by (Student’s Full Name)

submitted in accordance with the requirements for the degree of

MASTER OF ARTS

in the subject

Health Studies

at the

UNIVERSITY OF SOUTH AFRICA

SUPERVISOR: …………………

CO-SUPERVISOR: …………….

(Date of Submission)

 

ACKNOWLEDGEMENTS

I would like to express my special appreciation to my instructor (Instructor’s Name) for being a tremendous mentor. I would like to thank him for allowing me to grow as a student and for encouraging my research. His advice on both my career as well as research have been invaluable. A special thanks to my family. I cannot express how grateful I am to my parents for all of the sacrifices they have made on my behalf. Their prayers have sustained me thus far in life. My parents has been extremely helpful in all of the difficulties I have faced in life. It was due to tremendous support that I was able to finish my degree.

 

ABSTRACT

The epicentre of nursing studies is proper nurse mentorship. For practising purpose, it also has been perceived as a fit.  The international and domestic research studies have mapped out the universally agreed gaps and confusion around the issue. The effectiveness of a mentoring program on the organization, mentee, and mentor in China has been evaluated. A systematic literature review was conducted. Out of the few studies considered for systematic literature review, it was revealed that a mentoring program could effectively help in decreasing the stress turnover rate of the new nurses. The research aim of this dissertation is to clarify the confusion related to nursing mentorship practices. It has filled the available knowledge gap, which will provide numerous benefits to the service users within the scope of this research topic. Past research studies on student’s nurse mentorship have also been surveyed under this literature review. The ‘novice to expert’ theory by Benner and how it can contribute to a student’s nurse mentorship during their clinical internship has been studied briefly. Further, it has clarified all of the confusions related to the nurse mentorship practices. It also has filled the available knowledge gap. This dissertation has adopted survey design as its research methodology. It helped in gaining desirable information when the research is in the initial phases. Both primary and secondary data sources have been used. The questionnaire session included the filling of the questionnaire at around 18 mins per questionnaire. Some of the major factors found influencing student nurse’s mentorship during their clinical internship are number of contact hours, support from ward team members, the student to clinical mentor ratio, and facilities available at the learning environment.

 

 

 

Table of Contents

1.1.     INTRODUCTION.. 5

1.2.     BACKGROUND INFORMATION ABOUT THE RESEARCH PROBLEM… 5

1.2.1.      The Sources of the Research Problem.. 5

1.2.2. Background to the Research Problem.. 6

1.3.     RESEARCH PROBLEM… 8

1.4.     AIM OF THE STUDY.. 9

1.4.1.      Research Purpose. 9

1.4.2.      Research Objectives. 10

1.5.     SIGNIFICANCE OF THE STUDY.. 10

1.6.     DEFINITION OF TERMS. 11

1.7.     THEORETICAL FOUNDATIONS OF THE STUDY.. 12

1.7.1.      Research Paradigm.. 12

1.7.2.      Theoretical Framework. 14

1.8.     RESEARCH DESIGN AND METHOD.. 15

1.9.     SCOPE OF THE STUDY.. 16

1.10.       STRUCTURE OF THE DISSERTATION.. 17

1.11.       CONCLUSION.. 19

CHAPTER 2: LITERATURE REVIEW… 20

2.1. INTRODUCTION.. 20

2.2. THE NURSE MENTORSHIP PRACTICES. 20

2.3. THE FACTORS INFLUENCING THE STUDENT’S NURSE MENTORSHIP DURING THEIR CLINICAL INTERNSHIP. 25

2.4. STRATEGIES FOR IMPROVING THE MENTORSHIP EFFICIENCY OUTCOME.. 30

2.5. CONCLUSION.. 35

CHAPTER 3: RESEARCH METHODS. 37

3.1. INTRODUCTION.. 37

3.2. RESEARCH DESIGN.. 37

3.3. RESEARCH METHOD.. 39

3.3.1. Sampling. 41

3.3.2. Data Collection. 45

3.3.3. Data Analysis. 48

3.4. INTERNAL AND EXTERNAL VALIDITY OF THE STUDY.. 50

3.5. CONCLUSION.. 51

CHAPTER 4: ANALYSIS, PRESENTATION AND DESCRIPTION OF THE RESEARCH FINDINGS  52

4.1. INTRODUCTION.. 52

4.2. DATA MANAGEMENT AND ANALYSIS. 52

4.2.1. SAMPLE SIZE.. 52

4.2.2. DATA SCREENING.. 52

4.2.3. DATA VIEW… 53

4.2.4. FREQUENCIES: COUNTS AND PERCENT. 54

4.2.5. FREQUENCIES: FREQUENCIES AND STANDARD DEVIATIONS FOR DEMOGRAPHIC CHARACTERISTICS. 54

4.2.6. DESCRIPTIVE ANALYSIS. 57

4.2.7. CORRELATION.. 59

4.2.8. REGRESSION ANALYSIS. 60

4.2.9. EFA.. 62

4.2.10. PRELIMINARY ANALYSIS. 63

.. 63

4.2.11. FACTOR EXTRACTION.. 65

4.2.13. GRAPHICAL REPRESENTATION.. 68

4.3. OVERVIEW OF RESEARCH FINDINGS. 75

4.4. CONCLUSION.. 85

CHAPTER 5: CONCLUSION AND RECOMMENDATION.. 87

5.1. INTRODUCTION.. 87

5.2. RESEARCH DESIGN AND METHOD.. 87

5.3. SUMMARY AND INTERPRETATION OF THE RESEARCH FINDINGS. 87

5.4. CONCLUSIONS. 87

5.5. RECOMMENDATIONS. 87

5.6. CONTRIBUTIONS OF THE STUDY.. 87

5.7. LIMITATIONS OF THE STUDY.. 87

5.8. CONCLUDING REMARKS. 87

References. 88

 

 

CHAPTER 1: ORIENTATION TO THE STUDY

1.1.           INTRODUCTION

One of the critical elements of midwifery training and pre-registration nurse is mentorship, as it aids in creating a positive environment for learning and that nurturing from mentors encourages professional and personal development. According to Althaqafi et al., (2019), the leadership skills required by the nurses for securing more significant roles in delivering, designing, and developing healthcare can be fostered through mentoring. Good mentorship is crucial in day to day nursing practise as it builds up the confidence of the students. Globally, before qualifying as a registered nurse, it is necessary to complete all prescribed period of supervised clinical practice. The mentorship period is indeed one of the significant element of the mastery and skill development process. In the healthcare world, it also provides an orientation to new nurses and helps them in understanding ethical and moral issues. However, past research studies have concluded that various factors also influence the student nurse’s mentorship. Therefore this dissertation will analyze the factors influencing student nurse’s mentorship.

1.2.           BACKGROUND INFORMATION ABOUT THE RESEARCH PROBLEM

1.2.1.      The Sources of the Research Problem

Numerous sources contribute to the development of research problems. However, it is essential that the researcher must be curious, imaginative, and astute to use these sources effectively.  This nursing research problem has been contributed by primary sources involving theory, literature review, peer interaction and researcher, societal trends, nursing administration, nursing education, and nursing practice. Since the factors impacting student nurse’s mentorship during their clinical internship are analyzed in this dissertation, therefore, one of the critical sources of research problem considered is clinical practice. For generating research problems, one of the significant resources is theory since forth ideas related to situations and events are set in the real world (Grove & Gray, 2018). Potential research issues and research topic are identified by reviewing different nursing publications. Moreover, questions related to practice that may result in research problems or concerns may be revealed from chart reviews. For various nursing studies published in the last ten years, some of the primary sources have been the desire to enhance nursing interventions and the unanswered questions in clinical practice. Further, in the clinical setting and classroom, the efficiency of different teaching methodologies is provided by nursing administration and nursing education.

1.2.2. Background to the Research Problem

According to Nowell et al. (2017), one of the integral elements of the qualified nurse role that supports development and learning is mentorship. Learning is influenced by the quality of the relation between mentee and mentor, specifically any disparity in their expectations. With a specific focus on the qualified nurse and nursing students, the different perceptions about the mentorship relationship are influenced. Mentoring is influenced negatively by factors such as lack of appreciation of daily life scenarios that impact each individual, lack of trust, different expectations between mentee and mentor, and poor communication. Issues can be counteracted or prevented in the relation by discussing the mentee and mentor’s expectations, using the information available in student handbooks, by developing ground rules, and by using learning contracts.

Further, Tuomikoski et al. (2018) highlighted that mentoring among nurse students has remained quite vague, although it has been investigated widely. Different mentoring approaches are presented as there is no universal agreement on student mentoring in nursing placements. For assuring the quality of placement learning in nursing organizations, a unified description of student mentoring is required. Two most common themes were found when defining mentoring of learning. First one was strengthening the professionalism of students by enhancing the professional competence of students in nursing and by empowering the development of their professional identities and attributes. Second is facilitating the learning of nursing students by enabling individuals learning processes of students and by creating supportive learning environments (Pramila‐Savukoski et al., 2019)., Different clinical, pedagogical, collegial, and environmental attributes are integrated by the description of student mentoring in clinical nursing placements. To assure active student mentoring, systematic preparation and adequate resources must be provided to mentors by management and organization.

Along with this, it is also crucial that an individual mutual relationship is created. Further, to maintain and accomplish a workplace definition, the definition of student mentoring must be reviewed systematically for reflecting changes in education and nursing. For enhancing the recruitment of nursing students to the workforce, one of the opportunity is provided by a systematic and clear strategy for student mentoring (Helminen et al., 2017). The support for students and quality of placement learning opportunities can be improved through a unified description of student mentoring. A clear definition of student mentoring also helps in enabling proper mentor preparation programs for nurses and systematic provisions for mentoring of nursing students in placements.

Moreover, Nowell et al. (2017) indicated that nursing mentorship is critical as it helps in advancing the career and developing new skills. For a less-experienced and new nurse, a more experienced nurse acts as a role model, expert, and guide in nursing mentorship. Nursing mentorship also helps in diversifying the workforce, retain employees, and cultivate leaders. Nelson et al. (2018) suggested that mentoring is a collaborative and reciprocal learning relationship between two individuals with shared accountability and mutual objectives for the success and outcomes of the relationship. Mentoring can also effectively guide nurses in their interpersonal, personal, and professional growth.

Moreover, for meeting the changing needs of the healthcare environment in Mauritius, a competent and safe nurse practitioner equipped with a healthy attitude, and necessary confidence, knowledge, and skills are provided. This shows how important it is to research about nurse’s mentorship during their clinical internship in Mauritius. Dale, Leland & Dale (2013) also highlighted that for the mentorship program one of the critical elements is a supportive clinical learning environment since most of the nursing training and studies take place during the clinical phase. A lack of confidence in and negative attitudes towards nursing practice may be reported by nursing students who are exposed to negative mentorship experience. The nursing trainee may be forced to abandon the program in some extreme situations due to the exposure to intense incivility force (Lewis et al., 2016).

1.3.           RESEARCH PROBLEM

Past nursing research studies have concluded numerous and different definitions of nursing mentorship. Due to which the concept of mentorship has remained quite vague among nursing students, although the mentorship concept has been widely investigated. Moreover, a unified definition of student mentoring is lacked by past nursing research studies based on the concept of mentorship. The confusion related to the nurse mentorship practices must be cleared.

Along with this, the available knowledge gap must also be filled as this can provide numerous benefits to the service users within the scope of this research topic. Secondly, past research studies have also concluded that different factors also influence the student nurse’s mentorship. Thereby, some of the relevant factors that may impact student nurse’s mentorship during their clinical internship must be analyzed.

Moreover, Jokelainen et al., (2011) in nursing education one of the critical element is the proper clinical experience as it helps sufficiently in transforming theoretical knowledge into practical skills and thereby creates the foundations of the nursing profession. Similarly as Lawal et al., (2016) highlighted that it had been emphasized by most of the studies focused whether the nursing trainee gains the desired practical skills through the application of the theoretical knowledge into practical use in the clinical environment placement. Therefore, the overall problem addressed in this study is whether the current practices and policies of student nurses mentorship are adequate and meet the requirement for the pupil nurses to qualify as a competent and safe professional practitioner.

1.4.           AIM OF THE STUDY

1.4.1.      Research Purpose

The research aim of this dissertation is to clarify the confusion related to nursing mentorship practices. It has filled the available knowledge gap, which will provide numerous benefits to the service users within the scope of this research topic.

1.4.2.      Research Objectives
For the successful accomplishment of research aim, it has been broken down into research objectives highlighted below:
Ø  To identify from the literature, which element must be rightly included in the survey instrument.
Ø  To assess the factors impacting effective mentorship.
Ø  To reveal the relation between the variables.
Ø  To correlate the difference and similarity between China and Mauritius about the validated factors.
Ø  To propose strategies for improving the mentorship efficiency outcome.  

1.5.           SIGNIFICANCE OF THE STUDY

The epicentre of nursing studies is proper nurse mentorship. For practising purpose, it also has been perceived as a fit.  The international and domestic research studies have mapped out the universally agreed gaps and confusion around the issue. The effectiveness of a mentoring program on the organization, mentee, and mentor in China has been evaluated well by Zang et al., (2016). A systematic literature review was conducted. Out of the few studies considered for systematic literature review, it was revealed that a mentoring program could effectively help in decreasing the stress turnover rate of the new nurses.

Additionally, mentoring can aid in establishing a supportive workforce environment and can enhance nursing competency, resulting in positive outcomes. A different research approach was considered by Law (2016). By conducting focus group interviews with doctors, ward manager, senior nurses, and stakeholders, the meaning of mentoring new graduate nurses was explored in the study. The findings concluded that for the pursuit and transition of good work, the complexity of mentoring new graduate nurses could be revealed by the shared experiences that have specific dimensions such as the place of the narrative inquiry space, personal social interactions, and temporal. It is important to note that the current foreign policy of China is to work in partnership with third-world countries, specifically in Africa.

