Introduction: Clinical learning experience has over the years become an important element of preparing nursing students for what they will be facing on a full-time basis once they are registered nurses. The objective of the study was to investigate the experience of advanced midwifery and neonatal care nursing students regarding their clinical practice at the University of Namibia, Khomas region. 

Methodology: This study adopted a qualitative research design. Purposive sampling was utilized to select 12 participants who were achieved at a point of saturation and took part in the study through a face-to-face interview. Data for this study was analysed through the use of thematic analysis. 

Results: The study found that there was a mixture of good and bad experiences when it came to clinical learning in the maternity ward. The good experiences revolved around gaining the much-needed practical experience and skills to handle various procedures and use various machines and equipment in the ward. On the other hand, the bad experiences revolved around the lack of adequate support and negative attitudes from registered nurses which made the experience unpleasant. 

Conclusion: All in all, the clinical learning experience of the students drew a wide array of experiences that showed the benefit of clinical learning and some of the bad sides of it. 

• The importance of clinical learning to the nursing education is that it equips nursing students with the requisite skills to develop clinical competence.
• An effective strategy to enhance the development of students in becoming independent and knowledgeable in rendering comprehensive nursing care is through the facilitation of clinical teaching
• Nursing student have a wide range of experience when they do clinical learning

Amoo and Enyan, (2022) point out the importance of clinical learning to the nursing education because it equips nursing students with the requisite skills to develop clinical competence. It awards the nursing students an opportunity to practice the theory that is learned in the classroom and lecture halls enabling them to translate the knowledge acquired in the classroom into patient care. An effective strategy to enhance the development of students in becoming independent and knowledgeable in rendering comprehensive nursing care is through the facilitation of clinical teaching (Mellish et al., 2018). A study conducted Amoo and Enyan, (2022) in Ghana, also found that expectations with regard to clinical teaching of student’s objectives were not meet and they were also not taught ideal techniques during clinical placement. The post graduate advanced midwifery and neonatal care course is a new course that was just introduced last year (2022) at the University of Namibia, making the current students for 2023 the second intake to be trained for this course at the University of Namibia. The researcher overheard complaints raised by the students and the nurses at the clinical settings, this have raised questions, concern within the researcher and interest in exploring the experiences of the post graduate diploma students.

This study was guided by the following objective to investigate the   experience of advanced midwifery and neonatal care nursing students regarding their clinical practice at the University of Namibia, Khomas region.

This study utilized a qualitative, descriptive contextual design. The population of 12 students was determined by data saturation using simple random sampling and inclusion and exclusion criteria from September to October 2023.

The interview guide was compiled by the researcher with one central question: tell me about your experiences as a post midwife and neonatal care student? Followed by probing questions such as: Tell me more? Intended to elicit views and opinions from the participants. Data collection commenced as the ethical clearance was received from the School of Nursing and Public Health and written informed consent was received from the participants. The researcher approached the students and explain the aim of the study to them after they have agreed to partake in the study, at the university board room at suitable time for the participants. The interviews took approximately 10 to 15 minutes. Interviews were conducted, where the researcher conducted face-to-face interviews with participants using a tape recorder and field notes. Data was analyzed manually, coded and grouped in to themes and sub themes.

Ethical considerations

The four principles required to guide research included, respect of persons, beneficence, non-maleficence and justice. Permission to carry out this study was obtained from the University and written informed consent from the participants.

Presentation of findings

Demographic data

Below are the demographic characteristics of the participants that took part in the study. 

As shown in table 1 above, all the were female. Additionally, majority of the participants while 7 were aged between 30to 39 years while 4 were between 20 – 29 years old with only 1 aged between 40 – 49. 

This section presented the results of the study on the basis of themes. In total there were 5 themes as well as 15 subthemes that were pivotal in investigating the perceptions of clinical learning at the maternity ward table 2. 

Themes      Sub-themes

Theme 1: Clinical experiences in maternity ward

This theme was important in establishing the various experiences that student nurses had during clinical learning at the maternity ward. The experiences varied from good, bad, challenging, complicated and educational depending on what that particular student went through during the process.  The experiences are presented below.

