Assessment of Factors Influencing the Quality of Clinical Supervision of Nursing and Midwifery Students at the 37 Military Hospital

Abstract

Background: Nursing and Midwifery is a practice-based profession that is built on theoretical knowledge gained through comprehensive nursing and midwifery education. This is done with the overall goal of equipping nurses and midwives with professional clinical competencies ready to deliver safe, quality nursing and midwifery care. The most effective way of integrating both theory and practice in nursing and midwifery to build the skills, knowledge and attitudes of nurses and midwives is through clinical supervision. Poor working relations between hospitals and health training institutions and the preceptorship model of practical supervision across the country have been identified as some of the many factors that limit clinical practice to only the acquisition of clinical skills. Objective: The objective of this dissertation was to examine the factors that influence the quality of clinical supervision among nursing and midwifery students at the 37 Military Hospital, in the Greater Accra region of Ghana. Methodology: The study adopted a cross-sectional design. A mixed method (qualitative and quantitative) approach was used to collect data for the study. A sample size of 200 Nursing and Midwifery students were selected using simple random sampling technique to respond to a structured questionnaire in the quantitative study. The qualitative data was collected through Key Informant Interviews (KII) with five clinicians and eight tutor supervisors who were selected using purposive sampling technique. Quantitative data was analysed using Stata version 15. Descriptive, bivariate and multiple logistic regression analysis were carried out to determine the factors influencing the quality of clinical supervision. The qualitative data was also analysed using content analysis and the transcripts read through to allow themes to emerge. Qualitative Results: The study showed that clinician and tutor supervisors held different views of what constituted quality clinical supervision. Quality clinical supervision was conceived as 1) clinicians or staff working with students posted to wards, 2) students being supervised by quality assurance nurses and in-charges in wards and 3) tutor and clinical supervisors putting measures in place to adequately supervise nursing and midwifery students. The study also revealed three main modes of clinical supervision namely; Objective-Based Supervision, Facility-Based supervision, and Preceptor-Based Supervision. Factors identified as influencing clinical supervision were pre-clinical student orientation, lack of training for supervisors, absence of a standard guideline for student clinical supervision, inadequate logistics for students to work with, time constraints and heavy workload schedules for tutor supervisors. Quantitative Results: Overall, only 19% of the nursing students experienced high quality clinical supervision at the 37 Military hospital. The study found that marital status, religion, program of study, how close a respondent‘s residence is to the hospital of attachment, whether the respondent‘s institution choose hospital for them, issues of accommodation, negative attitude of clinical staff towards respondents, issues of sexual harassment during clinical attachment, whether senior staff over rely on respondents work, whether enough time is given by the clinical supervisor to teach respondents, whether tutor supervisors visit respondents at the hospital to conduct supervision, when respondents buy their own clinical materials, whether respondents are emotionally stressed during clinical practice, whether respondents are aware of any standard guidelines for supervision, the interaction between respondents and their tutor supervisors as well as clinical supervisors have significant influence on the quality of clinical supervision of nursing and midwifery student at the 37 Military hospital from the nursing and midwifery students perspective. Conclusion: There should be a standard for supervising students in the country to ensure uniformity in nursing and midwifery training. The provision of standard guidelines for clinical supervision will address factors affecting tutor and clinician supervisors as well as those of the students. Enhanced efforts should be made by the various stakeholders like the Ministry of Health, Ghana Health Service and Nursing and Midwifery Council of Ghana, who are responsible for the training of nurses and midwives. When these factors are properly addressed, there would be improvement in the quality of clinical supervision of student nurses and midwives in Ghana.