Nurse Malaysia Students
1. 0 Introduction
On 31 August, 2004, the Health Minister of Malaysia disclosed that at least 130,000 nurses need to be trained by 2020 in order to meet the nurse-to-resident ratio of 1:200 as required by the World Health Organization. Malaysia's current ratio is 1: 645. As compared to Singapore (ratio is 1:203) and Japan (ratio is 1:134). Malaysian hospitals hire foreign nurses, especially from India and Philippines to meet the demand (Ministry of Health MOH 2004).
As of June 2004, there were only 39,232 trained nurses in Malaysia, and the Government and private nursing colleges had the capacity to train only 3,000 nurses a year, less than half the required number and four hundred nurses are lost annually to foreign hospitals. (MOH, 2004)
It is the government's intention to increase the number of nurses and improve the ratio to around that of developed countries by 2020. In the year 2020, the population should be around 34 millions. If we use a ratio of one to two hundred people, this means that by the year 2020 the country will need to have about 170,000 nurses. This is a big challenge for Malaysia, as we will have to train at least 130,000 nurses over the next sixteen years. To do this, we will need to increase our students intake in the future (Sharifah, Kasmah, Norazmi, Zalina 2004).
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Currently, eighteen nursing colleges under the Ministry of Health (MOH) take in about 2,000 students a year. Sixteen private colleges and six public universities take another 1000 students per year. These translate into an annual output of about 3000 nurses a year at present.
In this respect, more efforts of private colleges and public universities, are required to help MOH train more nurses for the country (Sharifah et al 2004). Recognizing the acute shortage, the Government has since classified nursing as a critical field and allowed the formation of many new nursing colleges (MOH 2004).
Many new colleges meant more and heavier responsibilities for the nursing education. It is a globally known fact that nursing education itself has complications internally and is experiencing significant changes since the mid 1980s. Malaysia is therefore no exception. (I don't 8nderstand this sentence) As what had been stated by Nafsiah (2006), in most parts of the world, nursing education has progressed to higher education and it was inevitable that nursing education in Malaysia would head in the same direction in order to ensure that nursing graduates are prepared to work in the fast-changing healthcare system where expectations in terms of quality and productivity are ever higher.
The change including transfer of undergraduate preparations from hospital based programme to more formal learning in the tertiary sector and later growth in postgraduate degrees and clinical specialization. Spouse (2001) said evidence suggested that behaviorist educational approaches grounded in traditional apprenticeships models are incongruent with evidence-based practice and may not conform to ‘best' practices anymore.
Birchenall (1999) suggests that learning and teaching within the traditional university classroom would diminish to give way to teaching in the practice setting. Regardless of programme changes, the clinical learning environment remains the single most important resource in the development of competent, capable, caring nurses (Ousey, 2000).
Changes to basic education and preparation for nursing registration resulted in a reduction in the quantity of clinical practice. Whereas clinical practice is a very important component as what had been said by Lee (1996) ‘clinical practice is a major component of nursing education and has been acknowledged as central to nursing education.
It should aim at developing students' critical thinking and analysis skills, competence in psychomotor, communication, and time management skills, and to increase self-confidence in their ability to perform as nurses'.
Clinical teaching not only enables the learners to integrate the knowledge and skills associated with caring for patients, but also gives learners the opportunity to internalize the role of a nurse as caregiver (Woolley & Costello 1988, DeYoung 1990) in Li(1997). This is all about to give the student more idea and has a better understanding about their profession.
These understanding will enhance student learning and indirectly will retain the students in nursing, as nowadays many nurses left the nursing profession. This is one way to retaining them. Also the quality of clinical practice depends on the quality of the clinical teaching which in turn, greatly depends on the characteristics of the clinical teacher (Li 1997).
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In Malaysia hospital based nurse training is still the major stream of nursing education. In the 3 years of hospital based nurse training programme, student nurses are required to spend about seventy percent of the training in the clinical area.