Subtheme 1: Good experiences

Some of the participants stated that their experiences at the maternity ward were good. The reasons for this revolved around being able to do what is required successful as well as helping in giving birth to the time the patient is discharged. Participant stated the following: 

"My clinical experience in the maternity ward in prem-unit was quite good since they have all the resources. Clinical experience in labour department most pregnant mothers getting in labour have to be done CTG print and patient are being discharged on family planning already e.g. putting implanon before discharges and i was able to help with most of this". P7

"Maternity ward is the best ward one can work. You work with pregnant women and see them carry their pregnancy to 9 months. You see them in labour pain and giving birth to their beautiful babies and you see neonates growing into full term babies". P9 

"Most nurses are so helpful and allow me to do my procedures. I gained more experiences on new things like CTG, scrubbing of Caesarean section and insertion of implanon and witnessing of procedures that are not being done (performed at district hospitals). Managing complications like cord collapse and hypertensive disorders". P5

Subtheme 3: Challenging and complicated experiences 

Some participants highlighted that clinical learning was challenging and complicated for them for various reasons.  These included challenges with rare procedures as well as having to use machinery and equipment that they were not used to. This made it quite challenging to implement or do some procedures effortlessly. Participant stated the following:

"There are challenges when it comes to the rare procedures in our practical registers". P5 

"The environment of prem unit WCH was something that gave me tough time because the CPAP machine and ventilator machine I was not exposed to it in my clinical experience. In addition, some staff were unfriendly". P8

"It was very complicated because it was Theory and practical that needed to be covered. On one side you have tests that you need to study for but the practical book is also having certain things that you need to cover. Secondly the practical book consisted of some procedures that are rare to find in the clinic areas so it was always a struggle". P3

Subtheme 4: Bad experiences

Other participants in the study described their experience as bad. The reasons that were cited for this included other more experienced nurses not being welcoming, incompetent staff and just general negative attitudes towards students. Participant 6 stated the following: 

"My experience in the maternity was bad because some nurses are not welcoming and they are not helping patients and clients with respect". P6

"The bad experience I had was to see incompetent staff doing a resuscitation of a new born and multiple pregnancy delivery. Procedures not well followed". P1

Subtheme 5: Educational

Most of the participants however found their experiences educational.  This is because they got to learn a significant number of procedures beyond the theoretical aspects and this also helped them to gain confidence about their skills. Participant states the following:

"I learn how to do CTG. Insertion of implants. Interpreting artery blood gasses. Commencing and changing TPN. Nursing neonates on CPAP and ventilators”. P10

"The experience I got in maternity ward during my clinical practice is the printing and interpretation of CTG. Management of cord prolapse within filling up of the bladder with 500mls and clamping of the catheter. Treatment of hypotension disorder and diabetes mellitus. Blood transfusion exchange for neonatal. Preparation of ventilator and CPAP machine. Caring and administration of Total Parental Nutrition. The implementation of sonar and practicing it". P11

Theme 2: Unforgettable experiences

Beyond establishing the experiences of the participants at an overall level, the researcher was also interested in establishing the most unforgettable experiences that the clinical learning students have had. This was pivotal in identifying if their time there is mostly remembered for good or bad experiences. The experiences mentioned revolved around complications in births, lack of adequate knowledge among staff, bad staff, mishaps and getting involved in procedures that brought experience. 

Subtheme 1: Complicated birth 

Some of the participants highlighted that their most unforgettable experiences revolved around having to deal with complicated births. Participant stated the following:

"A bad experience that I will never forget is to stimulate an infant in a breech delivery while the head was not yet born". P1

"The experience that I will never forget is for a 650g neonates who was born via NUD with shoulder presentation and interval version was done for the baby to be delivered breech. Mother had placenta collapse and the baby stayed for 24hrs without oxygen or its access". P9

Subtheme 2: Lack of knowledge among nurses

One of the participants stated that their most unforgettable experience was with regards to how some nurses lack the knowledge to implement and follow the right procedures. Participant stated the following:

"Most of the staff members (registered nurses) do not know or lack the knowledge on neonatal resuscitation and it is hard to correct them because they feel they are in charge and you are just a student but at the end the patient suffers". P2

Subtheme 3: Bad attitudes of doctors/nurses

Some of the participants stated that their most unforgettable memories revolved around the bad treatment and attitudes they received during clinical learning. Participant 3 stated the following with regards to this: 

"Doctors not having enough time to cater for us in the clinical area since they are the ones that are experienced with most of the things that are needed to know". P3

"I could not forget the first week at practical area when the nurses gives bad attitudes to post graduate students not willing to assist". P5

Theme 3: Recommendations 

Under this theme the participants were given the opportunity to present any information or views that they wanted to share about their experiences Beyond what was asked by the interviewer. This was pivotal in obtaining any information that may have been missed. The additional views revolved around training and education, having more knowledgeable lecturers, having adequate equipment at the wards, keeping calm during clinical learning and adequately equipping the maternity ward. 

