication difficulties. Many of the participants emphasized the students' lack of motivation to learn. One of the participants said: “the students lack the internal motivation to learn. Students often focus on tangible skills such as suturing wounds and giving medicine, and they turn away from intangible skills such as skills of communication, critical thinking and problem solving” (participant#1).

  

Table 1. Demographic characteristics related to participants.

No

Sex

Age

Educational level

Specialty

Experience years

1

Female

47

Master degree

Adult nursing

18

2

Female

43

Master degree

Adult nursing

16

3

Male

36

Doctorate degree

Community nursing

14

4

Male

34

Doctorate degree

paediatric nursing

11

5

Male

36

Master degree

Adult nursing

11

6

Female

35

Master degree

Maternity nursing

8

7

Male

31

Master degree

Community nursing

7

8

Male

31

Master degree

Maternity nursing

7

9

Female

33

Master degree

paediatric nursing

8

10

Male

31

Master degree

Psychiatric nursing

7

11

Male

34

Doctorate degree

Adult nursing

7

12

Male

33

Master degree

Adult nursing

9

  

Table 2. Main unit of meaning, categories and themes related to the challenges of clinical learning environment.

Unit of meaning

Categories

Themes

Instructor lack of commitment to specific objectives.

Adopting purely theoretical foundations in practical training.

The individual differences between clinical instructors in skills, knowledge and practice.

 

Excessive friendliness by clinical instructors to students.

There is no cooperation between clinical instructors.

Instructor incompetency

 

 

 

Instructor unprofessionalism

Ineffective clinical instruction

The absence of a clear and approved mechanism for student evaluation.

The practical curricula are not updated periodically.

 

Student’s training period is not enough.

 

Hospital administration refuse students’ entrance to some departments.

Difficulty in communicating with health personnel because they are not cooperative

Inaccurate evaluation

 

 

Shortage of time

 

Lack of coordination

 

 

Ineffective clinical administration

Insufficient number of clinical instructors.

 

The lack of tools and devices for training students.

 

A rise in the number of medical group students and their concurrent presence in healthcare facilities.

 

The student can only do the clinical skill once.

 

The small number of health care facilities and their overcrowding with patient.

Shortage of staff

 

Material resource shortage

Large number of students

 

Lack of student’s opportunity

 

Physical space shortage

Ministerial challenges

Students’ lack of commitment to attendance.

Students are not committed to staying in the place of practical training.

 

Some students’ unwillingness to learn, especially in philosophical subjects such as community health, students tend to learn tangible skills physically.

 

Students learn skills from others through imitation and not rely on evidence-based practice for learning

Individual differences between student result in patients refuse the care provided by some students.

Lack of student interest

 

Lack of student motivation

 

Experiential learning

 

 

Communication difficulties

Student related challenges

 

DISCUSSION

The findings obtained from the study demonstrated that Ineffective clinical instruction, Ineffective clinical administration, Ministerial challenges, and Student related challenges are the challenges in the clinical learning environment in the Nineveh governorate colleges of nursing.

The first theme gathered in this study agreed with the previous study(Sadeghi et al., 2019),that point to subjectivism, a lack of scientific and nursing practice expertise, a lack of dedication to teaching, and a focus on routine learning were all evident indications of low clinical competence, which hampered students' ability to develop their clinical competence.

The second theme of our study consistent with those(Achempim-Ansong et al., 2022), that mentioned, there are numerous  challenges of  clinical administration . These include a lack of authority, poor communication, time constraints, interpersonal conflicts with coworkers, a rise in workload, exhaustion, a shortage of employees, a lack of enthusiasm on the part of supervisees, and a lack of trust.

Another study(Gülten Sucu et al., 2019) agreed with the third theme of this study, there are a variety of circumstances, including an excessive number of students, insufficient hospital patient capacity, and a dearth of unique cases, that contribute to conditions in the clinical setting that are viewed negatively by instructors.There is also the issue of clinics and hospitals having inadequate infrastructure, including inadequate clinical practice rooms and lab facilities.

In addition finding of (Jamshidi et al., 2016) agreed with fourth theme of this study and suggest that many students lack the communication skills necessary for effective communication in the clinical environment, lack of theoretical knowledge and practical skills as well as presence of stress and inferiority complexes in students in confronting the clinical environment.

 CONCLUSIONS

It was determined that nursing clinical learning envirinment had many challenges include, instructor incompetency and unprofessionalism, inaccurate evaluation, shortage of training time, lack of coordination between instructors, shortage of faculty, material resource shortage, large number of students, lack of students opportunity, physical space shortage, lack of student interest , lack of student motivation, students experiential learning and communication difficulties of students.

 ETHICALCONSIDERATIONSCOMPLIANCEWITHETHICALGUIDELINES

Ehical approval was obtained to conduct the study from the collegiate committee for medical research ethics at the University of Mosul. The study's purpose and steps were explained and emphasized the study participant's right to self-determination, confidentiality, and anonymity, lastly, written consent was taked from participant.

FUNDING
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

AUTHORSCONTRIBUTIONS

Study concept; Writing the original draft; Data collection; Data analysis and Reviewing the final edition by all authors.

DISCLOSURESTATEMENT:

The authors report no conflict of interest.

ACKNOWLEDGEMENTS

We thank the nursing colleges at the University of Mosul, Nineveh and Telafer for their support and facilitation of the research task. We also thank the participants in the study for their acceptance to participate.

REFERENCES

Achempim-Ansong, G., Kwashie, A. A., & Ofei, A. A. (2022). Exploring the benefits and challenges of administrative clinical supervision in nursing and midwifery. Journal of Nursing Education and Practice, 12(1).

Addisie, A., Cherie, A., Gela, D., & Ataro, B. A. (2022). Challenges faced during clinical placement among nursing students. A mixed study conducted at highest institutions in Addis Ababa city, Ethiopia, 2020.

Berman, A. C. (2015). Good teaching is good teaching: A narrative review for effective medical educators. Anatomical sciences education, 8(4), 386-394.

Dahlke, S., Baumbusch, J., Affleck, F., & Kwon, J. Y. (2012). The clinical instructor role in nursing education: a structured literature review. J Nurs Educ, 51(12), 692-696. https://doi.org/10.3928/01484834-20121022-01

Gülten Sucu, D., Hülya Fırat, K., & Refia Selma, G. (2019). Difficulties in Clinical Nursing Education: Views of Nurse Instructors'. International Archives of Nursing and Health Care, 5(1). https://doi.org/10.23937/2469-5823/1510114

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