Research - International Journal of Medical Research & Health Sciences ( 2021) Volume 10, Issue 1
Satisfaction of Nursing Students in a Clinical Psychiatric Learning Environment and their Demographic Profile: A Comparative StudyFadhah Tayeb Alshammari*
Fadhah Tayeb Alshammari, College of Nursing, University of Hail, Kingdom of Saudi Arabia, Email: [email protected]
Received: 08-Dec-2020 Accepted Date: Jan 07, 2021 ; Published: 14-Jan-2021
Background: The Clinical setting has been regarded as a critical venue for nursing students to test and employ the nursing theories and practical skills they learned from the classroom. However, the quantity and quality of knowledge and skills competencies that the students gain from the clinical settings vary depending on the atmosphere in the ward to include the effectiveness of the nursing staff and nurse teachers. In this study, the objective was to uncover the satisfaction level of nursing students in the clinical psychiatric learning environment with the role of the nurse teacher and the ward manager at play. It also aimed at determining if there is a significant difference in satisfaction with their demographic features. Methods: The descriptive-comparative method and closed-ended questionnaire using the CLES+T evaluation scale were used in this study. 121 nursing students who completed clinical duties in the psychiatric ward answered the questionnaire. Frequency, percentage, mean, standard deviation, and t-test/f-test in Statistical Package for Social Sciences (SPSS) version 21 were utilized in the analysis of collected data. Result: Most of the respondents who participated are female regular nursing students registered in the level 8 nursing course. The general satisfaction level of nursing students in the clinical psychiatric learning environment is somewhat satisfactory. In all the five sub-dimensions of the learning environment, as specified in this study, the students were satisfied with the leadership style of the ward manager regardless of their gender, year level, and type of program they are registered. It was found that there was no significant difference in the level of satisfaction of nursing students in the psychiatric ward across all variables; gender, year level, and type of program. Conclusion: The common level of satisfaction of nursing students of Hail University in their psychiatric learning environment is somewhat satisfied. The diverse socio-demographic characteristics of the respondents do not in any way provide a significant difference in their satisfaction level in a clinical psychiatric learning environment.
Psychiatric, Nursing students, Satisfaction, Supervision
Researchers and scholars worldwide have established that the Clinical Learning Environment (CLE) is essential in molding nursing students to become efficient and effective future professional nurses . The clinical learning environment has a broad context, but, in this research, five attributes considered that have a great impact on the learning progress of nursing students: supervisory relationship, the pedagogical atmosphere in the ward, the role of the nurse teacher, leadership style on the ward manager, and premises of nursing in the ward . Exposures or actual duties of nursing students in the hospital is one way of completing a clinical practicum, and it believed that collective support from hospital management, health personnel, and clinical teacher contributes satisfaction to the students and the quality of clinical education .
A very challenging learning environment can either make or break a student’s learning momentum if without support. Research findings elaborated that nursing students have a low level of satisfaction in terms of their relationship with the nurse teacher and students tend to have low satisfaction levels with their clinical learning environment in the area of student-nurse relationship [4,5].
Several studies conducted on nursing students’ satisfaction in the clinical setting resulted in helping students develop clinical skills. However, investigations or studies directed specifically in mental health facilities are limited [1,6,7]. In the psychiatric area, patients with mental issues have a complex health problem that is difficult to resolve by health care professionals because of the need for substantial time and effort to comprehend the cause of the illness . Besides, a health worker assigned in a mental health treatment setting would certainly discern the physical and psychological pressures as it requires a proportion of strength to handle mentally disturbed patients. Similarly, a nursing student who is a novice to this clinical setting will find it very challenging, especially if there is no considerable support from the psychiatric personnel and clinical instructor; students would develop psychological and emotional symptoms .
In the University of Hail, the Bachelor of Science in Nursing program degree was introduced and recognized in 2007, and it was considered novel in the education industry. Since then, the university’s role in the nursing program has still been nurtured in the process of attaining the highest quality education. In the nursing curriculum design for the university, the nursing students who enrolled in a mental health nursing subject are assigned in a psychiatric area once only for an equivalent of eight hours for the entire duration of the semester. Given this limited number of hours of experience in the psychiatric ward, it would be interesting to look at the extent to which students’ satisfaction in a clinical psychiatric learning environment and find out what features and clinical learning need improvement. With this in mind, this research study conceptualized to determine the level of satisfaction of nursing students in the clinical psychiatric learning environment hypothesizing that there is no significant difference in the satisfaction level of nursing students in the psychiatric ward based on their demographic profiles.
