Clinical Instructor's Behaviors as Perceived by Themselves, Students and Nursing Faculty Staff

Background: the core of nursing education program is the clinical education in which training of nursing student occur to have competent nurse student. Also, clinical instructors play a significant role in creating positive learning experiences in the clinical setting that shape student behaviors at the work environment. Therefore, clinical instructors should have the effective clinical teaching behaviors to create a positive learning environment for nursing students. Aim: to assess the clinical instructor's behaviors as perceived by themselves, students and Nursing Faculty Staff. Research Design: The study was conducted using descriptive research design. Setting: The study was carried out at faculty of Nursing, Minia University. Subject: The study subjects consisted of all clinical instructors, staff members and about 80% of students at (2nd, 3rd, 4th year) at the Faculty of Nursing, Minia University. Tool: The Nursing Clinical Teacher Effective Inventory (NCTEI) was used for data collection. Results: revealed that, the high level of clinical instructors behaviors were from clinical instructors themselves view with (89.2%), followed by students view (68.2%) and then view of staff members (59.2%) with statistically significant difference between clinical instructors, students and staff members view (P=0.001). Conclusions: Clinical instructors had biased selfassessment regarding perception of their clinical teaching behaviors. Recommendation: Workshops/seminars should be organized and also orientation program for all newly clinical instructors on their roles in clinical teaching. Introduction Moreover, nursing practice in the 21st century faces a number of challenges that including: a growing population of hospitalized patients who are older and more acutely ill, increasing healthcare costs, and the need to be aware of rapid advances in medical knowledge and technology. These challenges are complicated by an existing shortage of nurses, an aging nurse workforce, and shortage of nursing faculty members, which affect nursing education (1-4). Nursing is a practice-based discipline that is accountable to the public for quality of care, therefore staff members should teach students the art and science of nursing and it should be not only academically rigorous but also clinically competent (5, 6). The overall goal of clinical nursing education is to prepare students for future practice through current learning experiences. Because of the rapid changes that can be occurred in the health care; understanding become more important than doing, and rationale more important than technique. Thus, for having effective clinical teaching; the clinical instructor (C.I) should permit students to have clinical experiences by which they reach the clinical competence (7, 8). The clinical instructors must maintain a focus on the essential activities in a way that ensure patient safety, provide opportunities for students to perform successfully in the clinical area, and communicate the fullness of the nursing role (9). Although many new C.Is have experience in their clinical area of practice, they may not initially have the ability to convey the proficiency to their students. The reasons for this C.I proficiency are twofold, generally, they do not have formal training and supervision in teaching; also they are thrown into unplanned activities where there is limited control over the factors that affect student clinical teaching (10, 11). Clinical instructors are the teaching faculty members who guide nursing students to gain fundamental knowledge, technical skills, and practice values. Also, they play a vital role in nursing students’ development by enabling them gain self-confidence for future practice (1214). They also play a significant role in creating positive learning experiences in the clinical setting that frame student perceptions of the work environment. Therefore, to create a positive learning environment for nursing students, a lot of hard work goes into the development and practice of clinical teaching. So, not only the instructors need to organize their clinical experience but they also need to facilitate the learning process (11, 15). Effective C.Is behaviors divided into five major domains as following: First, teaching ability: it is the process of transmission of skills and attitudes, and the creation of an atmosphere that facilitate learning process. Second, nursing competence: it is the clinical teacher's theoretical and clinical knowledge used in the practice of nursing. Third, evaluation: it is the type and amount of feedback the student receives from the clinical instructor regarding clinical performance and written clinical assignments. Fourth, interpersonal relationships: it is a state of reciprocal interest or communication between student and clinical instructor; and fifth, personality; it is the totality of the individual's attitudes, emotional tendencies and