Problems of Nursing Institutes Students

• Nursing and midwifery services are vital for attaining health and development.
• Nurses form the backbone of health care services representing over 50% of the health profession.
• Student nurses are the foundation of nursing services.
• Due to facing problem at their institutes every year a number of student nurses drop their study which may develop shortage of future nurse in our country. Which as well as wastes of national resources.
• To ensure a working and learning friendly environment with related problems are vital for the student nurses according to the expected level

General Objective

To find out the problems faced by student of nursing Nursing Institute

Specific Objectives

• To find out the problems as faced by student nurses at hostel,
• To assess the problems as faced by student nurses at Class Room
• To identify the problems as faced by student nurses during training
• To determine the problems as faced by student nurses during community program
• To find out the problems as faced by student nurses during hospital duty
• To determine the socio-demographic characteristics of respondents

Research Question

What are the problems faced by student nurses at their Nursing Institutes?

Conceptual Framework

Limitation of the study:

• Only one study area was selected and the selection was done without using random allocation procedure. So the result obtained might be representative of that area only and cannot be generalized as national situation.
• The questionnaire was structured one which did not have scope to go deeper into a problem.

Literature Review

A study was conducted by Chesney and Coventry  to see the perceptions of workplace problems among nurses and their managers such as–short staffing, sexual harassment, and verbal abuse. Focusing on supervisors and their perceived impact on their subordinates’ workplace outcomes, this study specifically examines staff nurses’ frustration and fulfillment. The researchers found nurses’ views of short staffing significantly affected staff nurses’ frustration with their managers but did not significantly affect fulfillment. The nurse managers’ view of sexual harassment, on the other hand, significantly affected staff nurses’ reports that their manager contributed to their fulfillment but did not significantly affect frustration. Nurses’ views on verbal abuse in the models significantly affected nurses’ reports that their manager contributed to both their frustration and fulfillment.

Study was conducted to determine the nature of the problems student nurses encounter during clinical training in Turkey. The focus-group interviews were used for this study. Three groups of 8, a total group of 24, composed of students completing their third year were included in the interviews. The students in this study had completed their practical training in the departments of internal medicine, surgery, pediatrics, psychiatry and public health. Among the problems mostly encountered by students, as established by the study, were inadequate assessment by the clinical educator, judgment, negative feedback, communication problems, inadequate guidance and overload. At the end of the research, recommendations were that educators should offer information in the direction of student expectations, increase their positive feedback and lighten the academic workload of these students.

One study by Abolfotouh, Bassiouni, Mounir and Fayyad assessed health-related lifestyles and their determinants among 600 Alexandria University students living in university hostels. They found that most students were not satisfied with their situation in terms of accommodation, health and support. About 86% ate unhealthy diets, 33.8% were physically inactive, 25.3% were overweight or at risk of becoming overweight, 17.5% of male students were current smokers and 32.2% had poor sleep behaviours. About 28% of the students adopted 3 or more risk behaviours. About 23% reported low perceived health status and 80.3% felt they had low to moderate social support. There were significant sex differences regarding some behaviours. 

Study by Erdil and Korkmaz conducted a descriptive study to determine nursing students’ observation of ethical problems encountered in their clinical practice. Data were collected through a questionnaire from 153 volunteer nursing students at a university-based nursing school in Ankara, Turkey. The students reported that some patients are either physically or psychologically mistreated by doctors and nurses; they were not given appropriate information; they were subjected to discrimination according to their socio-economic situation; and their privacy was ignored.

Study by Sharif and Masoumi ⁷ investigated student nurses’ experience about their clinical practice among 90 baccalaureate nursing students at Shiraz University of Medical Sciences (Faculty of Nursing and Midwifery) were selected randomly from two hundred students and were arranged in 9 groups of ten students.  The result of this study showed that nursing students were not satisfied with the clinical component of their education. They experienced anxiety as a result of feeling incompetent and lack of professional nursing skills and knowledge to take care of various patients in the clinical setting.

Clinical experience is one of the most anxiety producing components of the nursing program which has been identified by nursing students. In a descriptive study by Beck and Srivastava  conducted among 94 second, third and fourth year nursing students reported that clinical experience was the most stressful part of the nursing program. Lack of clinical experience, unfamiliar areas, difficult patients, fear of making mistakes and being evaluated by faculty members were expressed by the students as anxiety-producing situations in their initial clinical experience. In study done by Hart and Rotem  stressful events for nursing students during clinical practice have been studied. They found that the initial clinical experience was the most anxiety producing part of their clinical experience.

