Journal of Nursing and Midwifery Sciences 2014: 1(2): 31-39 http://jnms.mazums.ac.

ir
[ DOI: 10.18869/acadpub.jnms.1.2.31 ]

Original article

Exploring midwifery students’ experiences & perceptions of preceptorship project

Tahere Yaghoubi1, Zeinab Hamzehgardeshi2,*, Marjan Ahmad-Shirvani 3, Mojtaba Vais-moradi4

(Received: 1 July 2014; Accepted 17 Aug 2014)

Abstract
Background and Purpose: Special attention has been paid to instructor and preceptor in nursing and midwifery education.
This study aims to explore the experiences and Perceptions of midwifery students about implementing Preceptorship Program in
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delivery setting.
Methods: The current study is a qualitative research. The focus groups and in-depth interviews were used as data collection tools.
Targetful sampling was employed to choose 10 midwifery students from Mazandaran University of Medical Sciences in order
for them to participate in two discussion groups and in-depth interviews. The content analysis method was used for data analysis.
Results: 10 categories, 5 themes and 238 codes were conducted. The themes were: the characteristics of a good preceptor,
relationship, motivation and self-esteem, the expectations of a preceptor, and preceptorship experience.
Conclusion: The study showed that solving communication problems in educational environment, improving student-preceptor
interaction, boosting motivation level and self-esteem among midwifery students, and coordinating procedures conduction are
among the important principles of teaching and learning in clinical setting. The present study results can convey the essential
knowledge to midwifery education planers on this aspect of educational process and benefit from the advantage of peer preceptors
via the instructor’s supervision.

Keywords: Preceptorship, Clinical skills, Delivery setting, Qualitative research

Introduction
As a branch of medicine, midwifery deals with preparing the students for consistent scientific data
maternal care, before, during and after delivery, base, having skills of diagnosis, treatment, taking
and it is associated with all physiological, care of patients and acquiring different professional
pathological, psychological and social factors, skills (4). Since the goal behind clinical education is
which influence the quality and quantity of the providing the students with opportunities to match
new generations (1). Clinical education and the theoretical information with practical realities,
professional skills are considered to be the promoting its quality can lead to increasing the
most important parts of nursing and midwifery number of the students with clinical competence
education known as the focus of professional in different fields (5, 6). Since 50% of the nursing
education (2, 3). Clinical education refers to and midwifery educational programs are related

1
Department of Management Nursing, Nasibeh Nursing & Midwifery Faculty, Mazandran University of Medical Sciences, Sari, Iran.
2,*
Corresponding author: Department of Midwifery and Reproductive Health, Nasibeh Nursing & Midwifery Faculty, Mazandran
University of Medical Sciences, Sari, Iran. Email: Hamzeh@razi.tums.ac.ir.
Traditional and Complementary Medicine Research Centre, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran.
3
Department of Midwifery, Nasibeh Nursing & Midwifery Faculty, Mazandran University of Medical Sciences, Sari, Iran.
4
Department of Medical Surgical Nursing, Nursing & Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran.

31 JNMS 2014; 1 (2)

 Yaghoubi T, et al.
[ DOI: 10.18869/acadpub.jnms.1.2.31 ]