Similarly, the concept of mentorship is being embraced by SMEs (small-medium enterprises) in Mauritius. One such example of it is the SME Mentoring and hand-holding program that is a developmental partnership through which industry-experts/mentors share lifelong acquired abilities, skills, knowledge, and experience. For fostering the sustainable growth of SMEs, the long-term perspective is also shared by them. All critical elements of the business will also be evaluated by this program which eventually will help in contributing to business growth and increased sales. Another effective mentorship method practised in the women’s mentorship program by the Mauritius Institute of Directors. This program is designed to challenge the systematic barriers, empower women, and accomplish the critical process. The principal objective of this program is to empower, inspire, and educate women with the core skills, attitudes, and values that are foundations of quality leadership. These examples show that the concept of mentorship is being practised widely also in Mauritius. Therefore, this dissertation will play an essential role in assessing the factors influencing impacting effective mentorship, in correlating the difference and similarity between China and Mauritius about the validated factors, and in proposing strategies for improving the mentorship efficiency outcome.

1.6.           DEFINITION OF TERMS

Nursing: The practice or profession of providing care for the infirm and the sick is referred to like nursing. It involves the care of dying, disabled, and ill people, the prevention of illness, and the promotion of health. It comprises of collaborative and autonomous care of individuals of all communities, groups, families, and ages, well or sick in all settings.

Student Nurse: The student in a post-secondary educational program that leads to licensing and certification to practice nursing mostly as part of a program administered by a nursing school is referred to as a student nurse. While following the hospital procedures where practical experience is being acquired, the health of patients is restored, promoted, and maintained by a student nurse.

Mentorship: The guidance provided by a mentor, particularly an experienced individual in an educational institution or company is referred to as mentorship. It is a relationship in which guidance is provided to less knowledgeable or less experienced individuals by a more knowledgeable and more experienced person.

Clinical Internship: A year of complete full-time clinical training designed for providing intensive clinical experience to the student under supervision is referred to as the clinical internship.  

Clinical Practice: For particular clinical situations, assisting in patient decisions related to proper health care and practitioner is referred to as clinical practice. It is also referred to as the conventional and agreed-upon methods of delivering healthcare by health professionals, nurses, and doctors.

1.7.           THEORETICAL FOUNDATIONS OF THE STUDY

1.7.1.      Research Paradigm

Provided the complexity of the world within which nursing exist, the approach to this research bound to be logical. For this purpose, this dissertation has conceptualized the principles and aims of robust scientific investigation (methodology), the views on legal knowledge and truth (epistemology), and the nature of reality (ontology). Ontology is about what things are, whereas, epistemology is about the way we know things.

The philosophical underpinning of this research is embedded in the positivistic research paradigm. The positivistic research paradigm is the systematic empirical investigation of occurrences through computational, mathematical, and statistics.

1.7.2.      Theoretical Framework

One of the mentorship frameworks that has guided this study well is “From Novice to Expert” by Patricia Benner. It is one of the most useful frameworks for assessing the needs of nurses at various phases of professional growth. It also has been proposed by this framework through a multitude of experiences as well as proper educational background; expert nurses develop an understanding of patient care and skills over time.

Figure 2: From Novice to Expert Framework (Source: Benner, 1992)

1.8.           RESEARCH DESIGN AND METHOD

The dissertation has also performed a cross-sectional survey as a justified quantitative approach.

Table 1: Research Design and Method (Source: Self-Made)

Research Method	Technique	Instrument	Data Collection
This dissertation has adopted survey design as its research methodology. It helped in gaining desirable information when the research is in the initial phases.	A questionnaire with 5 Likert Scale option, secondary data from the literature and a survey	Validated questionnaire with close-ended questions.	Both primary and secondary data sources have been used. The questionnaire session included the filling of the questionnaire at around 18 mins per questionnaire.

Moreover, the questionnaire has been developed from the literature and comprises of different parts such as the closure statement, rating of the survey items by the 5-point Likert scale, the demographic section, and an enlistment statement with informed consent to participate. Along with this, student nurses doing practical training at the hospital in Mauritius are the population of interest of this dissertation.

1.9.           SCOPE OF THE STUDY

This dissertation has analyzed the factors influencing the student’s nurse mentorship during their clinical internship. The dissertation has mainly focused on the context of Mauritius. It has clarified all of the confusions related to the nurse mentorship practices. It also has filled the available knowledge gap, which will provide numerous benefits to the service users within the scope of this research topic.

Further, it has proposed strategies for improving the mentorship efficiency outcome. It also has correlated the difference and similarity between China and Mauritius about the validated factors. It also has assessed the factors impacting effective mentorship and has identified from the literature which element must be right included in the survey instrument. Further, by undertaking this research, the following questions have also been answered:

• RQ1: During the internship time, which dimensions make the student nurse’s mentorship?
• RQ2: Which of these factors enhance the mentorship process?
• RQ3: Which ones hinder mentorship in practice?
• RQ4: What is the correlation between the significant variables?
• RQ: What are the confirmatory factors for this?
• RQ5: How to improve the current practice of the nursing student’s mentorship?

1.10.       STRUCTURE OF THE DISSERTATION

Chapter’s S. No.	Chapter’s Name	Chapter’s Details
1.	Introduction	The preface of the dissertation has been provided in this chapter. The audience is introduced to the research topic and a summary indicating the interest of the researcher. It has prepared the audience for scientific evaluation and argumentation of the findings and information.
2.	Literature Review	One of the significant parts of the dissertation is the literature review. The research previously completed on the research topic is provided, along with a critical analysis of all relevant and current information.
3.	Research Methods	This chapter has explained the research methods used for gathering the data and information for fulfilling the research objectives. This chapter is perceived as the core of the thesis.
4.	Analysis, Presentation, and Description of the Findings	This chapter is perceived as the body of the thesis and comprises of the outcomes of the research along with critical analysis and sub-conclusions.
5.	Conclusions and Recommendation	All the loose ends have been tied up in this chapter. It informs the audience what has been discovered in each stage of the research process. An overview of the research process formulating the conclusions and findings related to the research problem has been provided.

 

1.11.       CONCLUSION

This chapter has provided a thorough review of mentorship and its importance in nursing. It also has emphasized how important is good mentorship in day to day nursing practice. Further it showed how only a limited number of research studies had studied factors influencing the student’s nurse mentorship. Further, it has indicated the sources that lead to the research problem. It also provided a critical and thorough research background for the problem. Moreover, it has highlighted the importance of carrying out this research study. It also has provided brief definitions of the critical terms in the study. Lastly, it provided theoretical foundations essential to the study.

 

 

 

CHAPTER 2: LITERATURE REVIEW

2.1. INTRODUCTION

An overview of past research on the mentorship of student nurses and nursing mentorship are addressed in this chapter. For the dissertation, the theoretical framework has been introduced that contains the critical focus of the dissertation. Past research studies on student’s nurse mentorship have also been surveyed under this literature review. The ‘novice to expert’ theory by Benner and how it can contribute to a student’s nurse mentorship during their clinical internship has been studied briefly. Further, it has clarified all of the confusions related to the nurse mentorship practices. It also has filled the available knowledge gap, which will provide numerous benefits to the service users within the scope of this research topic. Further, it has proposed strategies for improving the mentorship efficiency outcome. Lastly, it has identified the dimensions that make the student nurse’s mentorship during the internship time, which dimensions make the student nurse’s mentorship. Next, it has studied the factors that enhance the mentorship process and also the ones that hinder mentorship in practice.

2.2. THE NURSE MENTORSHIP PRACTICES

According to various changes have emerged in nursing education in Mauritius. The need for modifying the unified procedures in training and education has been emphasized by its educational policy for assuring equal qualifications of education. Thereby, this challenge must adequately be met by nursing education along with the element of clinical practice. In Mauritius, a proper clinical training framework has been implemented for nursing education. The framework reflects upon the staffing pattern for nursing educational programs college of nursing, staffing pattern, and proposed outpatient departments for each shift based on actual observation and staff to patients ratio forwards. It also reflects upon the Nursing Council of Mauritius norms, clinical facilities for college of nursing, physical facilities for a college of nursing, and the minimum standard requirement for a nursing college or school.

As per this framework, around 50% of the total degree program in nursing must reflect upon the element of clinical practice. Further, as per the guidelines provided for nursing education, the nursing students must be mentored during their clinical practice periods by a professional nurse in replacement. The relationship between student and professional nurses must be maintained. Moreover, the quality in placement learning is enhanced by the trend towards unifying the approaches implemented in the clinical practice factor of nursing education (Newton, Taylor, and Crighton, 2017). Throughout Mauritius, debates have emerged related to the opportunities, support and provision in placement learning for nursing students. However, it is also vital that attrition rates of students must be reduced. In the nursing profession, the retention and enthusiasm of students can be increased through positive clinical experiences and adequate support of students in placements.

Further, one unified terminology about mentorship must be used for comparing and describing clinical practice and education. Despite this, the phrase ‘mentoring’ is not used universally in the element of clinical practise of nursing education. In contrast to it, other related phrases such as facilitating, precepting, or supervising are used. Due to the lack of unified understanding and usage of the phrase ‘mentoring’ in the student’s context in clinical practice, differences have also emerged concerning placements. Consequently, differences have also prevailed in mentoring preparation programs for nursing professionals that act as student mentors. For example, there are national standards for student mentors in the United Kingdom that involve maintenance and review of qualifications, local registering, yearly updating, and training.

In contrast and compare, for mentor preparation, no nationally agreed standards have been maintained in Finland. The existing education is voluntary and indeed differentiates country by country. Therefore, for successful mentoring of students, it is necessary that a uniform preparation program must be implemented that is based on the agreed definition of mentoring of students (Nowell et al., 2017).

Moreover, nursing literature has been discussing the concept of mentoring for over 25 years. In the initial of the 1980s, different articles have been published. These research articles also came into existence even in 1987 when the phrase ‘mentorship’ first appeared in nursing. Since then, there has been a rapid increase in the literature based on mentoring. In the context of nursing education, different debates related to mentoring have emerged in the early 1990s. However, the phrase of mentoring is focused mainly on career development among nursing professionals in a long-term relationship (Vitale, 2019). Moreover, mentoring of students and perspective of students have also been focused by mentoring literature in the late 1990s. Along with this, the mentoring of students and perspectives of students were also presented as a long-term mentorship relation amongst a more experienced and an older nurse expert and a student.

Besides, since 2000 studies related to student mentoring have emerged in the United Kingdom as a consequence of changes in clinical placements and nursing education as learning environments. Mentoring has been perceived in these studies as the responsibility of a mentor who is the clinical nurse. It is the critical responsibility of the mentor to assesses, teaches, and supervises, student nurses in placements during their clinical practice period. Moreover, some of the elements that were considered highly important were positive emotional aspects and the relationship between mentor and student. Despite various studies based on mentoring in nursing, there is still confusion related to the definition of mentoring in the context of students. Previous research studies have mostly focused on nursing managers, academics, and professionals. Overall, it has been found that mentoring activity is related to nursing students and professionals.

According to Jokelainen et al., (2011), in placement learning, the quality is enhanced by the trend of unifying the approaches used in the clinical practice. Some of the mentorship practices involve creating a supportive learning environment that involved all the arrangements in placements that prepare the practice of students and organize their support system. For learning purpose, preparing clinical placement fitness comprise of planning of placement learning and training that involved being aware of details of students and their training documents such as the nursing curriculum, organising and planning learning opportunities and the applicability of placement. Some other arrangements involve assuring fluent implementation of placement learning and training, for instance, organising the first day of the student in placement and naming substitute and personal mentors. This helps in enabling an interpersonal relationship with the mentor.

It is also vital to note that different issues have been faced in old mentorship practices. During the clinical practice, it was quite problematic showing empathy towards students and taking care of them. These involved understanding, caring for and showing interest in students so that the capability of students in nursing can be confirmed. Jacobs (2018) also highlighted that one of the critical constructs of nursing practice and clinical education is mentoring, besides being a professional obligation of nurses. Within the nursing profession, the tradition of mentorship is rooted in the 19^th-century career of Florence Nightingale, who was the founder of modern nursing. One of the critical mentors to Florence Nightingale was Sir Sidney Herbert, who rooted mentoring in her nursing practice.

The example of Florence Nightingale in mentoring also presenting the interactions based on the traditional apprenticeship of the mentee/mentor relationship that was non-reciprocal and hierarchical typically. Within nursing, the significance of mentoring has remained a foundational aspect of professional development with a requirement of various nursing professional bodies and within the practice, while practices and processes of mentoring have changed over time. Mentoring itself is a misunderstood and complex phenomenon. There are there different practices and forms of mentorship in nursing. Mentorship is quite different from preceptorship. In nursing, the preceptorship includes learning and teaching within the clinical setting (Pelin and Ayise, 2019). It is implemented to provide significant assistance to the novice nurse for adjusting to a new role within an organisation or institution.

In contrast, mentorship is a long term relationship in which the growth of a less experienced nurse (mentee) is supported by an experienced nurse (mentor) with leadership support. Another significant difference between these two practices is formal hat evaluation is involved frequently in a preceptorship, whereas, mentorship evaluation is less formal. The senior practising nurse is referred to as the mentor, whereas, the preceptor is often the professional teacher or educator.

Several mentoring models have been adapted and created within the nursing profession since Nightingale’s time. Research literature highlighted student peer mentorship, staged, reciprocal, traditional, and little sister big sister as the five most common mentorship models that were used in mentorship practices. ‘Little sister, big sister’ model was used as mentorship practices in the 1940s onward. It was used for the apprenticeship of new students. The nursing knowledge was transferred typically from big sister to little sister. It also provided social activities like teas, picnics. From traditional mid-1970 to mid-1980s and onward, the hierarchical and non-reciprocal model was used. A senior nurse assisted a novice nurse in their role by providing knowledge and support. The mentee shifts independence on the mentor with the progress of the mentorship relationship for increasing independence (Nowell et a., 2017).

