Journal of Nursing Education

The articles prior to January 2012 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here

Criteria Used for Patient Selection for Nursing Students' Hospital Clinical Experience

Dolly Goldenberg, PhD, RN; Carroll L Iwasiw, MSCN, RN

Abstract

ABSTRACT

This study investigated the criteria used by nurse educators when selecting patients for students' hospital clinical experience. Criteria were defined as individual elements or characteristics considered when selecting patients. Factors were defined as broad categories of related criteria. The sample consisted of 54 nurse educators from college and university nursing programs. A researcherdeveloped questionnaire was used. The three most important criteria for patient selection were: students' individual learning needs, patients' nursing care needs, and matching patients' needs with students' learning needs. One-way ANOVA was performed on the factors by subjects' demographic variables. Teacher-student clinical ratio, program in which teaching, and age most influenced the factors considered (p<.05).

Abstract

ABSTRACT

This study investigated the criteria used by nurse educators when selecting patients for students' hospital clinical experience. Criteria were defined as individual elements or characteristics considered when selecting patients. Factors were defined as broad categories of related criteria. The sample consisted of 54 nurse educators from college and university nursing programs. A researcherdeveloped questionnaire was used. The three most important criteria for patient selection were: students' individual learning needs, patients' nursing care needs, and matching patients' needs with students' learning needs. One-way ANOVA was performed on the factors by subjects' demographic variables. Teacher-student clinical ratio, program in which teaching, and age most influenced the factors considered (p<.05).

Introduction

From the beginnings of formal nursing education, clinical experiences have been an inherent part of the educational process (Watson, 1979). Clinical experiences provide opportunities for students to integrate learning, apply theory to practice, acquire psychomotor skills, and make the transition from student to professional person (Infante, 1975; Ripley, 1986).

Students become socialized into the profession of nursing and learn to apply theories of action to nursing problems in the clinical field. It is only in the clinical area that there are experiences for applying these theories (Reilly & Oermann, 1985). According to Argyris and Schön (1976), theories of action have not been learned unless they can be put into practice, and the situations to which these theories correspond are available in the clinical field.

Clinical experiences must be selected and organized to represent nursing's scope of practice. The focus of nursing practice is the patient, who is, therefore, central to students' clinical learning.

Selection of patients by nursing faculty prepares the foundation of students' clinical learning. Although it is an important part of clinical teaching, the process of selecting patients has not been described in the literature. The purpose of this study, therefore, was to describe one aspect of the selection process: specifically, to identify those criteria judged by nurse educators to be important when selecting patients.

Literature Review

SELECTION OF CLINICAL AGENCIES- Selection of clinical agencies based upon clinical objectives has been described (Heidergerken, 1957; Jones, 1983; Nail & Singleton, 1983; Watson, 1979; Wong & Wong, 1981). Several authors have supplied lists of criteria for agency selection (Ontario Ministry of Colleges and Universities, 1977; National League for Nursing, 1977; Reilly & Oermann, 1985; Watson, 1979).

Characteristics of clinical agencies have been studied (Hawkins, 1981; Roper, 1976). Hawkins developed a model for selection based on rankings of agency characteristics by 250 faculty members. Bevil and Gross (1981) developed a 43item clinical site evaluation instrument from the school's program and level objectives, but which omitted the patient as a factor. Schweer (1972), however, included the patient in her criteria for selection of agencies.

Ehrat (1985), Nail and Singleton (1983), and Putt (1985) delineated factors to consider when selecting clinical agencies. Nail and Singleton (1983) established that for the experience to be positive, at least 80% of the nursing staff of the unit must prefer to have students.

SELECTION OF CLINICAL LEARNING EXPERIENCES - Directions in the nursing education literature for selecting clinical learning experiences are general in nature but in accordance with accepted educational principles. Putt (1985), Reilly and Oermann (1985), Wiedenbach (1969), and Yuen (1986) advised that clinical experiences are to be based upon objectives.

Little and Carnevali (1972) included geography of the clinical setting, policies and procedures, knowledge of the learner and patient, as well as role responsibilities of the clinical teacher as items to consider in selection. Brown (1981) and Karuhije (1986) found that teacher characteristics and behaviors influence selection of clinical learning experiences.

