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2020, Vol. 10, No. 9
ORIGINAL RESEARCH
Factors contributing to students’ satisfaction with
direct observation of procedural skills in the school of
nursing sciences at the University of Zambia
Martha Mbewe∗1 , Natalia Mbewe1 , Catherine M. Ngoma2
1
2
Department of Basic and Clinical Nursing Sciences, School of Nursing, University of Zambia, Lusaka Zambia
Department of Midwifery, Women’s and Child Health, School of Nursing, University of Zambia, Lusaka Zambia
Received: March 19, 2020
DOI: 10.5430/jnep.v10n9p47
Accepted: May 20, 2020
Online Published: May 31, 2020
URL: https://doi.org/10.5430/jnep.v10n9p47
A BSTRACT
Direct observation of procedural skills is an evidence-based assessment tool used for assessing competence in the practical
procedures that nursing students undertake during clinical placement. Having knowledge about students’ satisfaction with their
educational issues is very important as it helps both faculty and students to achieve educational goals. However factors that may
influence student satisfaction with this method of assessment are not known in the school of nursing sciences at the University of
Zambia. The purpose of this study was to investigate factors influencing student satisfaction with direct observation of procedural
skills in order to get students views on this assessment tool. A cross sectional quantitative survey was used on ninety two (92)
conveniently sampled final year undergraduate nursing students. Data were collected using a validated self-reported questionnaire
and analysed using IBM SPSS Version 20. Fisher’s exact tests were used to determine association between student satisfaction and
the independent variables. A p-value of ≤ .05 was considered statistically significant. Major findings revealed that poor clinical
environment 98.9% and faculty non availability 98% influenced student’s satisfaction negatively. Other significant associations
where clinical experiences, and feedback, with p ≤ .05. In conclusion, the major factors that influenced student satisfaction
included poor clinical environment which was not conducive for assessments as it lacked many essential medical surgical supplies
and non-availability of faculty in the clinical area who were needed to provide feedback, guidance and supervision to the students.
Improving the clinical environment, ensuring faculty availability in order to provide timely and constructive feedback may help
students achieve their learning objectives. Direct observation of procedural skills still remains an appropriate tool to assess
student clinical competence. However, further research and development of cheap, less stressful and economic methods of clinical
evaluation to blend with this tool is required in the school of nursing sciences.
Key Words: Student satisfaction, Direct observation, Procedural skills, Clinical assessment, Clinical competence
1. I NTRODUCTION
Having knowledge about students’ satisfaction with their
educational issues is very important as it helps both faculty
and students to achieve educational goals.[1] In their review
on students’ satisfaction in higher education, Salinda et al.
in Sri Lanka defined students’ satisfaction as a short-term
attitude resulting from an evaluation of students’ educational
experience, services and facilities.[1]
In nursing education, it is the ultimate goal of each nursing
∗ Correspondence: Martha Mbewe; Email: martha.mbewe@unza.zm; Address: Department of Basic and Clinical Sciences, School of Nursing
Sciences, The University of Zambia, Lusaka, Zambia.
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programme to prepare nursing students become clinically
competent nurses.[2] Clinical competence has been defined
as “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values
and reflection in daily practice for the benefit of individuals
and community being served”.[3] Competencies are gained
through pre-service education, continuous nursing education
in-service training, and work experience.[4] According to
WHO, 2013 competence has been recognized as a core component of professional standards and a major determinant of
provider performance as represented by conformance with
various clinical, non-clinical, and interpersonal standards.[5]
Many certifying bodies, both globally and locally, consider
clinical competence as an attribute expected of every practising nurse to demonstrate proficiency in the appropriate use
of procedural skills.[2, 6]
1.1 Overview of direct observation of procedural skills
(DOPS) assessments
DOPS a tool commonly used in workplace-based assessment
worldwide is used for assessing competence in the practical procedures that student nurses undertake in the clinical
area.[6] As opposed to many other assessments in medical education, these assessments do not occur in artificial settings,
but take place as part of the daily work. Workplace-based
assessments offer the opportunity to provide trainees with immediate feedback on their performance. Therefore, they play
an important role in competency-based medical education.[7]
DOPS involves the assessment of a student’s communication,
professional skills and attitude which will provide evidence
of appropriate everyday clinical competences as they interact
with patients in the real world.[8] According to the school
of nursing sciences curriculum description, DOPS is done
whilst the student undertakes the activity ensuring that they
are making satisfactory progress in the clinical area.[6] Two
different assessors conducts these assessments and cover a
wide range of procedures. The procedure being observed
takes 20–30 minutes. The assessor thereafter spends 5-10
minutes providing immediate feedback and completes the
assessment form with the student present. The assessment is
performed against the standard expected at the end of the student’s current stage of training.[2, 6] Assessors can be senior
staff nurses, registered nurses, or other healthcare professionals competent in the area being assessed (e.g. doctors and
midwives). No prior knowledge or approval of the student
is needed by the assessor from the university but brief information about the standard required for each stage of training
guided by the clinical objectives to be achieved via the assessment is given. The assessment process is led by both
the student nurse and the assessor who chooses the proce48
2020, Vol. 10, No. 9
dure for assessment. Key result area to focus the assessment
are outlined on the DOPS assessment form which must be
completed by the assessor following observation with the
student present. The outcome of the assessment is a global
professional judgement of the assessor that the student has
completed the task to the expected standard at that stage.