These mentorship models also helped in joining objectives between mentee and mentor. They shared meaning, empowerment, and control. These models also contributed to the professional body of nursing knowledge, and they emphasized personal verses of professional success in nursing. Further, in the 1980s, the student peer mentorship model was adopted in the clinical setting. The model was non-hierarchical and reciprocal. It was used for assisting nursing students in the clinical setting. These models also assist students in acclimatizing to the post-secondary nursing curriculum. Early in the 2000s onward, the staged model was used, which was adapted to the participants’ objectives and the forecasted nursing shortages was addressed by it.

2.3. THE FACTORS INFLUENCING THE STUDENT’S NURSE MENTORSHIP DURING THEIR CLINICAL INTERNSHIP

Chen, Watson and Hilton (2016) highlighted some of the factors that can impact, hinder, and enhance the student’s nurse mentorship during their clinical internship. These factors and dimensions were identified by reviewing past research studies based on mentoring. Psychosocial and career function were two significant factors that were found through MRI (mentoring role instrument) and MFS (mentoring function scale). Both of these factors were also identified by GMMP (Global Measure of Mentoring Practices). Intellectual guide, information, career guide, support and friend were also some factors highlighted by the mentoring function. Whereas, the mentee’s perception (mentoring instrument) also highlighted was four significant factors such as research together, mentee professional development, comprehensiveness, and mutual support.

Along with this, different behavioural functions were also found to be influenced such as student vision, mentor model, confrontation focus, facilitative focus, information emphasis, and relationship emphasis were identified by PAMI (Principles of Adult Mentoring Inventory). Relationship, guidance, and integrity were identified as factors by IMS (Ideal Mentor Scale). MEPST (Mentoring for Effective Primary Science Teaching) highlighted five significant factors such as feedback, pedagogical knowledge modelling, system requirement, and personal attributes. Whereas, destructive relational patterns, interpersonal problem, and performance problem were identified as three major factors by NMES (Negative Monitoring Experience Scale). CSMS (College Student Mentoring Scale) identified four major factors such as role model, academic subject knowledge support, career and degree support, emotional and psychological support (Nowell et al., 2017). Whereas, professional-pedagogical benefit, academic benefit items, and exclusive benefit items were identified as the three significant factors by technology mentor benefits instrument. The MRCS (Mentoring relationship Challenge Scale) highlighted some factors such as risk orientation, career goal, and standards of mentors.

Zang et al. (2016) indicated that some barriers might also be faced in implementing mentoring programs, despite the benefits provided to the organization, mentee, or mentor by mentoring programs. Some of the most common hurdles defined are scheduling limitations, space constraints, and time constraints. For implementing a successful mentoring program, these obstacles must be addressed successfully. Jokelainen et al. (2013) highlighted some of the dimensions that impact the student’s mentorship. The conceptions of mentors comprise dimensions of personal, educational, environmental, and organisational provisions that are connected with three different classifications of definition, such as improvement, insufficient, and workable requiring mentorship. The improvement-requiring mentorship emphasized additional personal and educational resources for mentors, the better level of student preparedness, and joint involvement of stakeholders with proper placement allocation, clearer guidelines and higher status for mentorship. The insufficient student mentorship was categorised by lack of personal skills of mentors and resources, unsatisfying cooperation with stakeholders, overloaded placements with stressed staff, and deficient managerial investments. Whereas, the workable student mentorship involved professional and personal competence of the mentors, the co-operative partnerships, well-equipped learning environments, and active organisations.

However, concerning the dimensions of personal, educational, environmental, and organisational procedures, both negative and positive statements were forwarded by Finnish mentors. Mentors from both countries (British and Finnish) felt that mentorship is successful when the collegial and managerial support is provided. The dimensions of resources and work-image represented the relevancy and conditions of placements for students, like the presence of work activities, multi-skilled personnel, and the workload stability and the current situations in the ward. Resources as a dimension were found to facilitate the coordination of stakeholders in placement suitable for student’s practice. For students, the resource dimension can create favourable placements of mentorship for students (Oluchina and Gitonga, 2016). However, for the student mentorship in the organisation, sufficient financial and human resources such as education, reward, and budget must be present. Whereas, the work-image controlled the current working conditions in placement suitable for students’ practice. Resources promoted a development-oriented work image in placement. For student mentorship in the organisation, the work-image contributed to the professional development of mentors for students.

It is also important to note that different factors can also influence effective mentee and mentor relationship in student nurse mentorship. They are the appreciation of situations that can impact trust and each party, and the different expectations between mentee and the mentor and communication. Factors affecting the relationship involve the demands of the higher education system as students strive to meet the required standard necessary to pass their theoretical assignments and her clinical competencies. This can be a struggle for those students who may have been away from education for many years. Some students may also be involved in their work system, as their circumstances may require them to work part-time even though they are studying. Some of them may also be married too. Having to cope with these pressures is bound to affect how they respond to the mentorship relationship.

As well as viewing the student or mentor in isolation, it is important to consider personality, motives, reactions and broader influences in the relationship itself. Mentorship relies on a support system where the mentor challenges the mentee to embrace opportunities and problems and realise their strengths and weaknesses. Working in partnership to negotiate, plan and manage to learn can help in achieving a balance (Peiser et al., 2018). There is also a need to consider: integration and assertion, co-operation and competition, dependence and autonomy. Both partners in a mentorship relationship may need to take a broader view, communicating and appreciating the factors that may be affecting each individual. By doing so, the mentor and mentee will be more readily equipped to meet desired goals and share the common purpose of the partnership.

Some other factors that can negatively influence the mentorship relationship include poor communication, differing expectations, lack of trust and lack of appreciation of the circumstances of everyday life that each person finds themselves in. The use of learning contracts, formulation of ground rules, use of information in student handbooks and discussion of the expectations of the mentor and mentee at the outset can help counteract problems such as those that occurred in the scenario. It can be too easy to apportion blame when a relationship is failing. What is needed is a thorough exploration of the issues to try to resolve differences, empowering the student and the mentor by creating equilibrium in the relationship. Mentor and mentee need to have an appreciation and acceptance of each other’s idiosyncrasies. With excellent communication, honesty and trust, mentorship relationships can be successful, healthy and robust.

Other than this, different factors are also involved in the process of mentoring apart from the involvement of two individuals; some factors are similar for both e.g. the professional and social context in which mentoring takes place. Others may be different, like the power to maintain the mentoring process. There are quite a few factors that influence a mentoring relationship. Some factors contribute to successful cooperation, and others might be hindering. The impact of the mentor can be positive or negative. For example, if a mentor adopts a pedagogical strategy, which challenges the often firmly held beliefs of a novice teacher (due to his education), then this could result in dissonance leading to change or rejection depending on the level of support (Moss and Jackson, 2019). Moreover, there is the agreement that challenges within a mentoring relationship can only be established if it is based on friendship and trust. Besides, there seems to be the widespread belief that mentoring means both providing constructive and critical advice and challenging practices and preconceptions. Some other factors that influence mentorship program implementation include mentorship training and guidelines; quality of the mentoring relationships; choice and availability of mentors; organizational support; time and competing priorities; culture of the institution; and evaluation of mentorship outcomes.

2.4. STRATEGIES FOR IMPROVING THE MENTORSHIP EFFICIENCY OUTCOME

The current practice of the nursing student’s mentorship can be improved by enhancing and addressing the loopholes present in practice. For overcoming the loopholes and barriers, different strategies can be implemented. Jokelainen et al., (2011) suggested that mentorship practices must also organise guidance for students that are required during training, for instance, regular meetings with the mentor and availability of a mentor. Addressing all of these issues related to the learning environment will help students in learning to nurse successfully. Along with this, the training must be organised in an interpersonal learning environment that will support students relating to nursing issues in placements. The students must be made familiarise with placement as a working environment, involving adjusting to the climate in the ward, to the culture of care, to different units, and the hospital. Besides, equal participation was also enabled in teamwork in placement. The student must also be familiarised with all the staff in the ward so that student can commit to the working society and towards placement.

The systematic review of research studies concluded that the student nurse mentorship practices in clinical placements must focus on strengthening the professionalism of students and facilitate their learning. This means that the practices must enhance the accomplishment of professional competence and must empower the development of professional identity and attributes. They must also enable the learning process of the individual and must create a supportive learning environment. It must aid students in developing reflective and critical thinking, must improve their theoretical skills, and must facilitate the accomplishment of stipulated clinical skills. It must interact as professional partners in a co-operative relation and must give equal treatment to nursing colleague and individuals. It must also assess the accomplishment of learning outcomes and personal development and must provide a personal goal-oriented learning path (Pennington and Driscoll, 2019). It must organise training in an interpersonal learning environment and must prepare clinical placement fitness for learning.  Some other significant steps that must also be considered involve co-operating with other stakeholders participating in the training. Working with mentors must be encouraged by sharing feedback and knowledge. The clinical and school placement work must be linked together, and adequate support from the educational/school unit must be acquired.

Further, support of the student must be shared with other staff along with a discussion of problems and training with other colleagues. Trusted collaboration between student and patients must be organised. Working must be done as an advocate of the student and in open and close relationships with co-workers. Participating in holistic patient care must be encouraged by other professionals.

Along with this, equal participation in teamwork in placement must be encouraged. For this, the student must be accepted as a legal worker in the working society. Equal staff rights must be provided to the student. Adequate help must be provided to the student for accepting the standards of placement and settling down. Students must be welcomed to placement.

Further, feelings of belonging to the person must be created, and the student must be integrated as part of the workers in the ward. The student must be involved with other personnel and the nursing staff. The student must be adapted to the nursing profession. Students must be provided with feelings of being an equal partner in the working group. The entry of the student into the working team must be taken care of, and participation of the student must be encouraged as part of a nursing team.

Moreover, the students must be made familiarised with placement as a working environment. The student must be connected to the new community, staff, and culture. Adequate help must be provided to the student for understanding the protocol, routines, and practices in the ward. Students must be helped in adapting to the atmosphere in the ward. The student must be familiarised with the ward and training hospital (Farkas et al., 2019). The students must be integrated with the work organisation and must be helped in adjusting to the new environment.

Further for placement learning, individual support opportunities must also be provided. Events must be shared with the mentor regularly, and frequent appointments with the mentor must be carried out. Along with this, quality time must be given to students. Time must be organised for the student every day. Specific time must only be spent with the student. As a present hostess, working must be carried out near the student. Besides, fluent implementation of placement learning and training must be assured. Working must be encouraged in similar shifts with the mentor. Varying shifts must be organised. For supporting the student with the mentor, commitments must be made to all of the staff, and during absence, a substitute mentor must be assured. The arrival of the student to placement must be arranged. A 1:1 relations between mentor and student must be organised, and a substitute mentor and a personal mentor must be named.

Along with this, the placement learning and training must be planned. Students must be provided orientation to the evaluation of training and learning tasks. All of the details about the nursing curriculum and the student must be known. Limitations of activities must be observed in placement for training. In placement, hands-on possibilities must be organised. For acquiring nursing experiences, suitable practices must be arranged. Learning visits and situations must be planned for different units. For training in placement, applicable patients must be planned, and the contextual learning possibilities in the ward must be presented to students. Despite the narrow specialities, learning possibilities must be assured. The student must be informed about placement and its pre-requisites, and for training, the relevance of placement must be provided.

These steps and strategies will help in understanding that in nursing placements, different clinical, pedagogical, collegial, and environmental attributes and organisational and individual aspects are integrated by student mentoring. This type of integration of personal and professional development and practice and learning will bridge the gap between practice and theory in working life. The mutual relationship between an individual nurse and the student is an important aspect, but it is increasingly essential for the managerial level to provide opportunities for student mentoring with enough resources and education. First, a very notable aspect is the creation of a supportive learning environment because it does not exist self-evidently. Some of the studies also found that a positive ward atmosphere in the learning environment is very significant for nursing students. Therefore, preparation and organisation of placements for students’ clinical learning are critical, because students feel safe and are assured of the quality of the placement learning opportunity, provision and support. This is crucial if we wish to retain nursing students and reduce attrition. Second, facilitating students’ individual learning processes is also essential; this requires pedagogical competence from the nursing professionals in placements. First of all, this influences their ability to provide a goal-oriented assessment of students’ performance, which requires, among other things, a deep understanding of the goals of education.

Strengthening the student’s professionalism and the development of a professional identity were other important aspects of mentoring. Students want to be treated as individuals and colleagues during placement learning. Therefore, enthusiasm and positive attitudes in placements are important, as they influence students’ learning significantly. Furthermore, in a mentoring relationship, it is possible to achieve a level of collegiality with students. Friendship was also included in mentoring, but it seldom happened in practice. On the other hand, current nursing education values the student’s independence and self-direction in learning, which puts the responsibility on students to be active in the mentoring relationship. However, it is significant that mentors motivate students to learn nursing in placements and act as role models of nurses.

Moreover a positive image of the profession strengthens students’ view of their own career as nurses and a negative image discourages students’ career planning in the future. In addition, the wellness and job satisfaction of nurses are enhanced by taking on mentoring. Student mentoring included facilitation of achievement of professional competence and professional growth of the students. Reflective learning and critical thinking are crucial for students to learn to be able to develop new thinking and practices in clinical nursing when working as professional nurses in the future. However, it was surprising to note that the influence and use of technology in nursing practice was not considered in mentoring of students. However, the growth of technology is increasing in health care, for example, in the use of electronic documentation.

Student mentoring was seen in this review mostly from the perspectives of a mutual 1:1 relationship between the student and a mentor, who is considered a very significant person for students in clinical placement and this working relationship has been said to be a requirement for effective mentoring. Nevertheless, leadership and management are essential baselines in organising, coordinating and developing student mentoring in placements. The relationship between education and practice has also been presented as inadequate which needs enhancing. Moreover, the roles of stakeholders in supporting nursing students in clinical practice vary internationally and need to be reviewed closely.

