This study investigated Vietnamese undergraduate Bachelor of Nursing students\u27 perceptions (n=891) of their education environment during university and clinical experiences in health care, within new competency-based curriculum contexts in four universities across Vietnam. Results inform future change in nursing education provision at both organisation and national level

Bonner, Ann

Chinh, Nguyen Minh

Dinh, Thi Thuy Ha

Duong, Tran Thuy

Huong, Nguyen

Ramsbotham, Joanne

Thanh, Dang Tran Ngoc

Truong, Hue Thi

English

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CRICOS No. 00213Ja university for the worldrealRQueensland University of TechnologyCRICOS No. 00213JVietnamese Nursing Students’ Perspectives on Learning Environments: A Cross-Sectional Benchmark Study Informing Future InitiativesAuthors: • Dr Jo Ramsbotham, (QUT) • Thi Hue Truong (Khanh Hoa Medical College) • Dr Thi Thuy Ha Dinh (Hanoi Medical University) • Dr Thanh Dang Ngoc, (Pham Ngoc Thach University) • Dr Nguyet Than Huong (Hanoi Medical University)• Dr Nguyen Thi Minh Chinh (Nam Dinh University of Nursing) • Tra  Thuy Du ng, (Hai Duong Medical Technical University)• Ms Lan Van Hoang (Hanoi Medical University)• Prof Ann Bonner (QUT)Presenters: Dr Joan e Ramsbotham (PhD) & Professor Ann Bonner (PhD) Queensland University of Technology (QUT), Brisbane, AustraliaCRICOS No. 00213Ja university for the worldrealRLearning Objective: Attendees will develop an understanding of learning environment measurement strategies and identifed challenges within nurse education environments in VietnamThis study was funded by a QUT and Atlantic Philanthropies project supporting development of Vietnamese Nurse Teacher capability (2014-16)No conficts of Interest are declared. No corporate sponsorship or commercial support other than that above was given to the authors to conduct this study or present it.CRICOS No. 00213Ja university for the worldrealRTrends in Nurse Education Globally • Graduates as lifelong learners, users of evidence and conduct/consume research• Curriculum – transformative learning. Improving interface between education & practice [1,2] • Greater focus on people: prevention of non-communicable disease burden and primary care location; patient/client safety and care that impacts health outcomes• Imbalance in number and education level of health professionals; nursing shortage[1]Factors known to efect competence development [3,4,5,6,7,8]Students’ opportunity to DO caretime, responsibility/looking for experiences, assessments, respond to feedback Teaching StafActive, student centred, evidence based teaching integrate VN competency standardsPrepare students STUDENT COMPETENCEStudentsEngagedKnowledgeableBeginning skillsPrepared and motivated to do practiceEnvironment relationshipsWorkload/time to work with student, nurse leader, patients and family, nurse teachers, staf nurses, feedbackLearning at university /collegeLearning Interactions in the clinical practice environmentCRICOS No. 00213Ja university for the worldrealRImportance of students’ perspectives• Challenge tradition: student as end user/consumer/ client of curricula• Student learning - complex interactions [4]• Students’ perspectives on learning experiences are associated with quality of university and clinical learning environment [3,4,6,7,8] • Form part of a wider view/data set on course performance  CRICOS No. 00213Ja university for the worldrealRThe Vietnamese contextNursing In VietnamCRICOS No. 00213Ja university for the worldrealREvaluation StudyDesign: cross sectionalObjectives: 1.To examine students’ perspectives of their learning environment (university and practice in hospital)2.To provide baseline benchmarks for decision making and improvements in teaching and learning in partner universities• Setting: 4 partner universities across Vietnam• Sample: convenience sample of  2, 3 & 4 year Bachelor of Nursing students (n = 891) • Data collection - March to August 2016• Ethical clearance: QUT and partner university agreementCRICOS No. 00213Ja university for the worldrealRInstrumentsUniversity environmentVietnamese - Dundee Ready Educational Examination Measure (V-DREEM) [11] (nursing version) • 4 sub-scales & 47 items (a= .80).• Original English:  Rof, 2005.  • 4 point Likert scale: 1 - Strongly disagree to 4 - Strongly agreeClinical environment Vietnamese - Clinical Learning Environment Inventory (V-CLEI) [12] (nursing specifc) • 6 sub-scales, 42 items, (a= .74)• Original English: Newton et al, 2010 • 4 point Likert scale: 1 = Strongly disagree to 4= Strongly agreePlus: Two open questions about clinical experiences. Describe: – 3 barriers to learning and– 3 facilitators of learning.CRICOS No. 00213Ja university for the worldrealRStudent demographic resultsAge (mean) 21 yearsGender  (n,  %)Male 138 (15.5%)Female 753 (84.5%)School Year  Year 2 530 (59.5%)Year 3 243 (27.3%)Year 4 118 (13.2%)Participating wards  Medical 318 (35.7%)Surgical 258 (29%)Others 315 (35.3%)Previous placement  in ward (yes)73 (8.2%)Length of clinical placement 2 weeks 162 (18.2%)3 weeks 288 (32.3%)4 weeks 84 (9.4%)6 weeks 158 (17.7%)More than 6 weeks 199 (22.3%)CRICOS No. 00213Ja university for the worldrealRUniversity learning environment Scale and subscale Possiblescore Mean SDAll V-DREEM (n=891) 47-188 127.8 15.9Students’ Perception of teaching & learning12-48 32.9 5.1Students’ Perception of teachers9-36 25.5 4.6Students’ Academic Self-Perception8-32 21.4 2.8Students’ Perceptions of Atmosphere11-44 29.1 4.1Students’ Social Self-Perceptions7-28 18.6 2.6Mid-range results. However Asian cultural rating norms often higher than west.CRICOS No. 00213Ja university for the worldrealRUniversity environment and yearNo item mean score met criteria for strong performance (mean of ≥ 3.5) using Western cut points.[10]Signifcant diference by year (p < 0.001), year 2 students rated higher than year 3 and 4Student scoresyear 2                 year 3                 year 4CRICOS No. 00213Ja university for the worldrealRHighlighted areasStrongly Agree/ AgreeItem (with item order) % Strongly Agree or Agree2. The teachers are knowledgeable 7516. The teaching helps to develop my competence7222. The teaching helps to develop my confidence8024. The teaching time is put to good use6040. The teachers are well-prepared for their teaching session6845. Much of what I have to learn seems relevant to a career in healthcare72Areas that ≈ or ≥ 50% participantsCRICOS No. 00213Ja university for the worldrealRHighlighted areas Disagree/ Strongly DisagreeAreas that ≈ or ≥ 50% participantsItem (with item order) % Strongly Disagree or Disagree5. Learning strategies which worked for me before continue to work for me now6812. This course is well timetabled 5327. I am able to memorized all I need5742. The enjoyment outweighs the stress of   studying nursing care4950. I feel able to ask the questions I want50CRICOS No. 00213Ja university for the worldrealRUniversity Environment   Overall impression• Nurse teachers leading change and impacting student learning • Some change evident in ways students learn• Challenges: – use of learning time, – shift away from content driven passive approaches to student centered and active learningCRICOS No. 00213Ja university for the worldrealRClinical environment learning Scale and subscale  Possible scoreMean SDV-CLEI 52 - 208 138.7 14.7Afordances and engagement16-64 42.5 5.3Student centeredness 20-80 53.3 6.3Enabling individual engagement4-16 10.8 2.1Valuing nursing work 3-12 8.4 1.7Fostering workplace learning 6-24 15.5 2.2Innovative learning 3-12 7.8 1.4 Low to mid-range results. However Asian cultural rating norms often higher than west.CRICOS No. 00213Ja university for the worldrealRClinical environment yearStudent scores Year 2                    year 3               year 4Statistical diference year 2 & 3 to 4 (p < 0.01)CRICOS No. 00213Ja university for the worldrealRClinical placement time1-2 weeks           3-4 weeks     more than 4 weeks  Student scores p < 0.001CRICOS No. 00213Ja university for the worldrealRClinical ward typeMedical               Surgical              other /specialityStatistical diference medical and surgical to other  /speciality (p < 0.001).  