This judgement could be stated as: Satisfactory-meaning the
student meets the standard overall and can proceed to the
next level or unsatisfactory meaning the student needs to
repeat the assessment before progressing to the next level.
Aspects of performance that are good as well as those that
need improvement are discussed with the student. Furthermore, areas for development are also identified, agreed and
recorded on the DOPS form.
Student assessment is an important issue in nursing education.[6] It is necessary to use objective, valid and reliable
assessment methods that are appropriate to the learning objectives and domain.[9] In a systematic review on DOPS
conducted by Naghma in 2013 on validity, reliability, feasibility, acceptability and educational impact of DOPS it
was revealed that DOPS was found to be a useful tool for
assessment of procedural skills.[10]
Equally in a study conducted by Hengameh et al. in 2015
at the University of Medical Sciences, Terran in Iran, it was
revealed that using DOPS improved the students’ scores in
clinical procedures.[11] However, despite DOPS having being
considered as the most effective and evidence based commonly used clinical evaluation method by many scholars, it
has a number of challenges.[12, 13] It is believed that DOPS
is a stressful evaluation, has time limitation for participants,
and also has bias between assessors.[7] Other researchers
feel that DOPS is only possible when sampling a fraction of
what is needed to be produced in a nurse and play a judgemental role rather than a developmental role.[14] This implies
that DOPS is subjective as the assessor may just observe
and judge a fraction of the performance of the student. For
example a student checking a patient’s temperature may perform the task very well without explaining the procedure
and its relevance for the patient to understand. The assessor
may only concentrate on observing the performance of the
procedure forgetting other aspects.
1.2 Student satisfaction with DOPS in the School of
Nursing Sciences
As earlier mentioned, having knowledge about students’ satisfaction with their educational issues is very important as
it helps both faculty and students to achieve educational
goals.[1] If students are able to achieve their educational
objectives in the clinical areas, they become competent practitioners.[15] In clinical assessment, student satisfaction is an
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individual overall subjective evaluation of experience during clinical assessment as well as the perception of the gap
between what is done and the expected specific objective
to be achieved.[15] There are a number of factors that may
influence student satisfaction. Identification of these factors
is important as it may help in suggesting good ways of boosting the student’s performance and confidence. Giving the
students an opportunity to voice out their opinions about the
quality of education or assessments they do, can be seen
as part of broader commitment to the institution and student participation in educational planning as well as learning
processes.[16] The nursing students’ satisfaction is considered as an important factor of such assessment, contributing
to any potential reforms in order to optimize the learning
activities and achievements within clinical settings. Therefore, satisfaction could be used as an important contributing
factor towards the development of better clinical learning
environments in order to satisfy the needs and expectations
of students.[13]
The school of nursing sciences established in 1976 at the
University of Zambia mostly uses DOPS method for both
formative evaluation to check on the extent to which students
have learnt in the clinical area and summative evaluation to
confirm the competences achieved in the clinical area. Formative assessments can highlight specific procedural strengths
and weaknesses, allowing performance enhancing feedback
and objective setting. The school has been offering degree
programs at undergraduate and postgraduate levels to registered nurses (in-service) after obtaining their diploma and
also the direct entrants (pre-service) from high school over
a period of five years on full time. Students are allocated to
different clinical areas throughout their training to acquire
the relevant nursing skills after theory component in class.
