ISSN: 2469-5823

Dağ et al. Int Arch Nurs Health Care 2019, 5:114

DOI: 10.23937/2469-5823/1510114
Volume 5 | Issue 1
International Archives of Open Access

Nursing and Health Care

Research Article

Difficulties in Clinical Nursing Education: Views of Nurse Instructors’

Gülten Sucu Dağ*, Hülya Fırat Kılıç and Refia Selma Görgülü
Nursing Department, Faculty of Health Sciences, Eastern Mediterranean University, Turkey Check for
updates

*Corresponding author: Gülten Sucu Dağ, Nursing Department, Faculty of Health Sciences, Eastern Mediterranean
University, Famagusta, North Cyprus via Mersin 10, Turkey, Tel: +90-392-611-13-31, Fax: +90-(392)-630-3940

Abstract Clinical education serves as one of the primary edu-

cational experiences for nursing students and as such,
Aim: The study was conducted to determine the difficulties
has been an indivisible part of the educational process
that nurse instructors’ experiences in clinical education.
in all phases of nursing education history [2,4]. Clini-
Material and methods: This is a descriptive study. cal education gives students the opportunity to learn
The sample of this study was comprised of 199 nurse
academicians. A socio-demographic data collection form
in real-life conditions. Nursing students must be fully
and a survey on the difficulties that nurse instructors’ prepared by both “knowing” the issues required for
experiences in clinical education form was developed by nursing functions and “performing” these functions. It
researchers to be used for data collection in an electronic is therefore important that students be prepared for
environment. their actual professional roles in the clinical area. In oth-
Results: It was determined that the difficulties of nurse er words, clinical education and learning are a primary
instructors’ experiences included having a heavy workload educational experience that helps students gain nursing
(41.7%); providing clinical practice area (30.29%); having
skills [5-8]. Clinical education gives students opportuni-
an excessive number of students (64.8%); being able to
implement the nursing care plan (25.6%); a poor physical ties to prepare for their future roles. These opportuni-
environment in clinics, and difficulties with health care team ties include participation in teamwork, decision-making,
members (29.7%). assessments, problem solving, critical thinking, coping
Conclusion: It was determined of nurse instructors’ with actual patients and their problems, and applying
experiences that some difficulties in clinical education and theoretical knowledge in actual practice [9-11].
they have the opinion that these difficulties have a negative
effect on teaching. Nursing instructors are responsible for creating
an environment that can help students reach their
Keywords
educational goals. Learning outcomes are aimed at
Education, Nursing, Students, Challenge, Clinical nursing achieving high cognitive, affective and psycho-motor
instructor, Clinical teaching skill levels in the classroom, laboratory and clinical
area [12]. While it may differ from country to country,
Introduction clinical teaching in nursing education tends to be done
The general objective of nursing education is to by instructors on the faculty of universities or schools,
help students gain professional nursing qualities and to by clinical educators working in hospitals, by clinical
prepare them for their future professional life. One of nurse educators, and by nurses working in hospitals
the targeted terminal behaviors in nursing education is [13]. However, it should be kept in mind that the most
“professional nurse” behavior [1] and nursing education important factor determining the quality of education
is fundamentally a process that serves to raise students’ is the adequacy of nurses’ educators. The World Health
awareness about nursing. This process involves two Organization emphasizes the need to address the
main areas that are integrated and complementary quality of nursing education in order to train competent
with one another, namely, Organizational/Theoretical nurses equipped with the knowledge, attitudes and
Education and Clinical/Applied Education [2,3]. skills necessary to provide quality care services, and

Citation: Dağ GS, Kılıç HF, Görgülü RS (2019) Difficulties in Clinical Nursing Education: Views of Nurse
Instructors’. Int Arch Nurs Health Care 5:114. doi.org/10.23937/2469-5823/1510114
Accepted: January 01, 2019: Published: January 03, 2019
Copyright: © 2019 Dağ GS, et al. This is an open-access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction
in any medium, provided the original author and source are credited.

