The Effects of Specific Clinical Experiences on the Attitudes of Students Toward Patient Care.

Abstract

The purpose of this study was to determine the effects of specific clinical experiences on the attitudes of nursing students toward care of patients. The study identified similarities and differences of students' attitudes in the sophomore, junior and senior classes in three specific clinical settings. The rationale and research questions which guided this study were derived from a review of: (1) studies dealing with attitudes of students toward the elderly, the acutely ill, the mentally ill, and toward stressful situations and events, and (2) studies which demonstrated the existence of gaps in knowledge about background characteristics from which attitudes are formed. The instrument used to collect the data was designed by the investigator to measure attitudes of students before and after experiences in three clinical settings, the nursing home, hospital and public health agency. The sample population consisted of 312 baccalaureate nursing students from Wayne State University College of Nursing, Detroit, Michigan. The attitude scores were factor analyzed to build a set of nine attitude indices. These indices were related to a set of background characteristics, to class level and to clinical setting. The t-test for correlated means was used to test the extent to which the students changed on the nine attitudinal indices after each of three different placements. Age, place of birth, and race of students were related to some of the attitudinal indices. Among the more important relationships were several indicating a decline in the belief that nursing homes were appropriate settings for the care of the elderly and acutely ill, and evidence that student perception of the need for supervision is greatest in the more stressful hospital setting. In hospital settings, the most significant change of attitudes in students was in relationship to the instructor and was positive. Students showed a slight change in their attitude and ability to care for acutely ill patients. In the nursing homes, the study revealed that students found their overall experience to be a highly positive one. Their attitudes toward patient care and the instructor were more positive, and some change occurred on the majority of the nine indices. There was no significant change in student attitudes toward the terminally ill patient. Students who had nursing home placement showed no significant change in attitudes related to fear of the environment or to caring for the acutely ill, but indicated that the race of the provider of care was of some importance. In public health settings, changes in attitudes of students indicated they fell somewhere between those reported for hospitals and nursing homes. Student responses indicated less fear of the environment, less dependence on supervision in the clinical setting, and the ability to provide care to the acutely ill patient. An important implication of the findings is the need for frequent and continuing review and evaluation of clinical settings and experiences used for the education of nursing students. The objective should be to engender in students positive attitudes about the patients to whom they give care.