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VIETNAM ACADEMY OF SOCIAL SCIENCES GRADUATE ACADEMY OF SOCIAL SCIENCES PHAN HOANG TRONG CLINICAL PRACTICE MANAGEMENT UPON DIRECTION OF DEVELOPING CAPACITY OF MEDICAL STUDENTS AT UNIVERSITIES IN HO CHI MINH CITY Major: Educational Management Code: 9.14.01.14 SUMMARY OF DOCTORAL DISSERTATION Ha Noi, 2020 The dissertation has been completed at GRADUATE ACADEMY OF SOCIAL SCIENCES Supervisors: Assoc Prof Dr Nguyen Thi Hoa Assoc Prof Dr Nguyen Sy Thu Examiner 1: Assoc Prof Dr Nguyen Xuan Thuc Examiner 2: Dr Nguyen Thi Yen Thoa Examiner 3: Assoc Prof Dr La Thi Thu Thuy This doctoral dissertation will be defended before the Panel of Examiners, at Graduate Academy Of Social Sciences At…… on…… 20 This doctoral dissertation can be found at: National Library of Vietnam Library of Graduate Academy of Social Sciences INTRODUCTION Rationale for the study Among training activities at university, vocational training plays a key role in improving the quality of professional training, determining the working ability of students after graduation Following the current trend of integration of the country, vocational training for students should focus on comprehensive development which integrates knowledge, skills, and practice, as well as on how students after graduation are able to put things they learned into practice, to orientate and to develop themselves in the direction of the defined educational goals, on which basis, vocational training promotes the quality and capacity values to meet the requirements of society Therefore, vocational practice management, in general, is one of the urgent needs The medical profession is directly related to human life and health That requires medical students, in the learning process, to practice prudence, thorough thinking, positive thinking, practical problem solving, and decision-making skills, as well as teamwork and the ability to work independently Students who are able to practice health care treatment for the sick need to spent 4-6 years on clinical practice during their studies In addition, medical ethics stipulates that protecting, preventing, maintaining, and improving human health is a noble responsibility and obligation of medical students Therefore, even when studying at university or after graduation, medical students cannot make mistakes in practice Therefore, the management of professional medical training should focus on the management of clinical practice Practical training needs to help students integrate knowledge, reasoning and practice Clinical practice management of medical students has attracted many research projects with different approaches Currently, clinical practice training upon direction of developing capacity has been implemented at many medical universities across the country However, there is little in-depth research on evaluating the clinical practice management process following the capacity-building for medical students From the above reasons, we choose the issue of "Clinical practice management upon direction of developing capacity of medical students at universities in Ho Chi Minh city" as the doctoral dissertation topic 2.Aims and objectives of the study 2.1 Aims Based on theoretical research and assessment of the current status of clinical practice management in the direction of capacity development for medical students at universities in Ho Chi Minh City, the thesis proposes many management solutions for clinical practice activities in the direction of capacity development of medical students at universities in Ho Chi Minh City, contributing to improving clinical practice activities for students 2.2 Objectives 1) Review the research situation on clinical practice manage ment upon direction of developing capacity of medical students 2) Build a theoretical basis for managing clinical practice activities upon direction of developing capacity of medical students 3) Assess the current situation of clinical practice management upon direction of developing capacity of medical students and the factors affecting the management of clinical practice activities upon direction of developing capacity of medical students at universities in Ho Chi Minh City 4) Propose some solutions to manage clinical practice activities in the direction of capacity development for medical students at Ho Chi Minh City universities Conducting one trial solution in practice Subject and scope of the study 3.1 Subject of the study Solutions to clinical practice management upon the direction of capacity development for medical students at universities in Ho Chi Minh City 3.2 Scope of the study 3.2.1.Limitations of the scope of study The research on clinical practice management in the direction of capacity development for medical students focus on the following aspects: Managing the clinical practice objectives in the direction of developing students’ capacity; Managing clinical practice content in the direction of developing students’ capacity; Managing facilities for clinical practice in the direction of developing students’ capacity; Managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity This study was only conducted on nursing students at universities with nursing majors in Ho Chi Minh City 3.2.2.Limitations