Clinical Learning Experiences Research Articles

Livestreaming clinical experience to remotely located learners: A critical narrative review.

Medical education relies on real patient learning (RPL) to provide medical students with essential clinical experience. However, growing demand for clinical placements continues to be a challenge in providing sufficient RPL opportunities. The COVID-19 pandemic forced academic institutions to rethink the delivery of traditional clinical training and innovations in online clinical learning experiences, specifically livestreamed clinical experiences, have emerged which show promise in addressing the capacity limitations of traditional placements. Although previous reviews have explored the use of livestreamed clinical experiences during the pandemic, there is a lack of rigorous theoretical framing to support these innovations. The aim of this review is two-fold: to examine the effectiveness of livestreamed clinical experiences through an experience-based learning (ExBL) theory perspective and to provide practical recommendations to optimise and implement these innovations. A review of literature was conducted to identify journal articles published between September 2019 and January 2023 reporting on innovations relating to livestreamed clinical experiences. The search focused on undergraduate and postgraduate medical education but relevant evidence from other healthcare professions were also included due to a limited evidence base. Strengths and weaknesses were derived from the literature and analysed in relation to ExBL components. Principal strengths of livestreamed clinical experiences included expanded access to RPL opportunities and medical specialties, enhanced standardisation of learning experiences and positive perceptions from students regarding convenience. Clinical educators found these innovations enabled teaching at scale. Patients did not perceive such innovations to negatively impact their standard of care. Limitations included the inability to practice physical examination skills, challenges in ensuring learner engagement and connectivity issues. Livestreamed clinical experiences have the potential to effectively expand placement capacity and provide high-quality educational experiences for medical students. Although certain limitations exist, technological and pedagogical adaptations can help overcome these challenges. The application of theoretical frameworks to future online innovations will be fundamental to ensure effective clinical learning.

Assessment of the psychometric properties of the italian version of the midwifery student evaluation of practice (MIDSTEP-IT): A validity and reliability study

BackgroundClinical learning is a crucial component of the midwifery education program, necessary to support the acquisition of professional abilities through the integration of theoretical and practical learning experiences. Evaluating Bachelor of Midwifery students’ perception of their clinical learning experiences is important to improve midwifery educational programs. Aimthe objective of this study was the translation, cultural adaptation, and validation of the Midwifery Student Evaluation of Practice (MidSTEP) in a group of Italian midwives’ students. Methods“Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice” guidelines were adopted to achieve the MidSTEP Italian version. Exploratory Factor Analysis was performed. Internal consistency for reliability was assessed using Cronbach's alpha reliability coefficient (α) and Omega coefficient (ω), while Intraclass Correlation Coefficients (ICC) were used to determine if the tool was stable over time. FindingsThe Italian version of MidSTEP (MidSTEP-IT) has good internal consistency: considering the Clinical Learning Environment Scale, Cronbach's α was 0.839 (for the “Skill Development” subscale α was equal to 0.739 and for the “Philosophy of Midwifery Practice” subscale α was equal to 0.825) while considering the Midwifery Preceptor Scale, Cronbach's α was 0.920. Factor analysis does not fully reflect the factorial analysis of the original version. ConclusionThe MidSTEP-IT had been proven to be a valid and reliable tool, easy and fast to administer, that could be effectively helpful for investigating and measuring the Italian midwifery students’ perception of their clinical learning experiences, according to the setting and impact of mentors on their professional growth. It is an innovative tool, valuable in both clinical practice and research to highlight the importance of encouraging a supportive clinical learning environment and an efficient preceptorship.

