Creating and sustaining healthy work environment for professional advancement in health care institutions: a case study of nursing students’ clinical posting in Abia State

Enwereji Ezinne E., Ezeama Martina C., Enwereji Kelechi O.


Background: The need for nursing students to care and support patients especially those living positively with HIV and AIDS as well as those with terminal diseases should not be underestimated. By training, nursing students are expected to interact cordially with patients and other health care professionals but most times, the reverse is the case. Inter-professional and interpersonal education prepare nursing students on clinical posting to provide quality health care services to all patients irrespective of their ages and health conditions. Therefore, creating healthy work environment by encouraging team work, integrating treatment and prevention services to promote good health is imperative in ensuring patients’ safety, and enhanced inter-professional relationship.

Methods: A two-day pre-clinical seminar which centered on professionalism, teamwork, interpersonal and inter-professional relationships, as well as effective communication to guarantee healthy work environments was carried out. The pre-clinical seminar was also used to prepare 186 nursing students on their expected roles during the twelve weeks’ clinical posting in health institutions. At the end of the students’ posting, two days post-clinical seminar aimed to harness students’ experiences, views and performances, as well as the teachers’ observations during the clinical posting was conducted. Thereafter, all comments on performances, observations, experiences and other remarks from the teachers and students were grouped together and analyzed qualitatively and quantitatively.

Results: A good proportion of the students 142 (76.3%) established good interpersonal relationship with the patients who are HIV positive while 135 (72.6%) had effective inter-professional interaction with health care workers. Also 135 (72.6%) had good team work relationship with other health care professionals. There were better health care services to clients as evidenced by 95 (51.1%) of students who shared case managements with the health care workers and 122 (65.6%) of the students who used mobilization and advocacy to identify pressing challenges like inter-professional conflicts, poor uptake of messages about treatment and referrals as well as malnutrition among children. A respectable number of the students, 144 (77.4%) collaborated with colleagues to provide nutrition to malnourished children to improve their nutritional status, while 75 (40.3%) assisted in resolving some inter-professional conflicts.

Conclusions: Students’ initiatives in management of cases, inter-professional and interpersonal learning experiences during clinical postings increased students’ understanding of teamwork and professionalism as well as promoted friendlier environments that guaranteed better health care services to patients.


Advocacy, Clinical posting, Case management, HIV positive, Mobilization, Teamwork

Full Text:



World Health Organization. Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. Geneva, Switzerland: World Health Organization; 2014. Available at (Last accessed September1, 2014).

Davis W, White B. Introduction. In: Davis W, Jolly B, Page G, Rothman A, White B, Eds. Moving medical education from the hospital to the community. Report of the Seventh Cambridge Conference on Medical Education. Ann Arbor, MI: University of Michigan Medical School, 1995.

AVAC. Ongoing and Planned PrEP Trials and Demonstration Projects, as of June 2015. Available at (Last accessed July1, 2015).

Verby J, Lenarz G, Garrard J. Evaluation of an alternative clinical experience: the Minnesota rural physician associate program. J Med Education. 1974;49:696-8.

Hays R. Guiding principles for successful innovation in regional medical education development. Rural Remote Health 6: 516. (Online) 2006. Available at (Accessed 9 July 2012).

Oswald N. Why not base clinical education in general practice? Lancet. 1989;43:148-9.

Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS. 2015;29:102-10.

Leeuwenhorst Working Party. Second European conference on the teaching of general practice. The general practitioner in Europe. Med Educ. 1976;10:235-6.

Heidenreich R, Chenot JF, Kochen MM, Himmel W. Teaching in practice: a survey of a general practice teaching network. Med Teacher. 2006;28:288-91.

Mack N, Odhiambo J, Wong CM, Agot K. Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: Results of a consultation with community stakeholders. BMC Health Serv Res. 2014;21:231.

Tragakes E, Polyzos N. Health Care Systems in Transition-Greece. Copenhagen: World Health Organisation Regional Office for Europe, 1996. Available at

University of Crete. Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete. (Online) 2012. Available at http:// (Assessed 12 October 2012).

