CHAPTER 2

Review of Related Literature and Studies

Related literature and studies are significant because it would promote guidance and

direction in a chosen topic. It would help readers to understand more the subject matter and

would help broaden their thinking. They can learn from the different literatures and studies that

would help them appreciate the subject matter.

Literature must be an analysis of experience and a synthesis of the findings into a unity.

And a study should be applying the mind to learning and understanding a subject (especially by

reading).

Foreign Studies

On Watson’s article some propositions about learning are identified such as “Behaviors

which are rewarded (reinforced) are more likely to occur” .Positive feedback, or reward, is a

powerful tool in the hands of a teacher. If a learner performs well within the clinical setting, and

the teacher gives phrase or a positive written evaluation, the learner’s desirable behavior is more

likely to be repeated than if the teacher have said or written nothing. In fact, absence of feedback

is usually interpreted as negative feedback.

In relation to this study, positive feedbacks or rewards are needed to motivate students to

strive more or to do better in school/in the clinical setting. Student nurses need inspirations for

them to push themselves to do their best. A Clinical Instructor (CI) should learn to appreciate the

efforts done by the student nurse.

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Another proposition is “Learners progress in any area of learning only as far as they

need to in order to achieve their purposes. Often they do only well enough to ‘get by’; with

increased motivation they improve”. Some learners have intrinsic motivation that helps them to

excel. Intrinsic motives include wanting to be the best at whatever job one undertakes and

wanting to learn because learning brings its own satisfaction. Teachers can also use extrinsic

motivation to help learners rise above mediocrity. Curiosity is a great motivator. The educator

can arouse the learners’ curiosity and help set them on a path of discovering the things they are

curious about.1

Brown had stated an effective teacher is skillful in interpersonal relationships. This skill

is demonstrated by taking a personal interest in learners, being sensitive to their feelings and

problems, conveying respect for them, alleviating their anxieties, being accessible for

conferences, being fair, permitting learners to express differing points of view, creating an

atmosphere in which they feel free to ask questions, and conveying a sense of warmth. As

teachers developed these skills they become aware of their deficiencies and work on their

improvements.2

Nursing students and patients are often plagued by lack of self-confidence and by fear of

making mistakes while learning, which leads them to experience high levels of stress. While

some anxiety contributes to learning, too much anxiety interferes with the ability to learn.

Educators can help learners maintain self-esteem and minimize anxieties by using three basic

therapeutics approaches of emphatic listening, acceptance and honest communication.3

In relation to this study, nursing students need guidance and encouragement coming from

their clinical instructors to be able to reach their optimum potential. Clinical instructors are their
 12

model in becoming competent nurses in the future. And so, CIs should learn how to motivate

students.

Foreign Literature

According to Harrison, teaching influences behaviors. It may be said to manipulate

experiences in order to help modify behavior in desirable ways. Or, as indicated by Skinner,

“Teaching may be defined as an arrangement of contingencies of reinforcement under which

behavior changes.” It is attending to the problems of the learner.

In his role as selector of learning experiences, the teacher requires the assistance of the

supervisor in appraising the abilities of learners and their needs, and in selecting from the many

experiences possible those most suited to the abilities and needs of individual pupils and to the

needs of society at large.

 A sense of Humor

Seriousness is an important asset in education as it is elsewhere in significant

undertakings; however, school people often take life too seriously. Being able to deflate one’s

self once in a while is a good tonic for anyone. A light touch is needed here. The ability to see

things in their true light and to smile, if not laugh, at some of the things that one may see around

him is a vital attribute for supervisor to have. It seems t bear to bear a direct relationship to

security and well-being, possibly being both a result and a contributing factor.

 A sense of Human Values

Learning to supervise involves learning more basic human values and value systems. Any

preparation program for supervisory positions must be of such a nature as to assist in gaining

insight into human behavior, promoting the dignity and worth of individuals, helping individuals
 13

learn to rely upon cooperative action to solve group problems, and promoting a feeling of

security transmissible to others.

 The Intelligence requirement

One authority has suggested that intelligence and versatility are highly correlated. He

insists that one should not assume a leadership responsibility with which his intelligence is not

able to cope.

 Ability to Communicate effectively

Good communication is the epitome of good supervision; the first requisite of effective

communication is clarity and organization of thought. The second is the ability to listen and

assimilate judiciously. Oral and written communication is a force for shaping society and

instrumentalities for modifying human behavior.

