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The Factors Affecting Nursing Students’ Learning in Clinical Practice

Conference Paper · July 2017

DOI: 10.5176/2315-4330_WNC17.38

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 The Factors Affecting Nursing Students’ Learning
in Clinical Practice
Seyma Adibelli RN1
(1) Faculty of Nursing
Hacettepe University
Ankara, Turkey
symadibelli@gmail.com
Abstract- Clinical practice is important because it allows students
to apply their theoretical knowledge in a real environment,
develop psychomotor skills, observe and adapt the professional
role. In clinical practice, many factors may affect students’
learning. These factors are listed as students related issues,
clinical instructor related issues and clinical environment related
issues. In order to plan an effective learning, it is essential to
specify these factors and organize them in a way that will support
the students’ learning. This paper will discuss these factors in
detail and suggest new perspective for clinical placement
organization.
Keywords- clinical practice; baccalaureate nursing education; pupil
nurses
I. INTRODUCTION
Clinical education, enables students to practice skills
learned during courses in real and a controlled environment [1].
Clinical areas selected in education are environments in which
students develop professional attitudes and skills specific for
nursing by communicating with patient, making right decisions
and improve problem solving skills and self-understanding [2,
3]. Thus, it is highly important to select the best clinical areas.
These areas contain many factors that may affect learning such
as students, instructors, nursing and other healthcare staffs,
physical environment, equipment and patients [4].
Control of these factors are important in order to have an
effective clinical learning, prepare student nurses for
professional life and develop a positive attitude towards
profession. Therefore, in this study it was aimed to review
these factors that may affect nursing students’ learning in
clinical placements.
II. THE FACTORS AFFECTING LEARNING
Clinical education is a process which students experience
from the beginning to the end of his/her educational life.
During this process, some factors (student, instructor and
environment related) affect learning of students [4]. If these
factors well-managed, students can finish clinical placements
with a positive learning experience.
A. Student related factors
Fatos Korkmaz, PhD, MSN, RN1
(1) Faculty of Nursing
Hacettepe University
Ankara, Turkey
fkorkmaz@hacettepe.edu.tr
When general characteristics of students who prefer nursing
profession are evaluated; A profession in which a large part is
at the beginning of adulthood and at the end of adolescence;
They seem to have preferred nursing for employment
opportunity, family preferences [5], good salary, want to help
people [6] and so on. On the other hand, it can be said that
students have limited information about nursing profession
therefore they are trying to determine if they will continue their
education.
During clinical placements, age of students, previous
learning experiences [7], anxiety of making mistake and
harming patient, deficiencies in initiating and maintaining
professional communication with patients and relatives,
difficulties in transition from student role to nurse role [8],
level of readiness for learning [7] have been determined as
factors affecting learning. If these factors are not known and
controlled, anxiety experienced by student increases and sense
of trust to be developed among patient, health care staff and
instructor is lost [9]. Therefore, determination of student’s
characteristics, learning expectations from clinical placements
[10] and completion of orientation programme (planning visits
to clinics / wards before placements, introduction of students to
the staff) are required at the beginning of education.
B. Instructor related factors
In clinical education, the number of students (according to
number of students in theoretical education) per instructor is
more manageable that it strengthens the relationship expected
to be developed between student and instructor. As relationship
and communication improve, acquisitions of student from
clinical placement also increase [11]. Thus, characteristics of
instructor should be considered well. These characteristics may
be handled under two headlines as individual and professional
features.
Personal features such as the age of the instructor,
communication skill, self-expression, availability and
accessibility may affect students learning. On the other hand,
professional features of instructor such as professional
knowledge level, teaching techniques and effect of these on
learning, preference of feedback methods in education,
communication styles that maintain between staff and patients,
etc. affect learning as well [1, 12].
 In studies conducted on the subject, students state that they
want to spend their clinical training with knowledgeable and
expert instructors in their field for more effective learning [1],
that instructor may serve as an example for themselves [13],
they should be available/reachable for them [14], they should
be more involved in meeting their needs and expectations [15],
they should manage their time well [14], they should provide
on-time and individual feedback [16] and they should make
assessments about students’ knowledge, skill and professional
judgments [17].
