Strategies to strengthen the clinical accompaniment of nursing students through caring presence in higher education: a conceptual framework

To make clinical learning meaningful for nursing students, it was found that there is a need to introduce caring presence as a framework for learning processes. This study conceptualizes the integration of caring presence as an instructional approach to accomplish the goal of strengthening clinical accompaniment for nursing students enrolled for a nursing diploma at one public higher education institution in Gauteng, South Africa. A theory-generative, qualitative, exploratory, descriptive, contextual design was utilised to develop the framework. Dickoff’ (Pract Oriented Theory_17:415–35, 1968) practice-oriented model and Donabedian’s (Milbank Q 2005_83:691–729, 1966) structure, process and outcome model were used simultaneously to classify and categorise characteristics and activities of the practice of caring presence during clinical accompaniment of nursing students. The two models served as the foundation for developing a conceptual framework after synthesising findings of 12 individual interviews of lecturers and four focus group discussions of nursing students’ perspective for effective clinical accompaniment. The findings produced six themes and 24 sub-themes which were linked to the six conceptual aspects by Dickoff’ (Pract Oriented Theory_17:415–35, 1968): agent, recipients, context, procedure, dynamics, and the terminus. In this study, the agent was a lecturer, recipients were students, the context was health facilities, the procedure was clinical accompaniment; the dynamics were challenges of clinical accompaniment, while the terminus was competent, confident, caring nursing students. The six aspects by Dickoff’ (Pract Oriented Theory_17:415–35, 1968) were merged and packaged with the three concepts of Donabedian structure (agent, recipient, context, dynamics), process and outcome (terminus) to create a conceptual framework. The developed conceptual framework will assist lecturers in strengthening the clinical accompaniment of nursing students through caring presence. The conceptual framework consists of the clinical accompaniment structure, process and outcomes. Although the study was limited to the Gauteng province’s higher education institution, it is of high significance as the conceptual framework adds to the holistic understanding of clinical accompaniment based on a caring presence approach.