Competency domains for registered nurse preceptor professional development: Evidence from a modified e-Delphi study

AimTo develop an evidence-based framework of nurse preceptor competency domains and competency descriptors for use in nurse preceptor professional development. BackgroundNurse preceptors are registered nurses who coach, support and assess nursing students while simultaneously caring for patients. Working as both clinician and educator requires preceptors to develop additional skills. However, preceptor preparation is often overlooked and may not be evidence based. DesignA modified e-Delphi study. MethodsA three-phase e-Delphi method informed the study that was conducted between March and September 2023. In the first preparatory phase an expert group distilled the results of a previous literature review identifying seven preceptor competency domains and more than 200 competency descriptors. Two e-Delphi rounds followed. A 70% rater agreement response threshold was chosen as appropriate in this study. The CREDES reporting framework was followed. ResultsIn the preparatory phase, the expert group (n=6) reached consensus on six preceptor domains and 57 preceptor descriptors. In Round 1, nurse preceptors (n= 89) rated the domains and descriptors using a four-point Likert scale; from not important to very important. Six domains and 34 competency descriptors were ranked as very important’. Round 2 participants (n=30) who opted in from Round 1 indicated their 100% agreement with the Round 1 results. The results reveal that preceptors resonate intuitively with the six domains Role model, Facilitator, Leader, Evaluator, Teacher and Coach and the related descriptors. ConclusionThe preceptor evidence-based competency framework offers registered nurse preceptors and their employers the opportunity to focus efforts in developing a nurse preceptor workforce. The framework can be used to design preceptor professional development and offers registered nurses a self-assessment tool to identify their preceptorship skills strengths and areas for development. If implemented in these ways the framework may benefit healthcare organisations to provide quality nurse preceptorship, thus enhancing the clinical learning experiences of nursing preceptees.

Assessment of Factors Associated With the Acquisition of Competencies among Undergraduate Nursing Students in Ugandan Universities

Purpose: Like other developing countries, Uganda grapples with the critical challenge of equipping nursing students with essential clinical competencies. These competencies encompass vital nursing skills, knowledge, attitudes, and behaviors crucial for effective nursing practice. This study assessed student perceptions and confidence in applying acquired clinical skills among undergraduate nursing students in Ugandan universities.
 Methodology: A descriptive cross-sectional study was used to assess bachelor's in nursing students from central and western Ugandan universities. Data were entered into Excel and exported to SPSS version 22. Results were presented using frequencies, pie charts, percentages, and tables. Chi-square tests were conducted to assess associations of the variables in the study.
 Findings: The study showed that acquisition of clinical competencies is positively correlated with students’ perceptions (r=0.775) (p=0.000), Institutional factors(r=0.668) (p=0.000), clinical learning environment (r=0.556) (p=0.000), clinical feedback (r=0.439) (p=0.000). The study further shows that 69.9% (n=70) had adequate clinical learning experience, while 31% (n=31) had inadequate clinical learning experience. This implies moderate student supervision, feedback, and an unfavorable clinical learning environment. Competency acquisition in student nurses is positively influenced by the active involvement of students' perceptions, institutional factors, and a supportive clinical learning environment. A sufficient amount of clinical experience is pivotal in developing competent student nurses.
 Unique Contribution to Theory, Practice and Policy: Management should always invite experienced professionals to share career experiences to enhance realistic perceptions among nursing students. Students should be given more time to practice in clinical settings, and management should advocate for including student attitude tests in orientation programs across nursing and clinical training universities.

Experiences of University Nursing Students Regarding Overcrowding by Patients in The Training Health Facilities, Khomas Region Namibia

Overcrowding in healthcare facilities has emerged as a critical issue, posing significant challenges in the delivery of quality patient care. In recent times, there has been an increasing number of patients at the health centres, medical, and surgical emergency conditions, placing more emphasis on the need for quality nursing care. The aim of this study is to explore the causes, consequences and potential solutions surrounding overcrowding in training health facilities. The study employed exploratory, qualitative design. Ninety-eight participants that registered for the academic year 2023 as fourth years at the University of Namibia were recruited and saturated at 9 respondents. Data was coded and analysed using Tesch’s method of data analysis. Three Themes emerged from the exploration and description of nursing students clinical learning experiences. The results indicated that there was indeed overcrowding of patients in the health facilities. The study identified several major challenges confronting nursing students working in the training health facilities which are linked with lack of resources and staff.

