Introduction “Knowledge results from the combination of grasping (observation) and transforming reflections into action (concrete experience)” (Kolb, 1894). Nursing is a practice profession. Clinical experience in the clinical setting is the integral part of the total education process for nursing students.
(Estrella Cuarezma Sanchez, 1998) The clinical exposure of a student nurse is an experience that is not to be taken for granted. It is as important (if not more so) than the classroom lectures.In the field, the student nurse is allowed to experience dealing with actual patients and witnessing medical cases first hand. That is the reason why it is imperative that the student nurse make the most of his or her clinical experience. Learning is the acquisition of knowledge by study, instruction, practice or experience. To undergo a more meaningful learning, student nurses must have a positive experience in their practice setting.
The Related Learning Experience (RLE) is the practicum component of the revised BSN curriculum which is community-oriented and competency based.In the long run, student nurses eventually learn how to collect data, interpret and synthesize findings, evaluate critically the effects of actions taken, perform procedures skillfully and relate to patients in an ethical and caring manner. But mastery of these lores will not take place unless students learn how to transform their experiences at work. A student nurse must unfold different abilities in order to fully utilize his or her experiences so he or she can assimilate these learnings.These abilities include learning from actual experience, learning by observing others, creating theories to understand what is seen and finally, using these theories to solve problems. In due time, with all their gained experienced learning, student nurses will be equipped with proper skills, sufficient knowledge and right attitude to be competitive with colleagues in the real nursing world. Hospital is an institution equipped and staffed to provide medical, surgical and sometimes psychiatric care for the sick and injured. This is where all health care providers practice their profession, this includes student nurses.
As an institution, whether private or public, it maximizes the learning opportunities of student nurses. Student nurses are able to learn by observing health care professionals perform different medical procedures or by carrying out some of these activities themselves, of course under the supervision of a clinical instructor. Hospital learning experiences reinforce and strengthen their competencies both in classroom and in clinical area.
Eventually, it would lead them to exercise what is expected of them as they handle lives and assume the role of a professional health care provider.That is why in Manila Doctors College, student nurses are provided rotations on different affiliated hospitals, both private and public. This is due to the reason that types of hospital rotation (private or public) have advantages and disadvantages that could greatly affect their learning experience. Opportunities for learning when it comes to gaining clinical experiences are equal.
However, there are limitations in each type of hospital that give restrictions to the gaining of knowledge and experiential learning. The limitations hinder the students in practicing learned skills that they need to acquire.Each task a nursing student face during their clinical exposure requires a corresponding set of skills for effective performance. The effective matching of task demands and personal skills results in an adaptive competence gained from experience as the source of learning and development. The study comprises the extent of experiential learning to see which one is more likely to provide improvement in clinical ward area competencies in terms of concrete experience and reflective observation when group according to gender and type of hospital rotation (public or private). Background of the StudyAs part of the Bachelor of Science in Nursing, students are exposed to public and private hospitals.
This aims to apply all learning from lectures and discussions. Setting as their laboratory, these experiential learning prepares and improves them for their future clinical responsibility – providing care and handling lives. Highlighting a conducive learning environment, as stressed by Espiritu (2000), promotes more effective grasping of knowledge and increases the student’s self-confidence in hands-on work. This is more likely to promote the student’s ability to apply energy creatively and to achieve learning goals.As supported by Medina (2008), she emphasized these clinical experiences as a fundamental process. Experiential learning has numerous benefits in the clinical setting. Learning through experience provides the opportunity for immediate application of classroom knowledge to the work world.
It also aids the students to be more responsible for his or her learning. Moreover, the student nurse can establish professional relationships to mentors who can undertake the parts of role models. As mentioned by Rothwell (2003), Clinical environments continue to change dramatically as there would be new rules, policies or set up the hospitals may have.Students will be also assigned to different a hospital which also has different policies that they should follow and conform to. In the hospital setting, the students learn practical nursing and engage in performing more extensive care of patients with different cases.
In private hospitals, the health care providers especially the nurses really see to it that they deliver high quality care parallel to the charged fees from the accommodation and medical services of their patient. Sheth (2008) sighted that private hospitals possesses centralized care.Therefore, student nurses are exposed to a conducive learning brought by ideal nursing practice exhibited in the health care setting. In the said type of hospital, Colladilla and Argos (2000) claimed more opportunities available both professionally and personally for its staff. Thus, student nurses in return could profit from it.
Also, these hospitals are equipped with well maintained facilities, highly technologic equipment and complete medical supplies. (Johns, 2000) Thus, familiarization begins and would further evolve to learning. Adequate manpower plus limited handled patients could provide a centralized care.However, there are also disadvantages. Limited assignments are given to student nurses because they make sure they give quality care to patients due to patient’s payment for services rendered. There are strict norms associated with providing health care interventions.
