Effect of an Integrated Teaching Model on Clinical Judgement and Learning Experiences of Undergraduate Nursing Students in Kenya: a Case of University of Nairobi

Abstract

The need to improve clinical judgment competencies during training has been necessitated by the demand for the preparation of new nurse graduates to face an arena characterized by nurse shortage and acutely ill yet more informed clients. In Kenya, the nursing process has been the primary tool to help student nurses develop clinical judgment. However, local studies show glaring clinical judgment gaps among new nurse graduates that threaten safe patient care. There is, therefore, a need to examine how a combination of more evidence-based tools can enhance clinical judgment development to improve training outcomes. The objective of this study was to evaluate the effect of an integrated teaching strategy on clinical judgment and learning experiences of undergraduate nursing students during clinical attachment in the medical surgical ward.The study was carried out between February to August 2018. The target population was undergraduate nursing students from a Kenyan public university who were on medical surgical nursing clinical practicum at a National Referral Hospital. A mixed method approach was used to correct data. The study adopted a pre-test post-test quasi-experimental design for the quantitative part of the study. The pre-test was administered before the clinical practicum commenced to the 82 consenting participants. The students were conveniently allocated to the wards in groups. Simple random sampling was done to allocate the groups into either comparison or intervention. The students in the intervention group developed one concept map and one reflective journal entry per week for 4-8 weeks. Participants in the control group developed one nursing care plan per week. The pre-test and post-test scores were compared to identify the effect of the model. SPSS version 26 software and NVIVO version 11 were used for quantitative and qualitative data analysis respectively. Qualitative data was scrutinized using content analysis for the learning experiences and thematic analysis for the level of reflection. The study findings revealed that use of integrated teaching strategy is more likely to improve the clinical judgement of student nurses compared to the nursing care plans (p <0.0001). Eight themes emerged from the reflective journals analysis: Professional practice gaps, learning new skills and knowledge, confidence levels, resource availability, professional support system, emotional reaction and the ward reality. The student perceived the learning tools helped improve clinical skills, confidence and ability to integrate knowledge to clinical practice. The findings showed an integrated teaching model is an effective strategy in improving nursing students' clinical judgment competencies. Nursing students experience both positive and negative encounters that build their confidence as well as frustrate their desire to learn respectively. However, application of self -directed learning-based clinical teaching and learning strategies help students to gain new knowledge, integrate their theory to clinical practice and build their confidence despite the handles of the unpredictable clinical environment. The study findings imply the need to review clinical nurse training to incorporate more evidence-based strategies. However, the study recommends similar research to be carried out in multiple clinical sites to enhance the evidence's strength and the generalizability of the results and outcomes.