PERCEIVED DIFFICULTIES FACED BY NURSING STUDENTS DURING MIDWIFERY CLINICAL POSTING AT UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN.

CHAPTER ONE

1.1 BACKGROUND TO THE STUDY

Nursing education represents a critical pillar in healthcare systems globally, combining theoretical knowledge with practical clinical experiences to produce competent healthcare professionals (Phillips et al., 2023). This integrated approach ensures that graduating nurses possess both cognitive understanding and the psychomotor skills necessary for effective patient care (Murray et al., 2021). Within nursing specialties, midwifery occupies a uniquely significant position due to its direct impact on maternal and neonatal health outcomes, which remain key indicators of a nation’s overall health status (Cummins et al., 2020).

Midwifery care encompasses comprehensive management of women throughout the childbearing continuum, including antenatal care, intrapartum management, postpartum support, and newborn care. The quality of midwifery education directly influences healthcare systems’ ability to achieve targets related to reducing maternal and infant mortality rates, preventing birth complications, and promoting positive birth experiences (Homer et al., 2021). Consequently, adequate training in midwifery is not merely an academic requirement but a public health imperative.

Clinical practice placements constitute an indispensable component of nursing education, providing students with opportunities to apply theoretical concepts in authentic healthcare settings under professional supervision (Sarikoc et al., 2021). These clinical rotations facilitate the development of clinical judgment, technical proficiency, communication skills, and professional identity. The clinical environment exposes students to real patient care complexities, fostering critical thinking and decision-making capabilities that cannot be fully developed through classroom instruction alone (Al-Qahtani & Guraya, 2022). For midwifery students specifically, clinical placements offer essential exposure to childbirth processes, emergency obstetric situations, and the emotional dimensions of supporting women during significant life events.

Despite the invaluable nature of clinical learning environments, contemporary research indicates that nursing students frequently experience significant difficulties during clinical placements that can hinder their learning, affect their psychological wellbeing, and impact professional development (Ulenaers et al., 2021). Studies have documented various stressors including inadequate clinical supervision, insufficient opportunities to practice essential skills, poor relationships with clinical staff, lack of feedback, and discrepancies between theoretical teaching and clinical practice (Labrague et al., 2023). The midwifery clinical setting presents distinct challenges due to the unpredictable nature of childbirth, emotional intensity surrounding labour and delivery, need for rapid decision-making in emergencies, and the intimate nature of maternity care (Mollart et al., 2020).

Recent literature has categorized these challenges into multiple domains: educational challenges such as inadequate supervision ratios and limited learning opportunities (Mikkonen et al., 2021); environmental factors including inadequate facilities and equipment shortages (Zhao et al., 2021); interpersonal difficulties involving conflicts with staff and poor communication (Pront et al., 2022); and personal factors including fear of errors, performance anxiety, and emotional exhaustion (Tharani et al., 2020). In the Nigerian context, additional challenges include high patient-to-student ratios, resource constraints, infrastructural deficits, and cultural factors affecting student-staff-patient interactions (Adebayo & Ojewale, 2021; Okoronkwo et al., 2022).

Despite documented challenges in clinical nursing education globally, there remains limited empirical research examining specific difficulties encountered by nursing students during midwifery clinical placements at University of Ilorin Teaching Hospital (Adefila et al., 2023). This knowledge gap prevents the development of evidence-based interventions tailored to the local context and hinders efforts to optimize clinical learning experiences. Understanding these difficulties from students’ perspectives is essential for informing educational policies, improving clinical supervision models, and enhancing support systems.

Investigating these challenges enables nursing educators to develop targeted support strategies (Roney & Acri, 2020), helps hospital administrators allocate resources effectively and improve learning infrastructure (Dube & Jooste, 2021), assists curriculum designers in ensuring better alignment between classroom preparation and clinical expectations (Thomas et al., 2022), and ultimately contributes to producing more confident, competent midwifery practitioners who can deliver high-quality care (Gakeri et al., 2023).

This study therefore seeks to systematically investigate and document the perceived difficulties faced by nursing students during their midwifery clinical posting at University of Ilorin Teaching Hospital, with the aim of providing empirical evidence that can inform improvements in clinical nursing education, enhance student support mechanisms, and contribute to strengthening the preparation of future nursing professionals in the provision of quality midwifery care.