C. Clinical wards related factors
Clinical wards differ in terms of patient density and profiles
(emergency rooms, intensive care units and oncology clinics),
employee characteristics (attitudes towards students), physical
possibilities (dressing and internship rooms, dining facilities).
Therefore, it is important that wards should be appropriate for
the characteristics of the students (first class, third class etc.).
In this respect, organization and selection of these areas may be
handled under four headlines as suitability for learning
objectives, physical features, clinical staff and patient profile
that may affect learning [18, 19].
It has been reported that staff’s attitudes (happy to help and
have positive attitude towards the students) [20], and
information level (the aims and objectives of the clinical
practice) affect the clinical learning positively [21]. However,
students state that unwillingness of clinical nurses to teach
themselves and inability to spare time for learning due to work
load, assignment of tasks unrelated their responsibility,
negative attitudes of staff [22, 23], inability to utilize facilities
such as not having dressing-resting room and food & beverage
opportunities [22, 24, 25, 26] affect their learning negatively.
III. CONCLUSION
Learning of students in clinical placements is affected by
factors originating from themselves, the instructor and clinical
wards. Readiness of students, personal and professional
characteristics of instructor and attitudes of staff towards
students in placements have importance on learning of
students. Taking these results into consideration, it can be
suggested that providing pre-clinical orientation for readiness
of the students (small visits to the wards prior the placements
etc), planning of the activities to strengthen the instructor-
student communication, and informing the clinical staff
(especially clinical nurses) about learning objectives may be
proposed.
REFERENCES
[1] A. Elçigil, and H. Yıldırım Sarı, ‘’Determining problems experienced by
student nurses in their work with clinical educators in Turkey,‘’ Nurse
Education Today, vol. 27, pp. 491-498, 2007.
[2] Z. Eskimez, N. Alparslan, G. Öztunç, and S. Torun, ‘’Nurse’s Opinions
About the Students and Academic Staffs of Adana Health College,’’
Journal of Anatolia Nursing and Health Sciences, vol. 8, pp. 30-39.,
2005.
[3] K. Midgley, ‘’Pre-registration student nurses perception of the hospital
learning environment during clinical placements,’’ Nurse Education
Today, vol. 26, pp. 338-345, 2006.
[4] I. Papp, M. Markkanen, and M. von Bonsdorff, ‘’Clinical environment
as a learning environment: Student nurses’ perceptions concerning
clinical learning experiences,’’ Nurse Education Today, vol. 23, pp. 262-
268, 2003.
[5] S. Ünal, N. Gürhan, E. Saral, and A. Özbaş Atlı, ‘’ Socio-demographic
characteristics of nursing students and reasons of choosing nursing as a
career,’’ Florence Nightingale Journal of Nursing, vol. 16, pp. 179-187,
2008.
[6] S. G. Lim, and M. A. B. Muhtar, ‘’Factors influencing nursing students’
decision to choose nursing,’’ International E-Journal of Science,
Medicine and Education, vol. 10, pp. 3-10, 2016.
[7] H. Banneheke, S. Ravindranath, A. Sameera, S. Ramamurthy, B.
Effendie, Jeevaratnam, K., . . . V. Nadarajah, ‘’Multi centre study from
Malaysia on student preparedness for clinical learning-Perspectives of
lecturers and students from medicine, pharmacy and allied health
sciences,’’ Proceedings of Annual Scientific Sessions of Faculty of
Medical Sciences, vol. 2, 2015.
[8] R. Ab Latif, and M. Z. Mat Nor, ‘’Stressors and coping strategies during
clinical practices among diploma nursing students,’’ Education in
Medicine Journal, vol. 8, pp. 21-33, 2016.
[9] S. M. Melincavage, ‘’Student nurses' experiences of anxiety in the
clinical setting,’’ Nurse Education Today, vol. 31, pp. 785-789, 2011.
[10] L. B. Arabacı, E. A. Korhan, Y. Tokem, and R. Torun, ‘’ Nursing
students’ anxiety and stress levels and contributed factors before-during
and after first clinical placement,’’ Journal of Hacettepe University
Faculty of Nursing, vol. 2(1), pp. 1-16, 2015.