to the clinical courses, the clinical environment is the aiming to explore the nursing staff's experience
necessary source in preparing the students for their from preceptionship project indicates what might
professional role (4, 7). For the first time, Mentorship reduce stress level for the preceptor and increase job
and Preceptorship was used commonly in the 1970s and satisfaction and nurse's retention (18).
1980s, as a way to improve professional performance Midwifery students need a preceptor in every stage
in the U.S (8), and it was used by the private sectors of the clinical training. According to Midwifery and
in the U.K for management training in late 1980s. In Nursing Association (2008), the results of implementing
1990, mentorship and preceptorship became known preceptorship include providing an effective business
in society, and now it plays a significant role in the communication, facilitating learning, assessment and
constant development of nursing profession and responsibility, learning assessment, creating a learning
teaching (9). environment and evidence-based clinical education
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Special attention has been paid to instructor and and guidance (19). To achieve these results, a preceptor
preceptor in nursing and midwifery education. The should provide continuous support to facilitate learning
presence of a skilled and professional person with the and give effective feedback. A mentor and preceptor is
students removes their anxiety, confusion, improves the key factor behind the students' clinical competence
their professional skills, promotes their active learning, improvement in the clinical environment (20).
creates an appropriate learning environment for fresh Research has denoted that a mentor and preceptor is
students and the responsibility and self-confidence one of the most important factors affecting learning
for senior students and increases interaction among and improving the students’ self-confidence (21-24). In
the students (3, 10, 11). Preceptorship has been addition, the preceptor-student supportive relationship
consistently acknowledged in the literature as a enhances the clinical environment and learning quality
strategy to maximize the benefits of clinical education (20). In fact, the value of a good mentor and preceptor
in terms of knowledge , practice, confidence, and cannot be measured (25). In Queensland University of
professional skills (12). Technology, a Registered Nurse (RN) is used as a mentor
Preceptors are an invaluable and dramatic resource and preceptor. These nurses participate in the project
to prepare the students for their professional roles voluntarily. At the end of the second year of nursing
(13). There are many definitions for Mentorship and bachelor course, the students take part in the project as
Preceptorship. According to the definition proposed by a Mentee. In this model, mentorship and preceptorship
the National Nursing and Midwifery Board of England is defined as the participation, cooperation, and friendly
(2001), the term mentor and preceptor is used to define & promoting relations, it also involves professional
a nurse and midwife playing the role of a learning education and leadership. In other studies, senior
facilitator, supportive and assessor of the students in students have been used as preceptors (10, 16, 26, and
the clinical environment (14, 15). In some studies, 27). A number of researchers have examined the effects
it has been mentioned as a supervisor, an instructor, of mentorship and preceptorship project on stressing
a trained person or a senior student. In recent years, the clinical environment factors for the nursing students
being a preceptor has drawn special attention in (10, 16). An Iranian study divided 70 sophomore
nursing and midwifery, and practicing it is suggested nursing students into two groups of 35 (control and
as a method in order to prevent anxiety, confusion, to case) in a semi-experimental survey. The researchers
promote active learning, to create appropriate learning have reported that implementing preceptorship project
environment, self-confidence, to increase interaction has positive effects on reducing the stress of the clinical
among the students and to prevent the nursing students' environment factors for sophomore nursing students
desertion or disappointment (16,17). A research (16).

JNMS 2014; 1 (2) 32

 Midwifery students’ experiences & perceptions of preceptorship
[ DOI: 10.18869/acadpub.jnms.1.2.31 ]

The literature review suggested that most of the and experiences of the midwifery students clear in
studies were quantitative conducted among the nursing consistent with the facilities and characteristics of our
students (21, 26-31). According to the researcher's clinical environment. In this approach, content analysis
studies, no study has been conducted on implementing is an appropriate method for the texts subjective
preceptorship project and exploring Iranian midwifery interpretation through the process of systematic coding
students’ experiences about this project implementation classification and the available patterns or themes
in maternity hospital. Based on the researcher’s allocation (32).
experience, as a clinical service provider and clinical Setting and Participants: It is worth to explain that 42
instructor in maternity environment, the challenge senior midwifery students accompanied 42 freshman
has always been evident that students face with stress midwifery students 3 days weekly for three weeks,
and anxiety about the clinical environment on their fulltime & before the study. The required explanations
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arrival; and the presence of a skilled and compassionate about the research objectives and processes were given
instructor helps them to overcome their stress and it to the students and instructors. During the project
facilitates learning. Since a preceptor has a crucial implementation, the senior students taught the fresh
role in the students’ learning and the improvement ones via the indirect supervision of the instructor; the
of maternity facilitates learning, and due to different instructor entered the teaching session when necessary
nature of midwifery clinic from the other sectors, the and guided the training directly. At the end of the period
researchers decided to implement the preceptorship and during the present study, the group discussion was
project in maternity for the midwifery students and then held by the enthusiastic and highly informed students.
to survey the students’ experiences and perceptions of Data Collection: The focus group discussion was
the project through a qualitative research. used in present study other than the deep individual
interview in order to explore the participants’
Materials and Methods experiences of preceptorship project. The semi-
Design: The present study is a qualitative research of structural interview and open-ended questions were
content analysis type. Participants have been chosen applied in this study. The focus group discussion
based on targetful sampling and took part in deep (FGD) is an interview in a semi-organized group
individual interview and focus group discussion (FGD). under the leadership of a specific individual in an
The major question of this study is: “What is the informal situation to increase the information quality
understanding and perception of midwifery students and quantity by the group activity. Since the interview
about the implementation of preceptorship in labour is held with a group, rather than the individuals, it
room?” A qualitative approach has been used to is more flexible and thought-provoking and helps to
answer this question. The specific characteristic of remember the information and appropriately to enrich
the qualitative research is its exploratory nature, and the information. Unlike the other methods, it is not
its goal is to describe, explain and understand the based on an individual’s point of view, rather on the
phenomenon. The approach chosen for this study result and sum of a group’s thinking.
allows the participants to express their experiences The following questions were employed as the
about preceptorship, use their own words, without interviews guideline:
being exposed to predetermined responses of the "Please express your feeling about your expectation
quantitative research. On the other hand, not being about this preceptorship project?"
able to generalize the other cultures' studies to our "Which factors did you take as the facilitators and
culture, conducting a qualitative research becomes barriers? Please elaborate on how each factor affects
more necessary in order to make the understanding your physical activity."