2.5. CONCLUSION

This chapter has surveyed past research studies on student’s nurse mentorship. Further, it also has clarified all of the confusions related to the nurse mentorship practices. It also has filled the available knowledge gap which will provide numerous benefits to the service users within the scope of this research topic. Further it has proposed strategies for improving the mentorship efficiency outcome. Lastly it has identified the dimensions that make the student nurse’s mentorship during the internship time, which dimensions make the student nurse’s mentorship. Next, it has studied the factors that enhance the mentorship process and also the ones that hinder mentorship in practice. This chapter revealed some of the mentorship practices involve creating a supportive learning environment that involved all the arrangements in placements that prepare practice of students and organize their support system. For learning purpose, preparing clinical placement fitness comprise of advance planning of placement learning and training that involved being aware of details of students and their training documents such as the nursing curriculum, organising and planning learning opportunities and the applicability of placement. Some other arrangements involve assuring fluent implementation of placement learning and training, for instance, organising the first day of student in placement and naming substitute and personal mentors. This helps in enabling an interpersonal relation with the mentor. Further, it highlighted some of the factors that can impact, hinder, and enhance the student’s nurse mentorship during their clinical internship. These factors and dimensions were identified by reviewing past research studies based on mentoring. The chapter also highlighted some barriers may also be faced in implementing mentoring programs, despite of the benefits provided to the organization, mentee, or mentor by mentoring programs. Some of the most common hurdles defined are scheduling limitations, space constraints, and time constraints. For implementing a successful mentoring program, these obstacles must be addressed successfully. Lastly, it also indicated that the current practice of the nursing student’s mentorship can be improved by enhancing and addressing the loopholes present in the practice. For overcoming the loopholes and barriers, different strategies can be implemented.

CHAPTER 3: RESEARCH METHODS

3.1. INTRODUCTION

This chapter reflects upon the research methods chosen for the study. This research study has used positivistic paradigm. The positivistic paradigm is referred to as the systematic empirical investigation of incidents through computational and mathematical techniques and statistics. It is a mixed method study that has been performed for developing an instrument for measuring the efficient factors on clinical learning in nursing students. It also has used quantitative research approach for examining the relationship between factors and the student nurse’s mentorship. Further it has used survey design as the research method that has helped the study in acquiring desirable information in the initial phases. For research technique, it has adopted the questionnaire technique with five Likert scale option and secondary data from the survey and the literature. For data collection purpose, primary data collected through questionnaire has been used.

3.2. RESEARCH DESIGN

The mixed method research design has been used in this study for measuring efficient factors on clinical learning in nursing students. For the combination of data, one of the rich fields is mixed methods, because meaning to the numbers can be added through narrative, pictures, and words. The quantitative numerical data from a huge-scale study on the similar issue can be combined with qualitative data, including narrative, pictures, and words. This eventually help the study in deriving generalized results for future examinations and studies (Morse, 2016). The mixed method research design also provide a rigorous approach to researchers for answering research questions. It is necessary that research design must be articulated clearly to readers. For the last decade, the field of mixed methods have been accepted widely. Advantage of using different methods for exploring a research question is considered by mixed methods research. According to Subedi (2016) the basic characteristics of mixed method research design involve research process stages that can be influenced by continuous interpretation, any technique available to researchers is included in data collected, and sample sizes can also different on methods used. Some other characteristics are research problems that can become research hypotheses and/or questions based on the research process, experience, knowledge, and prior literature and design can be based on both or either perspectives.

Moreover, each of the dimensions of mixed methods design must be considered carefully and understood by researchers to design a mixed study. The issue of validity must also be focused. Design complexity, emergent versus planned design, interactive versus typological design approaches, point of integration, dependency and simultaneity timing, theoretical drive, and purpose are the seven different dimensions of design. During the design process, different secondary dimensions must also be considered. Other than this, fully integrated mixed designs, multilevel mixed designs, conversion mixed designs, sequential mixed designs, and parallel mixed designs are five sets of mixed methods research designs (Morse, Cheek & Clark, 2018). At all stages of the study, the mixing takes placed in fully integrated mixed designs in an interactive manner. The formulation of one approach is influenced by one approach at each stage. Along with this, different kinds of implementation process can takes place. For instance, at the inferential stage, the analysis stage, the methodological stage, the conceptualization stage, mixing takes place. The mixing in multilevel mixed designs takes place different levels of analysis such as QUAL and QUAN data are integrated and analysed for answering related aspects of the similar research question. In conversion mixed designs, the mixing takes place when the findings are added to the results and one kinds of data is analysed and transformed. Related aspects of the similar research question are answered by this design. In sequential mixed designs, QUAN and QUAL strands take place across chronological phases (Kaur, 2016). During the study, the research questions are evolved and interrelated. In parallel mixed designs, parallel qualitative and quantitative strands either simultaneously with some minimal time lapse, the results of the stand are integrated into meta-inferences once the separate analysis have been performed.

For mixed research design, the perceptions of nursing students related to clinical learning and its influencing factors were researched with the help of the qualitative content analysis approach. From the interviews, the main items and themes of the questionnaire were extracted from the data collected. In this step, the participants were chosen among the nursing students based on the study objectives. The process of sample selection continued until the data was saturated. By using the semi-structured individual interviews performed by the researcher, the data was collected. Further, the qualitative content analysis, the data was analysed. Along with this, survey design has been used in this study as it helped in acquiring desirable information when the research in the initial phases.

3.3. RESEARCH METHOD

The mixed research methodology has been used in the study. Both qualitative and quantitative data collection methodologies are used by the mixed research methodology. Some examples of mixed research methodology are interviews, questionnaire, performance tests, and document analysis. Other examples are follow up focus groups, questionnaires, observation, and performance tests, questionnaires, and interviews. Gray (2019) highlighted that numerical data is collected through quantitative methodology that also be subjected to statistical analysis. Some examples of data collection methodologies are content analysis, questionnaires with open-ended or close-ended questions, personality measures, and performance tests. The collected through quantitative methodology is mostly considered as the ‘hard’ data. Whereas, the data is subjected to analytic induction, for instance, searching for common themes and listening to the voice of the participants are involved in the qualitative methodology (Kumar, 2019). The qualitative methodology is quite exploratory in nature. Some examples of methods of data collection involved in qualitative methodology are focus groups, content analysis, observations, open-ended questionnaires, and interviews.

Mixed method research methodology also involved performing research that includes integrating, analysing, and collecting of qualitative (e.g., interviews and focus groups) research and quantitative (e.g. surveys and experiments). As a methodology, it also includes philosophical assumptions that also provide guidelines regarding the analysis and collected of data and the mixture of quantitative and qualitative data in a series of studies or a single study (Baran, 2016). The central premise of this methodology is that qualitative and quantitative approaches are used along with a better understanding about research problems. It is also important to note that mixed method research methodology also have certain weaknesses and strengths. Its major weaknesses involve little guidance on transformative methods, difficulty in deciding when to proceed in sequential designs, unequal evidence generated by some designs, resolving discrepancies amongst different kinds of data, and time required. Its major strengths are positioning of research in a transformative framework, helpful in validating and designing an instrument, helping in generalizing to a qualitative data, useful when unexpected results arise from a prior study, and can be quite easy to report and to describe.

The questionnaire research technique was used with the Likert scale option along with the secondary data from the survey questionnaire and literature. Validated questionnaire with close-ended questions was used as the research instrument. The expression, items, and main themes of the questionnaire were extracted from the concepts collected. Two quantitative and qualitative approaches were used for face validity of the work. Face-to-face interviews were performed with ten students for qualitative face validity and factors involving ambiguity (presence of ambiguity in the words or likelihood of misunderstanding the items), proportionality level (the relationship between aspects and the items of the questionnaire and the desired proportion), and difficulty level (difficulty of understanding the words and expressions). After correcting the items based on the opinion of the students, the quantitative item impact method was implemented for determining the significance of each expression and decreasing the improper expressions (Robinson, David & Hill, 2016).

3.3.1. Sampling

3.3.1.1. Population

Three participants were chosen from Mauritius. The population of interest will be student nurses that are doing practical training at the hospital in Mauritius.

3.3.1.2. Sampling and Selection Criteria

By applying the Cochrane formula, the sample size was calculated. An ideal sample size provided the estimated proportion of the attribute present in the population, desired confidence level, and desired level of precision, can be calculated through the Cochran formula. In scenarios where large populations are involved, the Cochran’s formula can be considered (Ahmad & Halim, 2017). More information is provided by a sample of given size about the smaller population in contrast to a larger one. This further presents a correction through the number provided by Cochran’s formula can be decreased, specifically if the entire population is small relatively. The Cochran formula is:

Z-value is found in a Z table, ‘1-p’ is q, the estimated proportion of the population that has the attribute in question is ‘p’, and the desired level of precision or the margin of error is ‘e’. The sample size can also be used by using Cochran’s formula and following certain steps, involving making no assumptions based about the knowledge of statistical methods, working out the finer details of how the sample size was derived, and identifying the symbols in the formula with actual figures (Rahi, 2017).

Further, for participation in the study, the exclusion and inclusion criteria has been specified. The characteristics that must be present in the prospective subjects if they are to be involved in the study is referred to as the inclusion criteria. Whereas, those characteristics through which prospective subjects are disqualified from inclusion in the study are referred to as the exclusion criteria. In this way, exclusion and inclusion criteria are written usually in a positive manner. Otzen & Manterola (2017) indicated that participants having an exclusion criteria are out of the study, whereas, those having an inclusion criteria are in the study. According to the inclusion criteria, the participants must be currently doing their clinical internship learning stage at the hospitals and they must be students’ nurses. The exclusion criteria involved those students who are not enrolled in the nursing programs, like midwives as they have different internship protocols. It also involved those students who participated in the preliminary pilot testing stage, those who had irregular attendance at their internship, and those who have any history of psychiatric illness.

3.3.1.3. Sampling Technique

The Cochran’s formula was used for determining the sample size. For small population, the Cochran’s formula sample size was used, where 0.0.5 is the margin of error, q is ‘1-p’, the estimated proportion of the population is ‘p’, the desired level of precision is ‘e’, the sample size is ‘n0’, and ‘Z2’ is the z-score (1.96) on normal standard variable curve corresponding to 95% confidence level.  The distribution of has been stated below:

Country	Hospital Sites	Student Nurses Population doing internship	The Number needed to be recruited in Survey
Mauritius	Victoria	150	123
	SSRN	150	126
	Flacq	150	131
	Recruits Needed		384

 

3.3.1.4. Ethical Issues related to Sampling

According to Martínez-Mesa et al., (2016), conducting research on samples is one of the key elements of performing a dissertation successfully. The manner in which a sample is selected for investigation can result into a huge number of ethical issues that must be overcome and understood. When considering how research ethics may be influenced by sampling strategies, some of the things must be considered by the researcher. They involve the role of gatekeepers that impact the researcher’s access to the sample, the sample size, and the sampling techniques chosen for the study.

Since this study has used exclusion and inclusion criteria thereby one of the ethical concerns faced was the danger that units may be unnecessarily excluded. There was also a chance that the sample size may become an ethical issue for two reasons that are under-sized samples and over-sized samples. Since an excessive number of units or people may be exposed potentially to the research, thereby, an over-sized sample may become an ethical issue. One of the basic principles of research ethics is the duty of not to expose an excessive number of individuals for harming or distressing them unnecessarily (Robbins, 2017). Therefore, the potential ethical issues that may come with an under-sized and over-sized samples were minimised in this study. Further, this study has adopted protocols that are complete congruence with the policies of the research ethics and the principles of beneficence. Informed consent has been gained from all of the participants. Voluntary participation has been encouraged. Confidentiality of the participants has been maintained and without any adverse impact on the participant, the withdrawal can take place at any time. For authorizations and clearance, the application has been forwarded to the hospitals and the institution review boards for acquiring authorizations before collecting the data.

3.3.1.5. Sample

The G*Statistics Calculation technique has been applied to determine the sample size. The association among the values is found through G*Statistics. Low and high clustering of observed values is also provided by G*Statistics by providing negative and positive Z-scores. The G*Statistics also helps in calculating the statistical power (Calin-Jageman, 2017). For a huge variety of statistical tests involving square-tests, F-tests, and t-tests, the ability of calculating the power is provided by G*Statistics. It also helps in determining the effect size if it cannot be calculated easily or estimated through the past literature (Greenland et al., 2016). The G*Statistics is also used when there is one nominal variable in the study with two or more values (like female and male). In each category, the observed counts of number of observations are compared with the expected counts. This is calculated by using some kind of theoretical explanation.

Along with this, the cluster sampling has been used in this study. The total population will be represented by each cluster that is a small-scale unbiased representation. In a statistical population, when internally heterogeneous and mutually homogeneous grouping are apparent, then a sampling plan is used which is referred to as cluster sampling (Qureshi, Kadilar & Hanif, 2020). The total population is categorised into groups such as clusters and then selection of a simple random sample is made. Further, in each cluster sampling of the elements are done. The ‘one-stage’ cluster sampling plan is referred to when all elements present in each sampled cluster are sampled. Whereas, the ‘two-stage’ cluster sampling plan is referred to when simple random subsample of elements is chosen within each of these groups. For cluster sampling, one of the major motivation is to decrease the total number of costs and interviews provided by the desired accuracy (Bowering et al., 2018). When most of the variation in the population is internally present not between the groups and within the groups, then the expected random error is smaller for a fixed sample size. Moreover, the cluster sampling will provide this study different advantages such as reduced variability, economical, feasibility, and less cost. In contrast to other sampling plans, the cluster sampling is quite cheaper. In contrast to data collected from a simple random sample, more accurate estimates will be derived from the estimators produced by cluster sampling by the estimators in the rare case of a negative intra class correlation amongst subjects. Further, two major concerns of expenditure that are listing and traveling are reduced greatly in this sampling method. Lastly in comparison to other sampling plans it is quite cheaper.