Initial clinical practice is stressful. Nursing students entering clinical practice for the first time in a five-year associate degree program in Taiwan are young and have questionable coping skills, all of which can affect their own health. One study   examined the following: (1) the degree of stress perceived and types of stressful events; (2) the physio-psycho-social status of nursing students during the practice; (3) the coping behaviors of these students; and (4) the effect of different coping behaviors on their physio-psycho-social health. The subjects were 561 nursing students who had completed their initial clinical practice at the largest nursing school in Taiwan. Three measurements, including Perceived Stress Scale (PSS), Physio-Psycho-Social Response Scale (PPSRS), and Coping Behavior Inventory (CBI), were adopted. Results showed that stress for these students came mainly from the lack of professional knowledge and skills as well as caring of patients. The most common response to stress was social behavioral symptoms. Staying optimistic had a positive main effect, which reduced the occurrence of physio-psycho-social symptoms and improved physio-psycho-social status. Finally, problem-solving behavior also had a positive main effect, while avoidance had a negative main effect, which deteriorated physio-psycho-social status.

An exploratory longitudinal study was conducted in Israel   to identify nursing students’ perceptions of stress in their initial clinical experiences in a hospital setting. Guided by the relational view of stress, a Nursing Student’s Stress Scale (NSSS) was developed to include six subscales: adequate knowledge, close supervision, adverse sights, causing pain, insufficient resources, and reality conflict. The NSSS was administered three times during the clinical experience to 46 nursing students. Results showed significant differences between the students’ preclinical expected stress levels and the actual levels of stress in the clinical setting. Theoretical, methodological, and practical implications of the findings are discussed. Nurse educators are encouraged to acknowledge students’ perceptions of stressful situations as a basis for stress reduction intervention. Students must first cope with their own stress in the clinical reality before being expected to deal with patients’ stress

Study Design

It will be a Descriptive type of cross-sectional study.

Place of Study

Nursing Institute, Comilla was selected as study place according to the convenient of the researcher

Sample Population

            All the student nurses studying in the Nursing Institutes the sample population of the study.

Sample Size

Using the following formula of one-sample population for calculating sample size,

Z²pq

n= ————————–

d²

Here

n= the desired sample size

z= the standard normal deviate usually set at 1.96 which correspondents to 95% confidence level

p= Proportion of nurses in health care manpower in Bangladesh is 50%

q= 1-p

d=degree of accuracy desired, usually set at 0.08%.

the required sample size should be

n = z²pq/ d2

= (1.96) ² X (0.5)X(0.5) .

(0.08) ²

= 150

Sample Technique

Simple Random sampling technique will be adopted for this study

Inclusion Criteria

All registered student nurses of Nursing Institute, Comilla

Exclusion criteria

Those were not interested to participate in the study.

Duration of the Study: 6 month      

Tool of Data Collection

The tool was prepared by keeping the objectives of the study as the framework that reflect the study variables. A pre-designed semi-structured questionnaire was developed to use as data collection instrument.

Procedure of Data Collection

Prior to the interview, the purpose of data collection was explained to the respondents and verbal consent was obtained. Data was collected by face-to-face interview by the investigator.

Data Analysis

Descriptive statistics will be generated and presented in tabular form using SPSS Programme

 Ethical Issues

• A written permission will be taken from the authority of the ADUST.
• Verbal permission will be taken from the Hospital authority and respondents prior to interview.
• The privacy and confidentially were maintained

Result

A descriptive cross sectional study was conducted among the students of a selected nursing institute of Bangladesh to find out the problems faced by student nurses during their study/training period. Among the respondents everyone was unmarried having HSC level of basic education. The other findings are presented in tabular form.

 Table.  Distribution of respondents by academic year (n=135)

The table shows the respondents by academic year. It was found that among the respondents majority 43.0% (n=58) were of 3^rd year followed by 32.6% (n=44) were of 2^nd and 24.4% (n=33) were of 1^st year.

Figure 1.  Distribution of respondents by sex (n=135)

The above figure shows the respondents by sex. It was found that among the respondents majority 98% (n=132) were female and rest 2% (n=3) were male.

Table .  Distribution of respondents by religion (n=135)

Among the respondents majority 86.6% (n=117) were Muslim, 10.4% (n=14)  were Hindu and rest 3% (n=3) were Christian by religion.

 Figure : Distribution of respondents by age group (n=135)

By age the above figure shows that among the total respondent majority 62.20% (n=88) were of below 20 years and rest 34.80% (n=47) were more than 20 years of age.

Table .  Distribution of respondents by monthly family income (n=135)

The above table shows that majority 54.1% (n=73) had a family income of BDT 10000 – 20000, 42.2% (n=57) had BDT 10000 and less and only 3.7% students had a family income of BDT 20000 or more.