33 JNMS 2014; 1 (2)

[ DOI: 10.18869/acadpub.jnms.1.2.31 ]

Students were asked to express their experiences about In this study, the conventional qualitative content
the project at the beginning of the discussion with regard analysis was used in which the categories have been
to the ethical standards of qualitative research and derived from the data and not from the primary theory
according to the principles of maintaining anonymity, (35). Also, the MAXQDA10 software (a computer
information confidentiality, the right to quit the study at software simplifying qualitative data analysis) was
anytime and finally acquiring an informed consent form applied for the data management (36). The individuals'
from the participants. The general questions with open expressions about their life experiences and histories
and descriptive responses were also designed as semi- were qualitatively dissected into small parts and
structured interview guide, and the students’ responses were descriptively analyzed (37). Content analysis
led the process. All of the conversations were recorded method is defined as a method for objective systematic
and transcribed, and then the content analysis was used description of manifest communication content;
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(33). The time allocated for each group discussion was furthermore, this method includes explaining the latent
90 minutes and interviews continued until the data communications content (38). In the present study,
saturation was achieved. both of the contents (manifest and latent) have been
Profound and exploratory questions such as ‘why’, evaluated. Generally, the qualitative content analysis
‘how’ and ‘give explanation’ were also given to the in this study was performed as the following:
groups based on their responses in order to perceive 1- Initially, the vocal files of the interviews
the depth of their experience. were transcribed; then, by precisely reading the
The following methods have been applied in order to transcriptions, the authors tried to understand the
increase the data consistency similar to the quantitative external and internal components of these experiences.
studies' validity and reliability: Member check has 2- By reviewing the transcriptions, the narratives
been used to ensure the accuracy and strength of were identified and the categories were formed after
the research data. Members of the study reviewed doing the primary coding.
the derived interviews, codes and classifications in 3- Synchronically, analytical memos were
order to investigate the coding process's accuracy and written in order to determine the primary relationship
determine if they have achieved the same codes. The between the intentions obtained from the participants'
researcher's creditability was used in the second stage. expressions.
In order to review the manuscripts of the participants, 4- By the interviews progression, the relationship
the relationship with the participants increased, and to between the intentions was specified in order to find
ensure the accuracy of the data, the interviews were held out the main models and meanings in the interviews.
in more meetings. Peer debriefing was used in the third 5- And finally, considering the content analysis,
stage, that is, to use the peers' additional comments & constant comparison method was employed in the
notes and the data results were given to the colleagues study implementation. This method based goals are to
and experts to confirm the results (33, 34). compare different individuals' opinions and experiments
Ethical approval was obtained from the Ethics about the phenomenon, to specify why the experiments
Committee of Mazandran Medical Sciences University. and opinions are different or similar, and to determine
Analysis: The data analysis was done with the purpose how they are related to each other (39).
to get the themes. Based on content analysis definition,
it is a method of objective, systematic and quantitative Results
obvious content communication description. However, Five main themes were achieved from the interviews
over time it changed to include the interpretation of the and focus group discussions, each of them with
hidden content communication (34). several categories. The main themes included: the