At the end of each allocation students are assessed using
DOPS method for formative assessments while OSCE is
used in the final examination. These assessments are to determine the skills the student has acquired during a particular
allocation.[6] As already described, the student performs a
procedure on a real patient they have interacted with in the
clinical area and is observed by an experienced assessor who
reviews the student’s performance using a structured check
list or rating scale. The assessor provides feedback to the
trainee, which allows the trainee, identify learning needs and
plan for future learning opportunities.[6] These assessments
are done for both formative and summative evaluation for a
student to move to the next level or complete a level. Both the
assessor and the student are required to sign the completed
DOPS clinical assessment form.
2020, Vol. 10, No. 9
and their assessors are satisfied with this method of assessment or not. There is need also to identify the factors contributing to students’ satisfaction as they are the ones being
exposed to this method of assessment. Evidence has shown
that the traditional clinical assessment method (DOPS) is
unreliable in testing students’ performance and has a wide
margin of variability between one examiner and the other.[17]
It is also believed that feedback oriented clinical evaluation
methods can promote learning in addition to evaluating the
difficult issues in traditional students’ evaluation.[11]
Although DOPS has been investigated in various educational
respects, there is a limited number of studies exploring the
nursing students’ point of view from the standpoint of their
satisfaction with DOPS on a worldwide basis.[17] Therefore,
the researcher decided to conduct a scientific inquiry that will
help to identify factors contributing to student satisfaction
with the DOPS methods of assessment as no study has been
done in Zambia before.
2. M ETHODS
2.1 Study design
This cross-sectional study design was guided by a modified
version of the Keaveney and Young customer satisfaction
model of 1997. This particular one was selected because it
considers satisfaction as a function of the extent to which
students’ expectations about the clinical assessments are met
with positive confirmations of their expectations leading to
higher levels of satisfaction.[18] This model incorporates a
comprehensive set of independent variables and self-reported
experiential assessments to predict performance, which in
return is related to student satisfaction. The model relates to
the students and administrative unit of SONS, on the aspects
that student experience purely depends on what the department is responsible for providing. Student’s experience in
an institution is based on the following: connection with the
faculty, advising staff, the environment and also the interactions in the classroom.[14] Jaradeen et al. 2012 in their
study on student satisfaction with nursing program in Jordan
once said that if students have positive experience, they are
more satisfied as compared to the students who have negative
experiences.[16]
2.2 Study setting
The study was done in the School of Nursing Sciences at
the University of Zambia in Lusaka. The school has been
offering undergraduate nursing degree programmes since
1976 and in 2004 postgraduate degrees at masters level was
introduced. The school is situated at the University Teaching
However, the DOPS clinical assessment method has not been Hospitals. The University Teaching Hospitals is the largest
evaluated at SONS and neither is it known whether students tertiary health institution in the country made up of five dif-
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2020, Vol. 10, No. 9
ferent hospitals offering a wide range of health services to
clients from all over the country. This is where students from
the school of nursing sciences as well as surrounding nursing
colleges and university students do their clinical placements
and clinical assessments.
Construct validity of the tool in this study was ensured by
asking participants to answer the same questions in the questionnaire. Its validity was also determined by computing the
Content Validity Ratio (CVR) and Content Validity Index
(CVI). The outcome of the tests (CVR and CVI) showed that
questions scored 0.80 and 0.82 respectively based on the ex2.3 Study population
perts’ panel opinions and pilot study results. The tool further
The study population included 92 final year undergraduate underwent a reliability coefficient (Cronbach’s Alpha) test
BSc nursing students in the School of nursing sciences. This for likert responses and obtained a value of 0.85 showing
population group was conveniently selected as the group had that it was reliable.
been assessed using the DOPS clinical assessment method
Pre-testing of the instrument was done on the fourth year studuring training and had completed most of the assessments in
dents who were still undergoing clinical placements and were
their training as outlined in the curriculum at this level. The
about to do end of allocation assessment using the DOPS.
undergraduate degree program is five years. Two types of
Most of the responses were ideal and the experts review restudents are enrolled. The direct entrants straight from high
ported minimal adjustments in the construction of sentences
school do five years while the in-service which are registered
and grammar which were attended to in the final instrument.
nurses with diplomas join in the fourth year after doing the
diploma at colleges for three years since they already have
2.6 Ethical consideration
a basic qualification. This university offers an innovative
mixed curriculum model where students learn first in class Ethical clearance was obtained from the University of Zamand then sent to various clinical areas for hospital based bia Biomedical Research Ethics Committee (UNZABREC).
