Vesna Čuk, PhD, Irena Trobec, PhD, Boštjan Žvanut, PhD
The development of students’ competences 
from the perspective of a clinical 
environment and the mentor’s role
Scientific article
UDC 378.147:616
KEY WORDS: clinical practice, mentors role, clini-
cal environment, nursing
ABSTRACT - The clinical settings and mentor’s role 
are relevant for successful clinical practice, and thus, 
for the quality of the nursing study. The aim of this 
study was to determine the effect of a clinical envi-
ronment on the mentor’s role. A combination of qua-
litative and quantitative research design was imple-
mented. A survey was performed in four Slovenian 
psychiatric hospitals or departments of psychiatry 
where the clinical practice for nursing students was 
performed. The final sample consisted of 52 clinical 
mentors. Furthermore, 15 randomly selected clini-
cal mentors participated in focus groups, where the 
aforementioned effect was discussed. Survey results 
indicate a strong (φ = 0.732), statistical significant 
(p<0.001) correlation between clinical environments 
and the mentor’s role. A qualitative analysis of the 
focus groups’ transcripts confirms this correlation 
and indicates different categories relevant for im-
proving the mentor’s role: e.g. the mentor’s lack of 
knowledge, the unpreparedness of the organisation 
for encouraging the mentor’s role. This study shows 
that a clinical environment has a strong effect on the 
mentor’s role. 
Znanstveni prispevek
UDK 378.147:616
KLJUČNE BESEDE: klinična praksa, mentorska 
vloga, klinično okolje, zdravstvena nega 
POVZETEK - Klinično okolje in mentorska vloga so 
ključni za uspešno klinično prakso in zato tudi za ka-
kovost študija zdravstvene nege, ki večinoma poteka v 
obliki klinične prakse. Cilj pričujoče raziskave je bil 
ugotoviti učinek kliničnega okolja na mentorsko vlo-
go. Uporabljena je bila kombinacija kvantitativnega 
in kvalitativnega pristopa k raziskovanju, v štirih slo-
venskih psihiatričnih bolnišnicah ali oddelkih, kjer se 
izvaja klinična praksa za študente zdravstvene nege. 
Končni vzorec je zajemal 52 kliničnih mentorjev, od 
katerih smo 15 naključno izbranih vključili v fokusno 
skupino, kjer je potekala razprava o omenjenem učin-
ku. Rezultati študije kažejo na močno (φ = 0,732), 
statistično značilno (p < 0,001) korelacijo med klinič-
nim okoljem in mentorsko vlogo. Kvalitativna analiza 
zapisov posnetkov fokusnih skupin potrjuje omenjeno 
korelacijo in nakazuje na številne kategorije, ki so 
ključne za izboljšavo mentorjeve vloge v povezavi s 
kliničnim okoljem (npr. pomanjkanje znanja mentor-
jev na področju učenja/poučevanja, nepripravljenost 
organizacije za spodbujanje mentorske vloge). Pri-
čujoča raziskava kaže, da ima klinično okolje močan 
vpliv na mentorsko vlogo. 
1 Introduction
Changes in society and the rapid development of science and technology have 
a significant impact on the health care system. Consequently, nurses require more 
knowledge, especially critical thinking skills, which are a prerequisite for effective 
decision making (Hoffman, 2008). Hence, during the study, students must develop 
competences required in the clinical environment. 
Nursing educators have a difficult task to design study programmes which support 
the develoment of nursing competences. These can be developed by implemeting acti-
The development ...
45Vesna Čuk, PhD, Irena Trobec, PhD, Boštjan Žvanut, PhD: The development ...
ve teaching and learning methods in the pedagogical process and by reducing the 
traditional ones that merely promote rote memorization (Clayton, 2006). 
One of the most effective active teaching and learning methods in nursing are 
simulations. These can be perfomed as clinical simulations or as a part of laborato-
ry practice. During the simulations, students develop nursing skills in a controlled 
environment by using their theoretical knowledge (Comer, 2005). Another effective 
teaching and learning method is role play, i.e. a type of simulation, which allows pra-
cticing the skills required in real clinical practice (Clapper, 2010). 
For the development of competences, the collaboration in a particular social con-
text is very important. Hence, clinical practice is an ideal environment for the acquisi-
tion of nursing skills and competences. Successful clinical practice is relevant for the 
quality of the nursing study. The goals of the clinical practice are: the development of 
key and specific competences, the development of ethical decision-making, and the 
development of critical thinking. Kolb (1984), Dewey (1997), and Jarvis (2002) emp-
hasize the importance of practical experience and the importance of the progressive 
learning environment, where these experiences can be achieved. These have an imme-
diate effect on the perception of the clinical situation and on the students’ approach in 
real settings. Clinical settings offer the students situation-, problem-, and experience 
based learning. Furthermore, the students interact with patients and other member of 
health care team.