JNMS 2014; 1 (2) 34

 Yaghoubi T, et al. Midwifery students’ experiences & perceptions of preceptorship
[ DOI: 10.18869/acadpub.jnms.1.2.31 ]

characteristics of a good preceptor, communication, tries to review the new research cases, updates her
motivation and confidence, the expectations of a information, conducts the clinical works based on the
preceptor and the experiences of preceptorship. These evidences and teaches the students.
basic themes and categories were explained using “A good preceptor reviews the new articles and is up-
some examples given by the study participants. to-date even clinically.” (A senior student)
Theme 1: Characteristics of a good preceptor: Most of Theme 2: Communications: Another given code is
the participants mentioned availability, empowerment, related to humanistic and emotional communication
and self-confidence, well mannered and evidence- of the students collectively and with the preceptor.
based working as the obvious traits of a decent Promoting the humanistic relationships in professional
preceptor. In this study, the students believed that a and intimate situations is stated as one of the merits
good preceptor is a very effective factor in facilitating of a preceptor. According to the students, this
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learning, boosting confidence and lowering anxiety. communication must be respectful, and the scientific
Availability: “A good preceptor is a person who is information of the senior students is effective in fresh
always accessible” (A bachelor student). students' learning.
Practical & Theoretical Empowerment: “A good Communication-related skills, especially an
preceptor is a person who is well informed and individual’s ability to communicate, seem to be very
experienced in practical courses” (A bachelor student). critical in creating the balance in professional and
High Self-esteem: “In addition to being theoretically friendly relationships:
and practically experienced, a good preceptor must have “Since my preceptor was a student like me, I felt
high self-esteem and should be able to make proper comfortable. Although I kept a distance from the
decisions in critical situations” (A senior student). preceptor as my senior, we were like friends.” (A
Well Mannered & Encouraging: Most of the bachelor student)
students asserted that a decent preceptor is the one “Since my preceptor was also a student and we were
who encourages students to learn through asking female and homogeneous, we talked a lot in our free
appropriate questions besides being well-mannered time. She was more experienced than me and guided me;
and supportive in clinical situations. we still have a close relationship.” (A bachelor student)
“A person, who thoroughly explains the clinical and Some of the students suggested that some preceptors
theoretical points, teaches us useful skills at proper tended to make less communication due to the
times and supports us in stressful situations.” (A weakness of knowledge and skills.
bachelor student). “My preceptor did not have a good interaction with
According to the students, it seems that being sure of me; she always seemed to resist against me. She was
the practical and scientific abilities of the preceptor is theoretically weak and did not talk to me because she
of the most important factors: was afraid that if I asked a question and she could not
“A good preceptor is a person who encourages us to reply; but I knew human being is not a computer to
study more and perform our clinical courses better, remember everything immediately, she could search
gives us the freedom to take delivery cases, but has and answer me the next session.” (A bachelor student).
control over our job for the patients’ convenience. She Theme 3: Motivation & Self-esteem: According
has practical and theoretical skills and is not bothered to the students, being unfamiliar with the maternity
by our questions.” (A senior student) hospital was the most important stressful factor, and
Evidence-based Practice: Most of the midwifery the students mentioned the presence of the preceptor
students believed that a good preceptor does not work as stress-reducing factor. Research has shown that a
based on her previous and old knowledge, rather preceptor is an effective factor in raising the students’