Table : Distribution of respondents by problems at hostel* (n=135)

• Multiple responses

When asked about problems at hostel, 94.8% respondents (n=128) reported that there is no provision for tea/snacks in between meal, 76.3% (n=103) complaints that there is no reading room, 75.6% (n=102) informed that bathrooms/ toilets are not always clean, 75.6% (n=102) reported that he food is unhygienic, 28.1% (n=38) complaints of lack of security, 29.6% (n=40) told about having no entertainment recreational facility(TV/playing), 53.3% (n=72) congested accommodation, 37.0% (n=50) no privacy, 26.7% (n=36) teasing and gossiping in building are common occurrence, 14.8% (n=20) for lack of prayer room, 27.4% (n=37) reported that they have to share rooms with other girls without allotment and  5.9% (n=8) respondents told that there is no waiting room at their hostel

Table : Distribution of respondents by classroom related problems* (n=135)

* Multiple responses

By classroom related problems, majority (91.1%) respondents told that there is deficiency of clinical teacher in hospital. 84.4% complained about inadequate supplies equipment and teaching aids. 62.2% respondents told that there is lack of library facility and 48.1% respondents told about congested classroom.

Table : Distribution of respondents by problems during clinical practice/ training * (n=135)

* Multiple responses

The respondents were also asked about their problems during their clinical/practical training. The table shows that 64.4% of the respondents reported for insufficient teacher, 38.5% complained that teachers are not well understood, 57.0% told about inadequate English language ability of teachers and rest 91.9% for inadequate knowledgeable and experienced teacher.

Table : Distribution of respondents by problems during community program* (n=135)

* Multiple responses

During community program the problems faced by the respondents are as lack of awareness from community people (76.3%), lack of specialized community nurses (86.7%), lack of transportation facility (74.1%), Resources not available according to the stated course outline (85.9%), large group of students (23.0%), some of the students are not interested (37.8%), bullying by client’s relatives (31.9%).

 Table : Distribution of respondents by problems during hospital duty * (n=135)

* Multiple responses

The problems during hospital duty as stated by the respondents are workplace bullying by patient/ and attendants workplace bullying by patient/ and attendants (34.1%), lack of proper guidance by the clinical teachers (48.1%), excess visitor/ attendant (85.9%),  shortage of clinical teaching (94.13%), security problem (74.8%), work Load (65.2%), ill behavior of supervisor (49.6%),

Table : Distribution of respondents by family income and hostel problems (n=135)

X²=8.583  p=0.014

The table shows that hostel problems are faced more by the respondents who were from monthly income group of BDT 1000 (p<0.05). As statistically it was found significant, it denotes that there is association between hostel related problem and familial economic status of students.

Table : Distribution of respondents by family income and Academic problems (n=135)

X²=2.915  p=0.233

The table shows that academic related problems are faced more or less in equal ratio among the respondents of different family income group. Statistically it was also not found significant (p>0.05).

Table : Distribution of respondents by family income and problems with academic practice (n=135)

X²=1.722  p=0.423

Likely problems related to academic practice also found no such difference among the respondents of different family income groups (p>0.05).

Table : Distribution of respondents by suggestions for solving / to improve the student nurses problem* (n=135)

* Multiple responses

The table shows that, by the suggestions from student nurses, the study revealed that the ‘Recruitment of adequate number of qualified and experience teacher’ and ‘ensure sufficient teaching  aids’ was suggested by almost all respondents followed by ‘Ensure security at hostel and hospital’ by 96.27% respondents,  ‘Improvement of hostel facilities (waiting room, food, prayer room)’ by 74.07% respondents, ‘Computer with internet’ by 71.85% and ‘Adequate and ‘Improve college environment (library, class room, game)’ by 62.96% respondents. It reveals that, all related problem are very closed to with one another.

Discussion

A descriptive cross sectional study was conducted among purposively selected 135 student nurses of a selected nursing institute of Bangladesh to find out the problems faced by them at their institute. All the respondents were unmarried having HSC level of basic education and most of them were female.  Among the respondents, about ninety percent were Muslim, 10% was Hindu and rest three percent were Christian by religion.  By age, among the total 65.20 percent were within the 20 years age and rest were more than years. Among the respondents, more than half had monthly family income within BDT 10000 – 20000, 42.2% had BDT 10000 and rest had more than BDT 20000.