Undergraduate Nursing Students’ Satisfaction Level with their Clinical Learning Experiences in Multan, Pakistan

Undergraduate Nursing Students’ Satisfaction Level with their Clinical Learning Experiences in Multan, Pakistan

Clinical Placement Experience, Supervision, and Nursing Career Aspirations of Undergraduate Nursing Students in Sarawak, Malaysia

This study aimed to explore nursing students' perceptions of the clinical learning environment and mentorship during their clinical placement in hospitals and how these factors relate to their intention to work as a nurse upon graduation. A survey was conducted among nursing students who had completed at least 12 months of clinical practice in hospitals located in Kuching, Sarawak, between January 2022 and February 2023. Data were analysed using percentages, frequencies, mean, standard deviation, t-test, Pearson's correlation, ANOVA, and regression analysis. Our findings revealed a significant correlation between the sociodemographic characteristic such as age of students and year of study towards clinical learning experience. Student perceived ward as good learning environment, clinical teacher teaching expertise, and clinical teacher ability to integrate between knowledge and practice rated the most satisfying element in students’ clinical experience. Our study established a significant correlation between student age, year of study, and their clinical learning experiences. Students found the ward environment, clinical teacher expertise, and knowledge-to-practice integration to be highly satisfying elements in their clinical education.

Reimagining rural clinical education from lessons learnt during COVID.

Securing access to sufficient and focussed learning experiences is a perennial challenge for medical trainees. This challenge was accentuated during the COVID-19 pandemic lockdowns and with physical isolation processes that decreased in-person patient presentations and a shift to telehealth consultations. This situation has prompted the need to optimise the available experiences and educational responses to overcome the limitations in the number, quantum and range of available clinical learning experiences. Semi-structured interviews were conducted with medical practice teams in four rural general practices to understand how medical trainees' education in rural general practices can be sustained in such circumstances. Key considerations included optimising the available experiences to assist medical trainees to generate the kinds of mental models needed by trainees to conduct medical work, and particularly, when it became even more restricted through remote or physically distanced consultations. It also identified lessons learnt during COVID-19 pandemic lockdowns to inform and improve the provision of trainees' experiences in such practices. Providing experiences for trainees to participate fully in clinical activities is imperative. A sequenced set of experiences was proposed to incrementally prepare trainees to engage in and conduct clinical consultations remotely using digital technologies. Such an approach may not always be easy or possible to enact but offers a pathway of experiences most likely to lead to positive outcomes for the trainees whilst maintaining patient care and safety considerations.

How medical students' trauma histories affect their clinical clerkship experiences.

As the gender demographics of medical students have evolved over the past decades, it is important to understand potential stressors and challenges that may affect clinical learning experiences. This study investigated the prevalence of prior sexual assault (SA) and interpersonal violence (IPV) in medical students and how these affect their clinical clerkship experiences. A survey was distributed to third- and fourth-year medical students at a single institution in August 2022 querying respondents on demographics and prior experiences with SA/IPV at any point in their lives. Respondents who indicated they had previously experienced SA/IPV were directed to questions about how these experiences affected clerkships. Of 419 students, 125 responded to the survey (30.8% response rate). Forty (31.1%) reported a history of SA/IPV-32 (80.0%) women, five (12.5%) men, and three (7.5%) who did not report gender or identified as non-binary. Of the 40 respondents with a history of SA/IPV, 20 (50.0%) reported that their prior history affected their overall clinical experience, and nine (22.5%) felt that it affected their performance. Only seven (17.5%) reported using any resources, such as counselling, during their clerkships. Narrative responses discussed significant effects on performing physical exams, taking a history, interacting with team members, and engaging during clerkships. This work demonstrates the high number of students affected by SA/IPV and how these prior experiences affected core components of their clerkship experiences. Institutions must be proactive to create better supports for learners with histories of trauma, including SA/IPV.