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DOI: 10.23937/2469-5823/1510114 ISSN: 2469-5823

has defined 8 core competencies that nurse educators between clinical staff and academia [17,21-25]. For
should have [14]. these reasons, nursing students graduate with lack of
clinical experience although they learned all skills during
Clinical environments have a multi-dimensional and
their education [18].
quite sophisticated social structure, wherein the low
and difficult control of conditions characterizing the It is widely known that there are serious problems
structure has an effect on learning [2,15]. The factors regarding instructor-student interaction in Turkey, par-
constituting this social structure include the conditions ticularly on account of the rapidly increasing number
of the clinical environment, the characteristics of the of students, especially in recent years. Some areas of
students and educators, and the instructor-student clinical environments are unsatisfactory in terms of pro-
interaction. It is highly important that students be able viding educational experiences that enable students to
to derive benefits from these factors and conditions [2]. learn and adopt targeted behavior and skills. In a study
analyzing stressful events commonly experienced by
Clinical teaching can pose various problems and dif-
educators in clinical work practice, it was determined
ficulties for both students and educators. A systemat- that inadequate physical conditions created an unfavor-
ic research study investigated the strategies students able environment for education [26]. Based on these
applied to address the difficulties they experienced in shortcomings, it is clear that reformatory measures
advanced practices of nursing education [16]. In this for clinical teaching should be taken by performing an
study, the difficulties affecting clinical education were urgent review of the clinical teaching process and the
examined and then labeled as either internal or exter- learning environments. Determination and analysis of
nal problems [16]. Problems like excessive student de- the difficulties instructors experience during clinical
mands, increase in faculty workload and the shortage education are highly important for maintaining and de-
of more nursing educators were identified as internal veloping quality-nursing education. The only way effec-
problems, while problems like limited number of clinical tive actions towards improving clinical teaching can be
areas and preceptor programs and decline in education- implemented is by sharing experiences and developing
al programs in urban areas were identified as external a comprehensive description of the extent of the prob-
problems. Facilitating cooperation between educational lem.
institutions and hospitals, developing patient-oriented
research and increasing the use of simulation are rec- Aim of the Study
ommended as solutions to these problems. This study was conducted to determine the
A qualitative study where they defined the difficul- difficulties that nurse instructors’ experiences in clinical
ties that instructors and clinical educators experienced education. To achieve this, we sought to answer the
in the clinical teaching of nursing students conducted in following questions:
Japan. The difficulties experienced were classified under 1. What are the difficulties that nurse instructors’
four categories: Difficulties involving efforts to directly experiences in clinical education?
change opinions; inconsistency in school curricula con-
2. What are the opinions of instructors about the effect
tent and clinical education content; difficulties in teach-
of these difficulties on achieving the goals of clinical
ing skills to insufficiently educated students, and human
teachings?
and time constraints in education [17].
In Turkey, the nursing programme resemble some
Material and Methods
similarities to the nursing education programmes Type of research
worldwide [18]. The Turkish nursing education
This is a descriptive study.
programme lasts 4 years and leads to a bachelor’s
degree in nursing. These programs provide 4600 hours The sample of the research
of theoretical and clinical education, thus meeting the
The population of this study was comprised of nurse
European Union (EU) requirement for the number of
academicians on faculties and in vocational schools that
hours of nursing education [19]. provide nursing education in Turkey and in the Turkish
In Turkey, clinical teaching in nursing education is Republic of Northern Cyprus. According to official data
generally performed by instructors in nursing schools derived from OSYM(Student Selection and Placement Center) that were
[20], and clinical nurses working in hospitals. There are accessed prior to conducting the study, there were 1,208
some difficulties in clinical education in Turkey. Clinical instructors working in nursing educational institutions
educators generally experience the following problems: during the 2012-2013 academic year in Turkey. The
increased numbers of students, students’ lack of study sample included 199 nursing instructors, who
proper preparation for clinical education, inadequate were selected from the e-mail addresses that were
time devoted to clinical education and time spent in obtained (1,156) and had voluntarily responded to the
the clinic, inadequate clinical field and an insufficient survey.
number of educators, inadequate collaboration

