Explaining the Status of Clinical Nursing Education: A Qualitative Research in Iran

Background: Challenges and problems of clinical nursing education are the most important factor in determining the quality of nursing students' education. Frequent assessment of the quality of nursing education without considering the existing challenges is an ineffective activity in analyzing the situation of nursing education. Objectives: This study aimed to explain the status of clinical nursing education at Jahrom University of Medical Sciences in Iran. Methods: This qualitative study based on the conventional content analysis approach was conducted at Jahrom University of Medical Sciences in 2018 - 2019. Data were collected through holding 10 semi-structured face-to-face focus group discussions (FGDs) with 110 nurses, head nurses, instructors, and students. Purposeful sampling was used and the interviews were analyzed by Graneheim and Lundman method by MAXQDA Software. Results: We obtained 626 in-vivo codes, 46 primary codes, eight subcategories (lack of attention to the evaluation process, non-participative evaluation, low staff educational cooperation, ineffective instructors, non-educational clinical space, student educational deficits, students' confusion in the clinical setting, and non-participatory planning), and three main categories (planning challenges, implementing challenges, and evaluation challenges). Conclusions: Educational leaders are recommended to shift to three areas, including democratic planning, wise implementation with frequent monitoring, and the use of modern clinical evaluation methods based on the participation of learners and other stakeholders.

Conceptions of clinical learning among stakeholders involved in undergraduate nursing education: a phenomenographic study

Background To prepare nursing students to become critical, autonomous members of the workforce, an agreement among stakeholders on how this can be achieved in the clinical setting is needed. However, a critical discussion of the clinical learning process in relation to actual and desirable outcomes is lacking in the nursing education literature. This study aimed to map conceptions of the desired process and outcomes of clinical learning among stakeholders involved in undergraduate clinical nursing education. Methods Twenty-five semi-structured interviews about their understanding of clinical learning were conducted with nursing students, supervisors, clinical educators and higher education institute professionals involved in clinical nursing education in a Dutch academic medical center. Data were analyzed using a phenomenographic approach. Results Four conceptions were identified: clinical learning as a process to 1) meet curricular demands, 2) learn to deliberately deliver patient care, 3) learn to deliver patient care within the larger (healthcare) context, and 4) become a continuously developing professional. Conceptions 3 and 4 represented a broader, more inclusive perspective on clinical learning than conception 1 and 2. Conceptions were distinguished by five dimensions: role of guidelines from the school; learning opportunities, focus of supervisor; focus of reflection; desirable outcomes of clinical learning. Conclusions Those directly involved in clinical learning in nursing may have qualitatively different understandings of its desired nature and outcomes. Two patterns across conceptions could be discerned: a) a shift in focus from learning as following standards, to following an individualized learning trajectory and b) a shift in focus from increasing patient load, to understanding oneself and the patient within the healthcare context. To prepare nursing students for the future workforce, a flexible, social form of self-regulated learning is warranted, as well as an understanding of one’s own role within the healthcare system and a critical attitude towards healthcare. Schools and hospitals should collaborate to integrate these values in the curriculum. The current study adds different ways of applying self-regulated learning as a relevant dimension in understanding clinical learning to the literature. Through the phenomenographic approach we identified conceptions that can be a basis for training and policy development.

The effect of Peer instructor teaching and clinical supervision on the status and stressors of clinical nursing education

Introduction: Peer instructor teaching is an educational model in which senior students teach to their classmates or junior students. Clinical supervision is a formal, systematic, and continuous that the inexperienced person reviews and improves their performance by receiving advice from a supervisor or expert. Clinical education is a vital component of the medical science curriculum and the quality and control of its stressors are important. The purpose of this study was to combine peer instructor training model with clinical supervision on the status and stressors of clinical nursing education. Methods: This is a quasi-experimental study in which a combined Peer instructor teaching and clinical supervision program was implemented. The research samples were 60 nursing students of Yazd nursing and Midwifery College who were studying in third and sixth semesters. They were selected by purposive sampling method. Data gathering tools included a four-part questionnaire including demographic characteristics, a questionnaire for assessing instructor performance in clinical education, a standard questionnaire for clinical stressors, a course satisfaction questionnaire and a clinical supervisor completed by self-report. Data analysis was done using SPSS 16 software. Result: on the finding the mean score of peer instructor evaluation was 56.42 ± 9.38 and mean score of clinical stressors was 38.72 ± 5.6. Peer instructor in most cases agreed with the peer instructor program and clinical supervision program. Conclusion: From the learners' point of view, peer instructor performance is at a good level, as well as clinical stressors at the boundary level between moderate and weak, although both results are satisfactory but there is a need for more careful planning and more training by peer educators and more accurate clinical supervision.