EVALUATION OF CLINICAL TRAINING OF STUDENT NURSES AT THE CAPE COAST TEACHING HOSPITAL

ABSTRACT
Clinical learning is a vital component in the curricula of nursing education, providing an opportunity to student nurses to combine cognitive, psychomotor, and affective skills. Evaluation is a basic part of clinical education. There are a number of problems and challenges associated with evaluation of clinical training of student nurses. Some of these concerns are subjectivity and variability in the use of effective clinical evaluation tools to evaluate the psychomotor, affective and cognitive learning domains. These invariably safeguards patients from unsafe practice. The purpose of the study is to explore the views and experiences of preceptors and clinical instructors regarding evaluation of student nurses’ clinical training. The study utilized a descriptive case study methodology and was conducted at Cape Coast Teaching Hospital. Ten preceptors and five clinical instructors participated in the study. The data was collected, using face-to-face interviews of fifteen participants each. The data was analyzed using thematic content analysis approach. Several themes emerged from the data analysis. Examples of these include problems with the evaluation process, subjectivity of evaluation tool, increased number of students, training needs and inappropriate clinical placement. It is recommended that preceptors and clinical instructors need to be professionally trained to fit for their demanding role. Again, the training should be ongoing to support and improve the quality of students’ evaluation.


CHAPTER ONE
INTRODUCTION
Background to the Study
Clinical learning is an important aspect of pre-registration nursing programmes. It enables students to acquire skills and knowledge required for quality care provision. In clinical learning, skills are taught and the knowledge can be applied in practice to help understand existing realities. Nursing educators consider clinical skills acquisition as an important part of nursing education. They also believe, nursing students can improve their theoretical knowledge by working in real clinical condition (Elcigil & Sari, 2007; McCarthy & Murphy, 2008).
In United States of America, Australia, New Zealand and European countries clinical teaching and learning form a significant part of pre-registration and education programmes (Price, 2007; Cooper, 2014). In these countries, clinical learning plays an important role in improving the practice of both healthcare professionals and student nurses, which in turn contributes to improved care provision. It is probably for this reason that Cassidy (2009) describes clinical learning as the heart of professional practice. Acknowledging this, the preceptor or clinical instructor constitutes an important aspect of students’ learning. Fitzgerald and colleagues (2010) claimed that students’ knowledge, skills acquisition, and theory-practice integration can be enhanced through preceptorship activities.

Preceptorship is a model or approach to teaching and learning that pairs nursing students with experienced practitioners to assist students in meeting specific learning objectives in the clinical setting (Myrick, 2005). Carr (2008) defined the preceptorship model as the act of teaching, assessing, supervising and coaching students. Preceptorship may also be defined as a one-to-one teaching and learning relationship between a Registered Nurse (RN) and nursing student whereby the RN acts as a role model to facilitate student learning and provide evaluation of learning objectives (Kaviani & Stillwell, 2000; Luhanga, Billay, Grundy, Myrick & Yonge, 2010). In countries such as United Kingdom, the term preceptorship is similar to mentorship and these terms are used interchangeably to indicate the same process of clinical teaching (Myrick, Caplan & Smitten, 2011). The clinical learning environment is where students learn to incorporate cognitive, psychomotor and affective skills necessary for professional development, and in turn become socialized into the profession (Luhanga et al, 2010). Midgley (2006) posited that most effective climate for learning and critical thinking is one that is devoid of fear, supportive, fosters openness and respect for the student as an individual. Myrick (2005) also asserted that in such an environment students can develop self-confidence, competence, interpersonal communication and problem-solving skills. These were further supported by various studies which show that students paired with preceptors have better learning outcomes (Wieland, Altmiller, Dorr & Wolf, 2007; Luhanga et al, 2010). As such, the responsibility of nurturing and supporting future nurses lies largely on nurse preceptors (Ohrling & Hallberg, 2000).

In Ghanaian nursing education, in order to improve effective clinical teaching and learning, preceptors have been introduced to supervise students in the practice setting. Preceptorship model was first introduced into a peri-operative nursing program in Ghana (1990s); this model was subsequently expanded to basic diploma and Bachelors in nursing education (Opare, 2000). The preceptorship model has proved to be highly useful strategy for clinical education as it allows education to be individualized. Classroom knowledge was likened to real patient management problems and provides for role modeling as the student’s develops standards and strategies for practice.
To safeguard patients from unsafe practice, it is important to evaluate student’s clinical competence. It should not automatically be assumed that learning is taking place in students’ practice experience. The preceptor provides constant feedback and support to the student and provides evaluation data to both the student and faculty (National Organization of Nurse Practitioner Faculty, 2000). However, this type of teaching is not without problems. It has been noted that teaching in clinical setting often occurs at a rapid pace with multiple demands on the preceptors. A variation in teaching and learning opportunities occurs because cases vary in number, type and complexity and may lack continuity (Irby, 2001). In a busy setting, there may be limited time for teaching and feedback from preceptors. Students may not find learning to be collaborative with the preceptor. Additionally, personal attributes of the nurse are found to influence preceptors’ role and commitment (Andrews & Chilton, 2000). These attributes of preceptors have been identified as mainly patience, non-judgmental, empathic, warm, respectful, fairness and flexibility (Burns, Beauchesne, Ryan-Krause & Sawin, 2006). It was reported that such personal attributes can affect nurses’ attitudes and beliefs towards preceptorship (Vallant & Neville, 2006) in turn affect whether they see preceptees as an integral part of nursing or a separate additional responsibility (Atkins & Williams, 1995). When preceptorship is seen as an integral part of nursing, RNs acknowledge the presence of the model as beneficial to both themselves and students. This benefit can mold and shape nursing education (Myrick, 2005). Additionally, it influences how they fulfill their roles as preceptors (Atkins & Williams, 1995) contributing to a positive learning environment and outcomes in students during clinical placement (Vallant & Neville, 2006). Moreover, preceptors who have positive attitude towards preceptorship are more likely to be committed to their roles, thus they are less likely to be concerned that precepting will compromise their time with other nursing activities (Atkins & Williams, 1995).