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Data collection instruments participating instructors, 98% were female, and

24.1% ranged in age between 31-35 and 36-40. It was
The data for the study were acquired [2,5,16,17,26,27]
determined that 80.9% of the instructors had doctoral
using a survey form prepared after analyzing research-
degrees and that 34.7% of them worked as assistant
ers’ experiences and problems regarding clinical ed-
professors. Furthermore, the study found that 35.7% of
ucation, as reported in the literature. The survey was
semi-structured. It was containing both open-ended the instructors had worked as academicians for between
(six questions) and (nineteen questions) closed ended 11 and 15 years in total, and 54.8% of instructors had
questions. The survey form consisted of two different worked as clinical nurses for 5 years or less.
parts, with the first part involving questions about the According to the data on the organizations in which
characteristics of the instructors and the organizations the instructors worked, 71.3% offered master’s level
wherein they worked, and the second part involving education as well as undergraduate education, 34.2%
questions about the difficulties instructors experienced had more than 26 instructors, 81.9% had 201 or more
during clinical teaching. The second part also included undergraduate students, 59.1% had less than 5 graduate
six open ended questions inquiring into the instructors’ students and 52.2% had less than 5 doctoral students.
opinions about the effects of these difficulties on clinical
teaching. The difficulties experienced by the instructors Analysis of the teaching process of the participating
during clinical teaching were listed under six categories: instructors showed that they mostly performed clinical
“Instructor”, “Student”, “Patient Care”, “Physical Envi- teaching in public hospitals (68.8%) and university
ronment”, “Nurse Team” and “Health Care Team”. The hospitals (67.8%). Regarding the instructor-student
possible responses to the statements organized under ratio, 32.7% of the participants stated that there were
each category were: “I do not experience any difficul- 11 students per instructor in clinics. In relation to this,
ties”, “There are some difficulties” and “There are quite 94.4% of the participants reported that the instructor
serious difficulties”. was responsible for clinical teaching, 47.7% stated that
they had responsibilities in 3 or more clinics, 29.6%
Data collection stated that they set aside time for students as needed,
The study data were collected in the electronic en- and 22.1% stated that sparing time for each student was
vironment from February to March, 2014. E-mail ad- not possible.
dresses of the instructors were acquired from university In the instructors’ general views of their clinical
websites, and from lists compiled by various organiza- environment, 19.8% reported that the laboratory and
tions responsible for arranging congresses after being clinic equipment were incompatible. In contrast, only
granted their permission. The lists of available congress 28.8% of the instructors stated that the clinic was
participants were used, from which a record containing suitable for clinical education in general, while 24.9%
1,156 e-mail addresses was drawn up. In some incidenc- stated that the physical structure of the clinic was
es, there was more than one e-mail address for the same adequate (Table 1).
person. Since researchers did not have the opportunity
to determine the instructors’ primary e-mail addresses, The opinions of the instructors on the difficulties they
an invitation letter for the study and a link to the elec- experienced in the clinical environment were examined
tronic data base allowing participants to respond were under 6 categories: Instructor-related difficulties, Stu-
sent to all e-mail addresses listed. The authors sent re- dent-related difficulties, Patient Care-related difficul-
minder emails twice. Participants were respond to the ties, Physical Environment-related difficulties, Nurse
questionnaire for two months. A total of 199 instruc- Team-related difficulties and Health Care Team-related
tors, which translated as 17.2% of the email addresses difficulties.
listed, voluntarily responded to the survey. Regarding the issues related to the clinical
Data analysis environment, it was found that 41.7%, 33.2%, and 30.2%
of the instructors, experienced quite serious difficulties,
The study data were assessed in an electronic respectively, concerning a) Having a heavy workload,
environment using SPSS 20.0 software. Numbers and b) Providing an adequate clinical practice area, and
percentage calculation were used for data assessment. c) Presenting educational experiences suited to the
Ethical approval educational goals of the course. It was also determined
that 65.8%, 63.8% and 61.3% of the instructors
All instructors were fully informed of the research experienced some difficulties, respectively, concerning
aims, and agreed to instructors in the research process. achieving the course objective, creating an environment
All instructors were voluntarily responded to the that facilitates learning, and achieving cooperation with
survey. The research was undertaken the principles of other members of the health care team.
the Declaration of Helsinki.
Analysis of the difficulties experienced regarding
Results issues about students determined that 64.8% of
Regarding the descriptive characteristics of the instructors experience quite serious difficulties about