Haukenes and Mundt (1983) presented a model for selection of clinical learning experiences which included the nature of nursing, health needs of populations, and the educational environment. Grimes (1977) cautioned that because of "habit, convenience, personal value systems, established contractual arrangements, or too rigid interpretation of accreditation criteria, clinical experiences that are no longer congruent with a program's stated philosophy and objectives are nevertheless continued" (p. 399).

SELECTION OF PATIENTS- Reference to the patient has been made by several authors, but criteria for patient selection are noticeably absent. According to Infante (1975), "patient contact is the heart of the student's activities in the clinical laboratory" (p. 22). She recommended that such contact should occur only when patients are essential for students to achieve their learning objectives. McCaffery (1968) specified that patient selection must coincide with theory classes.

Barr (1980) stated that patient needs must not be compromised by student learning needs. The patient assignment should be challenging and relevant to the students' current learning, should encourage transfer of learning from classroom to practical applications, should allow for decision-making, and should stimulate students toward further inquiry. Consent by patients for care by students has been discussed by Corcoran (1977) and Nail and Singleton (1983). Nurse educators are advised to be aware of the danger of "student overdose" for the patient. This danger exists when there is competition from other health science students for access to patients and learning experiences (Jones, 1983; Ossler, Goodwin, Mariani & Filliss, 1982).

Conceptual Framework of the Study

Tyler's (1949) principles for selecting learning experiences formed the conceptual framework for the study. This framework is objectives-focused, centers on the importance of learning experiences, includes the student as an active participant, and cites criteria for selecting learning experiences. "Learning experience" is defined as ". . . the interaction between the learner and the external conditions in the environment to which he can react" (Tyler, 1949, p. 63).

According to Tyler, the teacher can provide an educational experience through setting up an environment and structuring the situation to bring about learning behaviors. Although learning experiences vary according to the kind of objectives, Tyler offered general principles that apply to the selection of any learning experience.

1. For a given objective to be attained, students must have the opportunity to engage in the behavior specified in the objective. As well, the learning experiences should give the student opportunity to deal with the kind of content implied by the objective.

2. Students should derive satisfaction from participating in the learning experience. This requires the teacher to have information about students' needs and interests, about "basic human satisfactions," and to design learning experiences that will prove satisfying (Tyler, p. 66).

3. Experiences should be appropriate to the student's level of achievement. In other words, "the teacher must begin where the student is" (Tyler, p. 67).

4. There may be several experiences that can be used to attain the same objective. This means that the teacher has a "wide range of creative possibilities" to develop "a wide range of educational experiences," while capitalizing on personal interests and those of the students (Tyler, p. 67).

5. The same learning experience will result in a variety of learning outcomes. A well-planned set of learning experiences can save time and accomplish more than one objective, but may produce some undesirable outcomes as well.

Operational Definitions

Criteria - individual elements or characteristics considered by nurse educators when selecting hospitalized patients for students' clinical experience.

Factors - broad categories of related criteria considered by nurse educators when selecting hospitalized patients for students' clinical experience.

Research Questions

The research questions were:

1. What criteria do nurse educators use when selecting hospitalized patients for student clinical experiences?

2. Which criteria are of most importance?

3. Are there relationships between the factors identified for patient selection and variables about the faculty member, such as years of clinical teaching experience; age; educational preparation; clinical hours per week; class/tutorial hours per week; level of student taught; teacher-student clinical ratio; clinical teaching area; and type of program in which teaching?

Table

FIGURE 1FACTORS AND EXAMPLES OF CRITERIA

FIGURE 1

FACTORS AND EXAMPLES OF CRITERIA

Method

DESIGN - An exploratory, descriptive design was employed in this study, using quantitative and qualitative research methods. Quantitative and qualitative data were used in combination to provide a more powerful analysis than either single approach (Sieber, 1973). This method may have disclosed data that might otherwise have been unobtainable. A mailed survey was used to obtain the data.

