Proceedings Series on Health & Medical Sciences, Volume 2

Proceedings of the 2nd International Nursing and Health Sciences

ISBN: 978-623-5729-19-0, ISSN: 2808-1021

An Evaluation of Clinical Learning Experience among

Fourth-year Nursing Students of Nueva Ecija
University of Science and Technology
George M. Rivera1, Thea Irise M. Eugenio2, Romar M. Bendiola3, Marie Denise M. Esguerra4, Kelvin
Mark P. Quetua5, Danylen Felyze G. Paras6, Leinus Karl P. Santiago7, Divina B. Ocampo8,
Zuzette B. Catabona9
1,2,3,4,5,6,7,8,9Nueva Ecija University of Science and Technology, Philippines

ARTICLE INFO ABSTRACT

The clinical learning environment is an essential component of nursing
Article history: education as it allows students to integrate theory into clinical practice.
DOI: However, it is considered a critical factor as it may or may not help the
student nurses grow and expand their knowledge, skills, and professional
10.30595/pshms.v2i.221
attitude. As such, this study described the clinical learning experience of the
fourth-year nursing students of Nueva Ecija University of Science and
Submitted: Technology examining the underlying factors that influence the entire
December 6, 2021 learning experience. The study utilized a descriptive – quantitative
correlational design and total enumeration as the sampling procedure. The
Accepted: result showed that most of the respondents were in the early adulthood;
January 21, 2022 female; monthly family income is 5,001-10,000, and preferred working in
base hospital, operating room; and preferred the morning shift. The core
Published: competencies in which the respondents showed enhanced performance and
aptitude were legal responsibility, ethico-moral responsibility, and
January 26, 2022
collaboration and team work. The lowest, on the other hand, were personal
and professional development, quality improvement, safe and quality nursing
Keywords: care, and research. A significant relationship between the actual age and safe
and quality nursing and communication core competencies. A proposed
Clinical learning environment; action plan was devised for student nurses to strengthen their research
clinical learning experience; competency.
core competencies;
undergraduate nurses; This work is licensed under a Creative Commons Attribution 4.0
evaluation International License.

Corresponding Author:
George M. Rivera,
Nueva Ecija University of Science and Technology,
Gen. Tinio Street, Cabanatuan City, Philippines
Email: mgeorge.rivera@gmail.com

1. INTRODUCTION
Clinical Learning Environment (CLE) is clearly defined in the nursing framework as an interacting
network of variables inside the clinical context that impacts students’ learning outcomes. CLE has five
components namely: pedagogical atmosphere on the ward, supervisory relationship, leadership style,
premises of nursing, and role of the nurse teacher [1].
Students' exposure to clinical environment plays a huge role in the teaching-learning mechanism.
Research has found out that learning environments is regarded as one of the fundamental elements that
influence the aptitude of students [2].
However, newly graduated nurses with lacking nursing training are afraid to make mistakes in a life-
threatening situation [3]. The lack of opportunity to perform clinical practice is the biggest problem in terms
of the confidence of student nurses to perform core clinical skills. Therefore, enhanced educational strategies
and knowledge applications should be utilized to increase confidence and knowledge to perform clinical
skills and their competence in utilizing nursing process.

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ISBN: 978-623-5729-19-0 49

In addition, a research study done in Oman on student nurses' satisfaction with and effectiveness of
the learning experience found that satisfaction with the CLE sub-dimensions was highly essential and had a
positive relationship with the overall clinical learning environment [4]. In contrast, a study found that the
function of the clinical teacher in clinical practice had the lowest mean rate [5].
It has been shown that students who study in a supportive learning environment are more inspired,
engaged, and have higher overall learning potential. Students, on the other hand, studying in bad settings with
unpleasant, noisy, and full of distractions, will find it much harder to consume data and remain engaged [6].
Hence, this research study aimed to evaluate the clinical learning environment fostered by the
NEUST and its affiliated hospitals by identifying the demographic profile, clinical hospital assignment, core
competencies, and clinical learning experience of fourth-year student nurses. With this, the teaching
modalities implemented by the institution and the clinical instructors’ performance in the clinical setting are
evaluated based on the results of the respondents’ experiences. Thus, determining the institution’s
performance in terms of delivering a highly competitive and learning-conducive clinical learning
environment for its students.