An insight into the clinical learning environment of dental institutes: a study in the twin cities of Pakistan.

To assess the perceptions of dental students regarding their clinical learning environment in an urban setting. This descriptive, cross-sectional survey was conducted from March 2020 to May 2021 after approval from the ethics review committee of Islamic International Dental College, Islamabad, Pakistan. It comprised of clinical year students, house officers and postgraduate trainees from 6 dental teaching hospitals of Rawalpindi and Islamabad. Data was collected using a pre-validated instrument assessing the dental clinical learning environment. Data was analysed using SPSS 24. Of the 1030 students approached, 561(54.4%) responded. Of them, 448(80%) were girls, 234(41.7%) were 3rd year students, 110(19.6%) were 4th year students, 120(21.4%) were house officers and 97(17.3%) were postgraduate trainees. Female students had a better patient attitude and were more confident in their abilities to keep up with their peers (p<0.05). The students were content with the performance of their clinical teachers, with a mean score of 70.99+/-16.0, while the lowest score of 54.67+/-22.9 was for clinical infrastructure and materials. Students of Islamabad pointed out the lack of clinical materials and maintenance of equipment but noted better research opportunities compared to their Rawalpindi counterparts (p<0.05). The clinical learning environment for Islamabad and Rawalpindi cities individually was good. Overall, students were satisfied with their clinical teachers, learning and training experience. Dental materials, infrastructure and maintenance factors scored the lowest.

Development and usability testing of a patient digital twin for critical care education: a mixed methods study.

Digital twins are computerized patient replicas that allow clinical interventions testing in silico to minimize preventable patient harm. Our group has developed a novel application software utilizing a digital twin patient model based on electronic health record (EHR) variables to simulate clinical trajectories during the initial 6 h of critical illness. This study aimed to assess the usability, workload, and acceptance of the digital twin application as an educational tool in critical care. A mixed methods study was conducted during seven user testing sessions of the digital twin application with thirty-five first-year internal medicine residents. Qualitative data were collected using a think-aloud and semi-structured interview format, while quantitative measurements included the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and a short survey. Median SUS scores and NASA-TLX were 70 (IQR 62.5-82.5) and 29.2 (IQR 22.5-34.2), consistent with good software usability and low to moderate workload, respectively. Residents expressed interest in using the digital twin application for ICU rotations and identified five themes for software improvement: clinical fidelity, interface organization, learning experience, serious gaming, and implementation strategies. A digital twin application based on EHR clinical variables showed good usability and high acceptance for critical care education.

Perception of Nursing Students About Effective Clinical Teaching Environments: A Multi-Country Study.

The transition of nursing education from traditional methods to more advanced approaches is crucial for adequately preparing students to deliver competent care in tertiary care centers. Moreover, clinical faculty in nursing plays a key role in guiding nursing students through their clinical training in various healthcare settings. This study aims to describe the perceptions of undergraduate nursing students regarding the effectiveness of the learning environment and clinical teaching in clinical areas across various countries. The study, conducted using a descriptive, cross-sectional research design, gathered data from 215 nursing students using the Clinical Learning Environment Inventory and Clinical Teaching Effectiveness Instrument. Data analysis included frequencies, percentages, mean, standard deviation, t-tests, analysis of variance, and correlation assessments to comprehend the impact of clinical teaching and learning environments. Nursing students' perceptions of the clinical learning environment produced mean scores between 2.03 and 3.38 on a scale from 1 to 4, resulting in an overall mean score of 2.72 across 42 items. This indicates a general satisfaction with their clinical learning experiences. Regarding effective clinical teaching, the mean student responses varied from 3.02 to 3.40 out of a possible 5 points, with a total mean of 3.22. The study revealed notable correlations in the context of effective clinical teaching, particularly with demographic variables and the clinical learning environment. Specifically, a significant correlation with age (r = .177, p = .009) and the clinical learning environment (r = .572, p < .001) was identified. The study concludes that students expressed overall satisfaction with their clinical learning experiences. They recognized the importance of participating in clinical training, fulfilling clinical responsibilities for assigned patients, exerting extra effort for learning, receiving support from preceptors in clinical settings, and being attentive to communications from staff. The collaboration between clinical preceptors and academic nursing lecturers is crucial in providing a positive learning environment for students to complete clinical tasks effectively.

