Nursing and midwifery students’ experiences and perception of their clinical learning environment in Malawi: a mixed-method study

Abstract

Background The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives’ experiences and perception of the clinical learning environment in Malawi. Methods A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed. Results A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment. Conclusion Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

Experiences of Ghanaian Student Nurses’ and Midwives’ during Clinical Practice in the Kumasi Metropolis: An Ethnographic Study

“…Generally, the study findings revealed showed some congruence with other studies internationally Abdulmutalib et al [12], Bäck et al, [13], Mbakaya et al [14] and locally in findings of Adjei et al [15] that students' exposure to clinical practicum have impact on students learning outcome. Positively in our study, majority of the study participants expressed some satisfaction with the clinical exposure.…”

“…From the stories shared by the participants, they are not given the chance to acquire skills and competencies per the set objectives for practicum hence, are not fully prepared and are also not supervised to learn or acquire clinical standard skills and competencies. These findings showed some contradictions with the findings of [6,13,14] which revealed that, there are well-planned practicum activities by the nurses whenever students are on practicum. Also, there is an effective clinical practice of students under supervision and that promotes learning and helped students to achieve learning outcomes and competencies through the diversity of learning opportunities but this was not seen in our study.…”

A first-year, first-semester observership placement to increase nursing students’ satisfaction

“…This involves observing the physical space, the psychosocial interactions, culture of the workplace, and the learning and teaching factors. [23,24] The connection which the students reported they made between theoretical and practical nursing knowledge gained from their university studies and observership, aligns with what Mezirow [25] described as a transformative learning experience, or as Chick and Meleis [26] identified as a "passage", where the student moves from one state to another, that is from a nursing student to a professional nursing student.…”

Experiences of nursing students regarding clinical placement and support in primary healthcare clinics: Strengthening resilience

“…Looking at more recent, similar research findings (Motsaanaka et al 2020 ), the findings of this research are still relevant. More recent studies still report that students need emotional, cognitive and systems support such as personal attention, care, guidance to gain confidence and socialisation in nursing (Bazrafkan & Kalyani 2018 ; Hosseinabadi et al 2020 ; Hugo, Botma & Raubenheimer 2018 ; Kgafele, Coetzee & Heyns 2015 ; Mbakaya et al 2020 ; Mekgoe et al 2019 ), whilst the current study offers valuable findings and recommendations that can add to the body of knowledge on this important topic.…”

“…At the time of the research, the first author’s own experience as a professional nurse in a PHC clinic also confirmed the need for this research. Whilst more recent research has also been reported at the international level and in the African context on the learning experiences of nursing students during placement at PHC clinics, support for nursing students during clinical placement in PHC remains lacking (Fröberg et al 2018 ; Mackey et al 2018 ; Mbakaya et al 2020 ). There is thus an ongoing need for research to explore and describe nursing students’ experience of clinical placement in PHC clinics, in this case in a province in SA, and to apply the findings to recommend strategies for support to strengthen students’ resilience during challenging clinical situations.…”