2. RESEARCH METHOD
This study utilized a descriptive – quantitative correlational design and total enumeration as the
sampling procedure. This was conducted in Nueva Ecija University of Science and Technology at General
Tinio, Cabanatuan City, Nueva Ecija during the months of January to May 2021, gathering data from level
four student nurses as respondents. The researchers chose the Level Four students as the respondents because
they hold vast exposure to clinical settings compared to that of other year levels. Inclusion criteria includes a
total of 1148 clinical hours and under the CHED Memorandum Order No. 14 (CMO No.14) curriculum,
which agreed with the core competencies that were used in the questionnaire. Thus, the researchers
contemplated that they were the most suited individuals to participate in the study. Students that did not meet
the aforementioned criteria are excluded from the respondent population.
The instrument used in this study contains the following sections: (1) Demographic profile that
includes age, sex, and monthly family income; (2) Clinical Hospital Assignment that involves affiliated
hospitals, area of clinical rotation, and duty schedule; (3) Core Competencies adapted from CHED
Memorandum Order (CMO) no. 14 which include safe and quality nursing care, management of resources
and environment, communication, collaboration and teamwork, health education, legal responsibility, ethico-
moral responsibility, personal and professional development, quality improvement, research, and records
management; and (4) Clinical Learning Environment (CLE) that consists of pedagogical atmosphere on the
ward, supervisory relationship, the leadership skills of student nurses in peers, nursing care in the ward, and
clinical instructor relationship. For data analysis, the sample means, frequency, distribution, and Pearson’s r
Correlation were used to find significant relationship of demographic profile to core competencies and
clinical learning experience.
The researchers observed ethical considerations, reviewed and checked by the research board, to
promote the goals and objectives of the research itself, support the social and moral principles, and secure the
values of individuals involved in the research study. The researchers ensured that no respondents were
coerced, deceived, or harmed in participating in the study. Data collection was done after the respondents
were informed about the research objectives and signed the consent form. Also, the researchers assured the
respondents to implement data privacy and confidentiality.

3. RESULT AND DISCUSSIONS

Table 1. Frequency Distribution of Fourth-year nursing students characteristics at NEUST (n=15)

Characteristic Frequency Percentage
Age
21-25 8 53.3
26-30 4 26.7
31-35 3 20.0
Sex
Female 12 80.0
Male 3 20.0
Family Monthly Income
0-5,000 0 0
5,001-10,000 8 53.3

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50 ISBN: 978-623-5729-19-0

10,001-20,000 4 26.7
20,001-30,000 1 6.7
30,001-40,000 2 13.3

Based on table 1, it is known that there are 15 respondents (100%), showing that most respondents
are between the ages of 21-25 with 8 nursing students (53.3%) and most of the respondents are female
amounting to 12 (80%). The small quantity of respondents is the result of the K-12 implementation in the
Philippine education system that adds two more years in high school which occurred in the school year 2012-
2013[7]. The enrollees are students who belong in the old curriculum and are returning to college to pursue
their undergraduate studies, thus resulting to low enrolment rate. Meanwhile, the majority of respondents
have a family income between Php 5,001-10,000 consisting of 8 respondents (53.3%). This is included in the
demographic parameters to identify whether financial capability is a critical factor in enhanced clinical
learning experience. Since it was argued that a higher income family promotes better learning outcomes as
tools, books, and gadgets effective for learning are fulfilled [8].