of participants for the actual situation survey: Managers, lecturers, nursing students of medical universities, and doctors mentoring nursing students in clinical practice placements 3.2.3.Limiations of study areas: This study was conducted at universities/ colleges with nursing majors in Ho Chi Minh City, namely University of Medicine and Pharmacy at Ho Chi Minh city; Hong Bang International University; Nguyen Tat Thanh University 3.2.3 Limitations of the dissertation research objects -The number of participants surveyed by questionnaire includes: Managers (of universities and faculties), lecturers, students of universities: 350 people; Doctors mentoring students at the hospital: 10 people Total number of participants surveyed by questionnaire (quantitative): 360 people -The number of participants surveyed by in-depth interviews: Managers (of universities and faculties), lecturers: 15; Doctors mentoring students at the hospital: 10 people; Nursing students: 30 people The total number of participants surveyed by indepth interviews: 55 people 3.2.4 Limitations on management subjects There are many subjects involved in the management of clinical practice activities in the direction of developing students’ capacity, including (1) The main management subjects that manage the clinical learning activities of medical students (nursing students) are: university leaders (mainly the university principle), leaders of nursing faculties; (2) The direct management subject is the departments and doctors mentoring nursing students in the clinical practice placements However, in this dissertation, the main subject is identified as the principal of the medical university and the other subjects coordinate to manage clinical practice activities in the direction of developing medical students’ capacity Research Methodology and Research Method 4.1 Research approaches In order to conduct the research on clinical practice management upon direction of developing capacity of medical students, the dissertation identifies these following research approaches: Systems approach; Approach according to the capacity of medical students (nursing students); Standard approach; Process approach 4.2 Research methods The dissertation uses the following research methods: 1) Method of studying documents and materials; 2) Method of experts; 3) Method of investigating by questionnaire; 4) Method of in-depth interview; 5) Method of testing; 6) Methods of processing data by mathematical statistics 4.3 Scientific hypothesis Clinical practice management upon direction of developing capacity of medical students at universities in Ho Chi Minh City is performed at an average level Among the management aspects, the highest-scored aspect is the management of examination and evaluation of clinical practice activities in the direction of developing students’ capacity The lowest-scored aspect is the management of clinical practice objectives in the direction of developing students’ capacity If management solutions focusing on developing professional capacity in line with the law and ethics for nursing students are proposed and tested in clinical practice activities, it will contribute to improving the efficiency of the clinical practice management in the direction of developing medical students’ capacity at universities in Ho Chi Minh City 4.4 Research questions This dissertation will answer the following research questions: 1) From what scientific point of view is the research on clinical practice management in the direction of developing capacity of medical students approached? What is the rationale for the management of clinical practice activities in the direction of developing capacity of medical students? 2) What is the current situation of clinical practice management in the direction of developing capacity of medical students at universities in Ho Chi Minh City? What are the strengths and weaknesses of this management activity? What factors affecting this management activity? 3) What solutions to improve the efficiency of clinical practice management activities in the direction of capacity development for medical students at universities in Ho Chi Minh City today? 5.New contributions of the dissertation 5.1 Theoretical contributions The research on clinical practice management in the direction of developing nursing students’ capacity at medical universities in Ho Chi Minh city is currently one of the few studies on clinical practice management following the capacity-building for medical students The dissertation has identified a number of concepts served as a basis for practical research, clarifying the content and management of clinical practice activities upon direction of developing capacity of nursing students, pointing out the factors affecting the management of this activity The dissertation has constructed criteria for managing clinical practice activities of medical universities in the direction of developing nursing students' capacity This is the basis for organizing clinical practice activities and for clinical practice management in line with the capacity-building for nursing students at medical universities 5.2 Practical contributions: The dissertation has evaluated the status of clinical practice activities as well as