Flanagan et al. (2000) state that teaching and learning in a clinical environment is 
connecting self-knowledge, expertise at work, and formal knowledge. Gopee (2000) 
defines that work-based learning is an important characteristic of health profession co-
urses and as the body responsible for approving the educational programmes. Accor-
ding to the 77/452 EEC and 77/453 EEC Directives, approximately half of the direct 
contact hours is performed in clinical learning environments. Work-based learning 
in clinical practice provides an opportunity to learn and acquire professional skills, 
builds self confidence in performing nursing interventions, involves multi-professio-
nal working and is grounded in the real world and in realistic situations with variable 
resources. 
Zachary (2011), states that motivation has an impact on sustainability and com-
mitment. Mentors who facilitate effective learning relationships are comfortable using 
an assortment of related process skills (Zachary, 2011). The process tool kit consist of 
twelve generic skills: brokering relationships, building and maintaining relationships, 
coaching, communicating, encouraging, facilitating, goal setting, guiding, managing 
conflict, problem solving, providing and receiving feedback and reflecting. 
Besides clinical settings, mentors play a prominent role in clinical practice. In 
nursing and health care in general, mentorship has become one of the most important 
strategies for teaching and learning. Jarvis (2002) and Herman & Mandell (2004) 
define mentorship as a relation, where the mentor guides and supports the student in 
the learning/teaching process by helping them to: achieve self-confidence, achieve the 
required skills, and socialize in the clinical settings. Thus, a good relationship between 
the mentor and the students is very important for successful clinical practice. Mentors 
46 Revija za zdravstvene vede (2, 2014)
must be aware of the students’ expectations, and vice versa; also the students must 
be informed about the mentor’s expectations (Bartlett et al., 2000; Guilbert, 2004). 
Öhrling and Hallberg (2000) found the aspects of themes in the process of being a pre-
ceptor in nursing, i.e. place, time and security, creating space for learning, providing 
concrete illustration, exercising control and seeking reflection. 
In some clinical learning environments the role of the mentor is even more crucial 
due to extreme situations which students experience for the first time (e.g. psychiatric 
hospitals). Kragelund (2011) found that student nurses learning during their clinical 
placement had to do with how they learned to interact and develop a therapeutic rela-
tionship with a psychiatric patient and the barriers associated with it. 
Unfortunately, many institutions are not motivated to perform clinical practice. 
According to our experience not all clinical settings encourage the development of 
the mentors’ role. Hence, many mentors are not motivated to perform clinical practice 
with the students. This can result in a reduction in the quality of clinical practice or 
even the abandonment of this important activity in some institutions. The aim of this 
study was to determine the effect of the clinical environment on the mentor’s role. 
According to the literature review and our experience in this field, no relevant study 
has been conducted in Slovenian psychiatric hospitals. 
2 Methods
To determine the aforementioned effect, a combination of qualitative and quantita-
tive research design was implemented. The study was performed in the academic year 
2011/12 in four out of six psychiatric hospitals or departments of psychiatry, where 
clinical practice for nursing students was performed. The managements of the four in-
stitutions under consideration approved our study. The study was performed with the 
help of the institutions’ head nurses or clinical practice coordinators. Questionnaires 
were distributed to the clinical mentors and sent by post to the researchers. 
Furthermore, after the survey, approximately one third of the participants were 
invited to participate in the focus group, where the effect of the clinical environment 
on the mentor’s role was discussed. The focus group took place in one of the partici-
pating institutions and was conducted by one of the authors (VČ). Special attention 
was made to avoid reflexivity (where the participants of the focus group express what 
the researcher wants to hear).
2.1 Questionnaire
The questionnaire consisted of three sections: (I) basic demographic questions 
(gender, age, years of working experience); (II) 10 items regarding the variable men-
tor‘s role – the items were adopted from CLES+T (Clinical Learning Environment, 
Supervision and Nurse Teacher evaluation scale) questionnaire (Saarikoski et al., 
2002); (III) 10 items regarding the variable clinical learning environment – the items 
were adapted from Chan (2002), Henderson et al. (2006), and Newton et al. (2010).
47Vesna Čuk, PhD, Irena Trobec, PhD, Boštjan Žvanut, PhD: The development ...
The items were translated from English to Slovenian through the following steps - 
adopted from Råholm et al. (2010): (S1) forward translation by two researchers, in-
dependently; (S2) back translation, without any reference to the original instrument 
wording; (S3) comparison of the original and the translated version by another expert; 
(S4) revision of the translated questionnaire version according to the third resear-
chers’ knowledge and experience; (S5) examination of the translated questionnaire for 
clarity by five Slovenian clinical mentors; (S6) conducting a pilot study. All items in 
sections 2 and 3 were evaluated on a five-point Likert scale ranging from total disagre-
ement to full agreement, mirroring the extent to which the individual item described 
the participant’s personal opinion. The items are presented in Table 1.
2.2 Sample
All clinical mentors of the four institutions were invited to participate in the study. 