Experiences of baccalaureate nursing students in preceptorship during the COVID-19 pandemic: a systematic review protocol.

The objective of this review is to appraise and synthesize current evidence of the clinical experiences of baccalaureate nursing students in preceptorship during the COVID-19 pandemic. Nursing education programs support quality clinical practice learning experiences, which are essential for preparing students for both the current and future workforce. The COVID-19 pandemic has drastically changed the health care system and, previous estimates of the global shortage of nurses have now almost doubled. Understanding nursing students' clinical experiences during the pandemic can assist with identifying the needs of the future workforce. Nursing students complete the final practicum, also known as the last clinical, internship, or preceptorship, before they are eligible to apply for licensure. This review seeks to explore these pre-transitional, unprecedented preceptorship experiences during COVID-19 to better understand how to prepare pre-licensure nurses for the altered workforce. This review will include qualitative studies that address the clinical experiences of undergraduate nursing students in preceptorship during the COVID-19 pandemic from 2020 until the present. The databases to be searched will include CINAHL, MEDLINE, ERIC, Google Scholar, and Embase. Reference lists of included studies will be reviewed to identify additional studies. Gray literature will be searched for via ProQuest Dissertations and Theses, Google, and GreyNet International. Unpublished studies will be searched for on websites, including those of national associations of nursing. Study selection, critical appraisal, data extraction, and data synthesis will be performed independently by 2 reviewers. The findings will be collated using meta-aggregation to produce comprehensive synthesized findings and a ConQual Summary of Findings. PROSPERO CRD42022328303.

An In-Depth Analysis of Canadian Medical Students and Physicians Concussion Knowledge: A Cross-Sectional Study

Background: Research has shown that concussion education in a proportion of Canadian medical school curriculums is lacking. The objective of this study was to measure concussion knowledge among medical trainees, while comparing the impact of lecture-based and clinical learning on their concussion knowledge scores. Methods: A validated concussion knowledge survey was distributed to MS1, MS2, MS3, and MS4 students, as well as post-graduate learners in family medicine, pediatrics, and emergency medicine. Results: Participants with clinical learning experience (MS3 + MS4 + Residents) scored significantly higher (p &lt; 0.05) in the concussion knowledge test when compared to pre-clinical (MS1 + MS2) participants. 42.2% of participants learned about concussions from a lecture and 28.1% learned from a student organized interest group. Only 25% of participants correctly identified the red flags associated with a concussion. Conclusion: More emphasis should be placed on teaching concussion diagnosis and management in medical education.

Certified Nurse-Midwives as Teachers: Expanding Interprofessional Collaboration Learning Opportunities for Medical Students on the Obstetrics and Gynecology Clerkship.

