RESEARCH IN EDUCATION-AN ACADEMIC RESEARCH PROJECT: A SURVEY OF INTENSIVE CARE NURSES TO DESCRIBE THEIR PERCEPTIONS TOWARDS THEIR CLINICAL LEARNING ENVIRONMENT (CLE)

摘要

The key to delivering excellent patient care in the Healthcare system and improved quality of service lies in a clinical learning environment (CLE) that is conducive to clinical learning. Currently, there are few publications world wide that consider the CLE of nurses transferring to a critical care environment such as Intensive Care Units (ICU). When nurses move from one environment to the ICU environment a transition period is experienced and new skills such as care of the mechanically ventilated patient, endotracheal suctioning and arterial blood sampling are needed to be mastered. Also, ICU patients often have problems that affect multi-organ systems simultaneously; requiring nurses with a broad knowledge base and the ability to priorities amongst competing concerns ([16]Endacott, 1999). Therefore, ICU nursing is a complex mixture of roles responsibilities and paradoxes ([16]Endacott, 1999). [18]Hewitt-Taylor (1998) and [34]Redshaw & Harris (1994) explored Paediatric ICU courses and found that despite the fact that these courses have a strong clinical component where clinical competence is assessed, deliberation of the CLE was not included. A limitation of the above studies is a lack of knowledge of the new ICU nurses' perceptions of the CLE. This is in despite of [12]Collins (2002) outlining the need to assess the CLE of nurses adjusting to working in complex environments such as ICU. In the past, nurses were required to have two years of medical-surgical nursing before moving into ICU nursing. Nursing shortages in Ireland has led to the transition of newly qualified nurses into the ICU environment. [3][4]An Bord Altranais (1997, 2005) recognised that newly qualified nurses need support during the first year of practice. [2]Aiken, Clarke & Douglas (2002) stated that if these inexperienced nurses do not perceive their environments as supportive and conducive to the development of their new role then job dissatisfaction could be experienced, resulting in retention problems and further adding to the nurse shortage problem. [2]Aiken, Clarke & Douglas's (2002) study uses over 700 international hospitals; therefore it is reasonable to generalize their findings, albeit they are only preliminary findings. Furthermore, these findings are further supported with a study on staff turnovers in ICU, by [39]Suzuki et al (2006). Nurse shortages have led to an influx of nurses from non-European cultures entering ICU nursing in the DATH, Ireland. These nurses may need to learn new skills and get familiar with different technologies. No research has been found on the factors that non- European cultures perceive as affecting the CLE of ICU. A greater understanding of their perceptions of the CLE may enhance the ability of educators to develop strategies and provide a CLE in ICU that is conducive to all new ICU nurses, including non-Europeans nurses. This could potential lead to a greater job satisfaction and therefore a greater retention of nursing staff in ICU. With an aging population it is possible that an increase of patients entering ICU will occur. It is thus likely that inexperienced nurses and non- European nurses will continue to enter ICU nursing. Therefore it is important to access the variables that affect the CLE for both inexperienced and non- European nurses. [25]Leathart's (1994) research, utilising a grounded theory methodology, identified that new nurses in the transition to ICU experienced immense feelings of anxiety about their performance and being unsafe which led to extreme stress. The strategies that the new ICU nurses adopted to alleviate their fears included avoiding interaction with patients. [25]Leathart's (1994) established that this leads to a reduced standard of patient are in ICU and has an impact on the quality of service delivered. It is not possible to generalise these findings as it is uses a small sample of only six nurses. Nevertheless these findings provide some useful insights, with the significant of