Subtheme 1: Training and education 

The participants highlighted that there was a need for various training programs that will enable clinical learning students to learn how to apply their knowledge in a practical setting without panicking or forgetting what needs to be done. The participants stated that in clinical learning the environment can get tense such that one easily forgets what they know. Participant 1 stated the following: 

"Spot training should be encouraged on emergency procedures because health care workers we tend to forget once on emergency procedure occurs and to be calmed and learn from doctor”. P1

"The other thing that I learned or experienced about nurses sometimes when it comes to the delivery tend to panic. The process is normal anything that can happen the doctor is within the unit. Just calm down and deliver you patient". P4

Subtheme 2: Convincing more knowledge lecturers to share their knowledge 

The participants also mentioned that the institution could not get more qualified lecturers to come and teach them especially with regards to more specialized topics that the lecturers were not really well acquainted with. Participant stated the following: 

"Yes there was also a struggle with getting guest lecturers to come and teach us more on things that our lecturers did not have enough knowledge and background of. Even though we could get some, I feel like we needed more". P3 

Subtheme 4: Curriculum and clinical alignment 

The participants also stated that there is a need for better alignment of the curriculum and clinical learning. This is because there are certain things that are not covered on both sides due to schedules and time while also considering that some procedures are only done at certain hospitals.  Participant stated the following: 

"I am suggesting that the university should communicate with the doctors to set up a schedule to assist advanced midwifery students with teaching them some procedures which are rare example ABG (Aterial Blood Gas) interpretation and SONAR to allow students to practice we need more experience". P5 

"Suggesting for post graduate to have clinical mentor to assist with procedures and demonstrations with the course also being extended to 2 years due to the course content is too much for one year". P10

"The advance midwifery student should be allowed to work at other intermediate hospitals in Namibia as most procedures are rare to get at Katutura and central hospital which are overcrowded with students. There should be a request for student to work for their practical hours in advance like during weekends". P11

Subtheme 5: Adequately equip Maternity ward 

The participants highlighted that the maternity ward should be well equipped to ensure that 

Maternity ward should be prioritized when it comes to equipment and machines like HGT, HB, Suction machines, ambulance etc. P9

Theme 1: Clinical experiences in maternity ward

The study found that the participants had various experiences when it came to doing their clinical learning at the maternity ward. The study found that some experiences were good because of the experience gained in helping mothers from labour to giving birth, conducting CTG printings scrubbing of Caesarean section and insertion of implanon and managing complications like cord collapse and hypertensive disorders. This is similar to the findings of Amoo and Enyan, (2022) who point out the importance of clinical learning to the nursing education because it equips nursing students with the requisite skills to develop clinical competence in doing various procedures as well as experience in dealing with different types of patients as well as environments.

The study also found that there were complicated experiences that were a result of schedule issues and students having to try and find balance between theory lectures and practicals. Mellish et al., (2018) highlighted the same view stating that student nurses have to find time to balance theory that is taught in the classrooms with clinical practice which is mainly taught in hospitals, health centres and clinics where students learn to apply theory into practice. 

Additionally, the study for that some challenges were faced by students that revolved around having access to assisting in rare procedures, not being when acquainted with machinery such as CPAP and ventilator machines while navigating through an environment with unfriendly staff. These finding were similar to those of Mashamba and Ramavhoya, (2021) who stated that in some cases student nurse have They had to deal and work without the basic resources such as urinary catheters, infusion administration sets, suturing materials and delivery packs disabling them from managing various procedures. The challenging aspect was also found to be as a result of limited practical spaces, a significant number of students and undergraduates seeking these opportunities. According to Benamer et al., (2023) in developed countries, there is a more balanced distribution of clinical placements across private and public sectors enabling for the students to have wider opportunities to get their experiences from.

The study also found that there were bad experiences that were a result of nurses not being welcoming or helping patients in a respectful manner, the use of the wrong methods when helping patients and disregarding students and treating them badly. This was echoed by Baird, (2022) stated that student nurses tend to get frustrated due to the lack of independence and commitment by newly qualified nurses to teach them effectively and help them when they are struggling with certain things. Moreover, the study found that the experiences were also educational with student nurses learning a variety of things such as how to do CTU, commencing and changing TPN, CPAP and ventilators to meet their practical targets. Similarly, according to Adnani et al., (2020) nowadays student nurses tend to try to do a significant number of procedures within a short space of time so that they may gain as much knowledge as possible within that short period.