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Table 1: Instructors’ general viewpoints on the clinical environment (n = 199).

Partially
Appropriate Not Appropriate Total*
Appropriate
n % n % n % n %
Health care team 58 29.1 112 56.3 29 14.6 199 100.0
Nursing team 60 30.3 120 60.6 18 9.1 198 100.0
Physical structure of clinic 49 24.9 117 59.4 31 15.7 197 100.0
Number of patients/capacity 78 39.2 89 44.7 32 16.1 199 100.0
Equipment used in clinic 61 30.6 114 57.3 24 12.1 199 100.0
Laboratory-Clinic equipment compatibility 51 25.9 107 54.3 39 19.8 197 100.0
Case diversity 92 46.9 79 40.3 25 12.8 196 100.0
Education experiences in clinic 49 24.9 118 59.9 30 15.2 197 100.0
Clinic in general 57 28.8 126 63.6 15 7.6 198 100.0
*
Total number of instructors’ who answered the question.

Table 2: Opinions of instructors on difficulties experienced in the clinical environment (n = 199).

I do not experience There are some There are quite serious
difficulties difficulties difficulties
n % n % n %
Issues about instructors
Providing clinical practice area 26 13.1 107 53.7 66 33.2
Official correspondences 71 35.6 100 50.3 28 14.1
Creating an environment facilitating
19 9.6 127 63.8 53 26.6
learning
Presenting education experiences suited
23 11.6 116 58.2 60 30.2
to learning outcomes of course
Achieving course objective 30 15.1 131 65.8 38 19.1
Being a role model for students 54 27.1 114 57.3 31 15.6
Cooperating with nurse team 64 32.2 111 55.7 24 12.1
Cooperating with other members of health
45 22.6 122 61.3 32 16.1
care team
Work load 21 10.6 95 47.7 83 41.7
Issues about students
Number of students 16 8.1 54 27.1 129 64.8
Motivation of students 21 10.5 118 59.3 60 30.2
Orientation of students to the clinic 28 14 140 70.4 31 15.6
Attendance status of students 100 50.3 86 43.2 13 6.5
Basic knowledge and skills of students 22 11 145 72.9 32 16.1
Students' knowledge and skills specific to
16 8 145 72.9 38 19.1
practice area
Daily monitoring of students 34 17.1 119 59.8 46 23.1
Assessment of students 29 14.6 128 64.3 42 21.1
Issues about patient care
Putting learned theory into practice 15 7.5 137 68.9 47 23.6
Application of care protocols existing in
25 12.6 127 63.8 47 23.6
the clinic
Patient monitoring 48 24.1 129 64.8 22 11.1
Patient care practices 35 17.6 120 60.3 44 22.1
Drawing up nursing care plans 40 20.1 112 56.3 47 23.6
Application of nursing care plans 23 11.6 120 60.3 56 28.1
Completing nursing care monitoring forms 37 18.6 127 63.8 35 17.6
Participation in decision-making
16 8 127 63.8 56 28.1
mechanisms about patient care
Issues about physical environment
Number of patients 53 26.6 113 56.8 33 16.6
Case diversity 77 38.7 88 44.2 34 17.1

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Providing meeting rooms 20 10 75 37.7 104 52.3

Providing changing rooms for students 16 8 68 34.2 115 57.8
Issues about nurse team
Being accepting of students 47 23.6 121 60.8 31 15.6
Being supportive of students 48 24.1 109 54.8 42 21.1
Providing guidance to students 41 20.6 107 53.8 51 25.6
Issues about health care team
Information and opinion exchange with
42 21.1 128 64.3 29 14.6
members of health care team
Participation in decision-making
mechanisms about patient care and 17 8.5 123 61.8 59 29.7
treatment
Creating an environment facilitating
learning with members of health care 23 11.6 127 63.8 49 24.6
team

Table 3: Clinical educators by the number of instructors (n = 231*).

