Situational analysis of clinical learning environment for the undergraduate nursing students at selected health facilities in Central and Eastern Kenya

Abstract

Background: Clinical learning environment has an impact on the learning outcomes and performance. Nursing students, nurse educators, nurse preceptors and administrators play a major role in clinical learning. However, the extent to which these roles are effectively performed depends on the quality of clinical learning environment and the level of support provided. Learning opportunities change, therefore, should be identified. Challenges can hinder skill acquisition, reduce confidence, and compromise students’ readiness for independent practice. Identification of strategies can strengthen clinical learning. However, gaps persist in many settings. A situational analysis of the clinical learning environment can help in establish the state of clinical learning environment. Objectives: To assess the role of stakeholders, explore opportunities, explore challenges and evaluate strategies used to improve clinical learning in selected health facilities in Central and Eastern Kenya. Methods: The study used mixed methods cross-sectional study design with empiricism and grounded theory approach. No hypothesis was used, the study sought to answer research questions in line with the objectives. Taro Yamane formula was used to get a sample size of 235 students and 153 nurse preceptors. A census was used for the 23 nurse educators and 7 administrators from selected universities and hospitals. Stratified random sampling was used for students according to the year of study as well as nurses according to the wards. Proportionate random sampling was used to select participants from each stratum. A semi-structure questionnaire and key informant interview guide were used to collect data. SPSS Version 26 was employed to analyze quantitative data. Qualitative data collected were put in broad categories of themes and analyzed in frequencies. Results: The findings showed that majority of students, preceptors, and educators were aware of their roles in the clinical learning environment, while the majority of the administrators said: “I appoint the clinical coordinators and approve placement of students in the clinical rotations.” Likert Score means for nursing students, nurse preceptors and nurse educators for the opportunities available in the clinical learning environment indicators were 3.8±0.3, 3.9±0.5 and 3.8±0.3 respectively indicating that the respondents’ opinions oscillated between neutral and agree. The majority of the administrators said, “... the goals of clinical learning are in line with the Nursing Council of Kenya and that means we have no problem with the regulatory body as far as clinical learning is concerned.” The means for the challenges in clinical learning environment indicators were 2.9±0.4, 2.9±0.7 and 2.9±0.5 respectively indicating that the respondents’ opinion oscillated between neutral and disagree. According to administrators, space is a challenge as one said, “... the clinical sites are not adequate in number and also too small in size to accommodate all the nursing students from the universities.” 36 (20.8%) of the students said that the learning resource centres should be located within the hospitals, 71 (50%) of nurse preceptors said clinical instructors should be proactive in supervising students. On the other hand, 6 (26.1%) of the nurse educators said the number of trained mentors should be increased to supervise students closely. Majority of administrators said, “... proper means of communication between students and supervisors would minimize frustrations and misunderstandings that can hinder smooth learning during clinical rotations.” Conclusion: This study concludes that all stakeholders are aware of their key roles on clinical learning environment. The clinical learning experience of nursing students is significantly influenced by opportunities and challenges identified in clinical learning environment. The most crucial strategy is the need to improve collaboration between universities and hospitals to ensure proper planning of students’ placement in clinical learning environment. Recommendations: The study recommends that stakeholders be encouraged to understand one’s own role within the clinical learning environment. Learning opportunities should be supported and evaluated periodically. Challenges are addressed by adequate preparation of stakeholders. Collaboration between stakeholders is important.