CHAPTER ONE

INTRODUCTION

1.1       Background to the Study

Learning is a change in behaviour over time that is brought about by experience during training in educational encounter (Akubuiro and Joshua, 2003). Training as part of education, is the acquisition of knowledge, skills and competence as a result of the teaching of practical skills and knowledge that relate to specific useful competences (Angel, 2007). Training helps the learner to acquire certain useful skills and develop critical mind for the learner’s self development. Therefore, the knowledge that comes from training is more of knowledge of how to do or perform specific tasks. Thus, the modification in behaviour as the product of training can occur following newly acquired skills, knowledge, perception, facts, principles and new information at hand (Adeyanju, 2004).

Nursing education is a term used to describe the overall body of knowledge that applies to nursing profession. It encompasses a variety of knowledge, skills, concepts, and practices which revolve around the unique concepts of nursing, health, the person and the environment (Melone, 2010). Nursing education consists of acquisition of a body of knowledge that is partly delivered in a classroom setting which forms the theoretical bases of nursing knowledge and an organized and supervised clinical training experiences that take place in the clinical settings where the nurse- patient relationship is experienced directly or indirectly (Shariff and Masoumi, 2005).

Sonwuttanayut (2003) noted that the training process in nursing education should aim at enabling the students to gain skills and experiences up to their highest potentiality. This shall focus on the learners as being the most important in the process. In addition, basic knowledge, attitude, skills and the ability to apply knowledge into the actual practice of nursing should be developed and inculcated into the student nurses in these processes. Training can be reinforced with learning aids and equipment of different varieties simply because they stimulate, motivate as well as arrest learners’ attention for a while during the instructional process.

Clinical training which is part of nursing education takes place in hospitals, other health care institutions, communities and homes under the direction and supervision of trained personnel in nursing profession. Clinical training as an integral part of nursing education as identified by Smith and Fifz-Patrick, (2006), prepares student nurses with the ability of “doing” as well as “knowing” the clinical principles in nursing practice. The clinical experience which is a vital part of nursing education stimulates students to use their critical thinking skills for problem solving. It provides the students opportunity for their active self-learning, self development and ability to apply their knowledge from theoretical context situation to emergency and general public health care.

In line with this therefore, clinical education must be to help the students to acquire the necessary nursing skills and the ability to perform in order to establish their capacity to handle changing realities and situations in nursing practice, (Melone, 2010). The nursing skills to be acquired consist of series of courses in the nursing curriculum and manuals. These are designed to equip students with the required clinical nursing skills needed for optimal practice, (Rennie, 2009). These include nurse-patient relationship skill, interactional skills, basic physical examination skills, clinical encounter across the life span, therapeutic communication skills, positive attitudinal skills etc. These courses span throughout the years of studies. Students must successfully complete all the components of the clinical courses to progress as nurses. Examining the development of necessary nursing skills during training, Ericsson (2004) indicates that nursing skill acquisition is a continuous learning process. This indicates that extensive experiences and supervision from mentors, preceptors, supervisors, teachers, considerable time on task and involvement of students are necessary to achieve a considerable nursing skill performance. There is also supporting evidence that the students’ interest and the practice environment e.g. hospital, exert an influence on the development of nursing skill (Ericsson 2009). In this case, students’ goals should include increased self knowledge and scientific awareness in addition to their gradual improvement in professional nursing practice.

At the beginning of the last century, nursing training was based mainly on clinical experiences whereby students do more of clinical experiences in the wards and receive small sums of payment (Harrison, 2010). However, with increased complexity in today’s nursing care playing a challenge to the theoretical and clinical training of nursing students, it was realized that theoretical studies are of great importance in nursing education and practice. This then led to reduction of the proportion of time spent on clinical experience while the time and courses in relation to theoretical studies was increased (Harrison, 2010). Furthermore, Ehiemere (2009) had highlighted that the clinical environment is complex and rapidly changing with a variety of new settings and roles in which nurses must be prepared to practice. Such settings include families, schools, community settings etc. Therefore, clinical training should be aligned to meet the challenges facing nursing practice. Although clinical training is still an essential part of student nurses’ education, its role and application have changed in recent years. However, in nursing education, the classroom and clinical environment are linked and students must apply in clinical practice what they have learned in the classroom, online and through other exposures.

A study in Tanzania done by Sumari-Ayo (2006) revealed that lack of adequate supervision of students in the clinical areas; inexperienced teachers in the schools; unconducive environment in the school and in the clinical areas and lack of students’ involvement in planning their programmes hinder clinical nursing skill acquisition. However, little has been done empirically to know the factors influencing application of clinical instructions/training in nursing practice among student nurses in Madonna University in Nigeria to help find out what are involved in the training and practical application of instructions of student nurses in the clinical areas for efficient nursing practice.

 

1.2       Statement of the problem

In line with the declining development, Usufu (2005) reported that the Nursing and Midwifery Council of Nigeria (N&MCN) has observed with dismay the general poor performance of students in the General Nursing Council Examination especially in practical nursing examination. N&MCN also summoned all the principals of such schools of nursing with poor result for a conference on 20th April 2005. This was to critically review the reasons for the poor performance in General Nursing Council Examination in order to proffer solutions.