Since undergraduate student nurses need to invest ample time in the clinical setting to gain knowledge and skill in caring clients, therefore concern about the effectiveness of clinical educator is a must especially in the perspective of student nurses.
The quality of nursing care has been debated since at least the 1980s. An extensive literature and research reports describe a variety of interventions and methods to improve the quality of care. (Kristiina & Marita 2001). These include to polish the education system, particularly the clinical practice.
Lee (1996) said that although clinical education has been acknowledged as being the 'heart' of all nursing education programmes, the role of the nurse teachers in relation to the clinical learning experience of the student nurse is an area of long-standing confusion and dispute. This unresolved problem has led to the lack of a concerted effort in the provision of educational input in the clinical area and the quality of patient care is indirectly being affected.
1.2 Problem Statement
To cater for the changing need, unqualified and unprepared clinical educators had been appointed to teach in the clinical area and this will influence the outcome of learning activity in the clinical area (source?). Further more since the beginning of the nursing education, there has been a perceived discrepancy between what is taught to student nurses in the classroom and what is practiced in the clinical area.
Aston, Mallik, Day, & Fraser (2000) in their study explored the role of teacher/lecturer in practice found that despite overt commitment, the lecturers were unprepared, unsupported and unmonitored. Students and practitioners had very variable experiences and expressed a strong need for a better organized approach which would provide them with consistent and sustained support in the practice setting.
The Australian Nurse Education National Report (Reid 1994), reported new graduates lacked competence when undertaking clinical work and their perceived lack of competence led to under-valuation of undergraduate nursing programs and to claims that despite having satisfied registration requirements, graduates were not adequately prepared for clinical practice. According to three heads of Malaysian Nursing schools, this phenomenon is evidenced greatly among their students.(Does this happen in Malaysia too?)
Therefore the role of nurse educators must be negotiated seriously between teachers, clinical nurses and students, in order to find the best way to meet the needs of all parties concerned (Mark & Brain 2006). As what had been reported by Mei Kuen (1997) Clinical teaching behaviour is a critical determinant for quality clinical learning experiences of student nurses. It is believed that a better understanding of the perceptions of clinical teaching behaviours between student nurses and nurse educators will enhance clinical teaching. Therefore there is a must in exploring the effectiveness of nurse educator.
Clinical teaching and learning has been recognized as one of the most important and necessary parts of any educational process in nursing. However, as a large number of students have to be taught in a wide range of clinical areas where teaching and supervision by nursing staff is not possible, because of their shortage (Kotzabassaki 1997), many clinical teachers are required which makes clinical teaching very costly.
But because of scarce financial resources, the number of clinical teachers is not adequate. Unlike Malaysia, clinical educators are much needed in the service side hence scarcity is not due to lack of financial but allocation of tasks. As a consequence, if the quality of clinical education is to be maintained, clinical teachers must be as effective as possible.
1.3 Objectives of the study
The main objective of the study is to find out nursing students' and clinical educators' perceptions of the characteristics of effective clinical educators in nursing colleges in Kuala Terengganu
The specific objectives are to:
- investigate the characteristics of effective clinical educators as perceived by
nursing students and clinical educators.
- find out the differences of perceptions of effective clinical educators between
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nursing students and clinical educators.
- compare the differences of perceptions based on social demographic factors.
The research questions are:
- What do students nurses perceive as important characteristics of clinical educator?
- What do clinical educators perceive as important characteristics of clinical educator?
- If there any significant differences between student nurse and clinical educator regarding their perception of effectiveness of clinical educator?
- If there any significant difference on perception regarding effectiveness of clinical educator base on the gender?
- If there any difference on perception regarding effectiveness of clinical educator base on the student educational background (SPM, STPM, College and University)?
- If there any difference on perception regarding effectiveness of clinical educator base on the year as a student nurse(Junior/senior)?
- If there any difference on perception regarding effectiveness of clinical educator base on the student nurse achievement?
The significant of study
The finding of this study substantiate the value of students perception on the effectiveness of clinical educators will be a reliable tool or guideline for the nursing education as a whole, as well as health care organization and other organization.