35 JNMS 2014; 1 (2)

[ DOI: 10.18869/acadpub.jnms.1.2.31 ]

self-esteem. The current study students also stated that She was one of the cleverest and confident students of
the presence of the fresh students in the project helped the university, I learned a lot from her.
them to raise their confidence and their learning Management, Equipment and Physical Space
motivation. Factors: Since management, personnel and physical
“The project reduced freshmen’s stress and increased environment of training has a crucial role in learning,
our self-esteem.” (A senior student) and the communication style, skills and personnel’s
Some of the participants expected their preceptor cooperation are effective in creating a positive
to have the capability to transfer the information and learning environment, students consider these factors
meanings. to influence the improvement of their learning process;
Theme 4: Expectations of Preceptor: “My preceptor they mentioned proper communication of treatment
could be a very good midwife, she had a very good team members with the trainees, the behaviour of the
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relationship with her patients and her clinical work was preceptor with the instructor and personnel and having
excellent, but she was not a good preceptor, she could enough equipment as the effective factors boosting
not express herself properly.” (A bachelor student) their learning. Following it is the experience of a
Some of the students mentioned the contradictory senior student of the project:
expectations of the preceptors and believed that they “The maternity hospital where the project was
should be coordinated with each other and the students: implemented was an appropriate place because other
“Some preceptors expect us to do whatever they students were not like residents and we could work
want, which is not our duty, and even if it is, the other easily. Students fill the forms in our hospital to give us
preceptors do not ask their students, why there is no a responsibility. In order to have better cooperation, it
coordination?” (A bachelor student) is better for the manager and staff of the hospital to be
Theme 5: Preceptorship Experience informed of the project".
Gradual Achievement of Independence: Most of the Evaluation: Due to group nature of preceptorship
students stated that they extremely depended on their project, the participants in the study pointed out final
preceptors at the beginning of the project; but they the training evaluation as participatory and believed
gradually achieved the required experience and self- that it enhances learning process and performance of
confidence to act independently. the students, the instructor and even the personnel.
“At first, I was very dependent on my preceptor but she “The senior students' comments were important to
gradually trusted me and I started to work independently, evaluate fresh students but it would have been better if
under her supervision.” (A bachelor student) they asked increase the responsibility of fresh students
Hope for Professional Success: They believed that and accountability of the seniors. Students 'evaluation
the experience of working with a preceptor leads to must be participatory since the project was a group
their future professional success. One of the bachelor work.” (A senior student)"
students stated: Shifting conditions: All of the students agreed with
“I’d like to have different preceptors and benefit from full and night shifts in the project. They expressed that
the experience of all of them in order to be better able long sifts with a short break increased their training
to decide about my future method of work and learn quality. They believed that they could learn labour
many things from different preceptors.” control and delivery in these shifts.
Feeling Happy & Lucky: Students who had the “In my opinion, the project must not be implemented
experience of a good and intimate preceptor felt so in one shift since there is less chance of delivery; Long
lucky and happy. According to a fresh student: shifts were appropriate for the project.” (A bachelor
“I was really lucky to have a good and kind preceptor. student)

JNMS 2014; 1 (2) 36

 Yaghoubi T, et al. Midwifery students’ experiences & perceptions of preceptorship
[ DOI: 10.18869/acadpub.jnms.1.2.31 ]

Discussion A good preceptor motivates her trainees and facilitates

learning; these findings are compatible with the results
The results of the study implied that midwifery
of the previous studies (20).
students who participated in the study named lowering
In the present study, the students had various
anxiety, boosting motivation and self-esteem and
experiences of a good preceptor. One of the criteria
improving communication as the merits of the
was availability of the preceptor in different situations.
project. The study participants suggested the lack
They also noticed their negative experience as being
of coordination between the theoretical and clinical
afraid of asking questions since the preceptor got
education was as the project stressful factor. Similar
angry and could not reply to the questions on the
results were obtained in other studies (10, 16, and 40).
spot. A study indicated that the negative experience of
Similar to the results of other studies, the majority
asking questions was related to the feeling of ignorance
of the students in the current study had positive
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and stupidity (41). None of the students in this study