The final sample consisted of 52 clinical mentors in all four Slovenian psychiatric 
hospitals or departments of psychiatry, where clinical practice was performed. The av-
erage age of the participants was 42.6 years with a standard deviation of 8.6 years. The 
majority, i.e. 39 participants (75 %), were female, 13 (25 %) male. The participants 
had 18.9 (5.5) years of work experience. 
The participation in the study was voluntary. All the participants agreed to take part 
in the study. Finally, approximately one third of the participants (15 clinical mentors 
from one clinical learning environment) were selected to participate in focus groups 
in order to discuss the competences of the mentor’s role according to their experience 
in a clinical learning environment.
2.3 Statistical analysis
Univariate, bivariate and multivariate analysis were performed with the statistical 
package SPSS 20.0. Initially, Cronbach alpha was computed to determine the scale 
reliability of the variables; the clinical environment and the mentor‘s role. The av-
erage value, standard deviation, skewness and kurtosis were calculated. To test the 
correlation between the mentor’s role and the clinical learning environment, Spear-
man‘s correlation coefficient (φ) was calculated, as the distribution of the variable 
clinical environment was not normal. Its kurtosis was above 1, which is higher than 
that recommended in the literature (Leech et al., 2005).
3 Results
Table 1 presents the results of the univariate analysis of each item of the variables 
mentor‘s role and the clinical learning environment. Table 2 presents the results of 
the scale reliability test along with the mean value, standard deviation, skewness and 
kurtosis of the aforementioned variables. Cronbach‘s alpha coefficients were higher 
than 0.7, which is the minimum recommended in the literature (Iivari, 1996). The final 
48 Revija za zdravstvene vede (2, 2014)
variables mentor‘s role and clinical learning environment were computed by calcula-
ting the average value of their corresponding items. 
Results of bivariate analysis indicate a strong correlation between the variables 
mentor‘s role and clinical learning environment (φ = 0.732, p < 0.001), which is also 
evident in the scatter chart (Figure 1). As some dots in Figure 1 overlap, the results are 
also presented in Table 3.
Figure 1: Scatter chart of the variables mentor’s role and clinical environment
Different categories emerged in the analysis of the participants’ affirmations in the 
focus groups. The category »lack of competence« was identified in the affirmations, 
for example:
»I feel that I am not competent for motivating and evaluating the students cor-
rectly.«
The category »unpreparedness of the organisation for fostering the mentor’s role« 
was also identified:
»In the past, the faculty has organised mentorship trainings. Unfortunately, my in-
stitution does not recognize these trainings as formal education required for renewing 
nursing licenses.«
»I wish to gain more knowledge in the field of mentorship, but the organisation 
does not want to pay for this kind of education.«
The aforementioned correlation is evident in the following participants’ affirma-
tions: 
»The organisation of the work and the insufficient number of nursing staff does 
not allow me to prepare for working with students.«
49Vesna Čuk, PhD, Irena Trobec, PhD, Boštjan Žvanut, PhD: The development ...
»Besides being a mentor I am also a nurse at this institution. This is my primary 
role and the work obligation does not allow me to concentrate more on students.«
Table 1: Variables and the corresponding items of the questionnaire
Variable Item of the questionnaire Mean SD
Clinical learning 
Environment
1. Mentors in the clinical learning environment promote students’ 
learning with planned activities. 4.46 0.61
2. A positive atmosphere for teaching and learning was present in the 
clinical learning environment. 3. 73 0.99
3. A safe working environment for learning was guaranteed to 
students in the clinical learning environment. 4.38 0.63
4. In the clinical learning environment the relationships between 
students and mentors is based on trust. 4.15 0.83
5. The clinical learning environment fostered the transfer of 
knowledge and experience between the staff in the ward and with 
the students. 
