We would like to thank TUMS for the financial and scientific support and the participation of nursing students in this research and finally Ms. Zahra Roosta, instructor of the Khalij-e Fars Student Research Center in Arak, for pedagogical cooperation. 2. Conventional Education Group: In this group, researchers provided the same traditional educational methods in a clinical setting such as patient care, nursing processes, and bedside teaching. Each student received a patient each day and examined their own patient. The educator solved the students` problems and corrected their incomplete information and scientific problems. Then, a health and education plan was created for the patient based on the information gathered during physical examinations, the patient`s medical history, test results, and diagnostic tests. Results: There were no significant differences between the 2 groups in terms of gender, cumulative grade point average of previous years, and interest in care. However, the results showed a significant difference between the 2 groups in the overall self-directed learning score (p = 0.019). Although the mean satisfaction score was higher in the intervention group, the difference was not statistically significant. Comparing the satisfaction rate of the 2 groups for the teaching methods provided revealed no significant differences between them.
Ghazi and Henshaw suggested that pupils should have the freedom to choose their own method of learning and to organise their procedure (35). Bailey and Tuohy reviewed nursing students` experiences with LCs with thematic analysis; One of the topics was some students` fear of taking responsibility for learning (36). After applying LCs in a clinical setting and interviewing students and educators, Chan and Wai-tong found that one of the problems in implementing the plan was taking responsibility and responsibility for learning (37). One of the reasons for dissatisfaction with this method may be the unpreparedness and limited time of the training course to achieve the objectives, which increases the workload of the students. Maxie and Pryce-Miller also stressed the importance of preparing students in this regard (38). The use of LCs promotes learning among nursing students in particular and is a valuable tool in the clinical environment. Because of this method`s focus on individual differences, theoretically healthy learning in adults and strengthened LDS, which is one of the goals of nursing in the 21st century. The implementation of this method is highly recommended to nursing educators. However, one of the existing limitations is the ignorance of some educators with this method, which can be solved during educational courses. According to Tsang, “negative scores may indicate perceived cultural differences between Western and Asian students compared to educators.” Tsang noted that adequate training provided by senior clinical supervisors or elderly people, appropriate guidance and mentoring for learners can facilitate SDL through LCs and be a positive experience for process managers (31).
Based on the results of the literature review, this study aimed to determine the impact of an LC on SDL and the satisfaction of nursing students. Despite the positive properties of LCs, Tsang et al. highlighted several problems in the direction of LCs in the occupational therapy profession in Hong Kong. Many of their learners believed that writing LCs was difficult, and most learners wrote contracts with identical context and content. To pass classes and ensure a high score, some students wrote goals with fewer requirements than others (31). At the end of the training, students from both groups carried out self-directed and satisfactory inventories. The results were then analyzed using descriptive and inferential statistical methods (dependent and independent t-tests) using SPSS 20 software for Windows (SPSS, Inc., Chicago, IL, USA). Some experts believe that the most important responsibility of the education system in this rapidly changing world and short half-life of knowledge in medical schools is to require educators to set up SDL opportunities in the safe environment of universities, rather than providing a wealth of knowledge (16, 17). In addition, they must provide the necessary facilities and preconditions to develop the necessary skills and take responsibility for change (18, 19).
Health education, which has not been designed with active participation in learning in mind, will not convince pupils to take responsibility for their own learning independently of educators and teachers (10). More traditional training methods will also face bottlenecks in the preparation of professional members of the healthcare team (20). Various health professions such as health professionals, nurses, and radiology technologists have used LCs (29). Cross proposed one of the few studies in this area, suggesting that apprenticeship contracts are an effective tool to facilitate learning and improve the clinical experience for students (30). Conclusion: This study suggests that the use of the clinical learning contract method improves self-directed learning among nursing students. Because this model focuses on individual differences, the researcher recommends applying this new method to educators. One approach for SDL is an Apprenticeship Contract (LC) (21). Today, many teachers in some developed countries encourage LC nursing students to join SDL (23). LCs have enabled nurses to achieve their goals of professional development, distance learning and education services (24). LC is a method of learning and a reciprocal agreement between teacher and student to achieve educational goals (20).
LC is a learner-centered activity that helps students connect what they learn in the classroom to what they see in clinical practice, and this activity can lead to the integration of theory and practice (26). Since then, support for the benefits of using LCs in nursing education has increased significantly in the literature, many of which are aimed at promoting self-confidence and ubiquitous goods. However, there is less literature on assessing the reliability of LCs (21). LCs can promote the transfer of power and authority from the instructor to the leaner. Most of the LCs described in various studies deal with a more traditional and conventional approach to LCs, a process that begins with learners writing learning objectives (10, 27). Researchers have used many terms to describe LCs, terms focused on learners` participation in the learning process. Some of these terms include learning programs, learning plans, learning modalities and learning recommendations (28). Nursing education aims to achieve the ultimate goal of training, i.e. competence and efficiency in various aspects and to meet the care needs of clients (1-3). Several studies have shown that current nursing education has many gaps and bottlenecks and may not meet the learning needs of nursing students (4-7).
Therefore, there seems to be a need to evaluate and apply new approaches to education (8, 9). In recent decades, educators and trainers have used different approaches to transform learning into self-directed learning methods (LDCs) (10-12). Collaborative learning has been created in line with these efforts and has been disseminated in many countries (13). Collaborative learning adapts educational activities to the needs of learners (14). Thus, students are responsible for their own learning (15). Cite this article as: Sajadi M, Fayazi N, Fournier A, Abedi AR. The impact of the learning contract on self-directed learning and the satisfaction of nursing students in clinical settings. Med J Islam Repub Iran. 2017 (7 Dec);31:72. doi.org/10.14196/mjiri.31.72 1st intervention group: Researchers performed a pre-test to determine students` educational needs based on educational goals. A contract was signed between the educator and each of the students based on the results of the test.
During each session, students selected a specific patient based on the educational goals or lesson plans of that particular session and examined the patient closely (e.g. B medical history and physical examinations). Then the students discussed the results of the tests, diagnostic tests, medications and all the measures taken for the patient. Each student separately created a description of the patient in the form of a scenario based on the information collected. In the meantime, students accessed the library and the Internet when faced with a problem. As this was the students` first experience with this method, the educator looked at the students` success rate on the daily goals and tried to guide them accordingly. At the end of the day, the educator asked questions about the patient, made the students think, and gave them the opportunity to resolve the issue before the due date. In the second week, the treaty could possibly be amended based on pervasive weaknesses and strengths. Students completed 2 questionnaires at the end of clinical practice. The use of new educational methods to improve learners` competence and efficiency is inevitable.
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