experience about the project, which facilitates their
mentioned these feelings and words.
learning (16, 26, and 40). Asefzadeh et al. (2000)
The current study has been conducted in the clinical
studied 45 fresh medical students with 9 junior students
maternity hospital environment for midwifery students.
(preceptors) in Qazvin Medical University. The study
The senior students have been used as preceptors since
was run for a year. The students were evaluated at the
guiding in labour and delivery process is necessary.
end of the year. All of the students were satisfied with
The interview with the preceptor and learners has been
the project. Scott et al. (2005) implemented student-
held in order to explain the students’ experience of
student preceptorship project for nursing students,
consulting project in the maternity hospital. The study
they communicated via email and phone. In the first
findings are as the improvement of communication
year, all of the students had positive experience about
problems in educational environment, increased
the project and believed it leads to professional and the
interaction between the students and instructors and
leadership skills promotion. In addition, the researchers
the enhancement of motivation and confidence in the
maintained that the project prevents disappointment in
midwifery student as the basic principles of teaching
the students.
and learning in the clinical setting. Since using low-
In the present study, there was consensus about the
cost methods to promote learning quality is essential
characteristics of a good preceptor. According to the
for the managers, it is suggested that the administrators
students, an efficient preceptor is a person who is
of midwifery education focus more on this aspect
supportive and has enough scientific and practical
of education, and boost learning process quality by
information, expressive skills and high self-esteem.
employing senior students under the supervision of
Most of the participants had good experience about the
the instructor.
preceptorship project. As the students said, a decent
The study limitation was not being able to employ all
preceptor must encourage students to midwifery and
of the senior students as the preceptors. We hope that in
clinical tasks and give them appropriate feedback to
next year project all of the fresh students be employed
facilitate learning.
as preceptors. Senior (preceptors) and fresh students
The findings of this study are consistent with the other
would be assigned and the preceptors would guide the
studies implying the value of a good preceptor is not
fresh students through email, phone or their presence
measureable. As a result , a preceptor is effective in
in university until the start of training. At the end of
creating trust and confidence in the students to perform
the year, their performance would be evaluated by the
clinical tasks independently (25). The current study
cooperation of the students, instructors, lecturers and
findings suggest that the students’ self-confidence is
university officials.
the result of their experience and their preceptor's view.

37 JNMS 2014; 1 (2)

 Yaghoubi T, et al.
[ DOI: 10.18869/acadpub.jnms.1.2.31 ]

Conclusion 4. Salehi,Sh, Rahimi M, Ali Abedi H, Bahrami M.

Students experience with the hidden curriculum in
The study finding revealed that the removal of
faculty of nursing and midwifery of Isfahan University
communication problems in educational environment,
of Medical Sciences. Pejouhesh in Medicine. 2003;
the improvement of student-preceptor interaction, the
27(3): 217-223 (persian).
enhancement of motivation level and self-esteem among
5. Hassan Zahraei R, Atash Sokhan G, Salehi
midwifery students, and coordination in conducting the
SH,Ehsanpour S, Hasanzadeh A. Comparing the factors
procedures are among the critical principles of teaching
related to the effective clinical teaching from faculty
and learning in clinical setting.
members' and students' points of view. Iranian Journal
of Medical Education. 2008; 7(2): 249-256.
Conflict of Interests 6. Lowenstein AJ, Bradshaw MJ. Fuszard's innovative
The authors declare that they had no competing teaching strategies in nursing.3rd ed. United States:
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interests. Jones & Bartlett; 2004.

7. McAllister L, Lincolin M, McLeod S. An adult learning
Author's Contributions framework for clinical education. Facilitating learning in
clinical settings: London: Stanley Thorns Publishers; 1997.
All five authors contributed to the development of
8. Clutterbuck D. Everyone needs a mentor: Fostering
the study ideas and design. Z.Hamze-gardeshi wrote
talent in your organisation.4th ed. London: CIPD
the first draft of the manuscript reviewed by the other
Publishing; 2004.
authors. The final version of the manuscript was
9. Girot EA. Assessment of graduates and diplomats in
critically reviewed by Z.Hamze-gardeshi. All authors
practice in the UK–Are we measuring the same level of
read and approved the final manuscript. competence? J Clin Nurs . 2000; 9(3): 330-337.
10. Sprengel AD, Job L. Reducing student anxiety by
Acknowledgments using clinical peer mentoring with beginning nursing
We are grateful to all of the midwifery students and students. Nurse Educ. 2004; 29(6): 246-250.
their instructors who participated in the project for their 11. Oliver C, Aggleton P. Mentoring for professional
sincere cooperation. The present study was conducted development in health promotion: a review of issues
as a research project and supported by a grant (No.89- raised by recent research. Health Education. 2002;
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