4.15 0.78
6. The clinical settings are characterised by well-developed 
teamwork. 4.04 0.74
7. Mentors in the clinical learning environment regularly discussed 
the effectiveness of learning with the students. 3.62 1.12
8. Staff in the ward encouraged students to learn and gain new work 
experience. 4.08 0.84
9. Students have enough opportunities to get involved with the 
process of handing over to the staff in the ward. 4.23 0.78
10. Mentors in the clinical learning environment offered sufficient 
support. 4.19 0.63
Mentor‘s role
1. Mentors considered the characteristics of the clinical learning 
environment. 4.23 0.81
2. Mentors considered the different learning needs of the students. 3.98 0.80
3. Mentors operationalized learning goals in the clinical learning 
environment. 3.81 0.84
4. Mentors in a clinical learning environment collaborated with the 
students. 4.31 0.70
5. Mentors in a clinical learning environment linked theoretical 
knowledge and everyday clinical practice. 4.27 0.74
6. Mentors in a clinical learning environment were able to create 
learning activities for students. 4.27 0.63
7. Mentors have helped to increase the use of theoretical knowledge 
and practical skills. 4.25 0.76
8. Mentors encouraged and supported the students’ learning in a 
clinical learning environment. 4.46 0.64
9. Mentors encouraged students to be active and autonomous at 
work in the clinical learning environment. 4.33 0.71
10. As a mentor I promptly provided feedback about the 
effectiveness of the learning in the clinical learning environment. 4.04 0.84
50 Revija za zdravstvene vede (2, 2014)
Table 2: Descriptive statistics and the scale reliability test of the variables mentor‘s 
role and clinical learning environment (N=52)
Variable No. of items
Cronbach 
alpha Mean SD Skewness Kurtosis
Mentor‘s role 10 0.897 4.10 0.54 -0.35 -0.43
Clinical learning environment 10 0.875 4.19 0.56 -0.49 -1.11
Table 3: Distribution of mentors according to the relative mean of variables clinical 
learning environment and the mentor’s role (N=52)
Number (percentage) of mentors Clinical environment
< rel. mean ≥ rel. mean Total
Mentor’s role
≥ rel. mean 8 (15.4 %) 23 (44.2 %) 31 (59.6 %)
< rel. mean 16 (30.8 %) 5 (9.6 %) 21 (40.4 %)
Total 24 (46.2 %) 28 (53.8 %) 52 (100 %)
4 Discussion and conclusion
Advance reflective practice in nursing education is changing the processes of tea-
ching and learning in a clinical learning environment and allows the development of 
nursing competencies. Furthermore, it is also an important element of the mentor’s 
professional development. The characteristics of the mentor’s roles are associated 
with professional, communication and social capabilities.
All the items of the variables mentor’s role and the clinical learning environment 
were evaluated with relatively high values, considerably above the middle of the scale. 
The lowest values of the variable clinical learning environment received the item 7 
(»Mentors in the clinical learning environment regularly discussed the effectiveness 
of learning with students«), followed by item 2 (»A positive atmosphere for teaching 
and learning was present in the clinical learning environment. This indicates that a 
lot has to be done towards the improvement of the discussion between mentors and 
students, which has an impact on the atmosphere for teaching and learning. Item 3 
(»Mentors operationalized learning goals in the clinical learning environment«) and 
2 (»Mentors considered the different learning needs of the students«) received the 
lowest values of the variable mentor’s role. Our results indicate the lack of knowledge 
required for the operationalization of learning goals and consideration of the different 
learning needs of students, and therefore also the lack of education in the field of 
mentoring and nursing competence development. In the clinical learning environment 
the relationships between students and mentors are based on trust (item 4) and well 
developed teamwork (item 6). 
The clinical learning environment fosters a positive atmosphere and promotes the 
transfer of knowledge and experience between the staff of the ward and the students. 
In the process of teaching and learning in the clinical learning environment, mentors 
should promote students’ learning with plan activities. Our study shows that regular 
discussion with students (item 7) and a positive atmosphere (item 2) were evaluated 
51Vesna Čuk, PhD, Irena Trobec, PhD, Boštjan Žvanut, PhD: The development ...
with the lowest values of the clinical learning environment items. However, both va-
lues were significantly above the middle of the scale. 
The results of this study indicate the strong effect of the clinical learning envi-
ronment on the mentor’s role. The methodological triangulation was performed by 
combining the survey (quantitative results) and focus groups (qualitative results). The 
results of the survey indicate a strong correlation between the variables mentor‘s role 
and clinical learning environment (φ = 0.732, p < 0.001), which was also confirmed 
by the affirmations of the focus group participants. We can conclude that the clinical 
environment has a strong effect on the mentor‘s role. Similar results were reported 
by Ohrling and Hallberg (Öhrling and Hallberg, 2000). They discovered the main 
point of skills development in the process of being a preceptor in nursing. According 
to the The Nursing and Midwifery Council (2006) the key responsibilities of nursing 
mentors include: organising and coordinating student learning activities in practice; 
supervising students in learning situations; providing constructive feedback; setting 
and monitoring objectives; assessing students’ skills, attitudes and behaviours; provi-
ding evidence of student achievement; liaising with others about student performance; 
identifying concerns; and agreeing the action to be taken about concerns. Kragelund 
(2011) found that in a psychiatric clinical learning environment the mentor’s role is 
even more crucial due to the extreme situations which the students experience for the 
first time. She found that student nurses learning during their clinical placement had 
to do with how they learnt to interact and develop a therapeutic relationship with the 
psychiatric patient and the barriers associated with this. 
The relative means of the clinical learning environment and the mentor‘s role di-
vide the scatter chart into four quadrants (Figure 1: Q1 – Q4, also refer to Table 1). Q1 
includes 16 mentors (30.8 %), who perceived that the clinical learning environment 
was not on the elevated level and also the mentor’s role was relatively low. Q2 inclu-
des 5 mentors (9.6 %), who perceived that the clinical learning environment is at the 
appropriate level. However, they do not perceive themselves as good mentors. Q3 in-
cludes 8 mentors (15.4 %) who perceived that the mentor’s role was on the appropriate 
level; opposite to the clinical learning environment, which according to their opinion 
does not foster the mentor’s role. Finally, Q4 includes the majority of mentors (n = 23, 
44.2 %), who perceived that the clinical learning environment was on the appropriate 
level and they perceived themselves as good mentors (high level of the mentor’s role).