PROCEDURE- A letter describing the nature and significance of the study was sent to the deans of two university and two community college schools of nursing in Ontario. Permission was requested to include the faculty in the study. Questionnaires with attached letters of explanation for faculty were then sent to the deans, who distributed them to faculty who met sample criteria. Participation was voluntary. The anonymously completed questionnaires were returned by faculty directly to the researchers so that deans were not aware of the participation/nonparticipation of individual faculty. Completion and return of the questionnaire implied consent. One month after initial mailing of the questionnaires, a follow-up letter was sent. The final return rate was 68%.

INSTRUMENT- Since no instrument was found that was readily adaptable to this study, a questionnaire was developed by the investigators. The instrument was designed to identify those factors and criteria that nurse educators consider important when selecting patients for their students' hospital clinical experience.

The instrument was divided into seven factors that are considered in patient selection. The questionnaire listed 63 criteria which were derived from the literature and from experience (see Figure 1). Criteria in each factor were ranked by respondents using a five-item Likert-type scale, with 5 being "of most importance" and 1 "of no importance" (see Figure 2).

Respondents were asked to list and rank additional criteria that they believed might influence patient selection. They were also asked to list and rank the five overall most important criteria. A final section of the questionnaire requested demographic data. The time for questionnaire completion was 15 to 20 minutes.

Content and face validity were established by pilot testing the instrument with eight college and university nurse educators who had clinical teaching experience. Logical or sampling validity was established through the inclusion of categories identified in the literature. The instrument was modified after the pretest.

SAMPLE - The convenience sample was comprised of 54 nurse educators who had completed at least two academic years of hospital clinical teaching and who were engaged in clinical teaching at the time of the study (see Table 1 for sample description).

Results

RESEARCH QUESTION #1- All criteria identified in the questionnaire were rated as influencing the selection of patients. Table 2 presents the mean rating for each factor and the highest rated criterion for each factor by mean.

When asked to list other criteria that influenced them when selecting patients for their students' hospital clinical experience, the respondents suggested items that were all a rewording of those already on the questionnaire. No new criteria were identified.

RESEARCH QUESTION #2- Table 3 presents the five most important criteria chosen and ranked by each respondent. The three most important criteria used in patient selection were "students' individual learning needs," "patients' nursing care needs," and "matching of patients' needs with students' learning needs."

RESEARCH QUESTION #3- One-way ANOVA was performed on the factors by each of the demographic variables. Significant findings were confirmed with TukeyHSD post hoc tests (p<.05) (see Table 4).

For the variable, "years of clinical teaching," and the factor of "faculty member," the greatest variance occurred between the group with one to five years and 16 or more years of clinical teaching, with the more experienced group rating the factor higher. Also, criteria related to the "faculty member" were rated lower by the group with one to eight "hours of clinical teaching per week" than by the groups with 9 to 16 and 17 to 24 "hours of clinical teaching."

Table

FIGURE 2SAMPLE FROM QUESTIONNAIRE

FIGURE 2

SAMPLE FROM QUESTIONNAIRE

The group with the greater "teacher-student clinical ratio" (1:9 to 12) rated the factors of "curriculum" and "clinical environment" higher than the group with a clinical ratio of 1:1 to 8. Similarly, the group teaching in more than one clinical area rated the factor of "nursing staff" to be more important than the group teaching only in medical -surgical areas.

The members of the group who were 50 years of age or older rated the factors of "student" and "clinical environment" as being more important than did the two younger aged groups. The oldest group also rated the factor of "faculty member" higher than the youngest group.

College faculty rated the factors of "clinical environment" and "other" higher than university faculty. University faculty rated the factor of "nursing staff' higher.

Discussion

Respondents were able to identify and rank order the criteria used for patient selection for their nursing students' hospital experience. Whether this represented actual faculty practice is not known. The three most important criteria selected were consistent with four of Tyler's principles for selecting learning experiences. Further inspection of the questionnaire revealed that the factors did not lend themselves to Tyler's fourth principle.

The effects of the variable "age" of respondent on three factors, i.e., "student," "clinical environment," and "faculty member," and of the variables "years of clinical teaching" and "hours of clinical teaching per week" on the factor "faculty member" are noteworthy. Older faculty members gave more importance to the student, the nature of the clinical environment, and to themselves than did younger teachers. Increasing age, experience, and maturity not only cause concern over workload and health, criteria identified by these respondents, but presumably allow faculty to focus on the student as a learner, to recognize their own influence upon student learning, and to place a high value on the clinical field and staff. These results are congruent with Brown's (1981) premises about older faculty and the importance of relationships with staff, while the outcomes about older and younger faculty concur with research findings by Karuhije (1986) and Roper (1976).