3.3.2. Data Collection

3.3.2.1. Data Collection Approach and Method

The process of collecting information from all related sources for evaluating the outcomes, testing the hypothesis, and finding answers to the research problem is referred to as data collection. The methods of data collection can be divided into two different categories that are primary methods of data collected and secondary methods of data collected (Ghauri, Grønhaug & Strange, 2020). This study has used both of these data collection methods. Kind of data that has been published already in online portals, journals, magazines, newspapers, and books is referred to as secondary data. Regardless of the nature of the research area, huge amount of data is available in these resources. Thereby, a significant role concerning to increasing the levels of reliability and validity is used by the application of proper set of criteria for selecting secondary data. These criteria involve the extent of contribution of the text to the development of the research area, depth of analyses, quality of discussions, reliability of the source, and credential of the author.

Further, qualitative and quantitative are two groups in which the primary data collection methods are categorised. In different formats, the quantitative data collection methods are based in mathematical calculations. Median, mode, mean, regression, methods of correlation, and questionnaires with close-ended questions are involved in methods of quantitative data collection. In comparison to qualitative methods, the quantitative methods can be applied within shorter duration of time and are cheaper to apply (Paradis et al., 2016). Moreover, it is quite easy to make comparisons of findings due to an increasing level of standardisation of quantitative methods. On the other hand, the qualitative research method do not comprise of mathematical calculations or include numbers. The qualitative research is closely linked with colours, emotions, feeling, sounds, and words that are not quantifiable. To assure that a greater level of depth of understanding is provided is the key objective of qualitative studies. The qualitative data collection methods involve case studies, role or game-playing, observation, focus groups, and open-ended questions (Moser & Korstjens, 2018). The selection between qualitative or quantitative methods of data collection is dependent upon the nature of research objectives and aims and the area of the research. The primary data was collected through validated survey questionnaire. The survey was filled by spending 18 mins per questionnaire.  The survey aimed to assess the factors that influence student nurse mentoring while in the clinical area. The questionnaire has collected data about the operation of clinical mentorship within the healthcare sector. This data can be used to help set objectives and goals for the healthcare sector of Mauritius.

3.3.2.2. Development and Testing of the Data Collection Instrument

A psychometric scale where questions based on this scale are used normally in a survey is referred to as Likert scale. In a survey, it is one of the most widely used types of question. The respondents do not select between ‘no/yes’ option in a Likert scale survey, but there are particular choices based on ‘disagreeing’ or agreeing on a specific question in the survey. In measuring the attitude or opinion of the respondents that may be the key element of market research or towards a particular subject, significant help can be gained through Likert scale survey questions (Chyung et al., 2017). For measuring the agreement of the respondents with a variety of statements, the Likert scale is a nine-, seven-, or five-point agreement scale. The Likert scale helps in assessing the level of disagreement or agreement of a symmetric disagree-agree scale. The questionnaire of this study has been developed from the literature and comprises of different sections, including the closure statement, the survey items rated by the Likert scale, the demographic section, and an enlistment statement with informed consent for participation. The 5-point Liker scale was used for each item. The items involved: 1 – ‘not important at all’, 2 – ‘little important’, 3 – ‘medium important’, 4 – ‘rather important’, and 5 – ‘completely important’. For further analysis, the expression is identified through the item impact method (Lewandowski, 2020). For several times, the expressions were scrutinised by the researcher and then the suggestions were reviewed and implemented by experts.

3.3.2.3. Characteristics of the Data Collection Instrument

One of the major challenge faced by the researcher is defining the qualities represented by the data. An examination of the characteristics of data is required for judging the quality of data. The data quality can be defined through seven characteristics such as uniqueness and granularity, accessibility and availability, comprehensiveness and completeness, consistency and timeliness, consistency and reliability, validity and legitimacy, precision and accuracy (Rubinfeld & Gal, 2017). The dependent variables (input) are adequate number of cases for practicing, number of contact hours with the mentor, support from ward team members, the ratio of student to clinical mentor, the facilities available at the learning environment, and the demographic characteristics of the participants, and others as per the approved questionnaire. Whereas, the perceived standard of efficient mentorship from the student nurses is the proposed (outcome) variable.

3.3.2.4. Data Collection Process

The procedure of measuring and gathering information on variables of interest is referred to as data collection. This is done in a systematic fashion through which outcomes can be evaluated, hypotheses can be testes, and research questions can be answered. For maintaining the integrity of research, it is important to choose appropriate data collection. The likelihood of decreasing the errors that may occur can be done through proper selection of data collection instruments. This study has used the quantitative data collection method that is questionnaire with close-ended questions. The questions provides respondents with the predefined answer options.

3.3.2.5. Ethical Considerations related to Data Collection  

For maintain the integrity of data collection, some of the ethical issues have been addressed in this study. In the data collection process, the detection of errors has been supported from preserving the data integrity, whether they were intentionally made and were not random or systematic errors. Further, the data integrity was preserved and the scientific validity of study results was assured by two approaches such as quality control and quality assurance (Tong, Tong & Low, 2018). The quality control referred to the activities that were taken place after and during data collection. The quality assurance referred to those activities that were taken place before the data collection was started. Prior to data collection, the ethical clearances certificates have been collected from MOH Mauritius and CSU China. This research has also received ethical clearance from the University and has complied with the laws of data protection.

3.3.3. Data Analysis 

This research has used descriptive analysis for summarising the data, including frequency, mode, median, and mean. Along with this, the inferential statistical analysis has been used. According to Quinlan et al., (2019), the inferential analysis is referred to as the techniques that help in making generalisations about characteristics of a population based on a sample. For example, ANOVA, Chi square, t-test, and correlation. Further, by using SPSS 25 the statistical analysis also has been performed. There are different types of statistical analyses, such as multivariate logistic regression analyses or logistic regression, chi-square test and crosstabs, standard deviations, means, percentages, and frequencies.  For demographic characteristics, the standard deviations and frequencies have been compared. The CFA & EFA, factor analysis, ANOVA tests and Chi-square have been used. Moreover, the non-parametric usage can done through ordinal or nominal data. Whereas, the parametric use can be done with ratio or interval data. Further, for determining the construct validity of the items collected from the interviews for detecting the classifications from the parameters with the highest relation, the EFA – exploratory factor analysis was used. The internal relationship of the parameters can be evaluated through EFA. In designing the novel tools, one of the important steps considered is factor analysis (Babbie, Wagner III & Zaino, 2018). From the perspectives of researchers, the number of samples required for performing factor analysis describing the construct validity is quite different. For each expression of the questionnaire, five to ten is the number of recommended samples for factor analysis. However, it has believed by some experts that three samples may be quite enough (Ali & Bhaskar, 2016). One of the techniques for determining a category of related questions in a provided scale is factor analysis. A group of parameters that have increasing correlation amongst themselves comparative to the parameters is involved each factor or category. A similar property is explained by each factor and through the classification of parameters, it can be interpreted.

3.4. INTERNAL AND EXTERNAL VALIDITY OF THE STUDY

The reliability has been maintained through pilot testing with at least two various groups. For checking the user-friendliness nature, the pilot testing will be done on a few participants. After that the corrected version will be corroborated as usable. To assure internal consistency, the Cronbach Alpha value greater than 0.7 has been used. Back translation and translation checks has been used in China. To assure content validity, the items of the questionnaire has been reviewed by five independent expert. The drafter questionnaire was sent to at least five independent expert reviewers in the field of validating the content items that is degree to which items of an instrument present the content domain (Baldwin, 2018). Along with this, the external validity constructs and internal constructs reports has been reviewed. Moreover, the content validity was identified through the judgment of the students and experts. For qualitative evaluation of the questionnaire, feedback was collected from different experts for qualitative content analysis. CVI (content validity index) and CVR (content validity ratio) were used for quantitative content validity analysis. Moreover, different experts were requested to evaluate each item based on three-part scale comprised of expressions, involving ‘it is not necessary’, ‘it is useful but not necessary’, and ‘it is necessary’, to determine CVR. The minimum value of CVR was determined 0.49 by using the Lawshe tables. Then through the Walts & Bassel approach, the CRI was determined. Further, the constructed questionnaire was also offered to the experts for assessing clarity, simplicity, and relevance of the expressions in the questionnaire. Along with this, different experts were also requested to examine these three criteria (clarity, simplicity, and relevance) in a four-point Liker scale. In this study, the CVI score was obtained for each item through calculation. The number of experts that agreed with the expression with scores 3 and 4 was divided by the total number of experts. Based on CVI score, a score of 0.79 and higher was recommended for items reception (Fredericks t al., 2019). Next, based on the mean CVI scores of all the expressions, the mean CVI of the questionnaire (S-CVI/Ave) was calculated. Moreover, for S-CVI/Ave acceptance, a score of 0.9 and higher was recommended by (cite). Finally, the expressions were organized in the form of three themes involving clinical learning strategies (twelve expressions), learning conditions (four expressions), and human resources of clinical learning (twenty-nine expressions).

3.5. CONCLUSION 

This chapter reflected upon the mixed method research design used in the study for measuring efficient factors on clinical learning in nursing students. For mixed research design, the perceptions of nursing students related to clinical learning and its influencing factors were researched with the help of the qualitative content analysis approach. From the interviews, the main items and themes of the questionnaire were extracted from the data collected. In this step, the participants were chosen among the nursing students based on the study objectives. The process of sample selection continued until the data was saturated. By using the semi-structured individual interviews performed by the researcher, the data was collected. Further, the qualitative content analysis, the data was analysed. Along with this, survey design has been used in this study as it helped in acquiring desirable information when the research in the initial phases. Moreover, with the application of the Cochrane formula, the sample size was calculated and the ethical issues related to sampling were addressed.

CHAPTER 4: ANALYSIS, PRESENTATION AND DESCRIPTION OF THE RESEARCH FINDINGS

4.1. INTRODUCTION

In clinical placements, mentoring of nursing students is mostly presented in two themes, including strengthening professionalism of students and facilitating learning of students in clinical placements. These involve mentoring problems expressed as actions that promote professional and learning development of students. This chapter has found some of the major factors influencing student nurse’s mentorship during their clinical internship such as number of contact hours, support from ward team members, the student to clinical mentor ratio, and facilities available at the learning environment.

4.2.1. SAMPLE SIZE

Correlation coefficients differ much more from sample to sample in small than larger samples. The reliability of factor analysis and of other analyzes such as regression analyses and correlation analyzes depends also on the sample size. The sample size required for factor analysis is dependent on several factors. The sample size of our study is 384. Typically, over 300 cases are probably acceptable, but after extraction communalities should usually be above 0.5, and in our research it is above 0.5.

4.2.2. DATA SCREENING

SPSS can consider a factor solution for a number of variables almost always. However, if the variables evaluated are not sensitive, the solution is unlikely to have real significance. The first step is to look for a link between variables when performing factor analyzes or other studies. We expect them to agree with each other (because they’re measuring the same thing) if our test question tests the same underlying dimension (or dimensions). When we find variables that are not associated with other (or very few) variables, then before the factor analysis is carried out we need to consider exclusion of these variables. The following work discusses the correlations between variables using the correlate method and generates a correlation matrix for all variables. As part of the key analysis factor this matrix is created. The problem is if the variables are too strongly correlated. Although moderate multicollinearity cannot be a factor analysis problem, it is important to avoid extreme multicollinearity (i.e. very highly correlated variables) and singularity (perfectly correlated variables). Singularity creates difficulties in factor analysis as with regression, since the unprecedented contribution to a strongly interrelated vector of variables is not feasible (as was the case in our work with multiple regressions). Therefore, we are attempting at this early stage to exclude all variables which do not correlate with or are very strongly correlated with other variables. Through looking at the R-matrix determinant, multicollinearity can be observed.

4.2.3. DATA VIEW

The data are laid down for statistical applications in the Data View as the traditional rectangular format. Row is an observational unit, often also called a chart, or as a case within SPSS. The case number (observation) in the left column is automatically allocated and not reported as data. There is a variable in each column. All column data, whether numeric or string (also known as the character), must be of the same form.

 

4.2.4. FREQUENCIES: COUNTS AND PERCENT

Counts and percentages are perfect figures because they are easily understandable and easy to describe. Frequencies are also the basis of most probability explanations. They are an excellent place to continue and grasp all the data from which you can work.

4.2.5. FREQUENCIES: FREQUENCIES AND STANDARD DEVIATIONS FOR DEMOGRAPHIC CHARACTERISTICS

4.2.6. DESCRIPTIVE ANALYSIS

For example, summary statistics of the scale variable and measurement factors, descriptive statistics are useful in explaining the basic characteristics of data. Such statistics will help us to organize and present the data in a summary table in a research study with broad data. We will help us to handle a player record in a cricket match, for example, and also help us compare records of one player with the records of another player.

Following statistics are performed in our research work:

• N valid responses
• Mean
• Standard deviation
• Minimum
• Maximum
• Standard error of the mean (or E. mean)
• Skewness
• Kurtosis

Table 2 : Descriptive Statistics

In the table above, Adequate number of cases for practicing (m=2.9774 SD=0.98785) has the greatest Skewness of 4.664 followed by the demographic characteristics of the participants (m=2.2760, SD=0.36606), the facilities available at the learning environment (m=2.7860, SD=0.64161), student to clinical mentor ratio (m=2.9922 SD=0.60803), support from ward team members (m=2.7688 SD=0.61289), number of contact hours with the mentor (m=2.7938 SD=0.61844), and then perceived standard of effective mentorship from the student nurses (m=2.7818, SD=1.62220). Furthermore, student to clinical mentor ratio (m=2.9922 SD=0.60803) has the highest Kurtosis of 9.898 followed by Adequate number of cases for practicing (m=2.9774 SD=0.98785), demographic characteristics of the participants (m=2.2760, SD=0.36606), the facilities available at the learning environment (m=2.7860, SD=0.64161), support from ward team members (m=2.7688 SD=0.61289), number of contact hours with the mentor (m=2.7938 SD=0.61844), and then perceived standard of effective mentorship from the student nurses (m=2.7818, SD=1.62220). The values of Skewness and Kurtosis are within ideal range as can be seen in the above results, thus showing that the constructs do not disrupt the state of univariate normality.