Mentoring is very important for the development of nursing skills. Mentor com-
petences should be improved so that they can consider the different learning needs of 
the students and the specifics of clinical learning environments. The problem is that 
mentors do not always operationalize learning goals in the clinical environments and 
do not promptly provide feedback about the effectiveness of the learning. On the other 
hand, our study indicated that mentors very often encourage and support students 
learning (mean 4.3) and also encourage students to be active and autonomous while 
working in clinical settings (mean 4.5). Mentors also reported they felt most compe-
tent in clinical settings but they needed more support from the nursing management 
and need to develop more skills about the use of active learning and teaching methods.
52 Revija za zdravstvene vede (2, 2014)
Participants positioned in Q1, represent clinical mentors whose perceived low le-
vel of a mentor’s role is probably a consequence of the low perceived level of the 
clinical environment. Similarly, mentors positioned in Q4, perceive that a high level 
of a mentor’s role is probably a consequence of the high perceived level of the clinical 
learning environment. Thus, clinical mentors, positioned in Q1 and Q4, follow the 
correlation identified in our study. Organisations, with the majority of clinical mentors 
positioned in Q1, should consider the improvement of their clinical learning envi-
ronment, which as a result will probably improve the level of the perceived mentor’s 
role. In these organisations the development of students’ competences and the approp-
riateness of the institution for the clinical learning environment should be taken into 
consideration. If there is an interest for performing clinical practice, the organisation 
should identify the reasons for this situation. Mentors positioned in Q3, probably re-
present a group of nursing clinical mentors who try to develop their mentor’s role no 
matter that the level of clinical learning environment is low. We believe that this group 
of mentors represents the opinion leaders, which could provide the organisation with 
valuable information for improving the clinical learning environment. Special atten-
tion should also be given to the participants positioned in Q2, whose high perceived 
level of the clinical learning environment does not have an effect on their perceived 
level of the mentor’s role. That this group of participants represent clinical mentors, 
which are critical of their mentor’s role and hardly follow the requirements of the cli-
nical learning environment regarding mentoring. Although is a small group (9.6 %), 
we believe that this group of mentors should be identified by the organisation, which 
should help them to improve their perceived level of a mentor’s role with extra tra-
ining and supervision.
This study indicates an important correlation for the development of nursing com-
petence between the clinical learning environment and the mentor’s role. Before gene-
ralising the results to broader populations, the following limitations should be consi-
dered. The results represent the opinion of mentors from all Slovenian psychiatric 
hospitals or departments of psychiatry, where clinical practice is performed. Thus, this 
study should also be further performed in other socio-cultural settings (e.g. different 
geographic areas, countries) and different nursing clinical settings (i.e. nursing homes, 
community nursing) before generalising the results to the broader population of nur-
ses. Furthermore, the results reflect on the mentor’s personal opinion, which often can 
be subjective. Hence, the use of other instruments, which will provide objective re-
sults, should be considered in future. However, our results provide interesting insights 
into the development of students’ competences from the perspective of the clinical 
environment and the mentor’s role. 
The results of our study show a strong effect of the clinical learning environment 
on the mentor’s role. Unfortunately, the mentor’s lack of knowledge, the unprepared-
ness of the organisation for encouraging the mentorship represents a strong barrier for 
its development. Hence, special attention should be given to the identification of those 
factors that have a direct effect on the quality of the clinical environment, relevant for 
the development of mentorship.
53Vesna Čuk, PhD, Irena Trobec, PhD, Boštjan Žvanut, PhD: The development ...
dr. Vesna Čuk, dr. Irena Trobec, dr. Boštjan Žvanut
Razvoj kompetenc študentov zdravstvene nege z 
vidika kliničnega okolja in mentorske vloge
Nagle spremembe v družbi ter skokovit razvoj znanosti in tehnologije močno vpli-
vajo na sistem zdravstvenega varstva, katerega pomemben sestavni del je zdravstvena 
nega. Sodobna zdravstvena nega je področje, ki mora slediti tem spremembam in se 
prilagajati zdravstvenim potrebam prebivalstva. Za to pa medicinske sestre potrebu-
jejo več znanja in še posebno kritičnega razmišljanja, ki je nujno potrebno pri odlo-
čanju v vsakodnevni praksi zdravstvene nege in tudi v vsakdanjem življenju. Učitelji 
zdravstvene nege morajo zato razvijati ustrezne študijske programe, v katerih naj bi 
bodoče profesionalce opremili z znanjem in jih usposobili za učinkovito soočanje z 
nastalo situacijo. Zato naj bi v programe čim večkrat vključevali aktivne metode uče-
nja in poučevanja. Številni avtorji, ki jih navajamo v prispevku, priporočajo, da se 
pri poučevanju vseh zdravstvenih strokovnjakov, ne samo medicinskih sester, uporab-
lja kombinacija različnih pristopov izkustvenega in problemskega učenja z upora-
bo podpornih oblik učenja in informacijske tehnologije. Aktivne metode poučevanja 
in učenja omogočajo razvoj kompetenc, pomembnih za zdravstveno nego. Skladno z 
usmeritvami izobraževanja medicinskih sester v Evropi, ki jih navaja tudi Evropska 
direktiva (2005/36/ES), naj bi polovica predvidenih ur študija potekala v kliničnem 
učnem okolju. To okolje omogoča pridobivanje izkušenj na podlagi aktivnega dela. 
