The clinical instructor of nursing and the learning environment: A qualitative study

The purpose of this research was to investigate and describe the clinical learning environment, specifically how the clinical instructor in nursing education interacts with that environment to foster learning. Three supplemental questions were asked: what are the elements which comprise the clinical learning environment, what are the characteristics of these elements, and how does the clinical instructor cope with, adapt to, influence, and manipulate the environment? Symbolic interaction formed the philosophic foundation for the research approach used in the study. Key participants (clinical instructors, students, staff nurses, and head nurses) were invited to explain their experiences in their own works. These insights were coupled with participant observation and document analysis. The analysis of transcript units was facilitated by the use of a microcomputer and database software. All fields in the data base were identified by name of informant, date, site, and type of data (transcript, field note, memo), and further categorized as the data were analysed. As the data were unitized, key words and phrases were used to code the idea contained in the unit. As the number of units increased, themes and patterns began to emerge, and the units were constantly reevaluated and compared in light of these themes. Instructors were observed to be carrying out five major functions: personal orientation activities, preparation of the nursing unit to receive students, preparation of students for their clinical experiences on the unit, instructional activities, and monitoring and evaluation exercises. Four roles characterized her practice: coach, consultant, colleague, and counsellor. The clinical learning environment was conceived as being comprised of seven dimensions: personal, physical, social, curricular, contextual, political, and economic. A model was proposed to illustrate the environmental dimensions. No attempt was made to determine which dimensions of the clinical learning environment were most important. The intent of the study was to determine which elements existed and to describe them. In any given clinical learning situation all dimensions were more or less present. The teacher based her response to any situation on the prominence or salience of each dimension. The clinical learning environment was characterized by a set of four common characteristics, or properties. These properties were complexity, structure, stability, and opportunity. In attempting to manage the environment, the instructor viewed the clinical milieu in relation to her connection to the students and their learning needs. She wanted to be able to intervene directly in the milieu without her actions or decisions being mediated, compromised or thwarted by others. She viewed each clinical situation as a potential learning opportunity for her student, and worked to alter conditions where student learning might be hindered. Instructors acted to integrate college circular requirements with clinical experiences, creating circumstances from which students could learn what they needed and prepare themselves for their future roles and responsibilities in the profession. The author suggests that clinical instructors must begin to practice their craft with theoretical rationale for their strategies. There is a need for more planned educational and experiential preparation of clinical instructors. (Abstract shortened by UMI.)