4.2.7. CORRELATION

Correlation is a statistical methodology that shows the clear ties between two variables or the degree of correlation between them. For instance, we will figure out how these two variables apply to the weight and height data for large and shorter individuals with the correlation between them. Only the association between these two variables can be found and we conclude that their height is positive. The correlation is calculated by the coefficient of correlation. The correlation coefficient in SPSS can be determined very easily. We should have a basic knowledge of correlation before we measure the correlation in SPSS.

 

Table 3: **Correlation is significant at the 0.01 level (2-tailed)

In the above table, the facilities available at the learning environment  and student to clinical mentor ratio  is 0.364, which is the strongest relationship in the study, proves one hypothesis, which is, existence of a positive relationship between the learning environment  and student to clinical mentor ratio.

4.2.8. REGRESSION ANALYSIS

Regression analysis includes several observable approaches used to estimate the ties between a vulnerable variable and at least one autonomous component. It is used to determine the consistency of the ties between the factors and to show the potential relationship between them.

Table 4: Dependent Variable: DV standard of effective mentorship from the student nurses new

** All requested variables entered.

 

 

Table 5: Model Summery

Predictors: (Constant),

• IV_6_Adequate_number_of_cases_or_practicing_new
• IV_2_The_facilities_available_at_the_learning_environment_new
• IV_5_Number_of_contact_hours_with_the_mentor_new, IV_1_demographics_new
• IV_4_Support_from_ward_team_members_new, IV_3_The_student_to_clinical_mentor_ratio_new

Table 6: ANOVA

1. Predictors: (Constant)

• IV_6_Adequate_number_of_cases_or_practicing_new
• IV_2_The_facilities_available_at_the_learning_environment_new
• IV_5_Number_of_contact_hours_with_the_mentor_new, IV_1_demographics_new
• IV_4_Support_from_ward_team_members_new
• IV_3_The_student_to_clinical_mentor_ratio_new

 

1. Predictors: (Constant)

• IV_6_Adequate_number_of_cases_or_practicing_new
• IV_2_The_facilities_available_at_the_learning_environment_new
• IV_5_Number_of_contact_hours_with_the_mentor_new, IV_1_demographics_new
• IV_4_Support_from_ward_team_members_new
• IV_3_The_student_to_clinical_mentor_ratio_new

Table 7: Coefficients

4.2.9. EFA

In general, the Factor protocol in the SPSS Base Module is limited to the EFA study of exploratory component. According to the choice you make with regard to extraction and rotation, the amount of variables to be held, etc, this approach is the product of the numerical objectives optimization.

4.2.10. PRELIMINARY ANALYSIS

 

Output 1 EFA

The R-matrix version is shown in the above table. The top half of this table displays the Pearson coefficient of correlation for all the questions, while the lower half includes the one-tailed value. This matrix can be used to test relationship patterns. The correlation coefficients are then checked and searched for more than 0.9. At the bottom of the matrix, the determinant is given. The value of this data is 0.545, which is higher than 0.00001. Consequently, multicollinearity for these data is not a concern. In summary, all questions in the SAQ are very well correlated and none of the coefficients of correlation are especially large; thus, no questions need be dealt with at this point.

Output 2 EFA

The estimates for KMO range from 0 to 1 A value of 0 indicates that the number of partial correlations in relation to the number of correlations is high, implying that the correlation patterns are diffused (the study of the factor may therefore be unsuitable). A value near 1 indicates a fairly compact pattern of correlations, and therefore an analysis of the factor will yield specific, trustworthy factors. The value agreed should be above 0.5 as appropriate (values below will either collect more data or reconsider which variables to include). Furthermore, the 0.5 to 0.7 values are average, 0.7 to 0.8 values are good, and 0.8 to 0.9 values are fantastic and over 0.9 values are outstanding. The value of the data is 0.623, an average value: we have to be certain that this information can be factory evaluated. Bartlett’s estimate tests the null assumption that an identity matrix is an initial matrix of correlations. For factor analysis, they involve certain relationships between variables and if the R matrix were an identity matrix, all of the correlation coefficients would be zero. This check is therefore essential to us i.e. it has a meaning value of less than 0.05. An essential test says that the r-matrix is not a matrix of identity; thus, the variables that we are hoping to use in the analysis are connected. The test of Bartlett is very valid for such data (p < 0,001), and thus it is an effective factor analysis.

4.2.11. FACTOR EXTRACTION

Output 3

SPSS Output 3 lists individual component values before extraction, extraction and post-rotation association with each linear component factor. Prior to extraction, SPSS has defined 23 linear components in the collection of data. We know that as many vectors as variables and so as many factors as variables would be available. In the sense of the explanation for the percentage of variance, this explains factor 1 27.232 per% of total variance. The values of each factor reflect the variance explained by this particular linear variable. The first few factors clearly explain relatively high variance levels (particularly factor 1) and then only small amounts of variance. Instead, SPSS excludes all variables with values above 1. The size of the sum associated with these variables is shown again in the columns of the Sum Squared Loading Extraction, and the variance percentage is clarified. The values in this table section are the same as the values prior to extraction except that the values for the discarded variables are absent, i.e. after the second element, the table is blank. SPSS Output 4 shows the group table before and after extraction. The study of the main component operates on the initial assumption that all variation is common; thus, the populations are all 1 before extraction. The communities of the Extraction column reflect the common variance in the structure of the data. We may assume, therefore, for example, that 18.7% of the variance in question 1 is normal or shared. The proportion of variances described by the underlying variables is also another way to look at these groups. Some considerations have been discarded after extraction and some information has been lost. The quantity of variation in each variable described by the factors retained is indicated by the communities after extraction.

 

 

 

Four factors were defined by SPSS at this point. Factor analysis is an exploratory method, so it should be used to direct the researcher in making different decisions. The number of factors to be extracted is an essential decision. The communalities are shown in SPSS Production 4 and none is greater than 0.7. By adding and dividing into the number of communalities groups (1.817/6 = 0.302), the average of communalities can be identified. And the law of Kaiser may not be true for both reasons. You should find the large sample; however, as the Kaiser criterion work offers advice for much smaller samples. We can also use the screen plot that SPSS has been asked to create. The plot reveals the below thunderbolt, which suggests the curve turning point. This curve is difficult to read as after three variables the curve starts to sink, but after three, before a stable plateau is reached, there is another reduction. One or two or four variables would also theoretically warrant retention. Given the large samples, the Kaiser test could well be presumed, but you might rework the study to demonstrate that only two variables are being derived from the PLCS and the findings were to be compared.

4.2.13. GRAPHICAL REPRESENTATION

4.2.13.1. HISTOGRAMS

SPSS has three separate sets of graph-making commands. The oldest “legacy” graphics commands are the simplest to understand and use. You can find graphs that are adjustable by hand in the usual visual way (colour used, weight of lines, shape size, etc.). The histogram is vexative since, depending on how the bins (bar boundaries) are chosen, they are either informative or misleading. These are useful and popular because they are conceptually very simple, can easily be built and interpreted, and if well drawn, the distribution of values of a variable can be well visualized.

Figure 3: IV_1_demographics_new

 

 

 

Figure 4: IV_2_The_facilities_available_at_the_learning_environment_new

 

Figure 5: IV_3_The_student_to_clinical_mentor_ratio_new

 

Figure 6: IV_4_Support_from_ward_team_members_new

 

Figure 7: IV_5_Number_of_contact_hours_with_the_mentor_new

 

 

Figure 8: IV_6_Adequate_number_of_cases_or_practicing_new

 

 

Figure 9: DV_Standard_of_effective_mentorship_from_the_student_nurses_new

4.3. OVERVIEW OF RESEARCH FINDINGS

The results concluded that one of the major factor that impact student nurse’s mentorship during their clinical internship is facilities available at the learning environment. A supportive clinical environment influence student nurse’s mentorship during their clinical internship. The environment must involve all the arrangements in placements that contributes in organising a support system for students and prepare them for practice. The learning environment must involve advance planning of placement learning and training, including being aware of students’ details and their training documents such as the nursing curriculum and assuring the applicability of organising and planning learning, and placement opportunities. The other arrangements must involve assuring fluent implementation of placement learning and training. For example, enabling an interpersonal relation with the mentor, organising the first day in placement of the students and naming substitute and personal mentors. However, one preparation issue that may be faced is assuring individuals support opportunities of students in placement learning. This involved practices of organising guidance of student required during training, for example, regular meetings and enough time with the mentor, and availability of the a mentor. All of these issues related to the learning environment must be addressed as they can contribute greatly in helping students learn nursing. Training must also be organised in an interpersonal learning environment that must involve certain actions that can provide adequate support to students in learning about issues faced in clinical internship. One of the major actions is familiarising the student with placement as a working environment, involving adjusting to the climate in the ward, the culture of care, different wards, and the hospital. Another action is enabling equal participation of students in teamwork in placement. This involved making it possible for the staff to accept the student as member of the care team, for student to stay committed to the working society and to placement, and familiarising the student with all the staff in the ward. Moreover, another issue that must be addressed for creating a learning environment is co-operating with other stakeholders in placement who participants in clinical internship of students. This involved, for example, the regular meetings of the mentor with other educators or lecturer from the university and the mentor’s working in a collaborative relation with patients and colleagues.

According to Nowell et al. (2017), one of the integral elements of the qualified nurse role that supports development and learning is mentorship. Learning is influenced by the quality of the relation between mentee and mentor, specifically any disparity in their expectations. With a specific focus on the qualified nurse and nursing students, the different perceptions about the mentorship relationship are influenced. Mentoring is influenced negatively by factors such as lack of appreciation of daily life scenarios that impact each individual, lack of trust, different expectations between mentee and mentor, and poor communication. Issues can be counteracted or prevented in the relation by discussing the mentee and mentor’s expectations, using the information available in student handbooks, by developing ground rules, and by using learning contracts.

Further, Tuomikoski et al. (2018) highlighted that mentoring among nurse students has remained quite vague, although it has been investigated widely. Different mentoring approaches are presented as there is no universal agreement on student mentoring in nursing placements. For assuring the quality of placement learning in nursing organizations, a unified description of student mentoring is required. Two most common themes were found when defining mentoring of learning. First one was strengthening the professionalism of students by enhancing the professional competence of students in nursing and by empowering the development of their professional identities and attributes. Second is facilitating the learning of nursing students by enabling individuals learning processes of students and by creating supportive learning environments (Pramila‐Savukoski et al., 2019)., Different clinical, pedagogical, collegial, and environmental attributes are integrated by the description of student mentoring in clinical nursing placements. To assure active student mentoring, systematic preparation and adequate resources must be provided to mentors by management and organization.

Along with this, it is also crucial that an individual mutual relationship is created. Further, to maintain and accomplish a workplace definition, the definition of student mentoring must be reviewed systematically for reflecting changes in education and nursing. For enhancing the recruitment of nursing students to the workforce, one of the opportunity is provided by a systematic and clear strategy for student mentoring (Helminen et al., 2017). The support for students and quality of placement learning opportunities can be improved through a unified description of student mentoring. A clear definition of student mentoring also helps in enabling proper mentor preparation programs for nurses and systematic provisions for mentoring of nursing students in placements.

Moreover, Nowell et al. (2017) indicated that nursing mentorship is critical as it helps in advancing the career and developing new skills. For a less-experienced and new nurse, a more experienced nurse acts as a role model, expert, and guide in nursing mentorship. Nursing mentorship also helps in diversifying the workforce, retain employees, and cultivate leaders. Nelson et al. (2018) suggested that mentoring is a collaborative and reciprocal learning relationship between two individuals with shared accountability and mutual objectives for the success and outcomes of the relationship. Mentoring can also effectively guide nurses in their interpersonal, personal, and professional growth.

Moreover, for meeting the changing needs of the healthcare environment in Mauritius, a competent and safe nurse practitioner equipped with a healthy attitude, and necessary confidence, knowledge, and skills are provided. This shows how important it is to research about nurse’s mentorship during their clinical internship in Mauritius. Dale, Leland & Dale (2013) also highlighted that for the mentorship program one of the critical elements is a supportive clinical learning environment since most of the nursing training and studies take place during the clinical phase. A lack of confidence in and negative attitudes towards nursing practice may be reported by nursing students who are exposed to negative mentorship experience. The nursing trainee may be forced to abandon the program in some extreme situations due to the exposure to intense incivility force (Lewis et al., 2016).

Moreover, clinical, pedagogical, collegial, environmental attributes and organisational and individual aspects must be integrated by student mentoring in nursing placements. Such type of integration of personal and professional development and practice and learning will bridge the gap amongst practice and theory in working life. In student mentoring, all of these aspects have a unified importance by supporting professional and learning growth of students as highlighted in guidelines of nursing. Mentoring itself is a misunderstood and complex phenomenon. There are there different practices and forms of mentorship in nursing. Mentorship is quite different from preceptorship. In nursing, the preceptorship includes learning and teaching within the clinical setting (Pelin and Ayise, 2019). It is implemented to provide significant assistance to the novice nurse for adjusting to a new role within an organisation or institution. According to Jokelainen et al., (2011), in placement learning, the quality is enhanced by the trend of unifying the approaches used in the clinical practice. Some of the mentorship practices involve creating a supportive learning environment that involved all the arrangements in placements that prepare the practice of students and organize their support system. For learning purpose, preparing clinical placement fitness comprise of planning of placement learning and training that involved being aware of details of students and their training documents such as the nursing curriculum, organising and planning learning opportunities and the applicability of placement. Some other arrangements involve assuring fluent implementation of placement learning and training, for instance, organising the first day of the student in placement and naming substitute and personal mentors. This helps in enabling an interpersonal relationship with the mentor. Whereas, the workable student mentorship involved professional and personal competence of the mentors, the co-operative partnerships, well-equipped learning environments, and active organisations.