As Clinical educator - The responsibility of preparing student nurses to take on professional nursing role is a challenge. If clinical educators do not understand the students then they will not know, how to revise and develop the clinical teaching skill to better support students learning. Therefore it is essential that nursing students are provided with quality learning experience in the clinical area by the effective clinical nurse educator, in order for them to practice as competent practitioners in the healthcare system.
This finding can also be a guide for clinical educators to be more effective and ensure the teaching will benefit the student in the clinical area, as valuable experiences are gained by nursing students through working with client in the clinical area.
Beside that the finding can also boost the clinical nurse educators career in the country and attract more nurses to join nursing education as everybody know in fact the clinical nurse educator post are very unclear and hopefully with this finding the specification of clinical nurse educator post will be more clear and get recognition.
Nursing Education The working place is becoming increasingly complex and demands on new graduates are increasing. Clinical nursing has been the focus of concern (Anne 2000). Therefore the findings of this study based on perceptions of the student nurses should be helpful to the clinical educators, particularly the awareness of effective clinical teaching characteristics cause what teachers know and can do is the most important influence on what students learn.
With this findingTherefore if the clinical nurse educator enable to indentiy Clinical nurse educator that I worked with were concerned that students were being adequately supervised and effectively assessed by clinical nurse educatore. They were concerned that if clinical nurse educator were not able to identify student who did not demonstrate the required level of knowledge and skill in the clinical area,
The need to graduate clinically competent students from nursing programs is critical to decreasing any potential risks to clinet safety that could ultimatelu pose serious threat to the delivery of quality care in the healthcare system. As a result, there is the need for a curriculum to support the educaton of clinically competent nursing students.
This knowledge will also enable the medical faculty to provide an environment which is conducive for learning (Nehring 1990). Cause the effective clinical teaching and condusive environment plays a very important role to ensure learning is taking place.
Nursing Organization the data collected would provide significant finding and invaluable guide to future planning and organizing to employ and mould clinical educator base on the student need and also the pressure such as limited working place due to too many student in on clinical area.
This will enables the organization improving their central strategy in recruiting, preparing and retaining good clinical educators. It will also encourage nursing organization to develop standard criteria and documentation related to nurse clinical educator work of specification and role in clinical area.
With the current nursing shortage and the increased number of students requires experiences, the nurses without formal supervisory training and/or without extensive clinical experience will be assigned as clinical nurse educator. Then this could lead to clinically incompetent students graduating from the program and caring our sick out there.
Scope and Limitation
The study is limited to student nurses and clinical educators from 2 colleges only namely Kolej Kejururawatan K. Terengganu and Jabatan Sains Kejururawatan Perubatan & Sains Kesihatan, Universiti Darul Iman Malaysia. Hence the findings cannot be generalized. The findings are based only on perceptions and the questionnaire used is:
1.4 Operational definition
Nursing student in this study refers to a person enrolled in a 3- year diploma programme in nursing
A junior student is a student nurse who is in the first year of the training period and a senior nurse is a student nurse who is in the second or the third year of the training period.
In this study a clinical educator is a clinical teacher who is involved actively in clinical teaching in the hospital
Nursing colleges are the 2 colleges namely Kolej Kejururawatan K. Terengganu and Jabatan Sains Kejururawatan Perubatan & Sains Kesihatan, Universiti Darul Iman Malaysia.
Perception is a process which student nurses and clinical educators interpret and organize sensations to produce a meaningful experience toward the effectiveness of clinical nurse educators. In this study perceptions toward the effectiveness of clinical educators are measured by using an instrument known as the Nursing Clinical Teacher Effectiveness Inventory (NCTEI), a 48 item checklist that describes discrete characteristics clustered into five subscales or categories: teaching ability; interpersonal relationships, personality traits, nursing competence and evaluation. The tool has since been used in several countries including Greece, Hong Kong, Israel and North America and is the instrument most frequently used to identify effective clinical teaching characteristics of clinical educators.