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November 2017 -
Volume 15, Issue 9

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From the Editor

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Original contribution/Clinical Investigation
Diabetes Mellitus - Knowledge, Management and Complications: Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah Haider, Muhammad Masood Ahmad

Alanine aminotransferase indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley Pocock

Comparative Analysis of Antimicrobial Peptides Gene Expression in Susceptible/Resistant Mice Macrophages to Leishmania major Infection

Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani, Amir Tavakoli Kareshk, Arash Asadi

Does socio-economic status of the patients have effect on clinical outcomes after coronary artery bypass grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed Kouhpyma

Comparison of the uterine artery Doppler indices during pregnancy between gestational diabetes and diabetes mellitus and healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud Jaafarnejhad,
Parisa Bahrami Kamangar

Survey single dose Gentamicin in treatment of UTI in children with range of 1 month to 13 years old in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab

Evaluation of control of bleeding by electro cauterization of bleeding points of amplatz sheath tract after percutaneous nephrolithotomy (PCNL) in Jahrom Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo

Comparison of the three-finger tracheal palpation technique with triple ID formula to determine endotracheal tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori

Effect of Sevoflurane and Propofol on pulmonary arterial pressure during cardiac catheterization in children with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza Mohseni, Azim Zaraki
Population and Community Studies

Prevalence and risk factors of obesity in children aged 2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal Darwish

Study and comparison of psychological disorders in normal students and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Comparative study of self-concept, physical self-concept, and time perspective between the students with multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Relationship between Coping Styles and Religious Orientation with Mental Health in the Students of the Nursing-Midwifery Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid Dastras, Shirzad Arianmehr

Tuberculosis in Abadan, Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi, Rahil Hojjati,
Parvin Gholizadeh

Family Stability and Conflict of Spiritual Beliefs and Superstitions among Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad ; Hassan Zareei Mahmoodabadi ; Hossein Tavangar ; Seyed Mojtaba Yassini Ardekani ; Ali Akbar Vaezi

A comparative study of the self-actualization in psychology and Islam
Simin Afrasibi, Zakieh Fattahi

The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male students survivors of earthquake in the central district of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh

Reviews

Effects and mechanisms of medicinal plants on stress hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley Pocock

Comparing Traditional and medical treatments for constipation : A Review Article
Mohammad Yaqub Rajput

A review of anti-measles and anti-rubella antibodies in 15- 25 year old women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab

Review of percutaneous nephrolithotomy in children below 12 years old in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo

Physical and mental health in Islam
Bahador Mehraki, Abdollah Gholami

International Health Affairs

The Challenges of Implementation of Professional Ethics Standards in Clinical Care from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi

Cognitive Determinants of Physical Activity Intention among Iranian Nurses: An Application of Integrative Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki, Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi

Effect of resilience-based intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader Aghakhani, Vahid Alinejad, Yaser Moradi

Education and Training

Calculation of Salaries and Benefits of Faculty Members in the Ministry of Health and Medical Education of Iran
Abdolreza Gilavand

The effect of education on self-care behaviors of gastrointestinal side effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram Razie, Lila Nezam Abadi Farahani

Creating and Validating the Faith Inventory for Students at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Creating and Validating the Adjustment Inventory for the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Evaluating the Quality of Educational Services from the Viewpoints of Radiology Students of Ahvaz Jundishapur University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl

An Investigation of Psychosocial aspect of Iranian Nursing Students' Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari Anbohi, Amir Almasi-Hashiani, Fariba Borhani

Clinical Research and Methods

Comparison of the Antibacterial Effects of Chlorhexidine Mouth washes with Jaftex Mouth wash on Some Common Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi

Study of the effect of plasma jet on Fusarium isolates with ability to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss

The comparison of anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger alcoholic extract after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran Mirzaie, Ramin Seyedian, Narges Aria, Saman Jokar

The effect of curcumin on growth and adherence of major microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami, Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab


Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE

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November 2017 - Volume 15, Issue 9

An Investigation of Psychosocial aspect of Iranian Nursing Students’ Clinical Setting


Mahsa Boozaripour (1)
Zanyar Karimi
(2)
Sima Zohari Anbohi
(1)
Amir Almasi-Hashiani
(3)
Fariba Borhani
(4)

(1) Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(2) Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(3) Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR
Tehran, Iran
(4) Medical Ethics and law research center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Corresponding Author:

Fariba Borhani
Medical Ethics and law research center, Department of Medical Surgical Nursing,
School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences,
Tehran, Iran

Email:
faribaborhani@msn.com

Abstract


The clinical experience prepares nursing students to become competent and professional practitioners. Therefore, it is important to identify the key characteristics of a positive and constructive clinical learning environment. This cross-sectional study assessed undergraduate nursing students’ (n=313) perceptions of their clinical learning environment. The participants were freshman to fourth year nursing students enrolled in the Faculty of Nursing and Midwifery of Shahid Beheshti University of Medical Sciences.

