School of Nursing and Midwifery, Trinity College Dublin, Ireland.
Mother Theresa Postgraduate and Research Institute of Health Sciences, Pondicherry, India.
Nurse Educ Today. 2021 Jun;101:104875. doi: 10.1016/j.nedt.2021.104875. Epub 2021 Mar 18.
This systematic review aimed to offer insight and understanding, through synthesis of findings from studies that report on perspectives of student nurses/midwives, clinical instructors, clinical nurses/midwives on the challenges faced by student nurses/midwives in the clinical learning environment (CLE).
All primary qualitative research studies published in the English language that reported on the views of student nurses/midwives, clinical instructors and clinical nurses/midwives on the challenges faced by student nurses/midwives in the CLE were included.
The electronic databases of Medline EBSCO (1946-), CINAHL (1970), Embase Ovid (1974-), ScielO, WHOLIS (2002-), ASSIA (1985-), Web of Science (1956-), PsycINFO (1800s-) and Maternal and Infant Care (1970-) were searched in November 2019.
Retrieved papers were reviewed independently by two authors for selection by title, abstract and full text, and two authors agreed for inclusion of the papers. The COREQ criteria checklist was used for assessment of methodological quality of the included studies.
The review included 32 studies published over 22 years between 1997 and 2019 involving 853 nursing/midwifery students, clinical instructors, and clinical nurses/midwives from 14 countries. Three key themes emerged: 'The support structure', 'Personal factors', and 'Planning and organisation - influence of extrinsic factors'.
Attitude of clinical staff, instructors, and significant others had a major influence on students' clinical learning. Lack of a sense of belongingness and self-motivation to learn, and perceived fear of doing errors were some of the demotivating factors. Lack of resources to facilitate need-based training, staff shortages, workload and inconsistencies between theory and practice were other key challenges in the CLE. Understanding the challenges faced by students in clinical practice can help overcome the barriers leading to development of competent and confident nurses and midwives.
本系统评价旨在通过综合报告学生护士/助产士、临床教师和临床护士/助产士对学生护士/助产士在临床学习环境（CLE）中面临的挑战观点的研究结果，提供深入了解和认识。
纳入所有以英语发表并报告学生护士/助产士、临床教师和临床护士/助产士对学生护士/助产士在 CLE 中面临的挑战观点的原始定性研究。
2019 年 11 月，检索了 Medline EBSCO（1946 年-）、CINAHL（1970 年）、Embase Ovid（1974 年-）、SciELO、WHOLIS（2002 年-）、ASSIA（1985 年-）、Web of Science（1956 年-）、PsycINFO（19 世纪）和母婴护理（1970 年-）等电子数据库。
由两位作者独立对检索到的文献进行标题、摘要和全文筛选，两位作者对纳入文献达成一致意见。采用 COREQ 标准清单对纳入研究的方法学质量进行评估。
本研究共纳入 32 项研究，这些研究发表于 1997 年至 2019 年期间，涉及来自 14 个国家的 853 名护理/助产专业学生、临床教师和临床护士/助产士。研究结果揭示了三个关键主题：“支持结构”、“个人因素”和“规划和组织-外在因素的影响”。
临床工作人员、教师和其他重要人员的态度对学生的临床学习有重大影响。缺乏归属感和自我激励学习的动力以及对犯错的恐惧是一些消极因素。缺乏促进基于需求的培训的资源、人员短缺、工作量以及理论与实践之间的不一致性是 CLE 中的其他主要挑战。了解学生在临床实践中面临的挑战有助于克服障碍，培养有能力和自信的护士和助产士。