Also anecdotal reports from nurses in clinical arena indicated lack of clinical skills among the graduates of the 5-year generic degree programme. Hence between, 9th-10th August 2011, a similar meeting of Heads of Nursing Department with the N&MCN was held at Ibadan to discuss among other things the BNSc graduate nurses’ poor performance in clinical practice. N&MCN therefore, calls seriously for the adoption of a- one year internship programme proposal for all BNSc graduate nurses before they are legible for registration as qualified nurses to bridge their poor clinical practice competence. This implies the inclusion of Department of Nursing Sciences, Madonna University as the institution of study. The question is, what are the factors influencing application of clinical instruction/training among nursing students that could lead to poor performance in clinical practice?

 

1.3       Purpose of the study

The general objective of the study was to investigate factors influencing application of clinical instruction/training in nursing practice among nursing students in Madonna University.

The specific objectives of the study were to:

1. Identify the administrative factors that affect application of clinical training/instruction of nursing students in Madonna University.
2. Identify the training/supervisory factors that affect application of clinical training/instruction of nursing students in Madonna University.
3. Identify students’ factors that affect application of clinical training/instruction among in the Madonna University.
4. Determine the differences in the factors that affect application of clinical training/instruction of nursing students in Madonna University.

 

1.4       Research Questions

As a guide to the researcher, the following research questions and hypotheses were formulated:

1. What are the administrative factors that affect application of clinical training/instruction of nursing students in Madonna University?
2. What are the training/supervisory factors that affect application of clinical training/instruction of nursing students in Madonna University?
3. What are the students’ factors that affect application of clinical training/instruction among in the Madonna University?
4. What are the factors that affect application of clinical training/instruction of nursing students in Madonna University?

 

1.5       Research Hypotheses

Three null hypotheses were formulated and tested at significant level of p<0.05, they are:

Ho1: There is no significant statistical difference in the administrative factors affecting application of clinical training/instruction of nursing students in Madonna University.

Ho2: There is no significant statistical difference in the training/supervisory factors affecting application of clinical training/instruction of nursing students in Madonna University.

Ho3: There is no significant statistical difference in students’ factors affecting application of clinical training/instruction of nursing students in Madonna University.

 

 

1.6       Significance of the Study

Studying the factors that might affect nursing students’ application of clinical instructions in nursing practice while in training will assist in identifying the constraining factors for proper acquisition and application of such skills. Identifying such factors will improve students’ training in the clinical areas. Findings will inform the school administrators and N&MCN on new approaches to improve the system by formulating appropriate curriculum and procedures for clinical experiences and training. This will give the right direction to the nurse educators and supervisors and will facilitate acquisition of nursing skills by the students. It will widen the stake holders’ view on provision of adequate personnel like nurse educators and supervisors in the schools and clinical areas. It will also widen the stake holders’ view on provision of equipment and enabling environment in order to motivate students’ learning and thereby improve institutional efforts to improve nursing practice.

The findings will help the nurse educators, clinical supervisors and preceptors, to review how they carry out the role of clinical training of the students under their care for better nursing skill acquisition. It will help them to use the appropriate measures/methods in teaching the students to achieve clinical nursing skill acquisition. The findings will help the students to understand and play their own roles in improving their practical performance by putting in more effort and interest in their studies and clinical practice so as to achieve success. This will enhance their future practice as skilful and efficient nurses both in theory and practice. These findings could also stimulate further study.

 

 

1.7       Scope of the Study

The study was de-limited to the nursing students of Department of Nursing, Madonna University Elele in Rivers State. The study addressed the institutional factors as staffing which include teachers and supervisors, infrastructure/equipment, methods of training/ supervising of students and students’ factors in application of clinical instructions/training.

 

1.8       Operational Definition of Terms

Clinical training: refers to how to assess clients/patients clinically, give account of clinical health problems, prescribe and implement appropriate nursing measures, eg through the use of thermometer to measure the temperature of a patient and doing tepid sponging where necessary without being told.

Administrative factors: refer to human and material resources needed in proper clinical nursing training. These include provision of nurse educators and clinical supervisors in the schools and clinical areas (e.g. nurse educators, mentors, preceptors, clinical nurses and clinical instructors). Administrative factors include also infrastructure/equipment in the schools and clinical settings (e.g. adequate laboratory, library, equipment like oxygen cylinders, clinical thermometers, forceps, models and objects for inculcating clinical nursing skills to nurses).

Training/supervisory factors: These include the techniques or measures used to drill students during clinical training in order for them to acquire the necessary nursing skills, e.g. through giving assignments, field trips, practical procedures demonstration, ongoing teaching and correction of students by their supervisors during their clinical experiences.

Students factors: These include students’ interest and involvement in their training such as attendance to clinical experiences, punctuality and active participation in assigned tasks etc.

Nursing Student: A person enrolled for the 3years diploma in General Nursing Education programme or 5years Degree Nursing programme, in an accredited educational institution by the N&MCN.