Written permission to conduct the study was also sought
education.
from the Dean School of Nursing Science. The purpose of
the study and the research process was explained to the par2.4 Data collection
Data were collected using a validated self-reported ques- ticipants who were later requested to give their consent in
tionnaire which was developed by the researcher after re- written. The issues of privacy, anonymity and confidentialviewing the literatures and other related tools. The tool had ity were ensured by excluding the name of the participant
five sections with both open and closed ended number of from the questionnaire and that no other person except the
questions that helped to answer the study objectives. These research team members had access to filled questionnaires.
questions included how satisfied students were with the fol- Participants were further informed that participation was
lowing variables; clinical environment, clinical experiences, voluntary and that they were free to withdraw without any
faculty availability during clinical learning, feedback after consequences or punishment. They were further assured that
the DOPS clinical assessment method, clinical staff avail- their responses will neither affect their relationship with the
ability and clinical staff attitudes. Students rated their views faculty nor their grades or performance in school.
using a five point likert scale ranging from 1-5 as a measure
of satisfaction. This tool outlined the degree of satisfaction whereas 4-5 meant that they were satisfaction while 1-3
meant that they were not satisfied. On the factors that may
influence student satisfaction, questions were asked in various areas of the variables which include the DOPS clinical
assessment method process, feedback, clinical experiences,
equipment, faculty availability and the clinical staff attitude.
The clinical environment was assessed by the use of a modified clinical environment assessment form as outlined by the
University of Zambia revised Clinical Practicum Handbook.
Participants filled in the responses on their own after giving
consent.
2.7 Data analysis and presentation of findings
After sorting out the questionnaires, categorization and codes
were assigned manually and entered on data master sheet.
There after data were analyzed using IBM SPSS Statistical
software for Windows Version 20.0. Students’ satisfaction,
clinical environment, faculty availability during teaching in
the clinical area, clinical staff attitude and clinical experiences were variables under consideration. Univariate analysis of student satisfaction and the factors associated with
student satisfaction was carried out to describe the variables.
Bivariate analysis of student satisfaction and each of the independent variables was carried out to ascertain association.
Fisher’s exact tests were used to determine association be2.5 Validity and reliability
tween student satisfaction and the independent variables. A
Validity and reliability of the instrument are key components p ≤ .05 was considered statistically significant. The findings
of a study as they intel that data collected is a true reflection. were presented in tables and figures.
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3. R ESULTS
Table 1. Factors contributing to Student satisfaction with
The main objective of the study was to identify factors con- the DOPS clinical assessment method (n = 92)
tributing to students’ satisfaction with direct observation of
Variable
Frequency
Percent (%)
procedural skills in the school of nursing sciences at the
Feedback
University of Zambia. 92 final year undergraduate nursing
Untimely
81
88.0
students participated in the study. Therefore the results pre- Timely
11
12.0
sented below are factors contributing to students’ satisfaction
Total
92
100
with direct observation of procedural skills in the school of
Clinical Environment
nursing sciences at the University of Zambia. The results are
Poor
91
98.9
presented in figures and tables as outlined below.
Good
1
1.1
Total
92
100
Faculty availability when learning
Not available
88
95.7
Available
4
4.3
Total
92
100
90
98
Staff attitude
Negative
Positive
2
2
92
100
Bad
89
96.7
Good
3
3.3
Total
92
100
Total
Clinical experiences
Table 2. Students’ satisfaction with variables (n = 92)
Variable
Figure 1. Student satisfaction with the DOPS assessment
method (N = 92)
As shown in Figure 1 the majority 87 (94.6%) of the respondents were not satisfied while only 5 (5.4%) were satisfied
with the DOPS clinical assessment method.
