Nursing students clinical learning experiences in selected Colleges in Malawi : a model to facilitate clinical learning

PhD (Nursing Education), North-West University, Mafikeng Campus, 2015This study examined nursing students‟ clinical learning experiences in selected nursing colleges in Malawi. The importance of clinical practice cannot be overemphasized in nursing education, as nursing is a practice based profession. The quality of nurse education largely depends on clinical experience that nursing students receive in their operating clinical environment which can have a profound impact on their learning either positively or negatively. The objectives were to investigate i) the effectiveness of clinical learning across different levels, within and between training institutions. ii) the challenges experienced by nursing students in clinical practice. Concurrent triangulation design was used to explore nursing students‟ clinical experiences from eight (8) selected nursing education institutions from first, second and third year students pursing Bachelor‟s degree, Diploma and Nurse Midwife Technicians (NMT) nursing education programmes selected purposively. Quantitative data was collected using self-administered questionnaires from 590 participants recruited through simple random sampling. Through purposive sampling, 144 students were involved in sixteen focus groups of nine participants in each group. Quantitative data was analysed using Statistical Package for Social Sciences (SPSS) computer software (version 22.0). Data were analysed at univariate, bivariate and multivariate levels. Univariate analysis was used to measure socio-demographic characteristics of participants and independent variables. Bivariate analysis (One-way ANOVA) was performed to examine the association between independent and dependent variables. Binary logistic regression was used to develop logistic model showing the odds of independent variables having the probability effect on the dependent variables. Computer Assisted Qualitative Data Analysis Software (CAQDAS; Atlas ti (version 7) was used to analyse data collected from focus groups discussions. Results showed that about 73% of the students in this study indicated that there was no integration of theory and practice. The odds of Integrating theory and practice was less likely in almost all variables, including programme p < 0.010, institution p < 0.001 and level of study p < 0.001, hospital and duration of study p < 0.001 and p < 0.001 respectively and number of times students met with the NE p < 0.001. RN diploma ( ̅x) -0.1810, p < 0.03 was less likely to integrate theory and practice compared to those in the BSc programme. Students in third year ( ̅x) 0.1518, p < 0.005 were less likely to integrate theory and practice compared to those in their first year. About 75% of students were not given feedback on their performance in the clinical setting. These variables contributed significantly; institution of study p < 0.005, level of study p < 0.001, duration of placement p < 0.009 and number of times students met the NE p < 0.016. The results from the qualitative data showed that students were not adequately supervised as they learned on their own. The study also found from the discussions that there were poor student-staff relationships. In conclusion, in spite of the importance of clinical practice in preparing the nursing students for the work they do as practicing nurses after graduation, this study has shown that clinical practice had inadequately prepared students for the nursing profession in selected institutions in Malawi. These findings may have implications on the policies and practice of nursing education in Malawi. Further research would be recommended to analyze the curricula in relation to the quality of clinical learning.Doctora