Clinical placements in nursing education facilitate the contextualization and application of theoretical concepts to practical situations (Newton et al, 2009). Clinical placements provide an essential learning framework due to the significant emphasis on learning clinical skills, practical knowledge, professional conduct, and coping strategies in real-life situations (Flott & Linden, 2016). From this vital practical experience, nursing students have learned how to be independent clinicians that understand the need to balance between different expectations and their active role in patient care (Liljedahl et al., 2015). Indeed, clinical placements are so crucial that they affect the drop-out rate of nursing students from their nursing programs (Babenko-Mould & Laschinger, 2014).
Nursing students expect their clinical instructor to maintain a positive relationship with them by nurturing, guiding and promoting their development (Chan, Chien, & Henderson, 2018). This requires instructors to be not only an active mentor but also to show by example through being a professional medical provider (Newton et al., 2015). In short, instructors are key players in nursing students’ enculturation process (Strouse & Nickerson, 2016).
Nursing students need to feel welcome and wanted not just by the clinical instructor, but also by the nursing staff and leaders. The importance of the sense of belonging in nursing education is well documented and researched. A sense of belonging is an emotional need of the students; namely, to be an essential and important part of the social group they are interacting with and to feel accepted (Radford & Hellyer, 2016).
The negative influence of alienation (as opposed to belonging) on nursing students causes psychological stress, anxiety and a feeling of uselessness, all of which put significant strain on nurse-student relationship. Indeed, nursing students who are not confident and competent may have a more difficult time fitting in with their professional nurse colleagues (AACN, 2014).
Nursing students in the undergraduate program at the University of Haifa carry out their clinical placements for 12-32 days in eight different clinical sites with various medical specialties. Here, we provide a case report on an outstanding nursing student through his written journal reflections of his learning process during his clinical placement. In particular, he describes his personal feelings of alienation and belonging during this time.
This nursing student’s journal reflections are presented as a case report in order to provide an authentic, direct and honest perspective of a clinical placement experience. This is with the aim to highlight the current conditions that instructors and other nursing personnel provide to meet students’ emotional need for a sense of belonging. Moreover, this student’s reflections are reported to assist in developing an understanding about the relationship between a student’s sense of belonging and the effectiveness of their learning experiences in various nursing disciplines at different practice sites.
Methods:
Nursing students’ clinical practical experience takes place in various internal departments of public hospitals. These include: Surgery, Emergency Medicine, Women's Health, and Psychiatry. Clinical placements encompass practicing nursing in the community as well as in advanced practice nursing.
The clinical education model of teaching in nursing practice is secondment. The central feature of this model is that an individual from one organization is temporarily assigned to another organization. Thus, an individual staff member at a health facility, such as a nurse, is temporarily hired by an educational institution, such as a university, to work as a clinical instructor. This is often used to teach students the foundation knowledge and theoretical concepts of nursing. However, in order to apply their academic understanding to real-life practice, students are on secondment to clinical settings; here this educational model is somewhat more of a challenge. Nursing students in clinical placements are required to both observe and be hands-on.
Results:
The case report illustrates an outstanding nursing student’s first-hand experience during his clinical placements. The journal provides insights into the roles, characteristics and modes of the student’s relationship with both clinical instructors and the department staff. The journal provides a chronological continuum of feelings of alienation to a sense of belonging bringing to the surface the student’s emotional needs.
Conclusion:
The findings from this case report indicate that a sense of belonging leads to a successful student experience in clinical placement. They also show where further efforts need to be concentrated to more widely survey the emotional environment. This will allow faculty staff to find new strategies and possible solutions to improve students’ psychological well-being and reduce student drop-out rates.