Prav zato se mora poučevanje in učenje zdravstvene nege izvajati v kliničnem okolju, 
med zagotavljanjem neposrednih zdravstvenih storitev in z izvajanjem celovite zdra-
vstvene oskrbe. V kliničnem okolju je treba ustvariti pogoje za poučevanje in učenje 
sodobne zdravstvene nege, učno klimo ter razviti aktivne metode poučevanja in uče-
nja. Klinična praksa in usposabljanje študentov potekata v realnem delovnem okolju 
in lahko zagotavljata kakovostno pridobivanje zahtevanih kompetenc.
Klinično okolje in mentorska vloga sta izredno pomembni za uspešno klinično 
prakso in zato tudi za kakovost celotnega študija zdravstvene nege. Izboljševanje ka-
kovosti izobraževanja, in s tem kakovost pričakovanih izidov poučevanja in učenja, 
se kaže prav pri doseganju kompetenc, s tem pa tudi sposobnosti za prenos teorije v 
klinično prakso. Cilj pričujoče raziskave je bil ugotoviti učinek kliničnega okolja na 
razvoj mentorske vloge in razvoj kompetenc zdravstvene nege. Vsaka klinična situa-
cija ima postavljene učne cilje, ki identificirajo ključne koncepte v zdravstveni negi in 
uporabo različnih učnih situacij. Pričakovani učni izidi se kažejo v razvoju spretnosti 
za razumevanje in uporabo znanja v klinični praksi, spretnosti za opazovanje, ugotav-
ljanje potreb ter klinične presoje in odločanja. Na ta način se študenti naučijo reševa-
nja problemov ter pridobijo spretnosti za komuniciranje in refleksijo v obliki povratne 
informacije, ki jo omogoča reflektivna klinična praksa.
Da bi preverili omenjeni učinek, smo izvedli raziskavo, ki temelji na kombinaciji 
kvantitativnega in kvalitativnega pristopa. Raziskava je bila izvedena v akademskemu 
letu 2011/12 v štirih od šestih slovenskih psihiatričnih bolnišnic, kjer se izvaja klinič-
54 Revija za zdravstvene vede (2, 2014)
na praksa za študente zdravstvene nege. Raziskavo smo izvedli v sodelovanju z glavni-
mi medicinskimi sestrami omenjenih institucij oziroma koordinatorji klinične prakse, 
ki so vprašalnike zaprtega tipa razdelili kliničnim mentorjem. Vprašalnik je bil sesta-
vljen iz treh sklopov: (I) vprašanja za zajem osnovnih demografskih podatkov (npr. 
spol, starost, leta delovnih izkušenj); (II) 10 trditev, ki se nanašajo na spremenljivko 
mentorska vloga; (III) 10 trditev, ki se nanašajo na spremenljivko klinično okolje. 
Anketiranci so trditve sklopa II in III ovrednotili s pomočjo petstopenjske Likertove 
lestvice stališč. Končni vzorec je zajemal 52 kliničnih mentorjev, povprečna starost 
je bila 42,6 let (standardni odklon 8,6), povprečna delovna doba je znašala 18,9 let 
(standardni odklon 5,5). Večino anketirancev, tj. 39 (75 %) so predstavljale ženske, v 
raziskavo je bilo vključenih le 13 (25 %) moških. Po izvedeni anketi smo z eno tretjino 
sodelujočih izvedli fokusne skupine, kjer je potekala razprava o povezavi med klinič-
nim okoljem in mentorsko vlogo. Razpravo je vodila prva avtorica prispevka v eni 
od omenjenih ustanov, ker je potekalo klinično usposabljanje študentov zdravstvene 
nege. V klinično okolje študenti zdravstvene nege pogosto prihajajo s predsodki in sti-
gmo do oseb z duševnimi motnjami, pogosto pa sta na začetku kliničnega usposablja-
nja prisotna tudi strah in negotovost. Zaradi pomanjkanja teoretičnega znanja je pri 
študentih zdravstvene nege ob vstopu v klinično okolje pogosto oviran prenos teorije v 
prakso in s tem težje pridobivanje kompetenc. Ključne kompetence, ki jih študenti raz-
vijajo v specifičnem okolju na področju duševnega zdravja in psihiatrije, so povezane 
z razumevanjem duševnih motenj, spretnostmi za opazovanje in prepoznavanje nego-
valnih problemov, sposobnostmi klinične presoje in oblikovanjem negovalnih diagnoz 
ter kliničnim odločanjem in izvajanjem terapevtskih aktivnosti v procesu zdravstvene 
nege. Prav tako je pomembno, da študenti razvijejo spretnosti terapevtske komunika-
cije v odnosu do pacientov, svojcev in pomembnih drugih, pa tudi druge sposobnosti 
za medsebojno komuniciranje na različnih ravneh interdisciplinarnega sodelovanja 
in timskega dela.