The number of instructors in the Instructor Clinical nurse Guide nurse Total
organization n % n % n % n %
5 or less 14 66.7 6 28.5 1 4.8 21 100.0
6-10 18 64.3 4 14.3 6 21.4 28 100.0
11-15 25 61.0 10 24.4 6 14.6 41 100.0
16-20 28 60.8 9 19.6 9 19.6 46 100.0
21-25 12 60.0 4 20.0 4 20.0 20 100.0
26 or more 52 69.3 17 22.7 6 8.0 75 100.0
*
More than one answer is given.

Table 4: The opinions of instructors about the effect of the difficulties experienced in clinical practice on teaching (n = 199).
The effect of the difficulties experienced in clinical practice on teaching n %
Teaching of some nursing practices was not carried out 171 85.9
It prevented effective teaching and learning 137 68.8
It caused me to have difficulties in clinical teaching 127 63.8
The motivation of students in clinical teaching decreased 123 61.8
Clinical teaching did not achieves its goals 107 53.7
Clinical learning outcomes were not achieved 86 43.2
My motivation as a teacher in clinical teaching decreased 74 37.1
Clinical teaching became boring 70 35.1
Evaluation of students became difficult for me 70 35.1

the number of students. In terms of the difficulties organizations, found that 69.3% of the instructors
experienced in patient care, 28.1% of the instructors worked in organizations where 26 or more instructors
experienced quite serious difficulties in nursing were responsible for clinical teaching (Table 3).
care planning practices. Considering the difficulties
According to the opinions the instructors had about
the instructors experienced regarding the physical
the effects the difficulties they experienced in clinical
environment, 57.8% of the instructors stated that they
practice had on teaching, 85.9% of the instructors
experienced quite serious difficulties, about providing a
stated that the teaching of certain nursing practices was
changing room for students. Concerning the difficulties
not carried out (Table 4).
about the nurse team, 25.6% of the instructors reported
that the most difficult issue was providing enough Discussion
guidance for students. Moreover, 21.1% and 15.6% of
Clinical education pertains to the application
instructors stated that they experienced quite serious
part of nursing education and provides students the
difficulties, respectively, about providing enough
opportunity to learn under real conditions. However,
support and acceptance of students. To continue, it
the lack of control of the conditions constituting the
was determined that 29.7% of the instructors had
clinical environments can affect learning. Identifying the
quite serious difficulties about participation in decision-
challenges in clinical education in nursing is crucial [28].
making mechanisms regarding patient care (Table 2).
Various problems are known to exist in clinical education,
Analysis of the individuals responsible for clinical including those related to the educators, the health
teaching, in terms of the number of instructors in the care personnel, and the learning environment. Limited

