This chapter reviews literature and outlines the conceptual framework of this study. Aside from back chaining, information was obtained from electronic resources such as PubMed, MEDLINE, Science Direct, EBSCOhost, and Google scholar with search terms including;
demonstration rooms, Clinical Skills Laboratories, Self-directed Learning, Resources Utilisation, teaching and learning among others. Besides the seminal authors in the field, literature from 2010 to 2016 was specifically sought with quantitative, qualitative, and mixed methods studies being included. QSR International Nvivo version 11 for Macintosh was used to organise the searched literature which was coded into nodes using themes prescribed by the objectives. The literature is reviewed with respect to the following themes to address the study objectives;
1. Utilisation of Resources in Self-Directed Clinical Skills Laboratories 2. Self-Directed Learning Principles in Clinical Skills Laboratories 3. Students’ Self-perception of CSL as a Learning space in Nursing 4. Teaching and Learning in the Clinical Skills Laboratories
Notwithstanding the gaps in the literature, methodological and theoretical approaches to the various reviewed literature were used to identify relevant gaps and thereby providing clarity and reasons for using the methodology of this study. Figure 2.1 below shows the distribution of the literature by year that was used to back this study.
~ 25 ~
Figure 2.1 Distribution of Literature used 2.1.1 Scope of the Issue in Focus
As a profession, nurses need to maintain and enhance their competence as professionals to serve their patients. While this is a generally shared obligation among health professionals, there is little consensus concerning how best to accomplish this goal (Wise, Sturm, Nutt, Rodolfa, Schaffer & Webb, 2010:288). Nursing education can no longer be viewed as a finite process. Within the rapidly changing and advancing world of health technology, education is best considered as a lifelong process that spans the entirety of a professional career. Such “lifelong” learning has been defined as “a continuation of health education with an ongoing process of professional development along with self- assessment, which enables the professional to maintain the requisite knowledge, skills, and professional standards” (Boiselle, 2013:67). To learn beyond graduation, a professional must be able to self-direct their learning in other words lifelong learning
27 34 41
32
16 19 24
11 6 1 3 0
5 10 15 20 25 30 35 40 45
2004 2006 2008 2010 2012 2014 2016 2018
Numberof Articles
Year of Publication
Yearly Distribution of Articles
~ 26 ~
involves the development of self-directedness (SDL) (Chiang, Leung, Chui, Leung & Mak, 2013:1184).
The capability of lifelong learning is a stable set of attributes and skills related to interest and self-regulation of continuous learning (O'neill, Deacon, Larson, Hoffart, Brennan, Eggermont & Rosehart, 2015:124). An important learning goal of healthcare education in the past decade has been teaching students the skills of lifelong learning. With the rapid pace of technology and scientific research, the risk of becoming obsolete and out-of-date in the absence of continued reading and studying during our careers is very real (Sierpina
& Kreitzer, 2012:210).
Factors such as giving attention to learners’ educational needs, orienting them to the rules and regulations of clinical courses, nurturing the self-active management of clinical teaching-learning process and imparting these unto the learners are among the most significant issues in every educational institution, including nursing (M, Emamzadeh Ghasemi, Nikpaima, Fereidooni & Rasoli, 2015:30). Education has a projecting role in making changes and obtaining anticipated results and is seen by some scholars as a basic means to an end. Many useful changes and transformations had been possible by developing appropriate educational backgrounds. However, available literature suggests this is not absolute in nursing profession (Aarabi, Cheraghi & Ghiyasvandian, 2015:161).
According to Aarabi et al, nursing education provided in academic institutions has often been castigated for not adequately equipping students to improve the quality of patient care being too focused on the theoretical aspect of the profession (Aarabi et al., 2015:161). There is that robotic performance of nursing care that is usually rendered unto clients. Meanwhile transferring theoretical knowledge to practice in a real clinical setting is one utmost reason for nursing education and despite an improvement in nursing academic educational development, still nurses' behaviours are based mostly on traditional approaches (Cheraghi, Salsali & Safari, 2010b:1). This might be because education in nursing does not reinforce specialised nursing knowledge; rather, it simply conveys medical knowledge and hence care knowledge is not reinforced as a result (Aarabi et al., 2015:161).
~ 27 ~
The education and training of nurses became professional after Florence Nightingale established a nursing school in 1860. Nightingale considered that the axiom of nursing was patient care (Sun, Long, Tseng, Huang, You & Chiang, 2016:21). Subsequently, this led to nurses being educated in the classroom and trained in the clinical settings.
Contemporary nurse education comprises theoretical courses and practical training where student nurses are holistically prepared to be healthcare professionals (Nasrin et al., 2012:134). The practical training allows students to develop a better understanding of the nursing research, principles and theories and strengthen their professional nursing skills (Sun et al., 2016:21).
There is literature to suggest that even nurses with PhD titles only possess theoretical knowledge and therefore cannot participate adequately in clinical functions. There is thus not much hope for them to improve the clinical performance of nurses”. (Aarabi et al., 2015:161). Nursing is becoming more academic and the neglect of the patient is conspicuous in health institutions, with clinical skills laboratories becoming more sophisticated and the human touch, good attitudes and communication skills that make nursing an art being largely absent. So, training of nurses in our institutions with the advent myriad of technological availability and Self-directed learning skills is still lacking and needs refurbishment with proper approaches.
Maranon and Pera (Arreciado Maranon & Isla Pera, 2015:859) aimed of gaining insight into nursing students' perception of their theoretical and practical training and how this training influences constructing their professional identity. They found that students believed both theoretical and practical training were a prerequisite to the real life professional work environment. Nevertheless, clinical placements were considered essential to confer a sense to the theory and to shape their identity as student nurses, which will help them to experience their future professional reality and to engage with what they had been taught in theoretical and academic classes. The study argued that the problem of nurses' professional identity continues to manifest in the disjuncture between theoretical training and clinical placements, with both theory and practice being vital to nursing education (Arreciado Maranon & Isla Pera, 2015:859). Nurses need to
~ 28 ~
possess the ability to self-direct their learning since they would have to work independently after training.