Investigating the relationship between levels of clinical learning motivation and meeting basic psychological needs in nursing students of Gilan University of Medical Sciences in 2019

Dissertation to receive a master's degree in nursing education

(Internal orientation -

Abstract

Introduction: The clinical environment includes conditions and stimuli that affect learning, but motivation is the first and most important element of learning behavior. One of the important theories in this field is the theory of self-determination, which is a general theory of motivation. According to this theory, the satisfaction of three basic psychological needs: understanding of independence, competence, and sense of belonging are effective in the internalization of motivation. Therefore, this theory can be a suitable basis for the improvement of medical education programs; in this way, the motivation of nursing students in the clinical work environment is satisfied. How is it?

Materials and methods: This study was conducted in a cross-sectional, descriptive-analytical manner with a full-count method among third- to eighth-semester nursing students of Gilan University of Medical Sciences (243 people), which included nursing and midwifery faculties in Rasht and East Gilan. Data collection tools were demographic information questionnaire, levels of motivation for clinical learning and basic psychological needs. Data analysis was done with SPSS 16 statistical software and independent t statistical tests, Spearman and Pearson correlation, Mann-Whitney U and backward regression and considering the significance level p < 0.05.

Results: The results showed that the level of satisfying the basic psychological needs and motivation of the students was moderate be Statistical tests showed a significant relationship between the levels of motivation and the provision of basic psychological needs with demographic variables (p<0.05). Among the basic psychological needs, no statistically significant relationship was found between the need for independence and the self-determination index, but the regression coefficients showed that the need for competence and belonging can be a suitable predictor for the self-determination index. It can increase the index of self-determination and as a result internalize their motivation and positive results.

Keywords: motivation, clinical learning, nursing students

Statement of the problem:

Nursing is an independent discipline and a branch of medical sciences whose students are members of from the health team provide services in various fields related to it (1) In the education of this dynamic and practical profession, a set of theoretical sciences and practical activities, skills, creativity and experience are used (2). An important part of nursing education is clinical education. In fact, clinical education is one of the main and vital components of the nursing program and is known as the heart of nursing education and the stage of professional development (3). The educational structure of nursing was implemented in 1371 with the aim of improving the quality of nursing education and providing clinical services and providing a context for social and comprehensive nursing in nursing (1). At this stage, by learning clinical activities, a person acquires the necessary objective experiences and an opportunity is provided for the student to transform his theoretical knowledge into mental, motor and social skills that are necessary for patient care (3). The field of practice applies (4). In internship courses, all trainees are required to move towards the single goals that are considered in the internship program and acquire the skills that the profession requires for that course, despite their different interests and talents, because the purpose of each internship is to develop the skills, knowledge and attitude needed by the individual to perform appropriately in a specific job or profession. Internship courses usually meet the needs of the organizations managing these courses (5). In this course, in addition to the approved educational activities, the duties of the trainers are to create a sense of independence and decision-making and to increase the initiative power of the learners in different fields, and the students should also fulfill their duties in this regard.In this course, in addition to the approved educational activities, the duties of the instructors are to create a sense of independence and decision-making and to increase the initiative power of the learners in different fields, and the students should also fulfill their duties in this regard (6). There are more defects than other educational fields.  Nursing studies show that nursing students do not perform skillfully in the clinical environment despite having a good theoretical knowledge base. As a result, when these students enter the care and treatment system, the quality of this system decreases day by day (7).

Both academic and clinical nursing education environments are under a lot of pressure due to patient care, which can affect the care conditions. But the clinical environment is under a lot of pressure because its purpose is to educate nurses effectively and appropriately so that it can train nurses who can be ready to work. Nursing education today is facing many challenges. One of which is acquiring knowledge and updating, and there is a need for future nurses to become familiar with research and patient care based on clear scientific knowledge(8).

The clinical environment includes all the conditions and stimuli that affect learning. This rich psychological environment is composed of cognitive, social, cultural, emotional, emotional, motivational and educational factors(9). There are many factors that affect learning, but motivation[2] It is the constituent element of behavior and the most important condition for learning. Motivation plays a valuable role in explaining the causes of behavior, predicting the effect of actions and guiding behavior to achieve success (10). Therefore, even the richest and best organized training and training programs will not be useful in the absence of motivation in learners. Therefore, one of the main tasks of teachers is to create the necessary motivation for learning in students in order to increase the level of awareness, knowledge and technical skills, as well as to familiarize them with advanced sciences and modern methods. Therefore, by knowing as much as possible the effective factors in student motivation, it is possible to increase their active participation in learning (11).

In the studies conducted in England, Scotland and Ireland, it was reported that the dropout rate of nursing students was (16%), (24%), (6%) respectively, which had many reasons and the lack of necessary support was one of these cases (12).

The statistics of 35% of those who enrolled in nursing in one of the cities of Scotland between 1966-1967 dropped out before completing their studies (11). In Zenoriba's study titled "Investigating the causes of female associate nursing students in Tehran's higher nursing schools", which was conducted in Tehran in 1365, among the reasons for dropping out of nursing students were cold relations between colleagues, lack of intellectual and practical independence, inconsistency of theoretical content with practical work, and lack of facilities to provide optimal performance (13).

In Ardbil in 1989, among nursing (67.3%) and midwifery (37.7%) students, the lack of motivation in the educational environment to engage in the profession in the future of students (52.8%) was known as one of the weak points (14). 18% of nursing students have a positive opinion about their profession and 69% of them agreed to leave their field. Also, 63.6% of the samples decided to change their field and 51.64% decided to withdraw from their field. One of the priorities of leaving the nursing field is not having a positive social position, inappropriate clinical work environment and the negative attitude of the medical team towards this profession (15).

Therefore, one of the important factors in learning and wanting to be more successful is motivation. Regarding motivation, various theories have been presented that look at motivation from different aspects. In the meantime, one of the important theories in this field is self-determination theory [3], which is a general motivation theory that deals with this issue from another perspective and expresses the quality of motivation.