Frequency
Percent (%)
Clinical environment
Not satisfied
90
98
Satisfied
2
2
Total
92
100
Clinical experience
Not satisfied
89
96.7
As shown in Table 1, overwhelmingly 98.9% (91) of the
participants reported poor clinical environment while only
1 (1.1%) reported good clinical environment. Almost all
the 98% (90) participants reported non availability of faculty
when teaching in the clinical area except 2% (2) who reported
faculty availability. The majority of the 81 (88.0%) reported
that feedback was untimely while 12% (11) reported that
feedback was timely. Majority 95.7% (88) of the participants
reported negative staff attitude while only 4.3% (4) reported
positive staff attitude. Most of the participants 96.7% (89)
reported having had bad experiences with DOPS while only
3.3% (3) reported having good experiences.
Satisfied
3
3.3
Total
92
100
90
98
Not satisfied
88
95.7
As shown in Table 2, majority of the students were not satisfied with the following all the variables.
Satisfied
4
4.3
Total
92
100
Faculty availability when learning
Not satisfied
Satisfied
2
2
Total
92
100
Feedback
Not satisfied
81
88
Satisfied
11
12
Total
92
100
Clinical staff attitude
As shown in Table 3, Fisher’s Exact Test (2-sided), * indicates significant p-value at p ≤ .05, except for clinical staff
attitude.
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Table 3. Association between student satisfaction with the
DOPS clinical assessment method and factors (n = 92)
Student satisfaction
Variable
Not satisfied
n (%)
Satisfied n
(%)
p-value
*.054
Clinical environment
Poor
87 (95.6%)
4 (4.4%)
Good
0 (0.00%)
1 (100.0%)
Bad
86 (96.6)
3 (3.4)
Good
1 (33.3)
2 (66.7)
Clinical experience
*.007
Feedback after DOPS
Untimely
79 (97.5)
2 (2.5)
Timely
8 (72.7)
3 (27.3)
*.011
Faculty availability when learning
Not available
85 (96.6)
3(3.4)
Available
2 (50.0)
2 (50)
*.014
Clinical staff attitude
Negative
86 (95.6%)
4 (4.4%)
Positive
1 (50.0%)
1 (50%)
.106
*p ≤.05
4. D ISCUSSION
The discussion is based on the factors contributing to student
satisfaction with direct observation of procedural skills in the
school of Nursing Sciences at the University of Zambia.
The main objective of our study was to identify factors contributing to students’ satisfaction with DOPS.
2020, Vol. 10, No. 9
be considered.[15] Traditionally students’ overall satisfaction
with their educational experiences has been measured by a
simple ’yes or no’ question, or with one question assessing
the degree of overall satisfaction.[9] Since satisfaction plays
an important role in learning and skill acquisition, we can
reinforce positive factors and convert the negative ones of the
current evaluation status by assessing students’ attitudes to
promote their satisfaction. So, having knowledge about students’ satisfaction with educational issues is very important
to help the university to achieve educational goals.[9]
Before identifying the factors contributing to student satisfaction, this study investigated the general students’ satisfaction with the DOPS assessment method at SONS. The study
showed that an overwhelmingly ninety four point six percent
(94.6%) of participants were not satisfied with the DOPS
clinical assessment method while only 5.4% were satisfied
with the DOPS clinical assessment method (see Figure 1).