Table 2. Frequency Distribution of Fourth-year nursing students’ clinical

hospital assignment at NEUST
Clinical Hospital
Frequency Percentage
Assignment
Rotation
Dr. Paulino J. Garcia
Memorial Research and
11 73.3
Medical Center
(PJGMRMC)
MV Gallego
Cabanatuan City General 1 6.7
Hospital (MVGCCGH)
Eduardo L. Joson
Memorial Hospital 3 20.7
(ELJMH)
Gapan District Hospital
0 0
(GDH)
Area
Medical Ward 3 20
Surgical Ward 3 20
OB Ward 0 0
Pediatric Ward 0 0
Outpatient Department 0 0
Emergency Room (ER) 0 0
Operating Room (OR) 8 53.3
Delivery Room (DR) 1 6.7
Neonatal Intensive Care
0 0
Unit (NICU)
Orthopedic Ward 0 0
Duty Schedule
Morning shift 12 80
Afternoon shift 0 0
Night shift 3 20

Based on table 2, the respondents preferred PJGMRMC, the base hospital, for hospital rotation that
obtained 11 (73.3%), OR for hospital area with 8 (53.3%), and morning shift for duty schedule with 12
(80%). PJGMRMC is the leading government hospital in the province of Nueva Ecija and one of the oldest
hospitals in Central Luzon [9]. It has numerous services ranging from internal medicine, obstetrics and
gynecology, clinical nutrition, and surgery to name a few, which provides a wide-array of exposures for
students. On the other hand, a research study discovered that OR practice provided a significant contribution
to student nurses’ education and was effective in the determination of their career preferences after

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ISBN: 978-623-5729-19-0 51

graduation [10]. The preference of morning shift is also similar to what a scope review found that
emphasized despite considerable stress during morning shifts, nursing is more active, and there are different
opportunities for learning because more people work during the day [11].

Table 3. Rate and Description of Fourth-year nursing students’ core competencies at NEUST
Core Competencies Rate Description
1. Safety and quality
4.57 Always
nursing care
2. Management of
4.64 Always
resources & environment
3. Communication 4.77 Always
4. Collaboration and team
4.83 Always
work
5. Health education 4.65 Always
6. Legal responsibility 4.89 Always
7. Ethico-moral
4.84 Always
responsibility
8. Personal and
4.61 Always
professional development
9. Quality improvement 4.61 Always
10. Research 4.27 Always
11. Record management 4.81 Always

Based on table 3, legal responsibility obtained the highest rate of 4.89 with a description of always
while research having the lowest rate of 4.27. This means that the respondents always ensure competence in
providing safe care by respecting the client’s privacy and having documentation of care rendered to clients.
Ensuring that the safety and quality of the client are performed in the health care practices are considered to
be the most crucial and essential part of nursing care [12]. But, a few of the respondents do not apply
research findings in nursing practice and even share research conclusions all the time. Information literacy
empowers nurses to use research in their future endeavors to make meaningful and sound clinical decisions
[13]. As such, it is encouraged to promote the dissemination of research findings and apply them to nursing
practice.

Table 4. Rate and Description of Fourth-year nursing students’ clinical learning experience at NEUST

Clinical Learning
Rate Description
Experience
1. Pedagogical
3.69 Fully Agree
Atmosphere in the ward
2. Leadership Skills of
3.82 Fully Agree
Student Nurses in Peers
3. Nursing Care in the
3.82 Fully Agree
Ward
4. Supervisory
3.60 Fully Agree
Relationship
5. Role of the Clinical
3.81 Fully Agree
Instructor

Based on table 4, leadership skills of student nurses in peers and nursing care in the ward gained the
highest rate of 3.82 with descriptions of fully agree, while supervisory relationship secured the lowest rate of
3.60. The data shows that there is an equal opportunity for each member of the team in doing group works,
they educate the client regarding their health and make sure that the documentation is clear. The supervisory
relationship appeared to promote positive energy, but some do not agree with receiving individual
supervision. A cross sectional study concluded that the clinical learning environment and supervision
contribute to the formation of professional competence in future healthcare workers [14]. It was also
discovered that the supervisory connection has a substantial impact on the results of students' experiences.
Hence, supervisions specifically individualized setups support the growth of students.