Participants were invited to complete anonymously the actual versions of the Clinical Learning Environment Inventory (CLEI) (Chan, 2001). It was found that the participants gave a higher score to “Student Involvement” and a lower score to “Teaching Innovation”.

The study indicated that there is still work to be done to provide a healthy clinical learning environment for nursing students and this task belongs to nursing researchers, educators, and health care organization preceptors. In this study, students’ struggle to engage themselves in patients’ affairs ranked first indicating that it had its roots in the cultural and religious context of Iran. Iran is a country where nursing and patient care are holy issues.

Key words: Clinical environment, Learning, Nursing students, Iran


INTRODUCTION

Modern health care is provided within a dynamically evolving clinical environment, where new technologies and skills are applied. The learning environment plays a crucial role, especially during the clinical training of student nurses, as they come into contact with the realities of their function, and form opinions on their professional careers and the clinical area prospects (Egan and Jaye, 2009).

The clinical learning environment is important not just for clinical skill development, but for students to also learn about the ‘norms’ of practice, that is, processes in care delivery (Eraut, 2000).

Professional nursing is based on performance (Henderson and Tyler, 2011) while the most important part of the curriculum of this discipline is clinical training which serves as the bridge between theory and practice (Benner, 2012). In fact, the clinical setting is a suitable opportunity for practical application of the knowledge and skills provided to the students in the theoretical training (Elcigil and Sar, 2007). It provides the suitable conditions for acquiring the necessary practical experience to prepare the students for working in the real world (Hickey, 2010). Since gaining experience in the clinical setting and working at the patients’ bedside are much more useful than organizing scenarios in laboratory conditions and theoretical classes, clinical learning is of utmost significance.

The clinical training environment, which is the place for cultivating nursing students’ clinical skills, entails all the elements that have surrounded them. The clinical ward, devices and equipment, personnel, patients, and nursing instructors (Papp et al., 2003) are among the key components accepted as the clinical setting for training nursing students (Salmani and Amirian, 2006).

The complexity of the clinical environments has led scholars to explore this setting from different viewpoints. Categories like noting learners’ individual characteristics, satisfaction with clinical training, students’ participation in clinical activities, maintenance of students’ individuality, clarity of students’ duties and responsibilities during the clinical program and the use of innovations in the students’ clinical training are of great importance (Ip and Chan, 2005). Clarification of students’ perceptions of clinical learning is one of the challenges of nursing education (White, 2003). Indeed, the nursing students who receive the nursing education are able to describe the complex aspects of clinical experiences more than any other individual. To tell the truth, enjoying an appropriate clinical setting is vital for acquiring a suitable clinical experience. Some studies introduce various factors including instructors (Shahsavari et al., 2013, Kelly, 2007), hospital staff (Dadgaran et al., 2013), and patients as influential in this experience. From the students’ perspective, the relationship between the nursing school and teaching hospitals is very important so that the positive cooperation between nursing instructors and personnel has been reported as one of the impressive factors in promoting nursing students’ clinical learning (Johnson, 2015).

The major mission of the university is the training of the required expert manpower, development and promotion of knowledge, expanding research activities, and preparing the suitable context for developing the country. Universities ought to make continuous efforts to recognize problems, develop and implement programs, and finally, refine those programs. Undoubtedly, the identification of problems is the first step in reducing them. Also, the students themselves are the most reliable and the best source for exploring the problems in clinical training as they are directly involved in this process (Changiz et al., 2012). A study conducted to determine the nursing students’ perception of the present status of the clinical training environment demonstrated that the students were dissatisfied with communication errors and receiving feedback from their instructors at the patient’s bedside so that they rendered the continuous attendance of the instructors in the ward as a source of stress and anxiety. On the contrary, they believed that classmate support and suitable relations with peers was a factor that promoted their clinical learning (Serçeku and Bakale, 2016).

Some studies have been carried out in Iran on the important role of clinical training in nursing and the high importance of understanding the students’ attitudes towards clinical training and its application in planning nursing programs. Another study, conducted to determine the clinical limitations perceived in nursing student-instructor interactions in Iran, revealed that the effective interactions between students and instructors greatly influenced the quality of clinical training in nursing so that the identification of these limitations would help nursing instructors to manage the clinical nursing situations in an effective manner. In this study, continuous control and being observed by the clients, their families, and ward personnel as outsiders’ eyes, the disparities between theoretical teaching and clinical training, close contact, disputes in the clinical setting, instability, and unreliability are mentioned as the perceived limitations in student-instructor interactions (Shahsavari et al., 2013). Moreover, another study performed in Iran in 2009 showed that the students had no positive perception of the clinical training climate so that more comprehensive attempts must be made to enhance students’ satisfaction (Peyman et al., 2011).