[11] P, Serçekuş, and H. Başkale, ‘’Nursing students' perceptions about
clinical learning environment in Turkey’’ Nurse Education in Practice,
vol. 17, pp. 134-138, 2016.
[12] G. K. Madhavanprabhakaran, R. K. Shukri, J. Hayudini, and S. K.
Narayanan, ‘’Undergraduate nursing students’ perception of effective
clinical instructor: Oman,’’ International Journal of Nursing Science,
vol. 3, pp. 38-44, 2013.
[13] Z. C. Chan, C. Tonga, and S. Henderson, ‘’Power dynamics in the
student-teacher relationship in clinical settings,’’ Nurse Education
Today, vol 49, pp. 174-179, 2017.
[14] L. Sweet, and J. Broadbent, ‘’Nursing students' perceptions of the
qualities of a clinical facilitator that enhance learning,’’ Nurse Education
in Practice, vol. 22, pp. 30-36, 2017.
[15] G. Karadağ, S. Parlar Kılıç, N. Ovayolu, Ö. Ovayolu, and H. Kayaaslan,
‘’Difficulties encountered by nursing students in practices and their
views about nurses,’’ TAF Preventive Medicine Bulletin, vol. 12, pp.
665-672, 2013.
[16] N. Partlak Günüşen, and B. Üstün, ‘’The perspectives of nursing
students about feedback in clinical education’’ Journal of Anatolia
Nursing and Health Sciences, vol. 15, pp. 197-204, 2012.
[17] M. Engström, A. Löfmark, K. J. U. Vae, and G. Mårtensson, ‘’Nursing
students' perceptions of using the Clinical Education Assessment tool
AssCE and their overall perceptions of the clinical learning
environment-A cross-sectional correlational study,’’ Nurse Education
Today, vol. 51, pp. 63-67, 2017.
[18] E. A. Flott, and L. Linden, ‘’The clinical learning environment in
nursing education: a concept analysis,’’ Journal of Advanced Nursing,
vol. 72, pp. 501-513, 2016.
[19] F. Murphy, M. Rosser, R. Bevan, G. Warner, and S. Jordan, ‘’Nursing
students’ experiences and preferences regarding hospital and community
placements,’’ Nurse Education in Practice, vol. 12, pp. 170-175, 2012.
[20] K. Doyle, K. Sainsbury, S. Cleary, L. Parkinson, D. Vindigni, I.
McGrath, and M. Cruickshank, ‘’Happy to help/happy to be here:
Identifying components of successful clinical placements for
undergraduate nursing students,’’ Nurse Education Today,vol. 49, pp.
27-32, 2017.
[21] A. Akyüz, N. Tosun, D. Yıldız, and A. Kılıç, ‘’Reflection of the nurses
on their responsibilities and the students’ working system during clinical
teaching,’’ TAF Preventive Medicine Bulletin, vol. 6, pp. 459-464,
2007.
[22] I. Atasoy, and N. Sütütemiz, ‘’A group of final year students views on
nursing education’’ Florance Florence Nightingale Journal of Nursing,
vol. 22, pp. 94-104, 2014.
[23] O. L. Chuan, & T. Barnett, ‘’Student, tutor and staff nurse perceptions of
the clinical learning environment,’’ Nurse Education in Practice, vol. 12,
pp. 192-197, 2012.
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[24] E. Büyük Tural, S. Rızalar, A. Çetin, and S. Sezgin, ‘’Opinions and
suggestions of nurses about internship,’’ Balikesir Health Sciences
Journal, vol. 3, pp. 135-140, 2014.
[25] A. Erenel Şentürk, Ü. Dal, S. Kutlutürkan, and G. Vural, ‘’The views of
the fourth year students and nurses about internship practices,’’ Journal
of Hacettepe University Faculty of Nursing, vol. 15, pp. 016-025, 2008.
[26] M. F. Aydın, and M. Ş. Argun, ‘’The expectations of hospital practices
and faced problems of the students in Bitlis Eren University Health
School Department of Nursing,’’Acıbadem University Health Sciences
Journal, vol. 1, pp. 209-213, 2010.