No diference between medical or surgical (p = 0.178)Student scoresCRICOS No. 00213Ja university for the worldrealRShort answer question responses: most common facilitator of clinical learning• Positive interaction with chief nurse/staf (n = 353)• Clinical teachers (faculty) and preceptors willingness and to support student learning (n = 155)• More chance of practice (weekend shifts, swap positions) (n = 133)• Adequate facilities/resources (n = 118)• Cooperative patients/family (n = 85)• Opportunity to strengthen knowledge and skills (n = 84)CRICOS No. 00213Ja university for the worldrealRShort answer question responses: most common barrier to clinical learning• Unfriendly or uninterested ward staf (n=111)• Heavy workload (overcrowding patients, work pressure) (n = 91)• Uncooperative patients/family members (n = 89)• Clinical teachers or preceptors were too busy to provide help in learning or to listen to students (n = 81)• Few chances to practice taught skills (n= 79)CRICOS No. 00213Ja university for the worldrealRClinical Environment – Impressions• Similar clinical trends/challenges across VN • Need for a shift in organisational/resource support for partnerships and collaborations to improve clinical relationships/expectations and clinical mentoring behaviours• Connect hospital nurses with university as stakeholders – promote new culture of building nursing profession and leadership at local level• Priority: build more opportunity for students to learn by providing real care, positive efect on competence  CRICOS No. 00213Ja university for the worldrealRSummary:Nurse education environments in Vietnam• Similar patterns in VN students' expectations and challenges in learning environments as known globally [3,4,6].  • Students value new, active learning and moves away from traditional passive learning in university and clinical• Future - health sector/university partnerships embed student support - essential to development of nursing profession to meet population needs [alongside systems improvements]CRICOS No. 00213Ja university for the worldrealRReferences1. World Health Organisation (WHO) (2017). Country Profile –Vietnam. Geneva: WHO  2. World Health Organisation (2013) Transforming and scaling up health professionals’ education and training: World Health Organisation Guidelines, Geneva: WHO3. Bisholt, B., Ohlsson, U., Engstrom, A., Johansson, A. & Gustafsson, M. (2014). Nursing students’ assessment of the learning environment in different clinical settings. Nurse Education in Practice, 14(3), 304-310. 4. Dale, B., Leland, A., & Dale, J. G. (2013). What factors facilitate good learning experiences in clinical studies in nursing: bachelor students' perceptions.  International Scholarly Research Notices -Nursing, 628679. 5. Flott , E. & Linden, L. (2016). The clinical learning environment in education: a concept analysis. Journal of Advanced Nursing, 73(3), 501-513.6. Kristofferzon, M., Mårtensson, G., Mamhidir, A. & Löfmark, A.  (2013). Nursing students' perceptions of clinical supervision: The contributions of preceptors, head preceptors and clinical lecturers. Nurse Education. Today, 33 (10), pp. 1252–1257.7. Papathanasiou, I. V., Tsaras, K., & Sarafis, P. (2014). Views and perceptions of nursing students on their clinical learning environment: Teaching and learning. Nurse Education Today, 34(1), 57-60. 8. Sundler, A. J., BjÃrk, M., Bisholt, B., Ohlsson, U., EngstrÃm, A. K. n., & Gustafsson, M. (2014). Student nurses' experiences of the clinical learning environment in relation to the organization of supervision: A questionnaire survey. Nurse Education Today, 34(4), 661-6669. Newton, J., Ockerby, C. & Cross, W. (2010). Clinical Learning Environment Inventory: factor analysis. Journal of Advanced Nursing, 66(6) 1371-1381.10. Roff, S. (2005) The Dundee Ready Educational Environment Measure (DREEM)—a generic instrument for measuring students’ perceptions of undergraduate health professions curricula, Medical Teacher, 25, (4), p 322-325.11. Truong, T. (2015) Vietnamese nursing students’ perceptions of their clinical learning environment: a cross sectional survey, Masters Dissertation, Queensland University of Technology: Australia.12. Hoang, L. (2013) Translation, adaptation and content validation of the DREEM instrument: a Vietnamese Nursing education Pilot Project, Masters Dissertation, Queensland University of Technology: Australia.

Vietnamese nursing students\u27 perspectives on learning environments: A multisite benchmarking study to inform future initiatives

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Vietnamese nursing students\u27 perspectives on learning environments: A multisite benchmarking study to inform future initiatives

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