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number of studies have been conducted in Turkey and year, this number had risen to 14,048. In other words,
throughout the world, on the difficulties instructors in the nursing student quota had increased by 21.8 times
particular experience in clinical education [29]. in the last 20 years. On top of that, while the number
of students per instructor had been 25, this number
The situations in the clinical environment that are
has increased to 30 as of present [31]. The increase
regarded as unfavorable by instructors stem from var-
in the student-to-instructor ratio affected the findings
ious factors, such as excessive numbers of students,
of this study, as witnessed by the fact that the highest
insufficient patient capacities of hospitals, and limited
percentage of instructors reported the excessive
number of diverse cases. There is also the problem of
number of students as being a difficulty that they had
clinics/hospitals having poor infrastructure, insufficient
experienced. This same issue resulted in instructors
clinical practice areas, inadequate infrastructure in
experiencing serious difficulties in motivating students
laboratories, or conversely, having advanced laborato-
regarding clinical practice and in the daily monitoring of
ries but insufficient clinics. Being provided with conve-
students (Table 2). Furthermore, the participants noted
niences and opportunities that facilitate learning, and
that the increase in the number of students also caused
having access to physical conditions that foster clinical
other quite serious problems, especially in carrying
learning are fundamental to developing clinical skills
on education in schools with poor infrastructure and
[30]. Doğan, et al. [26] conducted a study to research
an insufficient number of instructors. These problems
the most common stressful situations instructors expe-
occurred in clinical education in particular. The lack
rience in clinical practice [26]. They determined that the
of sufficient laboratory and clinical practice areas
patient care systems applied in clinics were not in ac-
hampered the quality of education.
cord with the philosophies of education, that physical
conditions were not sufficient, that there were commu- An increase in the number of students created
nication problems, that instructors were unable to par- problems with students’ motivation and the placement
ticipate in decisions about patient care, and that treat- of students in suitable clinical areas [5,21,22,32]. It
ment and physical conditions were inappropriate for is thought that regulations like decreasing student
education. Similar difficulties were also reported in the quotas, improving the physical conditions of schools,
present study. In the participating instructors’ general and increasing the number and improving the quality of
view of the clinical environment in clinical education, instructors should be considered. In addition, continuing
they identified the incompatibility between laboratory education activities, departmentalizing courses, and
and clinical equipment, the insufficient capacity within placing students in private hospitals, special functioning
the clinics to handle the number of patients, and the hospitals, and in general hospitals, like public and
poor physical structure as the negative aspects of the university hospitals, should also be considered for
clinical learning environment (Table 1). improving clinical education. Increasing the number
of clinical rotation areas would also be beneficial in
In Turkey, it is the nursing instructors who are
reducing or preventing problems that arise from the
largely responsible for carrying out the clinical
excessive number of students.
education, as well as the theoretical education, of
the nursing education curriculum [20]. This study One of the difficulties that instructors experience is
found that the issue reported by the highest number motivating students in clinical practice. Its importance in
of instructors to be difficult was the heavy workload. clinical education is fairly evident, as studies have clearly
The heavy workload was attributed to such factors as shown that the biggest obstacle in clinical education is
excessive number of students, insufficient number student lack of motivation and interest [33-35].
of instructors in universities, being responsible for
Nasrin, et al. [34] conducted a qualitative study to
both undergraduate and graduate education, being
research the difficulties involving nursing students’
responsible for management of laboratory skills,
motivation in clinical education and found that the most
and the pressure of academic promotion. Moreover,
important theme was “anxiety about being a nurse”
because most of the participating instructors were
[34]. This theme was comprised of three categories:
responsible for supervising more than one clinic during
nurses’ perspectives on the future, monitoring of
clinical education, this also increased their workload.
clinical competencies and clinical education, and being
Strengthening the number of instructors, improving the
a role model. Researchers have determined that the
quality of instructors, creating a system to guide clinical
performances and professional attitudes of nurses
education nurses, and gaining the support of nurses
have an important role in motivating students in clinical
working at hospitals may all be effective in reducing
education. Furthermore, insufficient communication
instructors’ workloads.
between students and team members, non-acceptance
In recent years, the number of nurses who attend of students in practice areas, and negative prejudices
universities has increased to meet the nursing needs about nursing that affect the students’ motivation were
in Turkey. While the student quota in the 1996-1997 the most common problems that students experienced
academic year was 644, by the 2015-2016 academic in practice areas [24,36-38].