Interprofessional experiences provide critical exposure to collaborative health care teams, yet medical students often lack this experience during clinical clerkships. We created a labor and delivery triage rotation exclusively staffed by certified nurse-midwives in the obstetrics and gynecology clerkship to address this gap. We sought to evaluate the clinical learning experiences of medical students rotating on this midwife-supervised collaborative team. Between 2018 and 2020, we electronically sent all medical students an evaluation after each required clerkship. Our primary outcome was the quality of teaching score, as defined by level of agreement on a 5-point Likert scale with a statement regarding teaching quality. A secondary outcome evaluated scores from the National Board of Medical Examiners (NBME) Obstetrics and Gynecology subject examination taken by all students at the end of the rotation. Evaluations and assessments were compared between students rotating on labor and delivery triage and those who did not. Evaluation comments from students rotating on labor and delivery triage were collated to identify common themes. Of 374 students, 370 (98.9%) completed the end-of-clerkship course evaluation and 312 (83.4%) completed teaching evaluations. Sixty-seven students (17.9%) rotated in labor and delivery triage; of these, 52 (77.6%) completed both the course and triage rotation evaluations. There were no differences in the mean quality of teaching scores (3.9 ± 1.2 versus 3.8 ± 1.2, p = 0.54) or in NBME Obstetrics and Gynecology subject examination scores between students rotating in labor and delivery triage compared to all other rotations (79.9% ± 7.2% vs 80.2% ± 7.8%, P = 0.436). Comments from teaching evaluations highlighted student exposure to the midwifery philosophy of care model. This work demonstrates the feasibility and benefits of this midwife-led authentic interprofessional collaborative experience for medical students. This model can serve as an example of how to implement and evaluate interprofessional collaboration experiences in the clinical setting.

Seeing Beyond the Screen: Integrating Trauma- and Violence-Informed Care During a Telehealth Simulation

BackgroundIntimate partner violence (IPV) is prevalent in the United States and may escalate during pregnancy. Therefore, an IPV telehealth clinical simulation learning experience for senior-level maternal nursing students with a standardized live patient was created, implemented, and evaluated by faculty. MethodsTrauma- and violence-informed care was the framework for this telehealth simulation. ResultsFaculty created a video conferencing telehealth clinical experience that will continue to be utilized in the future. A unique “re-debrief” session was created in response to student learning needs. ConclusionStudent nurses need clinical experiences where they can safely practice caring for diverse populations, especially regarding IPV. Telehealth experiences are ideally suited to meet learning needs and student outcomes. Therefore, additional opportunities for assessing IPV risk and providing care should be incorporated throughout the nursing curriculum.

Creation of an Enhanced Primary Care Registered Nurse Preceptor Role: A Pilot Project

ABSTRACT Historically, community health nursing education has not encompassed clinical sites in primary care. Primary care can be an important domain of community health nursing education. However, student practicum opportunities are limited by the number of and underutilization of RNs practicing at the full scope of their licensure (including assessment, client education, care planning and evaluation of care interventions) who can serve as student preceptors, especially in rural areas. This article describes the creation and implementation of the Enhanced Primary Care Registered Nurse (EPCRN) role in rural primary care clinics, as well as evaluates student perceptions of the EPCRN-precepted clinical experience. One nursing school used a federal training award to create the role of Enhanced Primary Care Registered Nurses (EPCRNs) to practice in federally-designated Rural Health Clinics. The EPCRNs worked in the Rural Health Clinics performing patient care and also functioned as student preceptors. Student experiences were evaluated through quantitative and qualitative methods, namely the Clinical Learning Experience, Supervision, and Nurse Teacher (CLES+T) scale and focus groups. This pilot project demonstrated positive pre-licensure student experience feedback as well as role value and sustainability for the health system. This pilot served as an example of a process for EPCRN role design within a primary care clinic site. It also demonstrated the importance of innovative, sustainable academic-practice partnerships.