Table

TABLE 1SELECTED DEMOGRAPHIC CHARACTERISTICS OF THE SAMPLE (N = 54)

TABLE 1

SELECTED DEMOGRAPHIC CHARACTERISTICS OF THE SAMPLE (N = 54)

Faculty with the greater "teacher-student clinical ratio" rated the factors of "curriculum" and "clinical environment" higher. With more students, faculty members have limited time to assist students individually with the integration of classroom theory to clinical practice. Faculty must rely heavily on the learning resources in the clinical area and provide experiences that closely match the curriculum. Roper (1976) commented similarly upon finding that clinical learning is enhanced by lower teacher-student ratios. This rationale also would apply to the increased reliance on nursing staff by the faculty who taught in more than one clinical area.

Faculty in college programs rated the factors of "clinical environment" and "other" higher, whereas faculty in university programs rated the factor entitled "nursing staff' higher. College faculty was the group with the higher clinical ratio. This higher ratio may account for their higher rating of the factor "other," which included the criterion of "legal responsibilities." University faculty may have rated the factor of "nursing staff' higher because university curricula address issues such as collaborative relationships among nurses more so than college curricula.

Table

TABLE 2MEAN RATING3 FOR EACH FACTOR AND THE HIGHEST RATED CRITERION BY MEAN

TABLE 2

MEAN RATING3 FOR EACH FACTOR AND THE HIGHEST RATED CRITERION BY MEAN

Table

TABLE 3RANK ORDER* BY FACULTY OF MOST IMPORTANT CRITERIA IN PATIENT SELECTION BY FREQUENCY AND PERCENT

TABLE 3

RANK ORDER* BY FACULTY OF MOST IMPORTANT CRITERIA IN PATIENT SELECTION BY FREQUENCY AND PERCENT

Conclusions and Implications

Nurse educators can identify and rank in order of importance their criteria for selecting patients for students' hospital clinical experience. Faculty view the criteria of "students' individual learning needs," "patients' nursing care needs," and "matching of patients' needs with students' learning needs" as being most important in patient selection. These criteria are congruent with Tyler's principles. Variables such as teacher-student clinical ratio, type of program in which teaching, and age of the faculty member most influenced the factors considered in patient selection.

Selection of patients by faculty should be a rational and thoughtful process. Graduate programs that prepare nurse educators should include in their curricula the process of patient selection and the criteria used to achieve this.

Limitations and Recommendations

Sample size, the nonprobability sampling technique, and the setting from which the sample was drawn limit the ability to generalize the results. The study was subject to the limitations inherent in the instrument design. The criteria for patient selection delineated in the questionnaire may not be all-inclusive, despite a request for new criteria from the respondents. There may have been a tendency for respondents to choose the "correct" answer.

Table

TABLE 4SUMMARY OF SIGNIFICANT ANOVA RESULTS

TABLE 4

SUMMARY OF SIGNIFICANT ANOVA RESULTS

Construct validity and reliability of the questionnaire should be established. Once this is done, replication of the study with a larger and more geographically representative sample size would be valuable.