General Medical Council. Tomorrow's Doctors. Recommendations on Undergraduate Medical Curriculum. London: General Medical Council, 1993. Available at

Panagopoulou E, Kavaka N, Giannakopoulos S, Aslanoglou T, Smyrnakis E, Kiranou M, et al. Integrating communication, clinical and research skills in medical education: The Daisy Project. Educ Health. 2006;19:106-10.

World Health Organisation. The World Health Report 2006-Working together for health. Geneva: World Health Organisation, 2006. Available at

McLellan E, MacQueen KM, Niedig J. Beyond the qualitative interview: Data preparation and transcription. Field Methods. 2003;15:63-84.

NVivo Qualitative Data Analysis Software. QSR International Pty Ltd, version 10, 2013.

Humphris D. Multi-professional working, interprofessional learning and primary care: a way forward? Contemporary Nurse. 2007;26:48-55.

Gavana M. Planning, implementing and assessing a sentinel surveillance network in primary health care. (PhD Thesis) Thessaloniki: Aristotle University of Thessaloniki, Medical School. Available at mgavanaphd.pdf (Assessed 29 August 2011).

Althouse L, Stritter F, Steiner B. Attitudes and approaches of influential role models in clinical education. Adv Health Sci Educ. 1999;4:111-22.

King’s Undergraduate Medical Education in the Community (KUMEC). The KUMEC Practice-Liaison Booklet. King’s College London. (Online) 2011. Available at Teachers/practice-Liaison-Booklet.pdf (Assessed 12 October 2012).

Gray J, Fine B. General practitioner teaching in the community: a study of their teaching experience and interest in undergraduate teaching in the future. British J General Practice. 1997;47:623-6.

Wilson A, Fraser R, McKinley RK, Preston-Whyte E, Wynn A. Undergraduate teaching in the community: Can general practice deliver? British J General Practice. 1996;46:457-60.

Page S, Birden H. Twelve tips on rural medical placements: What has worked to make them successful. Med Teacher. 2008;30:592-6.

Cook V, Nicholson S. How can GP teachers be supported to make good teaching even better? Educ Primary Care. 2006;17:17-23.

Smyrnakis E, Panos A, Stardelli T, Chainoglou A, Gavana M, Kondylis E. Introducing primary health care clerkship in a hospital centred curriculum. In: Proceedings, 40th Annual Scientific Conference of the Society for Academic Primary Care 2013.

Howe A. Teaching in practice: a qualitative factor analysis of community-based teaching. Med Educ. 2000;34:762-8.

Stephenson A, Bailey R. Community Teaching Handbook for practices and Teachers 2010-2011. London: Department of General practice and Primary Care, King’s College London, 2010.

Rosenstock IM. The health belief model: Explaining health behavior through expectancies. In: Glanz K, Lewis FM, Rimer BK, eds. Health behaviour and health education. San Francisco: Josey-Bass; 1990:39-62.

Griffin SJ, Kinmonth A, Veltman MWM, Gillard S, Grant J, Stewart M. Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med. 2004;2:595-608.

Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load: a meta-analytic review of randomized controlled trials. J Acquire Immune Defic Syndr. 2006;43(1):S23-35.

Michie S, Abraham C. Interventions to change health behaviours: evidence-based or evidence-inspired? Psychol Health. 2004;19:29-49.

Haynes RB, McDonald H, Garg AX, Montague P. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev. 2002;2:CD000011.

Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N. Changing the behavior of healthcare professionals: The use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005;58:107-12.

Theunissen NC, De Ridder DT, Bensing JM, Rutten GE. Manipulation of patient–provider interaction: discussing illness representations or action plans concerning adherence. Patient Educ Counseling. 2003;51(3):247-58.

Mannheimer SB, Morse E, Matts JP, Andrews L, Child C, Schmetter B, et al. Sustained benefit from a long-term antiretroviral adherence intervention: results of a large randomized clinical trial. J Acquir Immune Defic Syndr. 2006;43(1):S41-7.

Posse M, Baltussen R. Barriers to access to antiretroviral treatment in Mozambique, as perceived by patients and health workers in urban and rural settings. AIDS Patient Care STDS. 2009;23:867-75.