Informatics And Nursing Opportunities And Challenges Pdf – Association between social support and physical activity in patients with coronary artery disease: multiple mediating roles of self-efficacy and autonomous motivation
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Informatics And Nursing Opportunities And Challenges Pdf
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Received: 12 January 2022 / Revised: 4 March 2022 / Accepted: 8 March 2022 / Published: 15 March 2022
Despite the growing demand for competent nurses to fill the shortage gap, nursing education institutions have not always been able to equip students with the necessary clinical competence in the practice setting. Several studies have described the experiences of undergraduate nursing students in the clinical learning environment. No study has been found on the experiences of diploma nursing students and post-registration nurses on teaching and learning of clinical competence in Ghana. This study, therefore, sought to describe the experiences and perceptions of diploma nursing students and post-registration nurses regarding teaching and learning of clinical competence in Ghana. A qualitative descriptive research design was employed in this study. Fifty-five (55) participants, comprising 40 students and 15 post-registration diploma nurses, from six research sites were recruited in focus group discussions (FGDs) using a maximum variation purposive sampling technique. A thematic framework method was used to analyze the data with the help of ATLAS.ti software. Three themes emerged from the focus group discussions: nursing education institutional factors; clinical placement design, implementation and system challenges; Challenges of clinical teaching and learning. We conclude that current approaches to clinical nursing education, such as the overreliance on clinical placement and the use of more teacher-centered learning approaches, are ineffective in facilitating the development of clinical competence. A review of the nursing curriculum, inculcating evidence-based simulation modalities and an adequate investment in nursing education may be required to ensure effective nursing education in the teaching setting.
Clinical education is the core of nursing education, because nursing is a practice-based profession. Clinical nursing education refers to the strategies adopted by nursing education institutions (NEIs) to ensure that nursing students develop clinical competence, either in the skills laboratory or in real-life clinical settings, to meet the standards set by nursing councils for qualification and registration as Nurses [1]. Clinical nursing education provides the platform for nursing students to actualize theory in direct patient care activities and, by doing so, be socialized to the real-world demands of the nursing profession [2]. Therefore, a critical link exists between the quality of clinical nursing education experience and the development of clinical competence. Clinical nursing competence refers to the ability to integrate knowledge, experience, clinical reasoning, sound clinical judgment, skills, beliefs, values and attitudes in the fulfillment of a professional role as a nurse in a given situation [3, 4, 5].
To promote the development of clinical competence, nursing education is designed to inculcate both theoretical and practical content that usually occurs in NEIs and/or clinical practice settings (CPSs) [ 6 , 7 ]. As a practice-based profession, the essence of the practical aspect of the curriculum cannot be overemphasized [6, 7]. Because of the need to provide nursing students with optimal practice opportunities in CPS, the clinical placement hours of nursing students are one of the highest among healthcare professions [8]. Despite the centrality of competence in nursing education, some observations in the CPSs called for the clinical competence of nurses. For example, there are the consequences associated with the late recognition of physiological deterioration among hospital in-patients, medication errors and poor aseptic techniques are numerous [6, 8, 9]. Although insufficient clinical competence is considered a problem with nurses in general, it is more prevalent among nursing students and immediate post-registration nurses [10]. Therefore, immediate post-registration nurses experience certain difficulties while transitioning into full-time professional roles, leading to poor job satisfaction and high job attrition [11, 12].
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The literature is replete with explanations for the lack of clinical competence demonstrated by nurses when they join the health workforce [8, 13, 14, 15]. Nurse educators of NEIs have been blamed for the use of outdated, non-standardized clinical teaching methods and materials [ 13 , 16 ], calling into question the expertise of individuals recruited to teach in NEIs. Botma et al. [17] exposed the need for well-trained nurse educators and clinicians who work in an environment of mutual trust characterized by the use of student-centered learning strategies as critical in developing clinical competence. Unfortunately, Salifu et al. [13] found that most nurse educators lack the qualification and clinical expertise needed to teach in NEIs. Furthermore, most NEIs in low-resource settings lack the necessary infrastructure and resources to support student learning [13, 18]. Therefore, NEIs resort to placing students in clinical settings to enhance their clinical competence [19, 20]. However, challenges in the CPS, such as the lack of resources and support, and the emergence of pandemics, seem to be excessively restrictive, limiting learning opportunities and impeding the development of clinical competence [13, 21].
Therefore, most NEIs have resorted to blending clinical placement with simulation-based clinical nursing education (SBCNE) to ensure effective mastery of clinical competence [ 22 , 23 , 24 ]. Clinical competence seems to be better developed through the use of experiential and student-centered teaching and learning strategies. Despite the positive impact of SBCNE, it has not been successfully used in low-resource settings, partly due to limitations in the application of frameworks developed in high-income countries [25]. Understanding the issues associated with the development of clinical competence in low-resource settings is necessary to aid in the redesign and implementation of clinical education to facilitate the development of clinical competence. To better understand the experiences of students and post-registration nurses in learning and teaching clinical competence in Ghana, we conducted focus group discussions (FGDs) with nursing students and post-registration nurses at six sites in three zones in Ghana. Our aim was to describe the experiences and perceptions of students and post-registration nurses with the teaching and learning of clinical competence in Ghana, a low-resource setting.
Nursing education in Ghana began as an apprenticeship program, where recruited novices learned about the work of the British colonial nursing sisters [26]. As the need for more knowledgeable and skilled nurses grew, the Nightingale Fund was instituted for the establishment of a one-year nursing training program in the setting. The training included teaching nurses the theory of disease while they received their practical training from the nursing ‘nurses’ in the hospital wards. Social changes in the 20th century required complex nursing services, which resulted in the need to equip nurses with a broader scope of knowledge and skills for practice. This resulted in the establishment of the first nursing college in the capital of the teaching setting in 1928 [26]. In 1963, the first bachelor’s program was established in a university located in the capital city of the setting through the partnership of the government and the World Health Organization. Currently, there are myriads of NEIs across the length and breadth of the setting, implementing general to specialized nursing programs [27]. The majority of the professional nursing workforce in the setting are diploma certificate holders trained by nursing colleges, despite the recommendation to make an undergraduate program an entry requirement for nursing [27, 28, 29]. The training of nurses in the setting is hampered by the building lack of resources. Infrastructure, logistics and human resources have all been described as insufficient to satisfy appropriate needs for nursing education [13, 27].
The study adopted a qualitative descriptive methodology. This approach allowed for a naturalistic investigation, enabling the description of experiences and
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