What If I Faint? Concerns of Maternal-Child Nursing Students Prior to Clinical

Background: Clinical rotations are an important component of nursing education to ensure the nursing graduate attains the expected outcomes deemed essential by key stakeholders. However, the chance to learn and use new complex psychomotor skills can create anxiety among students. While some degree of stress is expected and can enhance learning when present to a moderate degree, higher levels can interfere with learning and critical thinking, enough to threaten success in a clinical rotation. In clinical learning environments, task performance is negatively affected if student anxiety is not identified and addressed. By identifying concerns prior to clinical. teaching efforts may then focus on areas that cause the most concern to student. Through student survey, it was found that some of the concerns identified by students prior to their maternal-child rotation differ from those in other clinical settings. Students will likely be working with a woman who is in pain and need the skills to handle a newborn safely. The intimate nature of the setting and the natural tendency to personalize the events can be overwhelming and produce anxiety for some students.

Framework for the talk: Patricia Benner proposes that expert nurses develop skills and understanding of patient care over time through adequate education and past experiences. Student nurses in their first year of clinical education are at the first stage of Benner’s Model and are considered Novices. At this stage, behavior in the clinical setting is very limited and inflexible. While maternity nursing students may be in the first clinical course or later, nearly everything about the environment, the laboring patient, and the newborn are likely new. Hence, students are not able to prioritize efficiently as all aspects of a clinical situation appear to be of equal weight (Benner, 2005). This uncertainly and inability to prioritize can add to the stress and anxiety students feel when beginning their maternity clinical rotation.

Students on the first day of their maternal-newborn class at a midwestern nursing school identified specific concerns they may have regarding the upcoming clinical experience. Many students reported concerns that were similar to concerns in general medical-surgical clinical rotations. These included feeling inadequate, fear of making a mistake, fear of the unknown, freezing up, and feelings of rejection by staff, the patients, and faculty. Similar to students in the pediatric rotations who were worried about effectively helping patients (children) and family cope with painful procedures, students in the maternal-newborn rotation were concerned about not knowing how to help a women cope with the pain of labor. Other top themes identified included, witnessing complications including death of mom or baby, or reacting inappropriately to a birth (birth), safely holding and giving medication to a newborn (newborn), and feeling unprepared or that a family/nurse will not want the student as part of the experience (belongingness).

Implications for practice:

It was beneficial however to have students identify the specific areas of stress so that faculty in the classroom could cover these issues in detail and share with the clinical instructors as a whole students’ concerns in the clinical setting. As a result of these findings, faculty of the course developed labor support workshop (World's Largest Childbirth Class) for students and a simulation workshop. The simulation workshop consists of four stations and takes one patient through the triage area, labor and delivery, postpartum, and newborn care. These workshops are provided to students prior to clinical as a way to better prepare them and increase their confidence.