1.2 STATEMENT OF THE PROBLEM

Clinical practice is a key part of nursing education. It gives students the hands-on experience they need to become skilled nurses. However, moving from classroom learning to clinical practice is often difficult. This is especially true for midwifery clinical postings, where students face stressful situations like deliveries and emergencies that require quick thinking and technical skills.

Globally, nursing students encounter significant challenges during midwifery clinical postings. Studies from developed countries such as Australia, the United Kingdom, and the United States have shown that students face difficulties including inadequate supervision, limited hands-on practice opportunities, poor relationships with clinical staff, and anxiety related to managing obstetric emergencies (Mollart et al., 2020; Cummins et al., 2020). These difficulties affect students’ learning outcomes, confidence levels, and professional development.

In Nigeria, the challenges faced by nursing students during clinical practice are compounded by additional factors specific to the Nigerian healthcare system. Studies conducted in Nigerian teaching hospitals have documented difficulties such as inadequate equipment and supplies, overcrowded clinical facilities, poor infrastructure, high patient-to-staff ratios, and insufficient clinical supervision (Adebayo & Ojewale, 2021; Okoronkwo et al., 2022). Despite these documented challenges, there remains limited research specifically examining the difficulties faced by nursing students during midwifery clinical postings in Nigerian teaching hospitals.

At the University of Ilorin Teaching Hospital, nursing students undertake mandatory midwifery clinical postings as part of their training. Reports from students suggest that they encounter various difficulties during these postings including inadequate supervision, limited opportunities for hands-on practice, poor relationships with some ward staff, insufficient feedback, lack of equipment, and anxiety related to performing procedures. Students also report challenges bridging the gap between theoretical knowledge and clinical realities at UITH.

The consequences of these unaddressed difficulties are significant. Students who struggle may develop decreased self-confidence, increased anxiety, poor clinical competence, and negative attitudes toward nursing. Some may consider leaving the profession, contributing to workforce shortages. Furthermore, inadequately prepared nurses may compromise patient safety, particularly in maternal and child healthcare. Despite the importance of understanding these challenges, there is insufficient empirical data documenting the specific difficulties faced by nursing students during midwifery clinical postings at UITH. This study addresses this gap by systematically investigating these perceived difficulties to provide insights for enhancing the clinical learning environment and producing competent nursing professionals.

1.3 OBJECTIVES OF THE STUDY

The objectives of this study are to:

1. Identify the perceived difficulties faced by nursing students during midwifery clinical posting at the University of Ilorin Teaching Hospital.

2. Determine the categories of difficulties encountered by nursing students during midwifery clinical posting at UITH.

3. Explore possible solutions to address the difficulties faced by nursing students during midwifery clinical posting at UITH.

1.4 RESEARCH QUESTIONS

The following research questions will guide this study:

1. What are the perceived difficulties faced by nursing students during midwifery clinical posting at the University of Ilorin Teaching Hospital?

2. What categories of difficulties are encountered by nursing students during midwifery clinical posting at UITH?

3. What are the possible solutions to address the difficulties faced by nursing students during midwifery clinical posting at UITH?

1.5 RESEARCH HYPOTHESES

The following null hypotheses will be tested in this study:

1. There is no significant relationship between level of study and the perceived difficulties faced by nursing students during midwifery clinical posting at UITH.

2. There is no significant difference in the categories of difficulties encountered by nursing students during midwifery clinical posting at UITH.

3. There is no significant relationship between the identified difficulties and the proposed solutions by nursing students during midwifery clinical posting at UITH.

1.6 SIGNIFICANCE OF THE STUDY

This study is important for several groups in nursing education and healthcare delivery. For nursing students, the findings will help them understand the challenges they may face during midwifery clinical posting and prepare better to handle these difficulties. This will reduce anxiety and improve their learning experience.

Nurse educators and clinical instructors will benefit from the study as it will guide them in developing better teaching methods and support systems for students. The information will help them address student needs more effectively and improve the quality of clinical supervision.

Hospital administrators at the University of Ilorin Teaching Hospital will use the findings to make informed decisions about improving the clinical learning environment. This includes better resource allocation, improved supervision systems, and policies that support student learning.

The study will also help curriculum developers identify gaps between classroom teaching and clinical practice. This will enable them to design courses that better prepare students for midwifery clinical postings.

For the nursing profession, this study will contribute to producing more competent and confident nurses, which will improve the quality of maternal and child healthcare services in Nigeria. Finally, the study will add to existing knowledge on clinical nursing education in Nigeria and serve as a reference for future research.