References

  • Argyris, C, & Schön, D. (1976). Theory in practice: Increasing professional effectiveness. San Francisco: Jossey-Bass.
  • Barr, F. (1980). Are your students positive about their experience in the clinical area? Canadian Nurse, 76(10), 48-50.
  • Bevil, C.W., & Gross, L. (1981). Assessing the adequacy of clinical learning settings. Nursing Outlook, 29, 658-661.
  • Brown, S.A. (1981). Faculty and student perceptions of effective clinical teachers. Journal of Nursing Education, 20(9), 4-15.
  • Corcoran, S. (1977). Should a service setting be used as a learning laboratory? An ethical question. Nursing Outlook, 25(12), 771-776.
  • Ehrat, K. (1985). Clinical instruction: From an agency point of view. In S.R. Van Ort, & A.M. Putt (Eds.), Teaching in collegiate schools of nursing (pp. 143-152). Toronto: Little, Brown.
  • Grimes, J. (1977). Matching clinical experiences to program goals. Nursing Outlook, 25(6), 399-401.
  • Haukenes, E., & Mundt, M. (1983). The selection of clinical learning experiences in the nursing curriculum. Journal of Nursing Education, 22, 372-375.
  • Hawkins, J. (1981). Clinical experiences in collegiate nursing education. New York: Springer.
  • Heidergerken, L. (1957). Assigning credits for clinical nursing courses. Nursing Outlook, 5(10), 596-598.
  • Infante, M.S. (1975). The clinical laboratory in nursing education. New York: Wiley & Sons.
  • Jones, C. (1983). Negotiating student placements in ambulatory settings. Journal of Nursing Education, 22(6), 255-258.
  • Karuhije, H. (1986). Educational preparation for clinical teaching. Perceptions of the nurse educator. Journal of Nursing Education, 25(4), 137-144.
  • Little, D., & Carnevali, D. (1972). Complexities of teaching in the clinical laboratory. Journal of Nursing Education, 11(1), 15-22.
  • McCaffery, M. (1968). What is the student learning in the clinical laboratory? Journal of Nursing Education, 7(4), 3-10.
  • Nail, F., & Singleton, E. (1983). Providing experiences for student nurses: Perspectives for cooperating hospitals. Journal of Nursing Administration, 13(7, 8), 20-25.
  • National League for Nursing. (1977). Criteria for appraisal of baccalaureate and higher degree programs in nursing (4th ed.). New York: The League, Pub. #15-1361.
  • Ontario Ministry of Colleges and Universities. (1977). Criteria for the évaluation of diploma nursing programs and nursing assistant programs. Toronto: The Ministry.
  • Ossler, CC, Goodwin, M.E., Mariani, M., & Filliss, CL. (1982). Establishment of a nursing clinic for faculty and student clinical practice. Nursing Outlook, 30(7), 402-405.
  • Putt, A.M. (1985). Clinical instruction: From a faculty viewpoint. In S.R. Van Ort, & A.M. Putt (Eds.). Teaching in collegiate schools of nursing (pp. 129-142). Toronto: Little, Brown.
  • Reilly, D., & Oermann, M. (1985). The clinical field. Its use in nursing education. Norwalk, Conn.: Appleton-Century-Crofts.
  • Ripley, D. (1986). Invitational teaching behaviors in the associate degree clinical setting. Journal of Nursing Education, 25(6), 240-246.
  • Roper, N. (1976). Clinical experience in nurse education. Edinburgh: Churchill Livingston.
  • Schweer, J.E. (1972). Creative teaching in clinical nursing (2nd ed. ). St. Louis: CV. Mosby.
  • Sieber, S.D. (1973). The integration of field work and survey methods. American Journal of Sociology, 78, 1335-1359.
  • Tyler, R. (1949). Basic principles of curriculum and instruction. Chicago: University of Chicago Press.
  • Watson, J. (1979). How to select clinical agencies for clinical experiences in baccalaureate nursing education. Journal of Nursing Education, 18(2), 29-35.
  • Wiedenbach, E. (1969). Meeting the realities in clinical teaching. New York: Springer.
  • Wong, J., & Wong, S. (1981). The selection and organization of curriculum experience in nursing. Journal of Advanced Nursing, 6(5), 391-396.
  • Yuen, F. (1986). Broad-based clinical learning experiences: Some curricular issues. Journal of Advanced Nursing, 11(3), 339-341.

FIGURE 1

FACTORS AND EXAMPLES OF CRITERIA

FIGURE 2

SAMPLE FROM QUESTIONNAIRE

TABLE 1

SELECTED DEMOGRAPHIC CHARACTERISTICS OF THE SAMPLE (N = 54)

TABLE 2

MEAN RATING3 FOR EACH FACTOR AND THE HIGHEST RATED CRITERION BY MEAN

TABLE 3

RANK ORDER* BY FACULTY OF MOST IMPORTANT CRITERIA IN PATIENT SELECTION BY FREQUENCY AND PERCENT

TABLE 4

SUMMARY OF SIGNIFICANT ANOVA RESULTS

10.3928/0148-4834-19880601-06

Sign up to receive

Journal E-contents