Rezultati naše raziskave kažejo, da sta bili mentorska vloga in klinično okolje 
ocenjeni razmeroma visoko. Pri spremenljivki klinično okolje je trditev 7 (»Mentorji v 
kliničnem okolju so redno razpravljali o učinkovitosti učenja s študenti«) bila najnižje 
ocenjena. Sledi trditev 2 (»Pozitivno vzdušje za učenje in poučevanje je bilo prisotno 
v kliničnem učnem okolju«). Slednje kaže, da je treba še veliko postoriti na podro-
čju komunikacije med učitelji in študenti, saj to bistveno vpliva na vzdušje, potrebno 
za kakovostno učenje in poučevanje v kliničnem okolju. Pri spremenljivki mentorska 
vloga sta trditvi 3 (»Mentorji so operacionalizirali učne cilje v kliničnem okolju) in 2 
(»Mentorji so upoštevali različne učne potrebe študentov«) bili najnižje ocenjeni. Naši 
rezultati očitno kažejo na pomanjkanje znanja pri operacionalizaciji učnih ciljev in 
upoštevanju različnih učnih potreb študentov, kar kaže na pomanjkanje izobraževanja 
na področju mentoriranja in razvoja kompetenc v zdravstveni negi. Klinični mentorji 
so zaznali razkorak v pričakovanjih do študentov na začetku kliničnega usposabljanja 
in so se počutili odgovorni za izvajanje procesa poučevanja in učenja v kliničnem 
okolju. Kot razloge za neučinkovito mentorsko vlogo so v fokusni skupini navedli or-
ganizacijo dela, pomanjkanje človeških virov, pomanjkanje časa in opravljanje več 
dela sočasno. Študenti se učijo v kliničnem okolju od vseh članov tima ne samo od 
55Vesna Čuk, PhD, Irena Trobec, PhD, Boštjan Žvanut, PhD: The development ...
kliničnih mentorjev. Ključna prvina komunikacije je medsebojni odnos in ustvarjanje 
pogojev učenja v kliničnem okolju ter izvajanje različnih učnih aktivnosti. Pomembna 
za študente in klinične mentorje je tudi povratna informacija o uspešnosti učenja kot 
tudi možnost refleksije izkušenj o delovanju študentov v kliničnem okolju. 
V kliničnem okolju je pomembna vključenost študentov v timsko delo, razvoj so-
delovanja in možnost aktivnega sodelovanja na strokovnih sestankih, kjer se posre-
dujejo ključne informacije. Klinično okolje lahko spodbudi pozitivno učno atmosfero 
ter prenos znanja in izkušenj med študenti in vsemi zaposlenimi v kliničnem okolju. 
Mentor mora študente spodbujati k učenju z ustreznim načrtovanjem pedagoških ak-
tivnosti. Žal pa rezultati naše študije kažejo, da sta bili ravno trditev, ki se nanaša 
na naklonjenost okolja k razpravi s študenti, in trditev o pozitivnem vzdušju v učnem 
okolju, najnižje ocenjeni od vseh trditev, ki se nanašajo na spremenljivko klinično 
okolje. Rezultati študije kažejo na močno (φ = 0,732), statistično značilno (p < 0,001) 
korelacijo med kliničnim okoljem in mentorsko vlogo. Kvalitativna analiza zapisov 
posnetkov fokusnih skupin potrjuje omenjeno korelacijo in kaže na številne kategorije, 
ki so ključne za izboljšavo mentorjeve vloge v povezavi s kliničnim okoljem. Tako so se 
izrazito izpostavile kategorije pomanjkanje znanja mentorjev na področju učenja/po-
učevanja in nepripravljenost organizacije za spodbujanje mentorske vloge. Klinično 
okolje na specialnih področjih zdravstvene nege predstavlja izziv za izboljševanje kli-
ničnega usposabljanja zdravstvene nege. Študenti in klinični mentorji imajo na začet-
ku procesa poučevanja in učenja v povprečju različna pričakovanja in predstave o štu-
dentih, njihovem znanju in motiviranosti ter pripravljenosti za poučevanje in učenje. 
Prav tako se razkorak pokaže v spretnostih za prenos teorije v neposredno klinično 
prakso in uporabo terapevtske komunikacije in sposobnosti za sodelovanje in timsko 
delo. Klinični mentorji nastopajo v več vlogah, ki se v procesu učenja in poučevanja 
dopolnjujejo in izmenjujejo. Vloge se kažejo pri organizaciji dela ter vzpostavljanju 
pogojev in možnosti za učenje, ustvarjanju učne klime in aktivnosti za oblikovanje 
profesionalne vloge in profesionalnih medsebojnih odnosov. 