This is a descriptive-comparative study designed to know nursing students’ satisfaction level in a clinical psychiatric learning environment with a particular role performed by their nurse-teacher and ward manager. It also aimed to identify if there is a significant difference in their satisfaction in the psychiatric area exposure and their demographic profile.
Population and Sampling
This study’s target respondents were nursing students of the University of Hail, enrolled in levels 6 to 8 in the College of Nursing during the school year 2019-2020. However, in a non-random sampling, it was limited to the 121 who volunteered and have undergone rotations in the university’s affiliating psychiatric hospitals.
Data Gathering Procedure
The research proposal was presented to the Dean of the College of Nursing as well to the ethics committee of the University Review and approval. After the proposal’s approval, the researcher convened the nursing students who volunteered to participate as respondents for a brief orientation and distribution of the questionnaire. The details of the survey instrument were thoroughly explained, and it was ensured that there were no time pressures, thus allowing the students to comprehend and understand every question. While the respondents were answering the questionnaire, the researcher was readily available to answer clarifications.
A structured questionnaire derived from the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES+T) evaluation scale was used in this study. The CLES+T was initially been developed in Finland in 2008, internationally translated into different languages, and the extent of its usefulness and reliability was several times validated . The questionnaire consists of three parts. The first part contains the mechanics on how to answer the questionnaire, and the second part covers the demographic profile such as gender, year level, and type of program the respondent is currently enrolled in and, the third part deals on the clinical learning environment, supervision and nurse teacher evaluation scale with 34 statements. The 3rd part is subdivided into five sub-dimensions: supervisory relationships-10 items, the pedagogical atmosphere in the ward-10 items, the role of nurse teacher-6 items, leadership style on the ward manager-4 items, and premises of nursing in the ward-4 items. The 4-point Likert scale was utilized in measuring the responses of respondents to wit: (1) extremely satisfied, (2) somewhat satisfied, (3) satisfied, (4) extremely satisfied. There was no letter of permission forwarded to the original author to use the above research instrument as it is widely circulated worldwide; however, a proper citation was observed.
This research proposal has undergone an ethical review by the ethics committee of the University of Hail to ensure the study’s ethical soundness. Before handling the respondents, the questionnaire, the purposes, and the mechanics of the study were explained thoroughly. The participants gave their prior consent by signing a waiver. It was also reiterated before each respondent answered the questions that their right to withdraw from further answering is guaranteed. The respondents were told of their right to refuse to complete the questionnaire or to withdraw from further sharing information through the questionnaire. Every respondent was assured of the confidentiality of the information shared or collected.
The data gathered were tallied and treated through the use of the Statistical Package for the Social Sciences (SPSS version 21). Descriptive statistics were used in describing the data: frequency and percentage for the demographic profile, the mean and standard deviation for the satisfaction of nursing students in the clinical psychiatric learning environment, and sample t-test and f-test for the significant difference of the satisfaction of nursing students in a clinical psychiatric learning environment and their demographic profile.
Female nursing students comprise the majority or 62 percent of the 121 participants, as indicated in Table 1. The male respondents comprise only 38%. There seems to indicate an actual trend of the population of nursing students enrolled in the University of Hail in which males did comprise the minority. The respondents came from 3-year levels with level 8 contributing 72 participants, equivalent to almost 60 percent of the total, level 7 with 39 (32.20%), and level 6 with only 10 (8.30%). Of the 121 participants, 91 or 75.60% were enrolled in the regular class while 30 (24.80%) were from the bridging program.
|Type of Program|
Table 1: Demographic profile of the surveyed nursing students
As indicated by the calculated mean and Standard Deviation (SD) of 2.36 and 0.787, the general level of satisfaction of the nursing students in a clinical psychiatric learning environment is somewhat satisfied (Table 2). However, the students are satisfied with the ward manager’s leadership style, which garnered the highest mean of 2.52 and SD of 0.93. The other four sub-dimensions of the learning environment with mean ranging from 2.23 to 2.40 and SD from 0.80 to 0.93, fell under somewhat satisfied.