Herewith, staffs nurses have significant liability to their patients. They can not afford to make mistakes. That is why, unlike in public hospitals, students learn more through observation of the different procedures done in the hospital.
Public hospital provides culturally competent care (Vaknin, 2008).In public hospitals, student nurses learn from actual experience. They can assume the role of staff nurse. They are given the chance to deliver hands on care to patients. Numerous medical cases are encountered and through their recurrent handling of cases, student nurses are a step closer to expertise. They would develop certain schema on different nursing strategies so that the next time they come across a nursing problem similar to what they’ve encountered, they would already know how to approach the situation.
Due to the inadequacy of resources, there would be enhancement in critical and creative thinking.In contrast, the student nurses are out in the open of non ideal provided care. They have limited resources (equipment, medicine and facilities) and man power (lack of staff nurses and overwhelming number of patients) (Calo, 2006). Chosen respondents are the Level III MDC students. It is because they are much more exposed in RLE. It is expected that they had somewhat adapted on the clinical experience especially in ward area compared to Level II. Third year students have ample experience in witnessing health care providers, specifically the staff nurses, as they perform their given duties in the hospital.
Also, they are given the chance to perform a staff nurse’s task and accomplish more advanced procedures whenever permissible. This is very beneficial to them because they are able to attain higher level of knowledge, skills and attitudes with every experience they acquire. In addition, Level III student nurses are given longer clinical exposures especially in ward areas. Their clinical knowledge, skills and attitudes are being stabilized in preparation for staffing during Level IV RLE. Therefore, these respondents are surely apt in determining the extent of experiential learning obtained from their longer hours of clinical experience.The study was chosen because the researchers want to determine the extent of experiential learning in private and public hospitals as perceived by the Level III MDC student in terms of concrete experience and reflective observation. This study would enhance and further improve the RLE competencies of each student. Through the result of gender differences, this could also increase individuals’ understanding of the process of learning from experience and their unique individual approach to learning.
By increasing awareness of how they learn, the study aims is to increase learners’ capacity for meta-cognitive control of their learning process, enabling them to monitor and select learning approaches that work best for them in different learning situations. Conceptual Framework Kolb’s Experiential Learning Theory (2007), for over thirty-five years research based on experiential learning theory, talks about building upon earlier work by John Dewey and Kurt Levin, American educational theorist David A.Kolb believes “learning is the process whereby knowledge is created through the transformation of experience”.
They gave experience a central role to develop a dynamic, holistic model of the process of learning. It is a holistic theory that defines learning as the major process of human adaptation involving the whole person. As such, Experiential Learning Theory is applicable not only in formal education classroom but in all arenas of life. The theory presents a cyclical model of learning, consisting of four stages shown below.One may begin at any stage, but must follow each other in the sequence. Kolb’s four-stage learning cycle shows how experience is translated through reflection into concepts, which in turn are used as guides for active experimentation and the choice of new experiences. The first stage, concrete experience (CE), is where the learner actively experiences an activity such as a lab session or field work. The second stage, reflective observation (RO), is when the learner consciously reflects back on that experience.
The third stage, abstract conceptualization (AC), is where the learner attempts to conceptualize a theory or model of what is observed. The fourth stage, active experimentation (AE), is where the learner is trying to plan how to test a model or theory or plan for a forthcoming experience. The researchers believe that this theory is appropriate in the study with regards to the Clinical Experiences of students in the field.
These are the 1st and 2nd stage of Kolb’s learning cycle: Concrete Experience, and Reflective Observation. These two are the most common way of acquiring clinical experiences for students.The concrete experience is the duty itself to assume the role of a professional nurse with certain limitations and with supervision of the clinical instructor. The reflective observation happens when the student observes nursing procedure/skills in the area. Due to observation of the said nursing skill or procedure in that specific area, you learn on how the procedure or skill should be done, the way a professional nurse should do it. By attending your duty, as time goes by, your experience becomes stored in your memory, but only the meaningful experience can be stored, the one where you really earned from. So when time comes, you could look back at this experiences all over again to gain knowledge and wisdom from your past experiences. Student nurses are exposed to changing environment whether it is a public or private institution, recent study from the ELT perspective organizational learning requires that the opposing perspective of action/ reflection and concrete involvement/ analytical detachment are valued and integrated into a process that follows that whole learning cycle and is adaptive to changing environmental challenges that enhances learning.
