ESTUDIO PREOPERXTORIO: DIAGNÓSTICO

The CLE is where the students are placed to gain clinical experiences in nursing. A recurrent theme in a study of Emanuel and Pryce-Miller (2013:18) is that students perceive their mentors to be too busy to provide the required support. However, learning opportunities are dependent on the availability of support staff members in the clinical context. Human resources and equipment availability in the CLE affect the quality of learning opportunities provided in the CLE.

3.7.2.1 Human resources in the clinical learning environments

Participants’ point of view was that previously there were more personnel in the clinical areas who supported students with clinical learning opportunities. Currently the personnel complement is too small to support the students and due to work pressure they do not have sufficient time. The shortage of personnel in clinical areas jeopardised clinical teaching, and learning opportunities could not be utilised optimally.

“And when it comes to you know the activities that are done in the ward. Well, uhm, most of the time they are associating this with the shortage of staff and we really agree that comparatively ... if you compare the staff numbers in the ‘olden days’, there are much fewer now than previously. I mean, the number of staff has decreased nowadays; you do not have enough staff. They will also indicate that they do not have time to teach the students because they are really few in the ward and such things. And perhaps even the systems that we are using are a bit different because sometimes if you could have one sister with four students, where the sister could teach the students and at the end and lecture these things, and then thereafter the student could be left in direct supervision.” (C2)

In a study of Aiken, Rafferty and Sermeus (2014:24), it was found that professional nurses wanted to provide care, but the shortage of professional nurses in the working environment resulted in experiences of ‘uncaring’ behaviour towards patients and students.

Participants felt that the supervision of students in the clinical environment was inadequate. According to them, students are neglected in the clinical environment. A student should be exposed to more supervision and mentoring in the CLE.

“... currently one cannot rightfully say or outright say they are neglecting the students. Because we have the issue of shortage of staff and we’ve got the issue of burnout of the clinical personnel. … one is never sure whether it is burnout or a lack of supervision of the clinical staff of our students. In general they do not get enough supervision and enough mentoring in the clinical setting as one would have it, want them to get it. Now it takes you to check it, what is their attitude, what are making them doing that. Is it the shortage or is it the personnel who ... are just not interested in the student? So one cannot actually say which one actually is the cause.” (C1)

In the study of Amukugo and Mathew (2015:133), the shortage of health personnel was identified as a cause of the lack of quality nursing care. Personnel pointed out that the staff shortage created burnout because personnel had to run from one patient to another.

A shortage of professional nurses and human resources in the CLE enhanced the risk of shortcuts being taken with clinical procedures. These circumstances created an environment where students were not learning what they were supposed to learn during WIL. A lack of human resources in the CLE resulted in the procedures students had been taught being implemented incorrectly.

“So this is not enough coaching, not enough mentoring of this young nurses, especially ... because in the clinical area they really, there is a shortage, there is a shortage. So sometimes they do not learn what they are supposed to learn, because the sisters have to take a shortcut to finish, seeing that the work is finished in no time. You can do it without doing it the wrong way. So it is that misconception that no ... because we will never finish.” (B2)

“... We teach them one way, but in practice it is not usually done that way - often because there are no resources. Often because the person who is in the clinical area, who is their role model, also takes too many shortcuts, because they do not have time; they are too busy. That is usually their excuse.” (C3)

Proper staffing is important in the clinical environment to promote a clinical environment conducive to learning (McMahon & Christopher 2011:78). In the study of Moonaghi,

Mirhaghi, Oladi and Zeydi (2015:4) participants indicated that in the CLE many techniques are performed in a non-standard way.

Inadequate human resources, for example a shortage of professional nurses, put students at risk of internalising incorrect procedures, and future nursing practices might be negatively affected and result in a decline in nursing standards. Non-availability of equipment in the public CLEs also affected the WIL of students negatively. The shortage of support personnel in the CLE affected the quality of clinical teaching and learning offered to students.

3.7.2.2 Equipment available to support work-integrated learning

According to the participants, WIL clinical procedures were not practised correctly. This view was linked to the lack of resources and equipment, which resulted in students not gaining and internalising the correct procedures.

“... Many times it could also be because of a lack of resources here in the clinical area, so they improvise, obviously they improvise, meaning that the students do not gain what they are supposed to gain.” (B1)

Participants felt that the insufficient resources exposed students to medical risks when the correct stock and equipment were not available in the CLE.

“We do not have equipment in the ward. You will go there and you find that there are only 20cc syringes in the children’s ward. You do not know how they will be able to calculate ... and you ask yourself, how are they going to compromise to the kids’ treatment with a 20cc syringe, when there are no other equipment ... how are they going to nurse the child or administer the correct dose of medication?” (A2)

Some participants argued that when students had to improvise with procedures due to insufficient stock and equipment it should not harm or put the patient at risk during these procedures and nursing interventions.

“Even if you do not always have the equipment you can improvise to the best of your ability … carry out some procedure so as not to disadvantage the patient. They should actually be trained to function in this manner so that they can work in rural areas and not only in a technology hospital.” (D1)

The study of Amukugo and Mathew (2015:134) reveals that insufficient equipment in the clinical environments is a big problem and prevents quality nursing care. It was mentioned that a lack of medicine and equipment, such as blood pressure machines and scales jeopardises the quality of nursing.

Participants viewed that the standards of nursing in the clinical learning areas were at risk due to insufficient stock and equipment. Educators experienced powerlessness and embarrassment with this situation. Effective WIL depended to the availability of stock and equipment in the CLE. The concerns of participants were verbalised by them, stating that the availability of human recourses, stock and technology might have an impact on the trust placed in the teaching and learning environment.

3.8 CONCLUSION

To conclude the participants’ views: Three role players were identified as important figures in the nursing education environment, namely the educators, students and professional nurses. Expected characteristics of the role players included expert knowledge and skills, and professional conduct according to ethical norms and values. The need for accompaniment and support for students was expressed in order to maintain standards and ensure consistent approaches in the nursing education environment. Professionalism is a necessity for the role players in the teaching and learning environment. The shortage of resources in the theoretical and clinical areas impede the teaching and learning in nursing education. Resources mentioned included human resources and sufficient and appropriate stock, equipment and technology which supported the best learning opportunities. According to the participants the deficiencies and issues they mentioned could contribute to a breach of trust between educators and students. In the next chapter the participating students’ views will be shared and discussed.

CHAPTER 4

FINDINGS ON THE VIEWS OF STUDENTS REGARDING TRUST IN

NURSING EDUCATION

4.1 INTRODUCTION

In Chapter 3 the findings of the educators’ views were discussed. In this chapter the focus will be on the findings on the students’ views regarding trust in nursing education with supportive literature. The findings are based on the characteristics of role players and the expectations of students regarding important aspects for trust in the nursing education environment and the teaching and learning environment of students. Views reflected on the maintenance of standards were to create an environment where students could attain the required learning outcomes in nursing education.