character traits, which aren't specifically related to teaching, nursing or interpersonal relationships but may affect them (16). Significance of the Study Clinical practice is a significant component and critical part of nursing education which considered ''the heart'' of professional practice. The quality clinical practice delivered through clinical instructors are dynamic to success of clinical education and has direct impact on the quality of nursing which ensure students achieve positive outcomes in the clinical settings as well as in the future practice. Therefore, the clinical instructors as a cornerstone of nursing education, plays an essential role in preparing nursing graduates for their role as competent, capable and caring nurses. There were many previous studies were conducted in this field one of them was in Oman by (Madhavanprabhakaran, Shukri, Hayudini and Narayanan, Minia Scientific Nursing Journal (Print) (ISSN 2537-012X) Vol. (4) No. (1) June 2019 P a g e | 61 Rasha M A. , et al 2013) (17), who found that Omani nursing students rated professional competence of instructors as the most important characteristic and instructors’ relationship with students as the second most important characteristic without any discrepancy (p >0.05). And in Egypt, a study by Ismail, Aboushady, Eswi, (2016) (18) revealed that the highest ranked behaviors were teaching ability category followed by nursing competence and evaluation respectively. The personality and interpersonal relationship among nursing student set as the fourth and fifth factors that affect learning process in the clinical settings. All previous studies focused on determining the most effective and ineffective clinical instructor’s behaviors for learning process success as perceived by students' point of view about most important and less important behaviors only. Therefore, it is important to assess the clinical instructors clinical behaviors from different view of point. Aim of the Study The aim of the current study is to assess the clinical instructor's behaviors as perceived by themselves, students and Nursing Faculty Staff. Research Questions: 1. What are the clinical instructor's behaviors as perceived by them? 2. What are the clinical instructor's behaviors as perceived by their students? 3. What are the clinical instructor's behaviors as perceived by Nursing Faculty Staff? 4. Is there a relation between clinical instructors, students and Nursing Faculty Staff perception about clinical instructor's behaviors? Methodology Research design: The study was conducted using descriptive research design Setting: This study was conducted at the faculty of nursing at Minia University. This study included all nursing faculty academic departments. Subjects: The study subjects consisted of all clinical instructors, staff members and about 80% of students at (2nd, 3rd, 4th year) at the Faculty of Nursing, Minia University. All available clinical instructors at the time of collecting data (2nd semester 2017/2018) was (n= 74) and Faculty staff members (n=27) N.B: the students of 1st year were excluded from the study because of lack of their awareness about how to evaluate a clinical instructor correctly and objectively. Tool: one tool was used in this study: '' The Nursing Clinical Teacher Effectiveness Inventory'' ''NCTEI'' This tool was used to assess the clinical instructors’ behaviors as perceived by themselves, student and nursing faculty staff; it consisted of two parties as follow: 1) The first part is SocioDemographic data sheet: was attached with tool to get information about Nursing Faculty staff, clinical instructors and students at Minia University. It was one of the following for the study subject: 1. Staff member code, sex, years of experience, position, department, and clinical instructor code. 2. Clinical instructor code, gender, scientific degree, and department. 3. Student code, gender, age, academic year, last academic achievement and clinical instructor code. 2) The second part is '' The Nursing Clinical Teacher Effectiveness Inventory'' ''NCTEI''; it was developed by Knox & Magon (1985) (16). It consisted of 48 important instructor behaviors with 5 point Likert scale ranged as (Never= 0, scarcely=1, sometimes=2, often=3, and always=4). It was divided into sub-scales as follows: teaching ability (16 items), nursing competence (10 items), evaluation (9 items), interpersonal relationship (6 items) and personality traits (7 items). The scoring system was ranged from 0 to 192, the higher the score, the higher effective behaviors of clinical instructor, the scoring system was divided as the follows: (064= Low), (65128= Medium), (129192= High). Validity of the tool: The tool was submitted to a jury of 5 experts in the field of nursing administration and education field to determine its applicability and content validity. No modification was done. Reliability of the tool: Reliability of the tool was performed to confirm consistency of tool. The internal consistency measured to identify t