Figure I Research Paradigm The above figure shows that the profile of the Level III MDC students: gender and type of hospital, that the respondents were currently exposed in, can primarily influence the extent of experiential learning in terms of concrete experience and reflective observation. The profile of the respondents is the independent variable while the extent of experiential learning is the dependent variable. The arrow represents the significant difference in the extent of experiential learning when group accordingly to the profile.
A gender-based preference in learning style is only one area in which males and females are unique (Fleming, 2000). One purpose of the study was to assess gender differences in learning style preferences. The knowledge of nursing student preferred learning styles is of the essence so as to provide tailored strategies for a student nurse’s experiential learning. Knowing the differences of the preferred learning style helps to overcome the predisposition of many clinical instructors to treat and motivate all students in a similar way.In so doing, they can reach more nursing students because of the better match between instructors and learner styles.
According to Lie (2004), Males have a preference for rational evaluation and logic, whereas females use “elaborative” processing in which they tend to seek personal relevance or individual connections with the material being taught. This suggests that males tend to be more externally focused, but females tend to be more introspective and self-critical. Briefly as attested by Yeganeh (2006), male benefitting in Concrete Experience and females has advantage in Reflective Observation.
This led to as a challenge in formulating another research in gender in relation to the extent of their learning experience, this time in public and private hospitals. By being aware of their learning style, the students may contribute to their academic success by promoting self-awareness and their use of learning strategies that work for their learning style. As said by Espiritu (2000), a conducive environment provides a lasting teaching-learning experience. Environment, for student nurses, the hospital, is one factor that could manipulate and affect their learning experience in the clinical field.
Hospital is an institution equipped and staffed to provide medical, surgical and sometimes psychiatric care for the sick and injured. In Bachelor of Science in Nursing, Clinical experience is a vital part of nursing education. This in turn, provides nursing students with an opportunity to use the theory and skills they have learned in the classroom and laboratory setting (Medina, 2008). A hospital is a training ground for student nurses (Luat, 2002). This is the reason why every hospital somehow collaborates with an academic institution, or with a medical school.
The study included both private and public hospital because the aim is to find out if each type of hospital can yield different experiential learning for students. The two types of hospitals have their differences when it comes to protocols, practices, environment and use of technology. These differences can have a good or not so good corollary to students’ experiential learning. Therefore, it may be an advancement for the entire college to distinguish these differences and advantages and disadvantages of each type of hospital.The college of nursing will understand more the magnitude of equally exposing students to both private and public hospitals.
Moreover, the clinical instructors will be able to assess various teaching strategies that could apply to a certain type of hospital while the students will be able to take advantage of all the opportunities a private or public hospital can offer and cope up with the disadvantages. In the end, all of the inquiries can ultimately benefit the students’ gain of knowledge and skills so they can achieve a high experiential learning.In private hospitals, the health care providers especially the nurses really see to it that they deliver high quality care parallel to the charged fees from the accommodation and medical services of their patient. Sheth (2008) sighted that private hospitals possesses centralized care.
Therefore, student nurses are exposed to a conducive learning brought by ideal nursing practice exhibited in the health care setting. In the said type of hospital, Colladilla and Argos (2000) claimed more opportunities available both professionally and personally for its staff.Thus, student nurses in return could profit from it. Also, these hospitals are equipped with well maintained facilities, highly technologic equipment and complete medical supplies. (Johns 2000) Thus, familiarization begins and would further evolve to learning.
Adequate manpower plus limited handled patients could provide a centralized care. However, there are also disadvantages. Limited assignments are given to student nurses because they make sure they give quality care to patients due to patient’s payment for services rendered. There are strict norms associated with providing health care interventions.
Herewith, staffs nurses have significant liability to their patients. They can not afford to make mistakes. That is why, unlike in public hospitals, students learn more through observation of the different procedures done in the hospital. Public hospital provides culturally competent care. (Vaknin, 2008). In public hospitals, student nurses learn from actual experience.
They can assume the role of staff nurse. They are given the chance to deliver hands on care to patients. Numerous medical cases are encountered and through their recurrent handling of cases, student nurses are a step closer to expertise.They would develop certain schema on different nursing strategies so that the next time they come across a nursing problem similar to what they’ve encountered, they would already know how to approach the situation. Due to the inadequacy of resources, there would be enhancement in critical and creative thinking. In contrast, the student nurses are out in the open of non ideal provided care. They have limited resources (equipment, medicine and facilities) and man power (lack of staff nurses and overwhelming number of patients). Calo, 2006) Such study was selected because the researchers want to discover the extent of experiential learning in both private and public hospitals through the perception of level III MDC students.