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52 ISBN: 978-623-5729-19-0

Table 5. Relationship between Demographic Profile and Core Competencies of

Fourth Year Nursing Students of NEUST
Core Competencies Actual Age Sex MFI
*
SQMEAN Pearson Correlation -.514 .213 .224
Sig. (2-tailed) .050 .445 .422
N 15 15 15
MREMEAN Pearson Correlation -.497 .248 .203
Sig. (2-tailed) .060 .373 .467
N 15 15 15
CMEAN Pearson Correlation -.560* .147 .305
Sig. (2-tailed) .030 .601 .269
N 15 15 15
CTMEAN Pearson Correlation .065 -.038 .040
Sig. (2-tailed) .819 .893 .887
N 15 15 15
HEMEAN Pearson Correlation -.364 .093 .040
Sig. (2-tailed) .183 .741 .889
N 15 15 15
LRMEAN Pearson Correlation -.139 .092 .048
Sig. (2-tailed) .620 .744 .866
N 15 15 15
EMRMEAN Pearson Correlation -.071 .146 .187
Sig. (2-tailed) .803 .604 .505
N 15 15 15
PPDMEAN Pearson Correlation -.342 -.014 .160
Sig. (2-tailed) .212 .962 .568
N 15 15 15
*Correlation is significant at the 0.05 level (2-tailed).
** Correlation is significant at the 0.01 level (2-tailed).

Based on table 5, the correlation coefficient value of age and safe and quality nursing is -0.514 with
a p-value of 0.050. Since the p-value equals the level of significance established at 0.050, the analysis
indicates that the null hypothesis is rejected, indicating that there is a significant link between real age and
safe and quality nursing. Furthermore, the data indicated that the age and communication correlation
coefficient value is less than the specified level of significance; hence, the null hypothesis is rejected. As a
result, there is a direct relationship between real age and communication. Consequently, both of which are
interpreted as a moderate negative correlation. This implies that younger respondents or respondents who
belong to the common age range of fourth-year nursing students (21-25 years old) tend to have higher
competencies on safe and quality nursing care and in communication than older respondents who belong to
ages 26 years old and above. At the age of 25, the brain patterns start to solidify, and they will become harder
to change [15]. Individuals can still learn new things as they age, but it might take some extra effort.

Table 6. Relationship between Demographic Profile and Clinical Learning Experience of

Fourth Year Nursing Students in NEUST
Clinical Learning PA LS NCW SR RCI
Experience MEAN MEAN MEAN MEAN MEAN
Actual Pearson -.306 -.399 -.232 -.371 -.597*
Age Correlation
Sig. (2-tailed) .268 .140 .406 .174 .019
N 15 15 15 15 15
Sex Pearson .156 .284 .215 -.174 .199
Correlation
Sig. (2-tailed) .578 .304 .441 .535 .477
N 15 15 15 15 15
MFI Pearson .095 .324 .151 .047 .208
Correlation
Sig. (2-tailed) .736 .239 .591 .867 .456
N 15 15 15 15 15

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ISBN: 978-623-5729-19-0 53

*Correlation is significant at the 0.05 level (2-tailed).

** Correlation is significant at the 0.01 level (2-tailed).

Based on table 6, the p values are greater than the level of significance set at 0.050, analysis reveals
to accept the null hypothesis. Thus, there is no significant association between demographic profile and any
of the clinical learning experience parameters. This suggests that respondents' clinical learning experiences
are unrelated to whether they are young or elderly, male or female, or have a low or high monthly family
income. This finding is comparable to another study that identified that the age of the participants had no
meaningful connection with the clinical learning experience [16]. Though it was mentioned specifically that
students' learning experiences may be improved by providing preclinical orientation, defining clinical
learning outline and goals to students, and regular visits and monitoring of students in the clinical context.

4. CONCLUSIONS
Level four nursing students showed a good standing in core competencies and clinical learning
experience. Nonetheless, it was revealed that research and supervisory relationship had the lowest rate
compared to other core competencies and clinical learning environment areas. Hence, research competency
must be strengthened and individual supervision must be enforced.

Acknowledgements
This work was made possible by the Nueva Ecija University of Science and Technology – College
of Nursing. We thank our research instructor, Zuzette B. Catabona; research adviser, Divina B. Ocampo; and
dean of the CON, Dr. Jean Guillasper; for their supervision and insightful suggestions in making this study
more impactful. We also acknowledge Cheena B. Mallari, research unit head, for her unrelenting support to
make us, researchers, be better in what we do. We also give appreciation to Kim Jay Rivera for helping us
find participants for our pilot study.

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