The data analysis led to the emergence of four main categories, including, tasks oriented education, support and guidance for students, organizing interpersonal communication and professional-ethical role modeling (see Table 1).
Table 1
Nursing instructors’ clinical education competencies: Categories and subcategories
Categories | Subcategories |
Tasks oriented education | • Lack of clinical education development programs. • inappropriate learning climate |
Support and guidance for students | • Providing assistance to students during clinical practice • Providing effective feedback |
Organizing communication skills | • Inter-personal communication skills • Professional inter-personal skills |
Professional-ethical role modeling | • Ethical role modeling • Professional value role modeling |
tasks oriented education
Nursing instructors’ perception of educational competencies was predominantly tasks oriented education. It is a practical method to strengthen students’ psychomotor skills and less focused on educational objectives in the cognitive and emotional domains. The subcategories of this category were classified as lack of clinical education’ development programs and inappropriate learning climate. The majority of the part time CNIs expressed one of the most common reasons for tasks oriented education is lack of preparation programs in clinical teaching role. They emphasized ‘‘task-centered” approach to care rather than ‘‘patient-centered”. Part time CNIs did not use the nursing process in clinical teaching and were not capable of doing so themselves either. One Part-time CNI said:
“Institutions of higher education in nursing do not have orientation programs or workshops about how to clinical teaching for part time CNIs. In case of holding continuing education development programs for us, they were not operational” (P 7).
Another Part-time CNIs said:
“Based on the students’ interest, I teach clinical procedures (for example blood pressure and wound care) step by step in accordance with a standard checklist” (P2).
The nursing instructors stated that their clinical environment is mainly oriented task completion, priority was not given to nursing process-based practice, according to learned knowledge of nursing. They revealed that nursing students obeying the nursing staff and perform their duties.
One Part-time CNIs reported:
“Students find patient care based on the nursing process an excessive and difficult task, because their role models are the nursing staffs, who are tasks-based” (P3).
The students stated that, after graduating and entering the workplace, hospital authorities place greater emphasis on performing clinical skills and procedures rather than managing patient care. They believe that a good nurse is who has good technical skills, in fact, the staff nurses and their task-oriented actions also serve as role models for nursing students.
In this regard, one of the nursing students explains:
“I most like to learn the procedures and techniques when, I look at my career prospects; if I have great theoretical knowledge but don’t know clinical practice, the ward head and nursing staff will not accept us” (P5).
Academic clinical educators had experienced more active clinical teaching methods, such as group discussions and case-based clinical education. They believed that the use of these methods in clinical education made students familiar with group collaboration, sharing knowledge, and applying theoretical concepts in clinical practice. Respondents stated that effective group discussions by educators can result to make learning experiences, enjoyable for students.
One academic clinical educator expressed: “I would ask the students to discuss their positive or negative experiences of interning with other students in a clinical conference in a group” (P17).
Another Academic clinical educator explained: “Students identify the patients' needs, and discuss the patient care plan with other students” (P15).
One nursing student approved the academic educators' statements and said:
“The academic clinical educators introduced the cases to us. According to the nursing process, we identified the client's objective and subjective problems by reviewing the patient's file, taking a history and performing a physical examination of the clients. We then designed, implemented, and evaluated the nursing care plan for them. This method led to effective and lasting learning” (P5).
Academic nursing educators in this context do not have enough time to provide clinical education to students because of having to teach theoretical courses and run research activities. Also, most of them are on nursing PhD scholarships and are away from clinical practice. We found that these groups of academic clinical educators were rare and the majority of clinical educators in this context were part-time CNIs.
Guiding and supporting students
CNIs’ perception the competencies of clinical education, guiding and supporting students through providing effective feedback and assistance during clinical practice. They believe that providing assistance in the clinical settings promotes learning and enhances students’ self-confidence and independence. In this regard, one Part-time said:
“First, I perform special and sensitive procedures of patient care myself and the students observe my performance; then, they perform the clinical procedures themselves; I monitor and encourage their positive performance to boost their self-confidence and make them become independent in their learning activities” (P 9).
Also CNIs reported that providing feedback to students, about their performance in a timely and regular manner was an effective feedback strategy. It supports the students toward good clinical practice. In this regard, academic clinical educator adds:
“Feedback immediately after each procedure and without the nursing staff, patients and patient companions noticing will help the students to develop self-esteem and enhances their learning of clinical skills” (P16). A part-time CNI approved academic educators' statements and said:
“Feedback should be given clearly after every clinical practice which will help the students in learning clinical procedures which will avoid further mistakes and harm to the patient” (P8).
Organizing communication skills
CNIs perception of communication competence included categories: inter-personal skills and professional inter-personal skills. They described open, honest inter-personal skills with students as important facilitators in students learning. One Part time CNIs describe: “The first day of clinical education is orientation day. I communicate respectfully with students, Introducing the students with the clinical setting, equipment, personnel, internship rules”
(P 7).
CNIs stated that teaching students about honest interpersonal skills with clients and the health care team will lead to better patients care and the development of care plan for them.
Academic clinical educator explains: “teaching students in relation to therapeutic communication with patients leads to identifying patients' needs and designing a care plan based on their needs” (P18).
The Part-time clinical instructors, who belonged to the same clinical units, considered clinical experiences as the most important factor for their communicating with the healthcare team. They believed that good communication with the care team lead to students’ acceptance and greater cooperation of the staff in the students’ clinical education. In this regard, a Part-time CNI said “... I am an experienced clinical nurse and belong to the same clinical setting. So, it is easier for me to communicate with the nursing staff and the healthcare team in the area of work” (P1).
The other Part-time CNI participant said: “Communicating with the nursing staff will lead to a positive attitude towards me and my students, which will subsequently increase the efficiency of the internship” (P 6).
But, from point of view academic clinical educators, scientific expertise was the most important factor in their communication with the healthcare team. One academic clinical educator described her experience as: “I can communicate with the nursing staff by sharing knowledge on update topics in concerning the provision of nursing care to patients” (P 17).
The students also noted that the relationship between CNIs and nursing staff in the clinical settings can create an intimate atmosphere, improve clinical skills and increase the efficiency of the internship. They identified nursing staff as a resource for learning about clinical practice. A nursing student described the benefits of good relationships with the clinical staff:
“When we performed a clinical practice the wrong way, nursing staff taught us the correct method of performing the procedure be because a good relationship may be helpful in this situation”(P4).
Professional-ethical role modeling
Role modeling is one of the hallmarks of instructors’ competences in clinical practice to convey professional attitudes and behaviors to students. CNIs reported that they were functioning as a role model for the students. They believed that having passion and a positive attitude to the nursing profession is very important in students’ interest to the nursing profession. A Part-time CNI stated:
“I take care of the patients with passion and enthusiasm; I consider the patients part of my family. I believe that convey the perception and mindset, about my profession to the students” (P12).
CNIs reported that clinical education through role modeling has a profound effect on promoting the students’ professional values and ethical features by observing their behavior. They acknowledged that nursing students learn professional values such as accountability, professional commitment, respecting to the patients’ beliefs and values and maintaining confidentiality in caring for the patients by modeling after their clinical education.
Academic clinical educator states:
“If I demonstrate respect to the patients’ beliefs and values, students would naturally behave in a similar manner to those people” (P15).
Part-time CNI explained:
“At the end of the internship hour, I realized that the patient’s IV line was broken; although the internship time was over, I stayed with the student to replace the patient’s IV line so that the student would learn, responsibility, and professional commitment” (P11).