Clinical learning environment as perceived by students and qualified staff.

Abstract

The Clinical Learning Environment (CLE) is a multidimensional entity with a complex social context (Hand, 2006; Wan Vim & Chan, 2005; McKenna & Wellard, 2004) which has undergone significant changes over the years (Purcell, 2006; Henderson, Twentyman, Heel & Lloyd, 2006; Lambert & Glacken, 2005). The purpose of this study was to explore students' and qualified staff perceptions on the CLE, identify significant differences in the samples' views in relation to their demographic data and clinical environment and explore factors which participants viewed as enhancing or inhibiting learning in the clinical setting. A descriptive cross sectional survey collected quantitative and qualitative data by means of a Likert form, self-administered questionnaire referred to as 'Clinical Learning Environment Diagnostic Inventory' (Ho soda, 2006). An additional six open-ended questions were included to obtain qualitative data. The use of a semi-structured interview schedule explored further the CLE with 5 focus groups of students and qualified staff from two local hospitals. Kolb's Experiential Learning Theory guided this study whereby learning is considered as a continuous process where knowledge is generated through the transformation of experience (Kolb, 1984). The sample consisted of all second, third and fourth year Diploma and BSc (Hons) Nursing and Midwifery students and all registered Nurses and Midwives in the clinical placements were students were allocated in Semester 1 of 2007-2008. A response rate of 82% (n=163) of the students and 72% (n=286) of the qualified staff was obtained to the self-administered questionnaire. Additionally, a purposive sample of five focus groups were selected to further enhance clarification of findings and explore factors influencing learning. The quantitative data were analyzed through descriptive and inferential statistics using Windows SPSS version 16, whereas the qualitative data were analysed using Thematic Analysis framework (Burnard, 1991). Results revealed no significant differences between students and staff overall perceptions on the CLE (t=1.534, p=O.126). Additionally, no significant difference was found in CLE perceptions between males and females (students: t=1.576, p=O.117, staff: t=1.342, p=O.181). However, a significant difference was found between subgroups of students by clinical placements in the two different hospitals (F=4.062, p=O.004). Factors enhancing and hindering learning emerged under two themes, namely; the clinical environment and the ward organisation. Additionally, support through mentorship was perceived as important by both students and staff. A set of recommendations are proposed in order to enhance students' learning. Recommendations included an increase in the number of mentors and further continuing education in teaching and learning in practice placements. Further longitudinal research is recommended on students in their subsequent years in order to identify fluctuations in their perceptions of the CLE.