Pričujoča raziskava kaže, da ima klinično okolje močan vpliv na mentorsko vlo-
go. Žal pa pomanjkanje znanja mentorjev na področju učenja in poučevanja, zlasti 
pa nepripravljenost organizacij za spodbujanje mentorske vloge predstavljata veliko 
oviro za njen razvoj. V bodoče je treba posebno pozornost posvetiti identifikaciji tistih 
dejavnikov, ki imajo neposreden učinek na kakovost kliničnega okolja in so ključni za 
razvoj mentorstva znotraj posamezne organizacije, pa tudi širše. Ne glede na to pa ni 
odveč previdnost pri posploševanju rezultatov, saj moramo upoštevati omejitve priču-
joče raziskave. Prva je gotovo ta, da se rezultati nanašajo zgolj na mnenje mentorjev 
iz slovenskih psihiatričnih bolnišnic oz. oddelkov za psihiatrijo. Ocenjujemo, da bi 
morali izvesti primerljive raziskave tudi v ostalih sociokulturnih okoljih in na različ-
nih področjih zdravstvene nege, da bi pridobili celovito sliko o omenjeni povezanosti. 
Prav tako se rezultati nanašajo na samoocenjevanje in stališča kliničnih mentorjev, 
kar je lahko subjektivno. Zato bi bilo pri tovrstnih študijah smiselno razmisliti o upo-
rabi merskih instrumentov, ki bi omogočali pridobivanje objektivnejših rezultatov. 
56 Revija za zdravstvene vede (2, 2014)
LITERATURA
1. Bartlett, H. P., Simonite, V., Westcott, E. and Taylor, H. R. (2000). A comparison of the nursing 
competence of graduates and diplomates from UK nursing programmes. Journal of Clinical 
Nursing, 9, št. 3, str. 369–379.
2. Clapper, T. (2010). Role play and simulations returning to teaching for understanding. Education 
Digest, 75, št. 8, str. 39–43.
3. Clayton, L. H. (2006). Concept mapping: an effective, active teaching-learning method. Nursing 
Education Perspectives, 27, št. 4, str. 197–203.
4. Comer, S. K. (2005). Patient care simulations: role playing to enhance clinical understanding. 
Nursing Education Perspectives, 26, št. 6, str. 357–361.
5. Dewey, J. (1997). Experiance and education. New York: Touchstone book.
6. Flanagan, J., Baldwin, S. and Clarke, D. (2000). Work-based learning as a means of developing 
and assessing nursing competence. Journal of Clinical Nursing, 9, No. 3, pp. 360–368.
7. Gopee, N. (2000). Practice teaching in healthcare. London: Sage.
8. Guilbert, J. J. (2004). Didaktični priročnik za učitelje na zdravstvenih šolah. Maribor: Unigrafika.
9. Herman, L. and Mandell, A. (2004). From teaching to mentoring. London: Routledge.
10. Hoffman, J. J. (2008). Teaching strategies to facilitate nursing students’ critical thinking. Annual 
Review of Nursing Education, 6, št. 6, str. 225–236.
11. Jarvis, P. (2002). Adult and continuing education: theory and practice. London, New York: 
Routledge.
12. Kolb, D. (1984). Experiential learning. New Jersey: Prentice Hall.
13. Kragelund, L. (2011). The windmill of learning processes: a learning and teaching tool for student 
nurses and mentors. Nurse Education Today, 31, št. 1, str. 54–58.
14. Öhrling, K. and Hallberg, I. R. (2000). Student nurses’ lived experience of preceptorship. Part 2 — 
the preceptor–preceptee relationship. International Journal of Nursing Studies, 37, št. 6, str. 25–36.
15. Saarikoski, M., Leino-Kilpi, H. and Warne, T. (2002). Clinical learning environment and 
supervision: testing a research instrument in an international comparative study. Nurse Education 
Today, 22, št. 4, str. 340–349.
16. Zachary, L. (2011). The mentors guide. Facilitating effective learning relationships. San Francisco: 
Jossey-Bass.
ACKNOWLEDGEMENT
This project is financed by ARRS — Slovenian research agency: research J5-4281 »Longitudinal study 
in the competency potential of university graduates and the gap between graduates‘ competences and 
the labour market requirements in technology, education and health«.
Dr. Vesna Čuk, višja predavateljica na Fakulteti za vede o zdravju Univerze na Primorskem.
E-naslov: vesna.cuk@fvz.upr.si
Dr. Irena Trobec, višja predavateljica na Fakulteti za vede o zdravju Univerze na Primorskem.
E-naslov: irena.trobec@fvz.upr.si
Dr. Boštjan Žvanut, docent na Fakulteti za vede o zdravju Univerze na Primorskem.
E-naslov: bostjan.zvanut@fvz.upr.si