Providing a good learning environment to student nurse is highly essential. Lack of a good learning environment can influence the mentorship relationship negatively. Poor learning environment can be contributed by certain factors such as, poor communication, differing expectations, lack of trust and lack of appreciation of the circumstances of everyday life that each person finds themselves in. The use of learning contracts, formulation of ground rules, use of information in student handbooks and discussion of the expectations of the mentor and mentee at the outset can help counteract problems such as those that occurred in the scenario. It can be too easy to apportion blame when a relationship is failing. What is needed is a thorough exploration of the issues to try to resolve differences, empowering the student and the mentor by creating equilibrium in the relationship. Mentor and mentee need to have an appreciation and acceptance of each other’s idiosyncrasies. With excellent communication, honesty and trust, mentorship relationships can be successful, healthy and robust.

Jokelainen et al., (2011) suggested that mentorship practices must also organise guidance for students that are required during training, for instance, regular meetings with the mentor and availability of a mentor. Addressing all of these issues related to the learning environment will help students in learning to nurse successfully. Along with this, the training must be organised in an interpersonal learning environment that will support students relating to nursing issues in placements. The students must be made familiarise with placement as a working environment, involving adjusting to the climate in the ward, to the culture of care, to different units, and the hospital. Besides, equal participation was also enabled in teamwork in placement. The student must also be familiarised with all the staff in the ward so that student can commit to the working society and towards placement.

The importance of impact of learning environment on student nurse’s mentorship also has been proven by past systematic review of research studies concluded that the student nurse mentorship practices in clinical placements must focus on strengthening the professionalism of students and facilitate their learning. This means that the practices must enhance the accomplishment of professional competence and must empower the development of professional identity and attributes. They must also enable the learning process of the individual and must create a supportive learning environment. It must aid students in developing reflective and critical thinking, must improve their theoretical skills, and must facilitate the accomplishment of stipulated clinical skills. It must interact as professional partners in a co-operative relation and must give equal treatment to nursing colleague and individuals. It must also assess the accomplishment of learning outcomes and personal development and must provide a personal goal-oriented learning path (Pennington and Driscoll, 2019). It must organise training in an interpersonal learning environment and must prepare clinical placement fitness for learning.  Some other significant steps that must also be considered involve co-operating with other stakeholders participating in the training. Working with mentors must be encouraged by sharing feedback and knowledge. The clinical and school placement work must be linked together, and adequate support from the educational/school unit must be acquired.

Further for placement learning, individual support opportunities must also be provided. Events must be shared with the mentor regularly, and frequent appointments with the mentor must be carried out. Along with this, quality time must be given to students. Time must be organised for the student every day. Specific time must only be spent with the student. As a present hostess, working must be carried out near the student. Besides, fluent implementation of placement learning and training must be assured. Working must be encouraged in similar shifts with the mentor. Varying shifts must be organised. For supporting the student with the mentor, commitments must be made to all of the staff, and during absence, a substitute mentor must be assured. The arrival of the student to placement must be arranged. A 1:1 relations between mentor and student must be organised, and a substitute mentor and a personal mentor must be named.

Along with this, the placement learning and training must be planned. Students must be provided orientation to the evaluation of training and learning tasks. All of the details about the nursing curriculum and the student must be known. Limitations of activities must be observed in placement for training. In placement, hands-on possibilities must be organised. For acquiring nursing experiences, suitable practices must be arranged. Learning visits and situations must be planned for different units. For training in placement, applicable patients must be planned, and the contextual learning possibilities in the ward must be presented to students. Despite the narrow specialities, learning possibilities must be assured. The student must be informed about placement and its pre-requisites, and for training, the relevance of placement must be provided.

These steps and strategies will help in understanding that in nursing placements, different clinical, pedagogical, collegial, and environmental attributes and organisational and individual aspects are integrated by student mentoring. This type of integration of personal and professional development and practice and learning will bridge the gap between practice and theory in working life. The mutual relationship between an individual nurse and the student is an important aspect, but it is increasingly essential for the managerial level to provide opportunities for student mentoring with enough resources and education. First, a very notable aspect is the creation of a supportive learning environment because it does not exist self-evidently. Some of the studies also found that a positive ward atmosphere in the learning environment is very significant for nursing students. Therefore, preparation and organisation of placements for students’ clinical learning are critical, because students feel safe and are assured of the quality of the placement learning opportunity, provision and support. This is crucial if we wish to retain nursing students and reduce attrition. Second, facilitating students’ individual learning processes is also essential; this requires pedagogical competence from the nursing professionals in placements. First of all, this influences their ability to provide a goal-oriented assessment of students’ performance, which requires, among other things, a deep understanding of the goals of education.

Students want to be treated as individuals and colleagues during placement learning. Therefore, enthusiasm and positive attitudes in placements are important, as they influence students’ learning significantly. Furthermore, in a mentoring relationship, it is possible to achieve a level of collegiality with students. Friendship was also included in mentoring, but it seldom happened in practice. On the other hand, current nursing education values the student’s independence and self-direction in learning, which puts the responsibility on students to be active in the mentoring relationship. However, it is significant that mentors motivate students to learn nursing in placements and act as role models of nurses.

Another major factor found from results that influence student nurse’s mentorship during their clinical internship is support from ward team members. In the nursing profession, the retention and enthusiasm of students can be increased through positive clinical experiences and adequate support of students in placements.  Mentorship is a long term relationship in which the growth of a less experienced nurse (mentee) is supported by an experienced nurse (mentor) with leadership support. Another significant difference between these two practices is formal hat evaluation is involved frequently in a preceptorship, whereas, mentorship evaluation is less formal. The senior practising nurse is referred to as the mentor, whereas, the preceptor is often the professional teacher or educator.

Several mentoring models have been adapted and created within the nursing profession since Nightingale’s time. Research literature highlighted student peer mentorship, staged, reciprocal, traditional, and little sister big sister as the five most common mentorship models that were used in mentorship practices. ‘Little sister, big sister’ model was used as mentorship practices in the 1940s onward. It was used for the apprenticeship of new students. The nursing knowledge was transferred typically from big sister to little sister. It also provided social activities like teas, picnics. From traditional mid-1970 to mid-1980s and onward, the hierarchical and non-reciprocal model was used. A senior nurse assisted a novice nurse in their role by providing knowledge and support. The mentee shifts independence on the mentor with the progress of the mentorship relationship for increasing independence (Nowell et a., 2017).

Chen, Watson and Hilton (2016) highlighted that intellectual guide, information, career guide, support and friend were also some factors highlighted by the mentoring function. Whereas, the mentee’s perception (mentoring instrument) also highlighted was four significant factors such as research together, mentee professional development, comprehensiveness, and mutual support. CSMS (College Student Mentoring Scale) also identified four major factors such as role model, academic subject knowledge support, career and degree support, emotional and psychological support (Nowell et al., 2017). However, concerning the dimensions of personal, educational, environmental, and organisational procedures, both negative and positive statements were forwarded by Finnish mentors. Mentors from both countries (British and Finnish) felt that mentorship is successful when the collegial and managerial support is provided.

Moreover, mentorship relies on a support system where the mentor challenges the mentee to embrace opportunities and problems and realise their strengths and weaknesses. Working in partnership to negotiate, plan and manage to learn can help in achieving a balance (Peiser et al., 2018). There is also a need to consider: integration and assertion, co-operation and competition, dependence and autonomy. Both partners in a mentorship relationship may need to take a broader view, communicating and appreciating the factors that may be affecting each individual. By doing so, the mentor and mentee will be more readily equipped to meet desired goals and share the common purpose of the partnership. Further support of the student must be shared with other staff along with a discussion of problems and training with other colleagues. Trusted collaboration between student and patients must be organised. Working must be done as an advocate of the student and in open and close relationships with co-workers. Participating in holistic patient care must be encouraged by other professionals.

4.4. CONCLUSION

This chapter has found some of the major factors influencing student nurse’s mentorship during their clinical internship such as number of contact hours, support from ward team members, the student to clinical mentor ratio, and facilities available at the learning environment. Clinical practice can be valued by student nurses and the possibilities offered by it in the procedure of growing to become a professional and a nurse. It is necessary that through good co-operation between clinical staff must contribute in building a good clinical learning environment. It is concluded that a suitable clinical learning environment must be provided by student nurses at the right time so that the practice and theory would complement each other. Along with this, it is highly important that collaboration between nurse teachers and nurse mentors must be present in clinical internship. Lastly, the opportunity of experience the reality of professional practice must be provided to student nurses by the clinical learning environment. A highly supportive and safe environment must be provided.

 

 

 

CHAPTER 5: CONCLUSION AND RECOMMENDATION

5.1. INTRODUCTION

In professional life of a nurse, a powerful role is played by a mentor, as mentor provides adequate advice, perspective, and guidance. Nurses can be provided effective guidance by mentors for recognising and accomplishing their career objectives. Mentorship is far beyond providing significant support to nurses and providing them required tools for their career growth. For new nurses, such as student nurses, one of the great resources can be mentors. In nursing, mentoring is really essential as it a method of helping student nurses to share and present their institutional knowledge. A safe space for learning is also provided to student nurses through mentoring. This chapter has provided a brief detail about research design and method adopted by the study. Further it has highlighted comprehensive summary and concise interpretation of the research findings. Followed by critical conclusions and viable recommendations proposed by the study. Lastly it has provided how significant amount of contributions can be made by this study and the limitations present.

5.2. RESEARCH DESIGN AND METHOD

The mixed method research design has been used in this study for measuring efficient factors on clinical learning in nursing students. For the combination of data, one of the rich fields is mixed methods, because meaning to the numbers can be added through narrative, pictures, and words. The quantitative numerical data from a huge-scale study on the similar issue can be combined with qualitative data, including narrative, pictures, and words. This eventually help the study in deriving generalized results for future examinations and studies (Morse, 2016). The mixed method research design also provide a rigorous approach to researchers for answering research questions. It is necessary that research design must be articulated clearly to readers. For the last decade, the field of mixed methods have been accepted widely. Advantage of using different methods for exploring a research question is considered by mixed methods research. According to Subedi (2016) the basic characteristics of mixed method research design involve research process stages that can be influenced by continuous interpretation, any technique available to researchers is included in data collected, and sample sizes can also different on methods used. Some other characteristics are research problems that can become research hypotheses and/or questions based on the research process, experience, knowledge, and prior literature and design can be based on both or either perspectives.

Moreover, each of the dimensions of mixed methods design must be considered carefully and understood by researchers to design a mixed study. The issue of validity must also be focused. Design complexity, emergent versus planned design, interactive versus typological design approaches, point of integration, dependency and simultaneity timing, theoretical drive, and purpose are the seven different dimensions of design. During the design process, different secondary dimensions must also be considered. Other than this, fully integrated mixed designs, multilevel mixed designs, conversion mixed designs, sequential mixed designs, and parallel mixed designs are five sets of mixed methods research designs (Morse, Cheek & Clark, 2018). At all stages of the study, the mixing takes placed in fully integrated mixed designs in an interactive manner. The formulation of one approach is influenced by one approach at each stage. Along with this, different kinds of implementation process can takes place. For instance, at the inferential stage, the analysis stage, the methodological stage, the conceptualization stage, mixing takes place. The mixing in multilevel mixed designs takes place different levels of analysis such as QUAL and QUAN data are integrated and analysed for answering related aspects of the similar research question. In conversion mixed designs, the mixing takes place when the findings are added to the results and one kinds of data is analysed and transformed. Related aspects of the similar research question are answered by this design. In sequential mixed designs, QUAN and QUAL strands take place across chronological phases (Kaur, 2016). During the study, the research questions are evolved and interrelated. In parallel mixed designs, parallel qualitative and quantitative strands either simultaneously with some minimal time lapse, the results of the stand are integrated into meta-inferences once the separate analysis have been performed.

For mixed research design, the perceptions of nursing students related to clinical learning and its influencing factors were researched with the help of the qualitative content analysis approach. From the interviews, the main items and themes of the questionnaire were extracted from the data collected. In this step, the participants were chosen among the nursing students based on the study objectives. The process of sample selection continued until the data was saturated. By using the semi-structured individual interviews performed by the researcher, the data was collected. Further, the qualitative content analysis, the data was analysed. Along with this, survey design has been used in this study as it helped in acquiring desirable information when the research in the initial phases.

5.3. SUMMARY AND INTERPRETATION OF THE RESEARCH FINDINGS

The results concluded that one of the major factor that impact student nurse’s mentorship during their clinical internship is facilities available at the learning environment. A supportive clinical environment influence student nurse’s mentorship during their clinical internship. The environment must involve all the arrangements in placements that contributes in organising a support system for students and prepare them for practice. The learning environment must involve advance planning of placement learning and training, including being aware of students’ details and their training documents such as the nursing curriculum and assuring the applicability of organising and planning learning, and placement opportunities.

Moreover, for meeting the changing needs of the healthcare environment in Mauritius, a competent and safe nurse practitioner equipped with a healthy attitude, and necessary confidence, knowledge, and skills are provided. This shows how important it is to research about nurse’s mentorship during their clinical internship in Mauritius. Dale, Leland & Dale (2013) also highlighted that for the mentorship program one of the critical elements is a supportive clinical learning environment since most of the nursing training and studies take place during the clinical phase. A lack of confidence in and negative attitudes towards nursing practice may be reported by nursing students who are exposed to negative mentorship experience. The nursing trainee may be forced to abandon the program in some extreme situations due to the exposure to intense incivility force (Lewis et al., 2016).

5.5. RECOMMENDATIONS

The current practice of the nursing student’s mentorship can be improved by enhancing and addressing the loopholes present in practice. For overcoming the loopholes and barriers, different strategies can be implemented. Jokelainen et al., (2011) suggested that mentorship practices must also organise guidance for students that are required during training, for instance, regular meetings with the mentor and availability of a mentor. Addressing all of these issues related to the learning environment will help students in learning to nurse successfully. Along with this, the training must be organised in an interpersonal learning environment that will support students relating to nursing issues in placements. The students must be made familiarise with placement as a working environment, involving adjusting to the climate in the ward, to the culture of care, to different units, and the hospital. Besides, equal participation was also enabled in teamwork in placement. The student must also be familiarised with all the staff in the ward so that student can commit to the working society and towards placement.