|Sub-dimensions of learning environment||Mean||SD||Interpretation|
|Supervisory relationship||2.23||0.83||Somewhat satisfied|
|Pedagogical atmosphere in the ward||2.42||0.8||Somewhat satisfied|
|Role of nurse teacher||2.31||0.81||Somewhat satisfied|
|Leadership style of the ward manager||2.52||0.93||Satisfied|
|Premises of the ward||2.34||0.93||Somewhat satisfied|
Table 2: The satisfaction level of the nursing students
As indicated by the resulting p-values, which are higher than the significant level of 0.05, the differences in nursing students’ satisfaction in the clinical psychiatric learning environment across demographic profiles appear to be not significant (Table 3). Looking at each variable, the gender and type of program with almost equal p-values of 0.89 and 0.85, respectively, indicates not a significant difference. The year level, which has a p-value of 0.08, is far lesser than that of the gender and type of program, yet it is still not significant. However, it is almost near the value of the significant level, which is 0.05.
|Level of Satisfaction||Gender||t (-1.71)||119||0.89||Not Significant|
|Year level||F (2.60)||218||0.08||Not Significant|
|Type of program||t (0.18)||118||0.85||Not Significant|
Table 3: Difference between the satisfactions of nursing students in a clinical psychiatric learning environment across their demographic profile
The current situation of the Clinical Learning Environment (CLE) of the college of nursing of the Hail University has inspired the conceptualization of this study, which sought to determine the satisfaction level of nursing students in a Clinical Psychiatric Learning Environment (CPLE). Specifically, in the areas of the supervisory relationship, the pedagogical atmosphere in the ward, the role of the nurse teacher, leadership style of the ward manager, and premises of nursing in the ward, it aims to determine if there is a difference in the satisfaction on the CLE in a psychiatric ward and their demographic profile.
The significant finding in this study is that the nursing students of the University of Hail, as represented by the 121, who voluntarily participated, generally have low levels of satisfaction over the college of nursing’s clinical psychiatric learning environment. A general satisfaction level of “somewhat satisfied” would reflect the learning environment’s real condition, which needs a lot of enhancement. As to the differences between the satisfaction level across the demographic variables: gender, year level, and type of program, the result was “not significant.” With this result, the hypothesis is therefore rejected.
A related study on the satisfaction of nursing students in a clinical setting conducted in four universities in the Cyprus Republic revealed that the students have a high level of satisfaction with the nurse teacher’s supervisory relationship and role when in the clinical area. The high satisfaction attributed to staff and nurse teachers’ regular follow-up on nursing students’ skills performance . Similarly, research conducted in Saudi Arabia illustrated that students have high satisfaction over nursing premises in the ward . The above findings all point to positive findings of high satisfaction in contrast to this study’s findings, which show a low level of satisfaction. As mentioned above, the nursing students’ high satisfaction from the universities in Cyprus is influenced by the supervisors or clinical teachers’ positive actions or support.
Another study that considered the supervisors’ behavior and competencies to have an impact on the students’ clinical learning is that of Donuogh and Heever . In a qualitative study, the authors established that undergraduate nursing students have formative experiences with their supervisors and their clinical instructors in hospitals. However, on some occasions or instances, their behaviors and competencies alter the students’ learning needs in the clinical area .
The case of this current study in which the overall satisfaction level of students’ CLE in the psychiatric ward is “somewhat satisfied” supports the aforementioned findings through its outcome in the area of the leadership style of the ward manager. It only proves that the behaviors, leadership styles, and attitudes of clinical supervisors’ matter on students’ satisfaction in their CLE. However, the reason behind the low level of satisfaction or the somewhat satisfied feeling of the Hail students in a CPLE cannot be conclusively pointed to the attributes of the supervisors or clinical instructors. There are other factors to consider that affect the sub-dimensions of the learning environment, such as the limited number of hours of students’ exposure in the psychiatric area. It has been said that Hail nursing student were there in the psychiatric area for just one-day of duty in one whole semester. It can be comparable to another case, like that of the study in the University Hospital in Lithuania in which 42% of the student nurses who partook as respondents revealed their satisfaction with the pedagogical atmosphere in the ward, and it was believed that such a level of satisfaction is associated with the number of days of exposure in the ward .
This study’s result has exposed many weaknesses that limited the achievement of a complete rationalization of the nursing students’ satisfaction in a clinical psychiatric learning environment. Another weakness could be the structured questions provided for the respondents to answer that may consequently have limited the production of complete and reliable data. An interview process or other research approach is recommended significantly to discover the response of the nursing students.
The overall satisfaction of nursing students at the University of Hail in a clinical psychiatric learning environment is somewhat satisfied. The demographic profiles of the respondents, as used in this study: the gender, year level, and type of program do not cause any significant difference in the satisfaction level.
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