Effective communication must serve one or more purposes. It may be to convey ideas, to

transmit feelings, or to pass on or change attitudes. The main test of the effectiveness in

communication is, of course, its results. Are attitudes being changed? Are ideas being

transmitted? Are feelings known? The need for changes in attitude and behavior is not restricted

to teachers. This two-way process must be encouraged in every situation.

 Ability to organize

The ability to organize and assist with planning is a necessary asset of the supervisor. It is

doubtful if there are many who cannot organize and plan well who are unaware of their

shortcomings. Critical self-evaluation should be applied continually to reveal how well these

requirements are being met.4

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In relation to this study, how a Clinical instructor teaches will determine how a student

will learn and understand the subject matter. The behavior or attitude of a student in a particular

subject matter will depend on how a clinical instructor presents the information needed to gain

knowledge. A CI should possess the needed behaviors and attitudes like sense of humor, sense of

human values, has the ability to communicate effectively and ability to organize.

According to Robert G. Owens “organization behavior” more precise, narrower term that

falls under broader and general meaning of human relations. It seeks to describe, understand and

predict a human behavior in formal organizations of environment. Behavior and attitude is

affected by internal environment and external environment. Organization behavior is linked with

science also.

In relation to this study, the behaviors and attitudes of a student nurse are easily affected

by the external and internal environment. For example, if a student nurse was scolded (external

stimuli) by her CI because he/she did a mistake in giving the right nursing intervention to a

client, the student nurse would probably be depressed and would think that he/she would not be

a good/competitive nurse someday. A Clinical instructor should have the right attitude and

behavior to be able to influence or push the student nurses to do the best he/she can give.

The ideas of James D. Thompson described organization as having technical core which

the activities of actual work (teaching) are performed. Thompson developed a concept that has

something to do with nature of interdependencies between people in organization.

The following are the terms he used:

1. Coupling to describe the three possible ways in which to relate people and work.
 15

2. Reciprocal coupling refers to the situation in which workers pass their work back and

forth.

3. Sequential coupling is the situation in which the workers perform their work tasks one

after the other in serial fashion over.

4. Pooled coupling is the situation in which organization members share resources in

common but otherwise work independently.5

According to Sasson6 positive attitude helps to cope more easily with the daily affairs of life.

It brings optimism into your life, and makes it easier to avoid worry and negative thinking. If you

adopt it as a way of life, it will bring constructive changes into your life, and makes them

happier, brighter and more successful. With a positive attitude you see the bright side of life,

become optimistic and expect the best to happen. It is certainly a state of mind that is well worth

developing and strengthening.

Positive attitude manifests in the following ways:

Positive thinking.

Constructive thinking.

Creative thinking.

Expecting success.

Optimism.

Motivation to accomplish your goals.

Being inspired.

Choosing happiness.

Not giving up.

 16

Looking at failure and problems as blessings in disguise.

Believing in yourself and in your abilities.

Displaying self-esteem and confidence.

Looking for solutions.

Seeing opportunities.

The benefits of a positive attitude:

Helps achieving goals and attaining success.

Success achieved faster and more easily.

More happiness.

More energy.

Greater inner power and strength.

The ability to inspire and motivate yourself and others.

Fewer difficulties encountered along the way.

The ability to surmount any difficulty.

Life smiles at you.

People respect you.

In relation to this study, student nurses needs a lot of motivation and encouragement

coming from their Clinical Instructors to be able to strive in their chosen career. Positive

attitudes will help the student nurse to be optimistic and being optimistic would promote good

performance in school or in the clinical setting.

According to Lopper7, attitude is a mental position relative to a way of thinking or being;

 17

a leaning toward that which you believe. A positive attitude is, therefore, the inclination to

generally be in an optimistic, hopeful state of mind.

In relation to this study, positive attitude would attract positive thoughts that would lead

to a more productive build up of knowledge. The build up of knowledge would be a firm

foundation in becoming a competent nurse in the future.

Psychology Studies Reveal

In his ground-breaking book, A Primer in Positive Psychology, Christopher Petersen,

PhD, says, "...optimism has demonstrable benefits, and pessimism has drawbacks." He goes on

to say, "...optimism...has been linked to positive mood and good morale; to perseverance and

effective problem solving; to academic, athletic, military, occupational, and political success; to

popularity; to good health; and even to long life and freedom from trauma."

Even if you have been a pessimistic, negative thinker for many years, it's not too late to

change your way of

Optimists believe they are accountable for good things and that good things will

generally come their way. If something bad comes instead, optimists tend to write it off as an

isolated incident, an anomaly, or something out of their control; optimists believe things will be

better in the future.