 By problems at hostel, most the respondents reported that there is no provision for tea/snacks in between meal, no reading room, bathrooms/ toilets are not always clean, food is unhygienic and lack of security. 29.6% respondents told about having no entertainment recreational facility (TV/playing), 53.3% for congested accommodation, 37% for lack of privacy. 27 percent complaints for teasing and gossiping in hostel campus, 14.8% for lack of prayer room, 27.4% reported that they have to share rooms with other girls without allotment. Study by Abolfotouh, Bassiouni, Mounir and Fayyad ⁷ found that most students of Alexandria University were not satisfied with their situation in terms of accommodation, health and support. About 86% ate unhealthy diets, 33.8% were physically inactive, 25.3% were overweight or at risk of becoming overweight, 17.5% of male students were current smokers and 32.2% had poor sleep behaviours. There were significant sex differences regarding some behaviours. 

By classroom related problems, 48.1% of respondents told that the class rooms are congested; 62.2% respondents told there is lack of library facility, all most all respondents told lack of clinical teacher in hospital and inadequate supplies of equipment and teaching aids. Study by Sharif and Masoumi at Shiraz University of Medical Sciences (Faculty of Nursing and Midwifery) showed that nursing students were not satisfied with the clinical component of their education. They experienced anxiety as a result of feeling incompetent and lack of professional nursing skills and knowledge to take care of various patients in the clinical setting.

During their training, respondents reported about insufficient teacher, some teachers are not well understood; teachers have inadequate English language ability and inadequate number of subject wise knowledgeable and experienced teacher, as well as inter group communication gaps exists in both either institute or clinical field.

During community program the problems faced by the respondents are due to lack of cooperation from community people (76.3%), lack of specialized community nurses (86.7%), lack of transportation facility (74.1%), large group of students (23.0%), some of the students are not interested (37%), bullying by client’s relatives (31.9%).

The problems during hospital duty as stated by the respondents are workplace bullying by patient/ and attendants, lack of proper guidance by the clinical teachers, excess visitor/ attendant, absence of clinical teaching, security problem, and work Load and ill behavior of supervisor. Study by Erdil and Korkmaz determined nursing students’ observation of ethical problems encountered in their clinical practice. Study by Beck and Srivastava  reported that clinical experience was the most stressful part of the nursing program. Lack of clinical experience, unfamiliar areas, difficult patients, fear of making mistakes and being evaluated by faculty members were expressed by the students as anxiety-producing situations in their initial clinical experience. In study done by Hart and Rotem also found that the initial clinical experience was the most anxiety producing part of their clinical experience.

Study in Turkey ⁵ ascertained the problems as inadequate assessment by the clinical educator, judgment, negative feedback, communication problems, inadequate guidance and overload. Wich are very similar problems in context of Bangladesh Nursing education and services

The present study revealed that only hostel related problems are faced more by the respondents who were from poor and middle class (p<0.05). But no such difference was found among either male female respondents. That means academic and academic practice related problems are common for all.

On solving the problems, the suggestions from student nurses were ‘Recruitment of adequate number of qualified and experienced teacher’, ‘ensure sufficient teaching aids’,  ‘Ensure security at hostel and hospital’,  ‘Improvement of hostel facilities (waiting room, food, prayer room)’, ‘Computer with internet’ and ‘Adequate and ‘Improve college environment (library, class room, game)’. In addition with that there should be provision to minimize the inter group communication gap for the shake of the learners.

Conclusion

 The present study concluded that most of the respondents reported that they face problems in their institutes. The problems are categorized under five group namely 1.Problems at hostel, 2. Classroom related problems, 3. Problems during training, 4. Problems during community program and 5. Problems during hospital duty. It was noted that among the problems, lack of reading room, unclean  bathrooms/ toilets, unhygienic food and lack of security at hostel level, congested class rooms, lack of library facility, lack of clinical teacher and  inadequate supplies of equipment and teaching aids and  insufficient of trained and experienced teacher at institute and workplace bullying by patient/ and attendants excess visitor/ attendant,  shortage of clinical teaching, security problem, work Load and ill behavior of supervisor at hospital are notable. On solving the problems, the suggestions were ‘Recruitment of adequate number of qualified teacher’, ‘Prepare of experienced teachers by refresher training according to the demand of the course. Ensure sufficient teaching aids’,  ‘Ensure security at hostel and hospital’,  ‘Improvement of hostel facilities (waiting room, food, prayer room)’, ‘Computer with Internet’ and ‘Adequate and ‘Improve nursing institute environment (library, class room, game)’.

Recommendation

On the basis of the findings of the study the followings are recommended;

• Hostel facilities may be improved by providing library, reading room facility
• Regular and periodic visit and monitoring by supervisors may improve the situation related to food and cleanliness of bathrooms/ toilets.
• Appoint adequate number of trained and experienced teacher with appropriate teaching aids may be ensured by the authority
• Security at hostel and hospital may be monitored by the local authority.
• Further study may be conducted to reveal the root cause of the problem and undertake necessary steps to improve nursing strength in Bangladesh