Two approaches, concrete experience and reflective observation, were used to determine the range of experiential learning in private and public hospitals. Through this study, the students will be able to improve their cognition and performance during their related learning experience. As a result, each experience can be deemed as significant and can further contribute to mastery of R.L. E.
knowledge, skills and attitudes needed to become an excellent nurse in the future. In addition, the result of gender differences will assist will make the students understand that even though gender is not very significant when it comes to leaning, specific learning approaches may be more suitable to a certain individual. Consequently, students can assess what approach would best fit their learning style in a particular type of hospital, this way they are more in control of their experiential learning and will be able to navigate it to optimize their learning.
Statement of the Problem This study dealt with the extent of experiential learning in private and public hospitals as perceived by the Level III MDC students. The study intended to find out two things, one is in which method does the student learn more, by reflective observation, by observing the nursing procedure, or by concrete experience by practicing the nursing skill. The second goal is to discover on which environment the student will learn more, is it on a private hospital or on a public hospital. Specifically the following matters were answered: 1.What is the profile of Level III MDC Student respondents in terms of: 1.
1. Gender, 1. 2. Hospital Rotation, 1. 2. 1. Public, 1. 2.
2. Private? 2. What is the extent of experiential learning acquired by the Level III MDC Student respondents in terms of: 2. 1.
Concrete experience, 2. 2. Reflective observation? 3.
Is there a significant difference in the extent of experiential learning acquired by the Level III MDC Student respondents when grouped according to profile? Hypothesis In accordance with the problem of this study, the research problem originated and was tested at the level of significance of 0. 05.There is no significant difference in the extent of experiential learning acquired by the Level III MDC students when grouped according to gender and hospital rotation. Significance of the Study This study measured the extent of experiential learning of the students when grouped according to gender and non-surgical ward rotation exposure in private or public hospital. It aimed to find out which of the two hospitals will improve acquisition of clinical ward competencies in experiential learning based on the perception of Level III students of Manila Doctors College in terms of concrete experience and reflective observation.Moreover, the results of this study are significant to the following: To the College of Nursing, this study will help the nursing educators in making a decision in assigning the students on which clinical ward to expose them to be able to provide full extent of learning experience. The college will be more aware on which hospital can the students be able to acquire experiential learning in terms of concrete experience and reflective observation.
This could also help them in understanding student’s need of chance to experience and observe actual procedures in the hospital.To the clinical instructors, this study will be able to help clinical instructors to be more aware of the effects of different environment to their student’s way of learning. This study will make clinical instructors more adaptive in leading their students to work independently and to gain experience at a full extent. To the nursing students, this study will help students to vent out their opinions for them to acquire varied experience with the help of the educational institution.They could also gain advanced extent of learning experience for them to become more competitive in their chosen endeavor.
Male and female nursing students will be able to adapt on their weak points in learning through experience in terms of concrete experience reflective observation. To the future researchers, this will provide them background information and serve as a guide to come up with another study that may contribute to the improvement of nursing student’s extent of experiential learning. Scope and DelimitationsThe following discusses the coverage and the limits of the research study conducted: This study involves the perception of nursing students in the extent of their acquired experiential learning in private and public hospitals in terms of concrete experience and reflective observation when group according to their profile: gender and type of hospital rotation. A quantitative research design was used with a total number of three hundred four (304) respondents from a population that is comprised of one thousand two hundred fifty one (1251) that is comprised of Batch 2010 Level III nursing students of Manila Doctors College.A questionnaire was used as a tool in quantifying the extent of experiential learning. This was provided in their respective clinical rotation.
The study is limited to Manila Doctors Hospital as the private hospital and Pasay City General Hospital and National Children’s Hospital as the public hospitals used as the locale for they are the clinical rotation sites that had a non-surgical ward experience on May 2009. The researchers limited the study to the most recently exposed clinical rotation site of the respondents at May 2009. Definition of TermsThe following terms were used operationally for better comprehension of this study; these terms were now defined as it is used in the study: Concrete Experience refers to the learning of the student nurses through performing or doing nursing procedures and interventions during actual non-surgical ward exposure. Experiential Learning refers to the learning acquired by the student nurses through non-surgical ward exposure during their related learning experience (RLE) hours. Extent is the range, limit or degree in which student nurses learn from their non-surgical ward exposure in private and public hospitals.Non-surgical Ward refers to a clinical area in the hospital wherein patients in need of medical treatment are accommodated and admitted without the need to undergo surgical procedure. Reflective Observation refers to the learning acquired by the student nurses through observing nursing procedures and interventions while it is perform by the staff nurses during actual non-surgical ward exposure. Private Hospital refers to a hospital owned and run by a non-government organization.
Public Hospital refers to a hospital owned and run by the government.