The reasons for the students being not satisfied in the current
study included non-availability of the faculty in the clinical
area during teaching sessions as reported by 96.6% of the
students, poor clinical environment coupled with inadequate
equipment and shortages of medical surgical supplies to use
during the DOPS assessment, bad clinical experiences which
include uncaring attitude of clinical staff who are not willing
to help them. Generally students complained of the process
to be stressful as the clinical area had a lot of shortages in
terms of supplies and time limitation. Contrary to Sahebalzamani et al. (2012)[20] whose study showed that a high
percentage of teachers and students are very satisfied with
evaluation with DOPS, multiple researchers have seen the
students’ dissatisfaction in their evaluation status and the
results of the clinical evaluation. However, Sahebalzamani &
Jahantigh, 2012 argued that the students are satisfied when
assessed by those with more knowledge level.[20] The current study’ findings are also in line with the results for a
systematic review conducted by Erfani Khanghahi M, Ebadi
Fard Azar F in 2018. Their review reported that the major
strengths of DOPS evaluation method are providing feedback
to the participants, promoting independence and practical
skills during assessment. However, it was noted that there
were reports of the evaluation being stressful, time limiting
for participants, and biases between assessors as the main
drawbacks of this method.[21]
4.1 Overview of student satisfaction
Student satisfaction is the ability of students being able to
achieve their objectives and feeling good with what they are
doing.[13] Satisfaction plays a major role in determining the
originality and accuracy of a system especially the educational system because the higher the level of satisfaction the
higher the level of students’ grooming their skill development and course knowledge.[13] Having knowledge about students’ satisfaction with educational issues is very important
to help both faculty and students achieve their educational
goals. In the clinical area, if students are able to achieve
their educational objectives, it enhances their confidence and
satisfaction.[15] In clinical assessment, student satisfaction
is an individual overall subjective evaluation of experience
during clinical assessment as well as the perception of the 4.2 Factors contributing to students’ satisfaction with
gap between what is done and the expected specific objective
DOPS
to be achieved. In other words, student satisfaction is the
As earlier mentioned satisfaction is a relative measure which
student’s fulfilment.[19]
research literature shows, may be influenced by many factors
Satisfaction is, however, a relative measure which research lit- that should be considered.[13] The implementation of any
erature shows, may be influenced by many factors that should assessment tool is basically dependent on the acceptance of
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students. The present study revealed that, faculty availability,
clinical experiences, clinical environment and feedback, had
a strong association with student satisfaction with DOPS
assessment method (see Table 1). Meaning that if improvements are made in the DOPS assessment process, faculty
are available in the clinical areas, and give the necessary
support, students’ experiences will be good and this will
in turn lead to their satisfaction with the DOPS assessment
method. These findings are in line with the studies conducted
by Franz[17] and Mntambo[19] in South Africa.
In this study, the clinical staff attitude had no association
with students’ satisfaction with DOPS assessment method
(see Table 3). Despite this factor not being statistically significant, most of the students reported not being satisfied
with it and should not be ignored. Students reported stressful
experiences, subjectivity in the awarding of marks as some
of them where just shown marks without explanation, time
limitation and lack of proper guidance on how to conduct
themselves during the assessment.
Variabilities were noted on how the assessment is conducted.
Generally in this method of assessment, student should be
allowed to choose a client on their own with whom they have
interacted which does not happen. Students reported being
forced to do procedures even on a client they didn’t prepare
for. This in turn led to them not being satisfied with the
process. This is similar to what was reported by Masoumeh
et al. (2018)[18] in their systematic review of evidence on
DOPS evaluation method. They reported that satisfaction
with DOPS method was found to be moderate in medical education. Some of the contributing factors cited in the review
included: stressful evaluation, time limitation for participants, and bias between assessors as the main drawbacks of
this method.
2020, Vol. 10, No. 9
faced by students may lead to poor performance and luck of
confidence. In a similar research study done by Evridiki et
al. (2016)[15] on nursing students’ satisfaction of the clinical
learning environment at the Cyprus University of Technology, the findings reported that students felt that supervisory
relationship was one of the most influential factor in their satisfaction with the clinical learning environment.[15] However
to help solve this problem, SONS has embarked on capacity
building trainings of assessors where the faculty is oriented
on how to be good examiners and assessors without making
the student uneasy.
4.2.2 Clinical environment
Another factor influencing student satisfaction revealed in
this study was the clinical environment. Clinical environment
encompasses all that surround the students while practising
or providing nursing care and these include; the availability of functional different equipment, staff, patients, nurse
mentors and nurse teachers.[22, 23]
Activities that take place in the clinical environment should
allow students to achieve their objectives.[24, 25] Above all
students develop their professional self-image in the clinical
area and this helps them to go from being able to achieve various tasks to becoming a nurse who understands what their
role entails and someone who is an independent and competent practitioner.[26, 27] Furthermore, Khosravi et al. (2010)
emphasised that the students in clinical settings should have
an appropriate professional behaviour, establish an appropriate interaction with the patients, prioritize the problems,
have the basic knowledge about clinical methods, perform
the care procedures correctly, and apply critical thinking.[23]
In our study, the overall response on the clinical environment
was that majority (95%) of the participants reported poor
clinical environment (see Table 2). Among the reasons reported to describe the poor clinical environment were that
the clinical areas had inadequate equipment to use and had
a critical shortage of medical surgical supplies. Staff shortages also were cited as students were left alone to discover
things for themselves. Equally faculty members from the
SONS were not available to guide and focus their objectives
according to the level of practice. These findings are in line
with studies done by Hoseini et al.[9] in Iran, Mntambo[19] in
South Africa and Espeland and Indrehus[28] in Norway.