According to Lusk8, positive relationships between staff and nursing students improve the

quality of learning and the students motivation to learn. They also facilitate acclimation of

students to the nursing profession.

 18

In relation to this study, a student nurse and his/her Clinical Instructor (CI) should have a

harmonious relationship to be able to work effectively and efficiently. It would also motivate the

student nurse to be more serious in her/his chosen career.

Local Studies

De Guzman’s9 article shows, that understanding the attributes and unique distinction of

the nursing faculty has been the subject of most of the studies. A study has been conducted, and a

total of 195 senior nursing students recruited from a comprehensive university in the Philippines

were the subjects in this qualitative study. Data were gathered from self-generated illustrations

and written explanations made by the subjects to identify their concept of effective and

ineffective clinical instructors. Phenomenological reduction was observed through a repertory

grid, where doodles drawn were listed, categorized and the matised to reveal the qualities of the

clinical instructor. The subjective nature of the findings, though not generalizable, has surfaced

how doodling can be a potent tool in identifying collective interpretation of the essence of health

professions construct such as the one under study. The doodles revealed that an effective clinical

instructor (enlightening, engaging and embracing) is one who is able to facilitate the learning of

the students as well as being able to establish a harmonious learning atmosphere for and with

the students. On the other hand, an ineffective clinical instructor (detrimental, dangling, and

disturbing) impedes students' development in the clinical practice by causing conflict through

their personal attitudes and their teaching strategies. This can have benefits for clinical instructors,

to improve themselves and realize the impact of their attributes to the clinical

learning of students.
 19

In relation to this study, good understanding among the student nurses and Clinical

Instructors (CI) is needed to be able to come-up with a successful and harmonious relationship.

Good/harmonious relationship would affect the student nurses performance in the clinical

setting. They would have a better clinical experience/exposure and they would learn a lot. Their

interventions would most probably be effective.

Another article by De Guzman10 stated the concept of clinical credibility has attracted the

interest of some researchers in the field, it is interesting to note the substantive paucity of

literature on this since the mid 1990s [Fisher, M., 2005. Exploring how nurse lecturers maintain

clinical credibility. Nurse Education in Practice 5, 21-29.] specifically from an Asian context.

This qualitative study purports to capture how a select group of senior nursing students view

their clinical instructors' credibility. A total of 22 senior nursing students recruited from a

comprehensive university in the capital of the Philippines participated voluntarily in this

qualitative study. With the use of individual in depth interview as a qualitative tool, findings of

the study yielded three significant themes that elucidate the essence of credibility from the lens

of Filipino nursing students. These include (1) credibility as an image building activity; (2)

credibility as a work in progress; and (3) credibility as an influencing agent.

In relation to this study, the knowledge and intelligence of a Clinical Instructor (CI) are

needed to be able to categorize their credibility to teach student nurses. A Clinical Instructor

cannot impart knowledge which they are not familiar with. A student nurse would not be able to

gain knowledge if he/she doubts the credibility of a CI. The attitude of the CI to learn and gain

knowledge would help them gain their credibility as instructors.

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NOTES

1
G. Watson. Why psychology can we feel sure about? Teachers College Record, 61(5),

254

2
S.T. Brown. Faculty and student perceptions of effective clinical teachers: An extension

study. Journal of Professional Nursing, 6(1), 33-44.

3
P.J. Karns and T.A. Scwab. Therapeutic communication and clinical instruction.

Nursing Outlook, 30(1), 39-43.

4
Raymond H. Harrison, Supervisory leadership in education. Litton Educational

Publishing, Inc.1968

5
Robert G. Owens .Organizational Behavior in Education, Forth Edition
6
http://www.successconsciousness.com/positive_attitude.htm

7
http://changing-personalhabits.suite101.com/article.cfm/the_power_of_positive_attitude

8
Janet Lusk, et al. Nurses’ Perceptions of Working With Students in the Clinical Setting:

Nurse Educator Volume 32. No. 3, page 102-103

9
Allan De Gzman, et.al., Learning,  Studies,  Qualitative research,  Nursing  education, 

Teaching,  Teachers,  Teacher evaluations; Nurse Education Today. Edinburgh: Jan 2008. Vol.

28, Iss.1, 48

10
Allan De Gzman, et.al., Qualitative research,  Nursing  education,  Teaching,  Teachers;
Nurse Education Today. Edinburgh: Aug 2007. Vol. 27,