Midwifery students' perceptions of clinical learning experiences and midwifery preceptors in Turkey

BackgroundThe clinical education environment presents a valuable opportunity for students to learn, acquire and develop the clinical skills essential for professional midwifery practice. The presence of competent and relevant preceptors plays a pivotal role in ensuring the success of midwifery students and fostering positive clinical experiences. AimThis study was conducted to evaluate the clinical practice experiences of midwifery students and their perceptions of midwifery preceptors. DesignA descriptive and cross-sectional study. MethodsThis study was conducted with 205 students enrolled in the midwifery department of the Faculty of Health Sciences of a state university in Turkey. Data collection used a participant information form and the Clinical Learning Environment and Midwifery Preceptor Scales designed to assess factors affecting midwifery students' clinical learning. Data analysis was performed using the SPSS 22.0 program, employing methods such as the Independent Sample T-Test, One-Way Analysis of Variance and Tukey test. ResultsThe average total score on the Clinical Learning Environment scale was 31.08±2.16 out of a possible 32, while the average total score on the Midwifery Preceptors scale was 17.60 (SD 1.27) out of a possible 18. The mean total score of the Midwifery Preceptor Scale and the mean scores of the sub-dimensions of Skill Development and Midwifery Practice Philosophy were found to be statistically significantly higher in those aged 21 years and older than aged 20 years and younger (P < 0.05). The Midwifery Preceptor Scale total score, the Clinical Learning Environment Scale total score and Skill Development sub-dimensions mean scores of the second-year students were found to be statistically significantly higher than the first and third-year students (P <0.05). Furthermore, students who received education in larger groups and willingly chose and had a passion for the midwifery profession demonstrated significant positive perceptions regarding their clinical learning environment experiences and the impact of their preceptors on their professional growth. ConclusionsUnderstanding the perspectives of midwifery students regarding the clinical education environment, preceptors and the teaching and learning process holds great importance for enhancing the quality of the clinical education environment and fostering the development of clinical competencies among midwifery preceptors.

Nursing students’ experiences of workplace violence based on the perspective of gender differences: a phenomenological study

BackgroundWorkplace violence is a worldwide concern, and particularly affects nursing students. It has a seriously negative impact on nursing students’ clinical learning experience and their physical and mental health. This study explored whether there are differences in psychological responses and coping styles among different gender nursing students after exposure to workplace violence, and investigated the causes for these differences.MethodsWe enrolled 22 nursing undergraduates from Guangzhou Medical University and Zunyi Medical University, China. Phenomenological qualitative research and online semi-structured interviews were conducted. The data were analyzed by the Colaizzi seven-step content analysis method.ResultsTwo categories were collated: psychological experience and coping styles. Three themes of the former were extracted: negative emotional experience, low level of professional identity, and negative effect on self-efficacy. Two themes of the latter: responses to violence and adjustment after violence. In addition, fourteen subthemes were extracted.ConclusionsDifferent gender nursing students have different psychological experience and coping styles in the face of workplace violence. The causes of the differences are likely related to sociocultural factors and psychological gender status.

The Effectiveness of Self-Directed Learning Readiness on Competency Achievement of Basic Nursing Clinical Practice Students

Basic Nursing Clinical Practice is the first clinical learning experience for vocational nursing students. The achievement of complete competence will provide a positive experience, ability, willingness to learn actively and independently, and direct continuous learning so that competent vocational nurse graduates are achieved. Self-Directed Learning Readiness (SDLR) is a condition where students have full control in the process of making decisions related to their learning and accept full responsibility for it, even though later they need help and advice from lecturers and Clinical Instructors. Therefore, this research was conducted to determine the effectiveness of SDLR on the competency achievement of basic nursing clinical practice students. This study used a quasi-experimental design with one group pretest and posttest design. The sampling technique used total sampling, with as many as 91 respondents. Respondents were 2nd semester D3 Nursing Study Program students. The analysis used an independent sample t-test, with a 95% degree of confidence. The results of statistical tests using the Independent T-Test showed that there was a positive effect of SDLR on the Competency Achievements of Basic Nursing Clinical Students with a p-value &lt;0.05. Of course, a high level of Self Directed Learning Readiness, can have a positive impact on student competency outcomes in carrying out Nursing Clinical Practice, where competency achievement targets will be met. Achievement of plenary competence will provide a positive experience, ability, willingness to learn actively and independently, and direct continuous learning so that competent vocational nurse graduates are achieved.