The systematic review of research studies concluded that the student nurse mentorship practices in clinical placements must focus on strengthening the professionalism of students and facilitate their learning. This means that the practices must enhance the accomplishment of professional competence and must empower the development of professional identity and attributes. They must also enable the learning process of the individual and must create a supportive learning environment. It must aid students in developing reflective and critical thinking, must improve their theoretical skills, and must facilitate the accomplishment of stipulated clinical skills. It must interact as professional partners in a co-operative relation and must give equal treatment to nursing colleague and individuals. It must also assess the accomplishment of learning outcomes and personal development and must provide a personal goal-oriented learning path (Pennington and Driscoll, 2019). It must organise training in an interpersonal learning environment and must prepare clinical placement fitness for learning.  Some other significant steps that must also be considered involve co-operating with other stakeholders participating in the training. Working with mentors must be encouraged by sharing feedback and knowledge. The clinical and school placement work must be linked together, and adequate support from the educational/school unit must be acquired.

5.6. CONTRIBUTIONS OF THE STUDY

The epicentre of nursing studies is proper nurse mentorship. For practising purpose, it also has been perceived as a fit.  The international and domestic research studies have mapped out the universally agreed gaps and confusion around the issue. The effectiveness of a mentoring program on the organization, mentee, and mentor in China has been evaluated well by Zang et al., (2016). A systematic literature review was conducted. Out of the few studies considered for systematic literature review, it was revealed that a mentoring program could effectively help in decreasing the stress turnover rate of the new nurses.

Additionally, mentoring can aid in establishing a supportive workforce environment and can enhance nursing competency, resulting in positive outcomes. A different research approach was considered by Law (2016). By conducting focus group interviews with doctors, ward manager, senior nurses, and stakeholders, the meaning of mentoring new graduate nurses was explored in the study. The findings concluded that for the pursuit and transition of good work, the complexity of mentoring new graduate nurses could be revealed by the shared experiences that have specific dimensions such as the place of the narrative inquiry space, personal social interactions, and temporal. It is important to note that the current foreign policy of China is to work in partnership with third-world countries, specifically in Africa.

Similarly, the concept of mentorship is being embraced by SMEs (small-medium enterprises) in Mauritius. One such example of it is the SME Mentoring and hand-holding program that is a developmental partnership through which industry-experts/mentors share lifelong acquired abilities, skills, knowledge, and experience. For fostering the sustainable growth of SMEs, the long-term perspective is also shared by them. All critical elements of the business will also be evaluated by this program which eventually will help in contributing to business growth and increased sales. Another effective mentorship method practised in the women’s mentorship program by the Mauritius Institute of Directors. This program is designed to challenge the systematic barriers, empower women, and accomplish the critical process. The principal objective of this program is to empower, inspire, and educate women with the core skills, attitudes, and values that are foundations of quality leadership. These examples show that the concept of mentorship is being practised widely also in Mauritius. Therefore, this dissertation will play an essential role in assessing the factors influencing impacting effective mentorship, in correlating the difference and similarity between China and Mauritius about the validated factors, and in proposing strategies for improving the mentorship efficiency outcome.

5.7. LIMITATIONS OF THE STUDY & CONCLUDING REMARKS

The study was only performed in hospitals in Mauritius where professional nurses at the operational managers’ level were the participants along with nurse students for clinical practice. Other areas where student nurses perform their clinical practice, involving psychiatry and community were not considered. The interviews were limited to between forty-five and sixty minute and the participants worked on a tightly schedule. Whereas, participation in study was declined by other operational managers. It has been recommended by the researcher that further research can be performed on the model guiding mentoring in practice environments and kinds of mentoring. Further research can also be performed on regulatory guidelines for sustaining, monitoring, maintaining, and standardising the process of mentoring in nursing practice.

 

 

 

References

Ahmad, H., & Halim, H. (2017). Determining Sample Size for Research Activities. Selangor Business Review, 2(1), 20-34.

Ali, Z., & Bhaskar, S. B. (2016). Basic statistical tools in research and data analysis. Indian journal of anaesthesia, 60(9), 662.

Babbie, E., Wagner III, W. E., & Zaino, J. (2018). Adventures in social research: Data analysis using IBM SPSS statistics. Sage Publications.

Baldwin, L. (2018). Internal and External Validity and Threats to Validity. In Research Concepts for the Practitioner of Educational Leadership (pp. 31-36). Brill Sense.

Baran, M. L. (Ed.). (2016). Mixed methods research for improved scientific study. IGI Global.

Benner, P. (1992). From novice to expert: excellence and power in clinical nursing practice. 1984. San Francisco: Addisson-Wesley.

Bowering, R., Wigle, R., Padgett, T., Adams, B., Cote, D., & Wiersma, Y. F. (2018). Searching for rare species: A comparison of Floristic Habitat Sampling and Adaptive Cluster Sampling for detecting and estimating abundance. Forest Ecology and Management, 407, 1-8.

Calin-Jageman, R. J. (2017). After p values: the new statistics for undergraduate neuroscience education. Journal of Undergraduate Neuroscience Education, 16(1), E1.

Chen, Y., Watson, R. and Hilton, A., 2016. A review of mentorship measurement tools. Nurse education today, 40, pp.20-28.

Chyung, S. Y., Roberts, K., Swanson, I., & Hankinson, A. (2017). Evidence‐based survey design: The use of a midpoint on the Likert scale. Performance Improvement, 56(10), 15-23.

Dale, B., Leland, & Dale, J.G. (2013). What Factors Facilitate Good Learning Experiences in Clinical Studies in Nursing: Bachelor Students’ Perceptions. ISRN Nurs 2013(2013).

Farkas, A.H., Allenbaugh, J., Bonifacino, E., Turner, R. and Corbelli, J.A., 2019. Mentorship of US Medical Students: a Systematic Review. Journal of general internal medicine, pp.1-8.

Fredericks, S., Sidani, S., Fox, M., & Miranda, J. (2019). Strategies for balancing internal and external validity in evaluations of interventions. Nurse Researcher, 27(4).

Ghauri, P., Grønhaug, K., & Strange, R. (2020). Research methods in business studies. Cambridge University Press.

Gray, D. E. (2019). Doing research in the business world. Sage Publications Limited.

Greenland, S., Senn, S. J., Rothman, K. J., Carlin, J. B., Poole, C., Goodman, S. N., & Altman, D. G. (2016). Statistical tests, P values, confidence intervals, and power: a guide to misinterpretations. European journal of epidemiology, 31(4), 337-350.

Grove, S. K., & Gray, J. R. (2018). Understanding Nursing Research E-Book: Building an Evidence-Based Practice. Elsevier Health Sciences.

Helminen, K., Johnson, M., Isoaho, H., Turunen, H., & Tossavainen, K. (2017). Final assessment of nursing students in clinical practice: Perspectives of nursing teachers, students and mentors. Journal of clinical nursing, 26(23-24), 4795-4803.

Jacobs, S. (2018) “An analysis of the evolution of mentorship in nursing”, International Journal of Mentoring and Coaching in Education, Vol. 7 Issue: 2, pp.155-176.

Jokelainen, M. et al. (2011). A Systematic Review of Mentoring Nursing Students in Clinical Practice.  Journal of Clinical Nursing 20(19-20), 2854-67.

Jokelainen, M., Jamookeeah, D., Tossavainen, K. and Turunen, H., 2013. Mentorship provision for student nurses: Conceptions of Finnish and British mentors in healthcare placements. Journal of Nursing Education and Practice, 3(2), p.41.

Kaur, M. (2016). Application of mixed method approach in public health research. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine, 41(2), 93.

Kumar, R. (2019). Research methodology: A step-by-step guide for beginners. Sage Publications Limited.

Lacey, A. J. (2017, July). Novice Researchers’ Nightmare Journey of Paradigms and Methodologies:‘It’s Hard to Know What Is Right or Wrong’. In International Symposium on Qualitative Research (pp. 204-212). Springer, Cham.

Lawal, et al. (2016). Factors that influence the clinical learning experience of nursing students at a Caribbean school of nursing. Journal of Nursing Education and Practice 6(4).

Lewandowski, R. (2020, February). Evaluating the Interdependent Effect for Likert Scale Items. In Business Information Systems Workshops: BIS 2019 International Workshops, Seville, Spain, June 26–28, 2019, Revised Papers (Vol. 373, p. 26). Springer Nature.

Martínez-Mesa, J., González-Chica, D. A., Duquia, R. P., Bonamigo, R. R., & Bastos, J. L. (2016). Sampling: how to select participants in my research study?. Anais brasileiros de dermatologia, 91(3), 326-330.

Morse, J. M. (2016). Mixed method design: Principles and procedures (Vol. 4). Routledge.

Morse, J. M., Cheek, J., & Clark, L. (2018). Data-related issues in qualitatively driven mixed-method designs: Sampling, pacing, and reflexivity. The SAGE handbook of qualitative data collection, 564-584.

Moser, A., & Korstjens, I. (2018). Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. European Journal of General Practice, 24(1), 9-18.

Moss, C. and Jackson, J., 2019. Mentoring New Graduate Nurse Practitioners. Neonatal Network, 38(3), pp.151-159.

Nelson, N., Lim, F., Navarra, A. M., Rodriguez, K., Stimpfel, A. W., & Slater, L. Z. (2018). Faculty and student perspectives on mentorship in a nursing honors program. Nursing education perspectives, 39(1), 29-31.

Newton, J., Taylor, R.M. and Crighton, L., 2017. A mixed‐methods study exploring sign‐off mentorship practices in relation to the Nursing and Midwifery Council standards. Journal of clinical nursing, 26(19-20), pp.3056-3066.

Nowell, L., Norris, J. M., Mrklas, K., & White, D. E. (2017). A literature review of mentorship programs in academic nursing. Journal of Professional Nursing, 33(5), 334-344.

Nowell, L., Norris, J.M., Mrklas, K. and White, D.E., 2017. A literature review of mentorship programs in academic nursing. Journal of Professional Nursing, 33(5), pp.334-344.

Nowell, L., Norris, J.M., Mrklas, K. and White, D.E., 2017. Mixed methods systematic review exploring mentorship outcomes in nursing academia. Journal of advanced nursing, 73(3), pp.527-544.

Nowell, L., White, D., Benzies, K. and Rosenau, P., 2017. Factors that impact implementation of mentorship programs in nursing academia: A sequential-explanatory mixed methods study. Journal of Nursing Education and Practice, 7(10), pp.1-11.

Nowell, L., White, D., Benzies, K., & Rosenau, P. (2017). Factors that impact implementation of mentorship programs in nursing academia: A sequential-explanatory mixed methods study. Journal of Nursing Education and Practice, 7(10), 1-11.

Oluchina, S. and Gitonga, L.K., 2016. Factors hindering formal and informal nursing mentorship programs in Kenyan public universities. Am J Health Res, 4, pp.23-29.

Otzen, T., & Manterola, C. (2017). Sampling techniques on a population study. Int. J. Morphol, 35(1), 227-232.

Paradis, E., O’Brien, B., Nimmon, L., Bandiera, G., & Martimianakis, M. A. T. (2016). Design: selection of data collection methods. Journal of graduate medical education, 8(2), 263.

Peiser, G., Ambrose, J., Burke, B. and Davenport, J., 2018. The role of the mentor in professional knowledge development across four professions. International Journal of Mentoring and Coaching in Education.

Pelin, K. and Ayise, K., 2019. Assessment of Mentorship Applications in Nursing Clinical Education. International Journal of Caring Sciences, 12(2).

Pennington, G. and Driscoll, A., 2019. Improving Retention of Home Health Nurses: Fostering Outcome Sustainability Through an Innovative Orientation and Mentorship Program. Home healthcare now, 37(5), pp.256-264.

Pramila‐Savukoski, S., Juntunen, J., Tuomikoski, A. M., Kääriäinen, M., Tomietto, M., Kaučič, B. M., … & De Raeve, P. (2019). Mentors’ self‐assessed competence in mentoring nursing students in clinical practice: A systematic review of quantitative studies. Journal of Clinical Nursing.

Quinlan, C., Babin, B., Carr, J., & Griffin, M. (2019). Business research methods. South Western Cengage.

Qureshi, M. N., Kadilar, C., & Hanif, M. (2020). Estimation of rare and clustered population mean using stratified adaptive cluster sampling. Environmental and Ecological Statistics, 27(1), 151-170.

Rahi, S. (2017). Research design and methods: A systematic review of research paradigms, sampling issues and instruments development. International Journal of Economics & Management Sciences, 6(2), 1-5.

Robbins, M. L. (2017). Practical suggestions for legal and ethical concerns with social environment sampling methods. Social Psychological and Personality Science, 8(5), 573-580.

Robinson, R. V., David, E. J. R., & Hill, M. (2016). Participatory mixed methods research across cultures. Handbook of methodological approaches to community-based research: Qualitative, quantitative and mixed methods, 273-282.

Rubinfeld, D. L., & Gal, M. S. (2017). Access barriers to big data. Ariz. L. Rev., 59, 339.

Subedi, D. (2016). Explanatory sequential mixed method design as the third research community of knowledge claim. American Journal of Educational Research, 4(7), 570-577.

Tong, S. F., Tong, W. T., & Low, W. Y. (2018). Ethical issues in qualitative data collection among vulnerable populations in healthcare setting. In Ensuring research integrity and the ethical management of data (pp. 80-97). IGI Global.

Tuomikoski, A. M., Ruotsalainen, H., Mikkonen, K., & Kääriäinen, M. (2019). Nurses’ experiences of their competence at mentoring nursing students during clinical practice: A systematic review of qualitative studies. Nurse Education Today, 104258.

Vitale, T.R., 2019. The impact of a mentorship program on leadership practices and job satisfaction. Nursing management, 50(2), pp.12-14.

Zang, Y., Qian, Y, Wu, J, Wen, F, Zang, Y. (2016). The effectiveness and mentoring an of a nursing programme for newly graduate nurses: a systematic review. School of Nursing, Shanghai Jiao Tong University, Shanghai, People Republic of China.