A survey of the quality of clinical learning environments of clinical placement settings as perceived by students from a provincial nursing college

Abstract

This study investigated the quality of the clinical learning environments in the medical and surgical units of clinical placements used by a provincial college of nursing for student nurse training in South Africa. The purpose of the study was to describe the quality of the clinical learning environment of placement settings, as experienced by final year students from a provincial nursing college. The researcher used a quantitative, descriptive, cross-sectional design. Purposive sampling was used to recruit research participants. Participants were final year undergraduate students of the Provincial College of Nursing. Informed, written consent was obtained. Ethical approval was obtained from the relevant authorities and the ethical committee of the North West University. Data was collected by using an internationally validated Clinical Learning Environment, Supervision and Nurse Teacher Instrument (Saarikoski & Leino-Kilpi, 2002:259-267; Saarikoski et al., 2008:1233-1237). The quantitative data showed that students are relatively satisfied with the quality of the clinical learning environment of their placement settings, the supervision they received and the role the nurse educator played in the clinical setting. The results showed that a little less than two thirds of students are satisfied with their clinical learning environment and just a little over half of students were satisfied with the supervision they received. However, the pedagogical atmosphere received the lowest evaluation. Interestingly, the most significant factors in the clinical learning environment, supervision and nurse teacher evaluation were the philosophical grounding of nursing care in the ward and the nurse educator enabling the integration of theory and practice. More support and commitment is also needed from the operational manager who is the main driver of the vehicle which is the clinical learning environment and who steers clinical teaching and learning forward. There was a significant positive correlation between philosophical grounding of nursing care in the ward and supervisory relationship. The most common method of supervision was group supervision. Even though there was mutual interaction in the supervisory relationship, there is a need for staff to provide students with constructive feedback on their professional performance in order for them to improve on the areas identified in the clinical learning environment and thus improve the quality of patient care. There is a need for the nurse teachers to be more visible in the clinical learning environment in order to provide additional support. Provision of a learner centred environment by nurse teachers and engagement of students as equal partners in the learning environment will enhance learning. The open-ended questions revealed there were many challenges in the clinical learning environment. Thus, there is plenty of room for improvement in all aspects of the clinical learning environment by all stakeholders to promote quality clinical learning, quality of care and improved patient outcomes. There is also a need for a quality assurance program in nursing education to constantly monitor and evaluate the clinical learning environment in order to maintain high standards and quality clinical learning. In conclusion, participants rated the quality of the clinical learning environment where they were placed for their medical and surgical nursing experience relatively low. Although there is a discrepancy between the qualitative rating of the quality of the clinical learning environments of these settings and the quantitative scoring thereof using the CLES-T instrument, both assessments are necessary to get the full picture. Using this approach will assist nurse educators to continuously assess the quality of the clinical learning environment of the settings where students are placed as to intervene when it becomes clear that a setting no longer complies to the requirements for effective clinical learning.