5.2.2 Theme 2: Unforgettable experiences

The study found a wide array of unforgettable experiences that have stayed with the participants beyond their occurrence. The study found that some experiences were complicated with the students having to help with breech deliveries that can be complicated. Baird, (2022) agreed with this stating that student nurses tend to meet complicated procedures or situations at the hospital that also end up leading to stress and anxiety. 

A study conducted Amoo and Enyan, (2022) in Ghana also established similar results stating that in some cases the wrong techniques are used at hospitals leading to student nurses being shown or taught the wrong things. The study also found that unforgettable experiences also revolved around being involved in various procedures such as caring for women in labour until they give birth, inserting implanon assisting with blood exchange in a neonate, setting up of the ventilator and CPAP machine. Baird, (2022) highlighted a similar finding stating that Midwifery students learn from the women themselves during their practical exposure as well as through using the various machinery and equipment in different procedures. 

The unforgettable experiences were also found to include the bad attitudes of use and doctors who were labelled as not being helpful, accepting and having bad attitudes towards student learners. Mpho et al., (2020) also stated that a lack of support and supervision, lack of communication and poor interpersonal relationships between college lecturers, professional nurses and student nurses has become a contributing factor that created negative clinical experiences, blocking opportunities to learning and achieving student’s objectives. The study found that the student also could not forget the experiences of nursing babies in various situations such as the prem-unit especially those on CPAP and vents as well as those with congenital abnormalities. This was emphasized by Mpho et al., (2020) who stipulated the goal of clinical practice is to exposes students to clinical learning opportunities through performing different procedures as well as caring for different types of patients of different ages. 

The study also found that some unforgettable experiences included dealing with mishaps where complications happen because of various reasons such as mother touching the tubes while a baby is on CPAP and then the baby's condition starts to drop. Rodziewicz et al., (2023) similarly highlighted that there is a need for vigilance at hospitals so as to avoid medical errors as well as negligence be it from nurses, student or patients as these may be fatal.

5.2.3 Theme 3: Recommendations 

There were a number of additional views in the study that were of note. Firstly, it was found that there is a need for ongoing training and education initiatives to play as refreshers for the practical environment as well as to help nurses improve on how to take care of patients and applying the best appropriate procedures. Amoo and Enyan, (2022) also emphasized the importance of education and training initiatives being constant even for registered nurses to ensure that standards are kept high. Additionally, it was found that there is a need for more expert lecturers or field professionals especially those who did specialized courses to help teach the deeper aspects of modules. Similarly, Fukada, (2018) highlighted that employers should pursue instructors whose competencies are compatible with the practice settings demands, can function potently in inter-disciplinary teams across a wide range of healthcare environments. Do that they are available when needed. 

The study further found that there is a need to align the curriculum with the practical activities and find ways to involve student nurses in as many procedures that they learn in class so that they are more competent. Jamshidi et al., (2016) also highlighted the need to have a clear and effective link between what is learnt in theory and what is learnt in practice. Additionally, it was found that students should be sent to relevant hospitals that do different procedures so that they get the experience while also extending the period program to allow enough time for the students to cover their practicals effectively. Similarly, according to Ziba et al., (2021) clinical placement is a requirement for nursing and midwifery education and can occur in only hospitals therefore leading to inadequate spaces and time for enough practical for each student. 

Moreover, it was found that there is a need to adequately equip the maternity ward so that the right equipment may be used and for learners to gain the relevant experience through using this equipment as well as machines. Mashamba and Ramavhoya, (2021) also highlighted the need to ensure adequate equipment and training of those to use it to avoid it being broken and not accessible to students to learn how to use it.

It can be concluded that nursing student have a wide range of experience when they do clinical learning. These experiences revolve around the environment they are in, the people they interact with as well as the procedures that they find themselves having to do. Some experiences were negative relating to struggling with complicated procedures, lack of adequate knowledge on using equipment and machines, busy schedule between classes and practical’s and ill-treatment from registered nurses and doctors. On the other hand, some experiences were good including getting the much-needed experiences, carrying for mothers and babies and being involved in various successful procedures. All in all, the experiences are mixed due to the various situations one can meet at the ward however the most important thing is gaining experience and being involved in as many procedures as possible.

The authors declared no conflict of interest.

Nursing is a practice   profession that integrate both theoretical nursing education and practical nursing education.