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MCHIP supported the development of primary health care (PHC) clinical placements for trained nursing assistants and general nursing and midwifery students. The placements were designed to match smaller cohorts of students with preceptors to encourage better teaching/learning opportunities and appropriate oversight. To expand on its anecdotal program evaluation, MCHIP conducted operational research on PHC clinical placements to provide evidence for the effectiveness of the clinical placements. The aim of the research was to determine whether clinical placements prepared students and their preceptors to address Lesotho’s health priorities.
Methods: The study employed both qualitative and quantitative methods of data collection. A total of 96 preceptors, eight nurse/midwifery educators, 40 clinicians, and 241 diploma students were recruited as research participants. Eight data collection tools, including skills checklists, observation of preceptors, questionnaires, and 7 focus group discussions were used to collect the data.
Results: Students and preceptors both perceived PHC clinics to be appropriate settings to provide students with rich learning environments, allowing them to develop personally and professionally. While the quantitative data did not definitively conclude that the PHC experience directly increased the likelihood that students would accept placement in the PHC setting, the qualitative data supports this idea; students expressed their likelihood to accept deployment there post-graduation.
Preceptors expressed that PHC clinical placements were valuable as they enforced them to keep up-to-date with new evidence based practices in nursing/midwifery and to demonstrate skills competently to students. For those preceptors who were trained, the placements enabled them to practice the facilitation skills they were trained on. A comparison between trained and non-trained preceptors was also conducted with both groups being observed and evaluated for their performance on 22 skills. Trained preceptors scored an average score of 85% while non-trained preceptors scores averaged 71%. The trained preceptors had a significantly higher total score (p < .005).
In addition, results support the notion that PHC placements contributed to increasing all cadres’ confidence and competence in various clinical skills. Across all three cadres of students, there was improvement in the number of skills 80% of students deemed competent between baseline and endline. A majority of students (89%) reported they would work in a PHC setting after clinical placement.
Conclusion: PHC placements impacted confidence and competence in HIV care skills among all three cadres of students. The results of this study support the hypothesis that PHC clinical placements contribute to increasing nurse and midwife confidence and competence, though the effect was greater for nursing students than for midwifery students. PHC clinical placements are suitable for acquisition of the needed competencies and confidence for students in Lesotho. Clinical education should include varied experiences to ensure students gain skills in all areas relative to deployment. Communication and supporting clinical sites including training preceptors is key to successful placements. Continuing to support schools in health center placements is vital to creating primary health care clinical learning opportunities for students. Activities that increase the competence of students in the primary health care environment and acceptability of deployment post-graduation to health center settings where most Basotho receive access to care are crucial to ensure a well-staffed and competent rural workforce.