Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses

Abstract

BackgroundThe clinical learning environment is a complex social entity that influences student learning outcomes in the clinical setting. Students can experience the clinical learning environment as being both facilitative and obstructive to their learning. The clinical environment may be a source of stress, creating feelings of fear and anxiety which in turn affect the students' responses to learning. Equally, the environment can enhance learning if experienced positively.ObjectivesThis study described pupil enrolled nurses' experiences of facilitative and obstructive factors in military and public health clinical learning settings.MethodUsing a qualitative, contextual, exploratory descriptive design, three focus group interviews were conducted until data saturation was reached amongst pupil enrolled nurses in a military School of Nursing.ResultsData analysed provided evidence that acceptance by clinical staff and affordance of self-directed learning facilitated learning. Students felt safe to practise when they were supported by the clinical staff. They felt a sense of belonging when the staff showed an interest in and welcomed them. Learning was obstructed when students were met with condescending comments. Wearing of a military uniform in the public hospital and horizontal violence obstructed learning in the clinical learning environment.ConclusionStudents cannot have effective clinical preparation if the environment is not conducive to and supportive of clinical learning, The study shows that military nursing students experience unique challenges as they are trained in two professions that are hierarchical in nature. The students experienced both facilitating and obstructing factors to their learning during their clinical practice. Clinical staff should be made aware of factors which can impact on students’ learning. Policies need to be developed for supporting students in the clinical learning environment.

Nursing Students' Opinions on Facilitating and Hindering Factors in the Clinical Training Setting

“…Most of nursing students of the three academic years highlighted one of the most common facilitating factors, which is having good collaboration with staff gives confidence. This finding is conforming to Lekalakala-Mokgele & Caka, (2015) [30] study which stated that when students receive support from the staff, being self-directed and empowered, the clinical experience becomes easier.…”

Undergraduate nursing students’ experience of clinical supervision

“…Notwithstanding time constraints, Sosteric ( 2012 :1) relates that educators are powerful representatives who display shameful and abusive behaviour towards students. The findings of a study completed by Lekalakala-Mokgele and Caka ( 2015 :5) also confirmed the abuse of power amongst lecturers and that abuse transpired through verbal abuse such as shouting and threatening students with possible failure. In this respect, reprimanding or scolding a student in front of their peers or an audience is wrong (Whitaker & Breaux 2014 :108).…”

“…Professional behaviour and respect are important elements of the clinical learning environment. Lekalakala-Mokgele and Caka ( 2015 :5) explain that the student nurse needs to be treated with respect and as an equal partner in the clinical supervision relationship. As a result, nursing students should not experience any supervision that relates to abusive behaviour.…”

Practices of caring for nursing students: A clinical learning environment

“…Emphasis is placed on caring as being fundamental to nursing [ 4 ].Lekalakala-Mokgele and Caka however mention that there is a lack of care displayed in caring for nursing students within their clinical learning environment where nursing students have described their clinical learning environment as unsupportive and a stumbling block, creating within them feelings of dread and apprehension [ 4 ].…”

“…Minimum attention is given to the nursing students’ emotional and psychological development; the caring factor that recognises the nursing student as an individual is neglected [ 18 ]. Finally, according to Lekalakala-Mokgele and Caka [ 4 ], the clinical learning environment may be stressful, causing anxiety and fear, and affecting learning negatively. Emphasis is placed on caring as being fundamental to nursing; however, a lack thereof is displayed in caring for nursing students within their clinical learning environment [ 13 ].…”