Experiences of nursing students undertaking clinical placement in a bachelor degree : a perspective of diversity

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Evidence suggests that nursing students’ diverse cultures and backgrounds may have a less positive experience than mainstream students during their clinical placement and leave their nursing courses at higher rates, but whether their clinical experiences play a role is unclear. Further, little is known about which socio-demographic characteristics or attributes if any, may lead to nursing students feeling different to their peers during their clinical placements and how this may affect the quality of their clinical experiences. There is therefore a need to better understand these effects not only from the student’s perspective but from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. This study, ‘Exploring Diversity Among Nursing students (EDAN) on clinical placement’, used a mixed methods approach involving an anonymous web-based survey. A broad-based definition of diversity described by Loden and Rosener (1991) was modified and used to include age, gender, ethnicity (including language and religious belief), sexual orientation, educational background, income, marital status, parental status, work experience and disability. First, second and third year students undertaking any Bachelor of Nursing course (N=704) and university staff involved in the clinical learning environment (N = 165) were recruited from seven Australian universities. Both quantitative and qualitative data indicated that diversity attributes affect students’ experience on clinical placement. When comparing the sociodemographic characteristics of those who felt different with those who did not, students who were older, male, International, had previous nursing experience, had lesser English language skills, a previous degree, non - Australian born and not in paid employment were more likely to report feeling different (p <0.001 for all characteristics except not in paid employment p <0.05). Analysis of the open-ended comments refined three themes under the construct of diversity, Difference, Difficulties and Discrimination. Subthemes within the theme of Difference were “being and feeling” and “experience, exposure and expectation”. Within the theme of Difficulty were the subthemes “not prepared for diversity” encountered during the placements, “speaking up” about the challenges, and “surviving financially”, the financial impact of a reduction or absence of part-time employment. The subthemes within Discrimination were “prejudices do prevail”, “send them home” and “walked away”. The finding that students and workforce staff for whom English is a second language affected the clinical and learning experiences of students who spoke English as a first language has not been previously reported. The model proposed used in this study, based on diversity theories was supported by the findings and also helped to identify where further research is required. The findings are important to enable the provision of appropriate support for nursing students who feel different because of socio-demographic characteristics and will also provide guidance for universities developing curricula and the clinical placement facilities where students obtain their experience. More importantly, there is an urgent need for Australia to develop a national profile of nursing students. Changes in the socio-demographic characteristics of the nursing student population have occurred and will continue. These must be acknowledged and strategies developed both locally and nationally to manage these changes.
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