The major themes that emerged from the transcribed data were: The clinical environment with subthemes of Student motivation, lack of material resources and human resources. Learning opportunities in the clinical area with subthemes of student allocation, role modeling, time for practicing in the clinical area, interpersonal relationship and Knowledge gap between the tutors and clinical staff (See Table 1).
Clinical environments
Under this theme three subthemes emerged from the transcribed data.
Student motivation
One of the findings from this study on factors that affected skills acquisition was student motivation. It was mainly reported by clinical nurses and tutors that students are not motivated to learn the skills as they lack initiative in their own learning and one tutor said this.
‘Individual interests of the students vary; some are not mature enough to handle situations”.
The same tutor continued to say;
‘Some students do not have personal interest they come to nursing because they are told to do so’.
Another tutor pointed out that if students had to acquire the skills they needed to have interest in the profession since the supervision that is done is not enough, as such students should have the personal initiative to learn. In agreement to this, one nurse said.
‘Other students are reluctant to be taught and they undermine the knowledge they are taught from the clinical nurses’.
When students are well prepared they are motivated and the opposite is true that if not well prepared they are demotivated. One student said;
‘we were given objectives and the tutor explained what we were to do in the clinical area’.
While there were mixed views on this area it seemed that students had a strong feeling that it is the presence of patients that would enable them to acquire the skills. Another student said that it is the set up of the hospital that would motivate or demotivate someone to acquire the skills not necessarily the presence of clients alone. She went on to say that.
‘The hospital set up, that is to say I was at a central hospital and there were a lot of patients on whom we could learn the skills on unlike the mission hospital’.
There was also widespread agreement that preparation of students enhances the acquisition of psychomotor clinical skills in the clinical area.
Support and supervision
The issue of competence guidance by tutors and clinical staff emerged prominent from many participants around acquisition of psychomotor clinical skills.
Many students said much on the provision of competence guidance by qualified nurses and tutors. It was uncommon to hear statements such as:
‘Clinical staffs were assisting us a lot because there were some things that we did not cover in class but we managed to do those things with clinical nurses ‘Tutors were able to demonstrate the required skills in the clinical area’.
Shortage of materials
The findings further have shown that students were not able to acquire the skills due to lack of resources in the clinical area. This was reported by one student who said;
‘Equipment was not available in the ward as a result there was a lot of improvision for example, there was no mackintosh in the ward as such the women were told to bring their plastic papers, some could not even afford and some were bringing dirty ones’.
Furthermore, most students mentioned that despite the lack of equipment in the clinical area they were still compelled to work due to the presence of patients. One student stated this:
‘The presence of clients compelled us to work on hence acquiring the skills, because with no clients there is no way we could have acquired the skills”.
Shortage of clinical nurses
Even though it was mentioned that students can acquire the psychomotor clinical skills easily when they are provided with competence guidance, on the other hand non availability or inadequacy of qualified nurses for the student in the clinical area, affected skill acquisition. One student reported.
‘We were left alone in the labour ward without being supervised by neither the Tutor nor the clinical nurse’.
Learning opportunities
Role modeling
The findings of this study have also shown that role modeling for the clinical practice has an influence on skill acquisition by students. This was elaborated by one student who said;
‘Qualified nurses were role models to me because they provided good care to the patients’.
On the other note some students said that qualified staffs were uncooperative as they were saying it is not their duty to teach the students. One student reported this;
‘One day I did not finish the procedure then my senior nurse shouted at me and as such I was afraid to ask him anymore.’
It was further revealed that poor role modeling by nurses hindered skill acquisition. One student said.
‘Mastering of the procedure was a problem as there were short cuts from qualified nurses.’
And she continued to say,
‘When giving medication we learnt that we should go to patient bed side and give the drug, but when we tried to do that clinical nurses were saying we were wasting time.’
Similarly tutors shared the same view that clinical teachers are supposed to be good role models. It was learnt from one tutor, who strongly said,
‘We tutors have to be exemplary so that students can emulate the way we perform the procedures’.
Student allocation
Another factor that hindered acquisition of psychomotor clinical skills by students was: Too many students versus number of patients in the clinical area. It was reported by many students and this was summarized by one of them who said this:
‘There was too much competition to find clients, for example, when you are allocated to a specific ward there are requirements for you to achieve, so if there are so many students in that area you tend to have problems on how to achieve your objectives’.
Interpersonal relationship
The ability of clinical teachers to interact with students, both on one to one basis and as a clinical group is another important teacher behavior. However it was reported that there was poor interpersonal relationship with the students and qualified nurse, as a result skill acquisition was compromised. One student reported this:
‘Qualified nurses were not cooperative, when you try to ask them they would say just do it the way you learnt’.
Another student also noted that this was from individual nurses as other nurses were willing to assist in the clinical area.
Knowledge gap
In this study it was also found that knowledge gap between nurses and tutors hindered clinical skill acquisition by students. Most students reported that they had noted a discrepancy when it came to performing of procedures among the tutors themselves as well as the clinical nurses.
One student reported.
‘There is knowledge gap between what we learn in class and what the nurses in the ward know, for example management of second stage of labour’.
Time for practicing
The findings have further indicated that time was also another factor that hindered skill acquisition by students in the clinical area. To support this, one tutor reported.
‘We need to give students more time to practice in the skills laboratory as well as in the clinical area if the students have to be competent’.
Students too, shared the same view that they were not staying long in a particular clinical placement as a result it was difficult to master a skill.