4.2.1 Clinical staff attitude
Clinical staff’s attitude refers to the way the clinical staff
responds and treats the students that are undergoing their clinical experience in the clinical areas.[21] The clinical learning
process aims to promote the integration of theory into clinical practice with the nurse teacher in the coordinator role.[22]
This calls for a mutual relationship between students and the
clinical staff to enhance learning. In instances where there is
no good relationship between students and clinical staff, it
could result in tension and deterioration of work conditions
4.2.3 Clinical experience
and decreased student satisfaction.[22]
On clinical experience is what students go through as they
In this study, 95.6% of the students reported that the clinical practice in the clinical areas. Students’ experiences are said
staff attitude was bad. Most of them cited assessors intimidat- to be good if they are given an opportunity to interact with
ing students, underrating them and giving them poor marks. patients, do procedures with all resources needed for the
This is in line with the study conducted by Mntambo[19] in procedure are available and participate in clinical decision
South Africa and Hoseini et al.[9] in Iran. The intimidation making.[29, 30] In our study majority 96.6% of the students
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reported to have had bad experiences related to shortages
of supplies, staff and equipment (see Table 1). These findings concur with a study conducted by Mntambo[19] in South
Africa, when they studied Students ‘clinical experiences. It
was reported that good clinical experience boost students’
performance and morale. Most of the contributing factors
to bad clinical experiences reported by students included
critical shortages of medical surgical supplies, inadequate
equipment and non-availability of qualified assessors. This
is a true reflection as the University Teaching Hospitals were
students do their practical are funded by the government
and most of the time funds are not available leading to critical shortages. To this effect, the government through the
Ministry of Health have introduced clinical placement fee
as a measure of cost sharing where all students are paying
for their clinical placement. Funds realised from these fees
helps in the purchasing of medical surgical supplies for daily
use by students. The challenge is that the fees are too high
making it difficult for students to pay for the recommended
number of weeks they are supposed to spend in the clinical
area.
2020, Vol. 10, No. 9
have stated that students should be given feedback on time
before writing their examinations.[8, 31]
4.2.5 Faculty availability
Not forgetting to mention, faculty availability was another
notable revelation of this study. Faculty plays various roles
in DOPS assessment method which includes a constant presence, coordinator, liaison person and the assessor.[8] This
study revealed that the faculty from the school are not available in the clinical area and if they are to be present, it is only
during assessments. Almost all the students 96.6% reported
the absence of the faculty in the clinical area (see Table 1).
Nursing teachers must be in charge of clinical practice because they are the ones ultimately responsible for learning
in the clinical practice.[32] Thus, it is in the clinical area that
students must relate theory to practice, learn the necessary
technical and interpersonal skills, make clinical judgments,
become socialized into the profession and begin to appreciate
its values and ethics.[32] The development of competent practice is a primary goal for nursing education. To demonstrate
this competence, graduates must be able to practice in the
“real word”.[32]
4.2.4 Feedback
Another notable finding on the factors influencing student
satisfaction with DOPS assessment method was feedback.
Feedback is information about the result of a performance,
usually in the context of an observed performance of a skill.
It occurs when a student is offered insight into what he or
she actually did as well as the consequences of his or her
actions. In this study, majority 90.8% (79) of the respondents
who were not satisfied with feedback process and revealed
that feedback is untimely (see Table 1). It has been observed
that the standard for giving feedback is not adhered to in
the school of nursing sciences hence most of the assessors
delay to give immediate feedback. Students reported receiving feedback weeks or months after the assessment has been
done contrary to the standard that say immediate feedback
after DOPS assessment should be given.[7]
This was in agreement with a study conducted by Franz and
Anthea[17] in South Africa which revealed that 70% of the
students felt that teachers should be approachable, helpful to
provide student nurses with necessary support and try to foster student nurses’ self-esteem. Non availability of faculty in
the clinical area could be attributed to the reason that SONS
has inadequate staff to assess and supervise the students as
the school is currently using part time demonstrators, lecturers and tutors to help mitigate the shortage of staff in the
clinical areas. As earlier mentioned there is no provision
at the University’s establishment for full time clinical lectures to monitor students, supervise and couch the students.