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Highly motivated students in clinical practice areas knowledge into practice [36,44]. Based on the results
contribute to efficiently maintaining the education from this study, it is believed that cooperation between
process. Therefore, when students are supported schools and hospitals plays a key role in providing
and accepted by their colleagues they will be able to solutions to the difficulties that instructors experience
gain greater satisfaction from educational activities with nurses and health care teams in clinical education.
[23,24,39-41]. In addition to this support and acceptance
The difficulties that instructors experience in clinical
from the nurses, members of the health care team and
education have negative effects on clinical education.
instructors, the function of clinical nurses as role models
Similar to the findings from this study, the results from
and leaders can also increase motivation. Moreover, the
the study by Eta, et al. [5] showed that the difficulties
effective use of a reward system to acknowledge the
encountered in clinical education made teaching
achievement of students, the arrangement of regular
difficult, prevented effective learning and teaching
meetings to share experiences with colleagues, who in
and led to negative learning results [5]. The difficulties
their function serve as role models, and the continual
experienced in clinical education are considered to be
support of instructors are considered as important
the most significant obstacles in achieving objectives.
measures for increasing students’ motivation.
Another difficulty in clinical teaching that instructors
The Limitations of the Study
experience pertains to the preparation and application The two limitations impacting the outcomes of this
of nursing care plans by students. One of the primary study were that data collection was performed in an
concerns of nursing education is that students are not electronic environment due to access problems, and
able to put knowledge into practice. When educators that, according to the number of outgoing emails, there
mostly focus on theoretical information, students do was a response rate of just 17.2%.
not learn to sufficiently comprehend how theoretical
information is put into practice. There are differences Conclusions
between practicing nursing in the actual environment It was determined that instructors experience various
and learning theory. Lack of support from instructors difficulties, including those related to having a heavy
and nurses, short patient care time in the clinic, and workload, providing an adequate clinical practice area,
inappropriate practice areas can hinder learning goals. having an excessive number of students, implementing
These are regarded as the main reasons for the difficul- nursing care plans, having a poor physical environment
ties students experience in transferring knowledge to in clinics and gaining the support of health care team
the practice area; in other words, it is a shortcoming in members. Instructors stated that these difficulties
the preparation and application of nursing care plans. negatively affect the education of some nursing
One of the seven items defined in a systematic investi- practices, as well as effective learning and teaching.
gation carried out by Jokar and Haghani [27] to research
the difficulties of clinical education was students’ lack of It is clear from these results that there should be
autonomy in care planning [27]. Providing as many case careful planning regarding the number of students
studies and examples as possible to students during receiving clinical education. The physical and
theoretical education on nursing care planning will help educational opportunities of organizations must
to facilitate students’ ability to put theoretical knowl- be considered in order to increase the efficiency of
edge into practice. It is believed that being supportive of clinical education. Clinical practice areas should be
students, discussing the daily care plan and use of meth- selected from institutions that have a suitable physical
ods (concept map, etc.), and facilitating the learning of infrastructure to create positive learning environments.
planning and application of care will contribute to the When laboratories in educational institutions are
solution of the problem [42,43]. not adequate, clinical areas should be equipped with
advanced technology simulators (e.g. realistic high-
Clinical education gives students the opportunity fidelity procedural simulators, and high-tech interactive
to use and improve the professional knowledge and human simulators). Effective communication and
skills specific to nursing, to make the right decisions, to cooperation should be provided between clinical teams
increase self-understanding, and to prepare themselves and instructors, and cooperation protocols should be
for professional roles [22,23,39]. However, clinical signed between schools and clinical practice areas.
education can present a number of problems and
difficulties for students, educators, nurses and other Acknowledgements
members of the patient care team. Successful clinical We would like to thank all the Instructors who
practice can be achieved through the close cooperation participated in this study.
of the school and the hospital [22,24,36]. Studies
researching student opinions about school and hospital Author Contribution
cooperation have reported that close cooperation GSD, HFK and RSG was responsible for the study
can help students adapt to the profession, increase conception and design. GS and RSG performed the
motivation and self-confidence, and help put theoretical data analysis. GS, HFK and RSG was responsible for

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the drafting of the manuscript. GS, HFK and RSG made students’ opinions regarding the clinical practice guide.
critical revisions to the paper for important intellectual Procedia - Social and Behavioral Sciences 2: 2162-2165.
content. 19. Dal U, Kitis Y (2008) The historical development and current
status of nursing in Turkey. OJIN: The Online Journal of
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