Assessment of clinical performance involves collecting data for a better judgment of nursing students. Clinical learning outcomes emphasize skills related to patient care standards (Billings & Halstead, 2009). The process of evaluation involves data collection, interpretation and formation of judgments and conclusions about students’ clinical performance (Mahara, 1998). Additionally, evaluation helps in the maintenance of professional standards and the protection of the public by ensuring that those that graduate from nursing programmes have attained the requisite skills and are safe to practice (Goldenberg & Dietrich, 2002). Evaluation has two interrelated functions which are achieved through formative and summative methods. Formative evaluation is intended to provide feedback on the learning which has taken place and to identify areas requiring remediation, while summative evaluation aims at making judgments to determine if the student’s performance meets academic and professional requirements. (Atkins & Williams, 1995). Formative and summative evaluations are similarly seamless; there is formative element in any summative evaluation (Schoenhofer & Coffiman, 1994).
Various authors have revealed that, evaluation of the clinical performance of nursing and midwifery students has been a long-standing concern for nurse educators (Andre, 2000; Lasater, 2007). Clinical evaluation is complex and challenging for both seasoned and novice educators, thereby raising concerns among students and faculty (Isaacson & Stacy, 2009). Some of the concerns are the subjectivity and variability involved in evaluating students’ clinical performance. Much of the discussion have centered on the thorny issue of subjectivity and a plethora of clinical evaluation tools that have been devised or abandoned in the quest to overcome this ongoing dilemma. Wood (1982) proposed that the problem probably persists because clinical evaluation relies upon the observation of the performance of one individual by another, which itself is inevitably subjective.

Evaluation is an important component of the preceptor-student relationships. Evaluation is performed by either a preceptor or clinical instructor. The preceptor and clinical instructor need to be familiar with the institution curriculum. There are goals and objectives for the specific clinical experiences and the evaluation tool that is required by the institution at the completion of the placement. An evaluation session at midpoint of the term and at the end of the rotation is essential. The preceptor’s evaluation also needs to be shared with the faculty person who is responsible for grading the student’s performance (Khodadadi, 2012)
There are many issues in assessing clinical nursing skills (Coates & Chambers, 1992). Inconsistency in the use of applied tools and disagreements in evaluation process by clinical educators are two of the issues. Most student nurses believe that clinical evaluation cannot distinguish the level of their theoretical and practice knowledge (Sheikholeslami, Masole, Rafati, Esmaeili, Vardanjani, Yazdani- Talami, & Khodadadi, 2012).

Statement of the Problem
The quality of nursing education depends largely on the quality of clinical experience planned in the nursing curriculum. The evaluation of students’ competency to practice is a worldwide matter of concern to all practice-based professions (Whiteford, 2007). The multiplicity of factors influencing evaluation indicates its complexity and difficulty in ensuring its objectivity and accuracy. It is therefore not surprising to note that student’s’ clinical skills are sometimes not accurately evaluated (Roberts, 2011). Acknowledging this, students who perform poorly may slip through the net of education programmes and subsequently enter professional practice. Patients encountering these categories of nurses may be at risk of receiving inadequate care which may have a negative impact on their health.

Evaluation, as a way of determining the clinical competence, is one of the fundamental principles of development and measurement of student achievement in nursing education (Wallace, 2003). The clinical teacher; preceptor’s role is of fundamental importance in shaping the student nurses’ clinical learning experiences. Competence in clinical practice is a necessary element of professional nursing practice. Determination of student’s progress towards the achievement of course objectives is one of the most important roles of the preceptor and clinical instructor. Competence is a construct which is not directly measurable but can be inferred from the evaluation of performance (Stuart, 2003). Despite this, limited studies have been conducted on factors that may affect clinical performance and evaluation of students in practice. This is particularly the case in Ghana, although the preceptorship and clinical instructorship model has been introduced in nursing education, it has not been fully integrated into the nursing education curriculum as asserted by Lewallen and DeBrew (2012).

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Item Type: Ghanaian Project Material  |  Attribute: 116 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH110 ($20)  |  Delivery: Within 30Mins.
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