The school of nursing sciences are currently advocating for
positions of clinical lecturers to be included in the university establishment. Students need constant presence of the
teacher to guide them as they perform procedures on their
Studies in Norway[28] and South Africa[19] have revealed that patients. Faculty availability in the clinical area will help
untimely feedback lead to increased levels of anxiety among students be focused and do what is right.
students and others may continue doing wrong things without knowing what is right. Equally respondents in this study 5. C ONCLUSION
reported being anxious and restless as they wait for the DOPS Indeed satisfaction is a relative measure which research literassessment results. Students reported fears of repeating the ature shows, may be influenced by many factors that should
same mistakes in the final examination as they would not be considered. The present study revealed that the major
know the right way to do some procedures without feedback. factors that influenced student satisfaction with DOPS in the
Previous studies are in agreement with our study findings as school of nursing sciences at the University of Zambia were
they have also revealed that following guidelines for giving poor clinical environment, and non-availability of faculty (p
useful feedback may help to reduce student’s anxiety, im- < .05). If improvements are made in the DOPS assessment
prove performance, and increase morale. The University of process, faculty are available in the clinical area, and give the
Zambia recently reviewed the progression regulations and necessary support, students’ experiences will be good and
54
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Journal of Nursing Education and Practice
this will in turn lead to their satisfaction. Creating conducive
environment in the clinical for students is of paramount importance as it is likely to increase student’ satisfaction which
will lead them to perform well and help them achieve their
objectives in attaining the required competence. There is
need for the school of nursing sciences to collaborate with
the hospital management so as to meet the requirements ideal
for the students to practice well. The school of nursing sciences should be conducting check-ups to identify the areas
of needs in the clinical area in order to make the learning
experience of students fruitful. Cost sharing measures should
be enhanced to help cushion the shortages of supplies while
students are on attachments. DOPS still remains an appropriated tool to assess student clinical competence but can be
strengthened by blending it with other clinical assessment
methods like OSCE. However, further research and development of new methods of evaluation to blend with DOPS is
required in the school of nursing sciences.
5.1 Implications
The current study’ implication is that factors influencing student satisfaction with the DOPS assessment method at the
SONS has been known i.e. majority 94.6% of the students at
the SONS are not satisfied with the DOPS method of clinical
assessment due to poor clinical environment, bad clinical experiences, untimely feedback and non-availability of faculty
when teaching in the clinical area. There is a need to look
into these areas that affect student satisfaction by providing a
conducive environment for students to achieve their learning
objectives in the clinical areas.
2020, Vol. 10, No. 9
revealing the factors contributing to student satisfaction with
this particular method of assessment at the SONS. By adding
to the body of empirical knowledge, the identified factors
contributing to student satisfaction with DOPS should be
considered by others using the same method of assessment.
These findings will help to direct the SONS finding means
to enhance better ways of making clinical assessments ideal
by meeting all the requirements and perhaps even changing
ways of clinical assessments.
5.2 Limitation of the study
Limited data from scholarly nursing journals made the search
for information difficult as most of the studies were just concentrating on the DOPS methods only with no regards to
student satisfaction with the method. However other medical
fields (e.g. medical students, pharmacy, radiology, physiotherapy and general education) in general have done a
number of studies on student satisfaction with DOPS. Furthermore the study used a self-report method to collect data
which has a number of limitations. The sample size was
too small as it only involved the final year students instead
of the whole School. This is the first time a research on
factors contributing to student satisfaction with the DOPS
assessment method has been conducted in Zambia and the
number of respondents was approximately 20% of the total
number of students in the school of nursing sciences which is
just a small proportion of the University of Zambia making
it difficult to generalize the findings.
C ONFLICTS OF I NTEREST D ISCLOSURE
The current study has added to the body of knowledge by The authors declare that there is no conflict of interest.
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