Undergraduate nursing students’ perception of the psychosocial clinical learning environment at a selected Higher Education Institution
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Background: Globally there is an urgent requirement for skilled nurses. For this reason, interventions in nursing education need to be carefully assessed and strategically planned and coordinated. In order to establish an effective clinical learning environment at education institutions, it is strongly recommended that one should gain insights from the perceptions of students, regarding their experience of their learning environment. Aim: The aim of the study was to investigate the undergraduate nursing students’ perceptions of the psychosocial clinical learning environment in a Higher Education Institution. Methodology: A quantitative descriptive survey design was used for this study in the form of questionnaires. The study utilized the pre-existing Clinical Learning Environment Inventory (CLEI) instrument developed by Chan (2001). The study utilised third year and fourth-year undergraduate nursing students. The target population comprised third year undergraduate nursing students (n=250), and fourth year undergraduate nursing students (n=248). The total target population was (n=498) undergraduate nursing students. A random sampling technique was used to select the study sample size of n=218. Self-administered questionnaires were distributed to two hundred and eighteen (218) respondents during class time and two hundred and eighteen (218) completed questionnaires were returned. The data was analysed using the Statistical Package for Social Science version 25. Descriptive statistical analysis was used to generate frequencies, mean values, median and standard deviation of observations. Reliability and validity of the study was ensured as described in the methodology section. Permission to use students for the study was sought from the registrar of the University. Informed written 3 consent was sought from all the participants in this study. The ethical principles were adhered to ensure confidentiality and anonymity of the participants throughout the study and beyond. Results: The fourth year respondents, 64.7% (n=90) agreed that their facilitators often think of interesting activities compared to their third-year counterparts, 35.3% (n=49); whereas, 63.6% (n=77) agreed that the facilitator thinks up innovative activities for students as compared with 36.4% (n=44) third years. This significant difference between the year levels cannot be justified from the study findings. However, it can be attributed to an underestimation of the impact of innovation and its impact on teaching and learning. The perception of fifty percent (50%) each for both year levels reported that the clinician talks more, rather than listening to the students. These findings indicate that communication between students and their clinical facilitator is hindering the clinical learning experience. There was a significant difference found between the groups (t=1.1, p=.027), as the average opportunities for interaction between students and clinical facilitators were lower for third year [2.3(±0.4)], compared with the average participation score for the fourth year 2.4 (±0.4). Most of the respondents, 81.2% (n=177) reported that clinical placement was a waste of time. The findings showed that the degree of satisfaction declined as students progressed from third to fourth year. There was a significant difference between the groups with 91.1% (n=102) fourth years reporting that clinical placement was a waste of time compared to 70.8% (n=75) of their third-year counterparts. A probable explanation for this might be the fact that the learning objectives and activities differed in the academic progression. The extent to which students are allowed to make decisions and are treated fairly was found to be more favourable by fourth years than third years, with mean scores of 2.7±0.4 and 2.6±0.4 respectively; thus highlighting a greater level of independence at the more senior 4 level. Study findings reported that 47% (n=102) agreed that the preceptor/clinician often became side-tracked instead of sticking to the point and only 45.9% (n=100) stated that clinical placements were disorganized. The findings from this study indicated that half of the students did experience a certain level of clarity and organization across their classes, while others did not consistently receive this level of clarity. Conclusion: The findings of the study indicates that there was inadequate supervision, poor student-mentor interaction, a lack of clarity and organization and ineffective teaching methods that impacted negatively on their decision making skills and revealed the need for new strategies to be implemented in the nursing education system, in order to ensure a successful CLE. Recommendations: This study demonstrated that students perceive the CLE as a place to learn and obtain skills for the nursing profession, yet their perceptions of how they were taught did not reflect their enjoyment of learning, and showed room for improvement in how clinical facilitators used different teaching methods, interacted with learners, and allowed them to make decisions, all the while ensuring that the lines of communication were kept open. Clarity and an organizational culture were lacking in the students learning environment which impacted negatively on their perception of learning. It is imperative that clinical facilitators evaluate their behavior with students consistently, be aware of their behavior and be open to suggestions and recommendations on how to improve their teaching.