Iran is a country with a 98% population of Muslims in which the healthcare system and nursing performance originate from culture and religion. In Iranians’ view, giving care to the patient is rendered as the best practices accepted by God, Almighty (Shahriari et al., 2012) and these systems of values and beliefs have entered the educational system (Joolaee et al., 2006).

Given the significance of clinical experience in forming the basic skills and nursing students’ professional capabilities and also considering that recognition of clinical setting problems from students’ perception as the clients of the teaching process serves as one of the first steps in fostering the quality of clinical training, and also noting the disparities in the Iranian community compared to other societies, this study aimed to determine BS nursing students’ perception of the psychosocial aspects of the status of clinical training setting in the teaching hospitals affiliated to one of state medical universities in Tehran, capital of Iran in 2016.

METHODOLOGY

This was a descriptive cross-sectional study conducted on all the nursing students studying in the first to sixth semester who had passed their clinical training in teaching hospitals affiliated to one of the medical universities in Tehran, capital of Iran, in the second semester of the academic year 2014-2015. Using student numbers, 52 nursing students were selected randomly from each semester so that, on the whole, 313 students entered the study. The inclusion criteria were: being a BS nursing student and signing an informed written consent. In this study, in addition to demographic information questionnaire including age, gender, and marital status, the “Clinical Training Environment Inventory” was used. This Inventory was first developed by Chan and assesses students’ perception of psychosocial aspects of clinical training setting. Various studies have used this instrument and scholars have repeatedly approved its validity in different countries (Midgley, 2006, Newton et al., 2010, Chan, 2003). It has also been used in Iran in various studies and its reliability and validity have been confirmed (Manoochehri et al., Rahmani et al., 2011). It consists of 42 items with six 7-item categories including respecting students in the clinical setting, students’ satisfaction with the clinical environment, students’ participation in clinical activities, noting individual differences among the nursing students, clarity of students’ clinical duties, and the application of educational innovations in students’ clinical training. These categories are measured by a 4-item Likert scale ranging from completely agrees, agree, and disagree, to completely disagree. The positive phrases are scored as completely disagree=1, disagree=2, agree=3, and completely agree=4. On this basis, the negative phrases are scored reversely. The deleted responses are given 3 points. Although the validity of this checklist was previously confirmed by Chan (Newton et al., 2010) in Australia using correlations mean and by Pakpour et al. in Iran using content validity(Pakpour et al., 2015), its validity was investigated in this study using content validity on the basis of research goals. In so doing, first the original questionnaire developed by Chan was translated into Persian and then given to 10 expert scholars along with the English version. After exerting the experts’ opinions, the corrected form was given to 2 experts for final use. After confirmation, it was given to the study units to be completed. Using Cronbach’s , the reliability of this questionnaire was estimated in previous studies as 0.73 and 0.84. Yet, it was estimated again in this study as Cronbach’s =0.85. To carry out the research, the researcher attended the students’ clinical setting in the last days of their training according to the appointments made beforehand. The research goals and procedures were elucidated, informed written consent was obtained, and ethical considerations were explained and observed. Then, the questionnaire was handed to them and completed by them in 30 minutes. Subsequently, the questionnaires were collected and scored on the basis of the scoring procedure explained above. The gleaned data were analyzed using SPSS13. The data were described with frequencies for qualitative variables, and mean, SD, and 95% of CI for quantitative variables. Moreover, the data were analyzed using Chi-square test, Fisher’s exact test, independent t-test, and ANOVA (analysis of variance) with P<0.05.

Ethical considerations
The formal research approval was obtained from ethics center of Shahid Beheshti University of Medical Sciences and nursing schools (Ethics code: SBMU2.REC.1394.101).

RESULTS

A total of 313 questionnaires were collected. The total mean of perceived clinical training was 129.95±17.93 for BS students of nursing. Seeing that 35 points are devoted to each category, the maximum and minimum score obtained in this study pertained to the categories “students’ participation in clinical activities” and “the use of educational innovations in clinical training”. Our findings indicated that the nursing students ranked “clarity of students’ clinical duties” as second, “respecting students” as third, “students’ satisfaction” as fourth, and “noting individual differences among the students” as fifth (Table 1).

Table 1: Mean and SD of total score of perceived clinical setting and its categories in BS nursing students in 2016

In this study, most of the study units were female (55.59%), single (90.09%), and without a history of hospital work (73.48%). ANOVA showed that students’ gender was significantly correlated with total score of perceived clinical environment so that the mean total score of perceived clinical setting was significantly greater in male students than in female students (P=0.024); however, students’ gender (P=0.881) and a history of hospital work (P=0.916) were not significantly correlated with total score of clinical training setting (Table 2).

Table 2: Absolute and relative frequencies of students’ demographic information and the correlation between this information and total score of perceived clinical setting in BS nursing students in 2016