the clinical practice management in the direction of capacity-building for nursing students through following points: Managing the clinical practice objectives in the direction of developing students’ capacity; Managing clinical practice content in the direction of developing students’ capacity; Managing facilities for clinical practice in the direction of developing students’ capacity; Managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity The thesis also assesses the status of the factors affecting the management of clinical practice activities in the direction of developing nursing students’ capacity Experimental results show that it is possible to improve the clinical practice capacity of nursing students when applying the proposed solutions Theoretical and practical significance of the dissertation 6.1 Theoretical significance The research results of the dissertation contribute to completing a number of theoretical issues about clinical practice activities in the direction of developing capacity of nursing students as well as the management of clinical practice activities in the direction of developing capacity of nursing students, showing the role of entities in managing clinical practice activities of medical students 6.2 Practical significance The research results of the dissertation can be a reference for principals, faculties, managers, and lecturers of nursing departments of medical universities in planning and managing content and activities of clinical practice upon direction of developing capacity of nursing students The research results of the dissertation are also a reference for hospitals in managing nursing students when the clinical practice is performed in those hospitals The findings of the thesis are also a reference for nursing students in enhancing their capacity in clinical practice Structure of the thesis Besides the introduction, conclusion, and annex, the dissertation has chapters Chapter OVERVIEW OF EXISTING RESEARCH ON CLINICAL PRACTICE MANAGEMENT UPON DIRECTION OF DEVELOPING CAPACITY OF MEDICAL STUDENTS 1.1 Existing research on clinical practice management upon direction of developing capacity of medical students There are many studies on clinical practice activities of medical students in the direction of capacity development, such as: Curry & Docherty, 2017, Gravina et al 2017, Frank et al 2010 studied the effectiveness of CBME in developing practical competencies and demonstrated that CBME is very effective in developing clinical practice capacity for medical, pharmaceutical, nursing and dental students In addition, Gruppen et al 2012 have proven that CBME can bring about the development and improvement of health care all over the world L Lassnigg (2015) [69]; Leung (2002) [89]; Tan, Chong, Subramaniam, and Wong (2018) [62] showed promise to train the most professional medical staff, according to L Parson, Childs and Elize in 2018 [67] In this regard, there are also studies by Al-Dabbagh and Al-Taee; Horntvedt (2018), Jauhiainen 2009, Hoffart et al 2017, Nousiainen et al 2018 1.2 Overview of the management of clinical practice activities of medical students upon direction of capacity building Stark, Warne & Street have studied the clinical practice of nursing students, and Xie et al 2013 showed that the capacity of medical students in clinical practice is also reflected in their communication competencies In general, the implementation of CBME-oriented education has been carried out quite early in the world for about 20 years, and studies on the management of construction, implementation, evaluation has been conducted specifically In Vietnam, there are a number of authors interested in doing research on clinical practice management Some of the following authors may be mentioned: Nguyen Thi Kim Thoa studied the practical teaching management at The University of Medicine Pham Ngoc Thach Regarding clinical practice training at Ho Chi Minh University of Medicine and Pharmacy, Huynh Thi Minh Hang 2008 and Vo Thanh Nhan 2009 worked on the management of students' academic quality Dang Van Phuoc, Tran Ngoc Bao, and Tran Thi Bich Huong 2006 studied the advantages of OSCEs and concluded that OSCEs are clinical evaluation methods that bring about more positive results than the old method Vu Thi Loan at Thai Binh University of Medicine performed research on managing clinical practice The research by Nguyen Thanh Son, Yersin Medical University, Da Lat argued that the current practical training for medical students does not yet meet the competency standards Besides medical universities, some researchers such as Le Duc Trung 2015, Le Xuan Truong 2015, Nguyen Duc Chinh 2014, Nguyen Thi Ngoc Xuan 2015, Nguyen Thu Ha 2014, in various fields of vocational education and training, also conducted research on vocational training upon direction of developing students’ capacity The issue of clinical practice management has been studied by a number of authors, but each study approaches a certain aspect Therefore, the theory about managing students' clinical practice activities has not yet proven to be comprehensive, systematic, and intensive There is some research with a general perspective, some with a specific perspective Meanwhile, managing clinical practice activities of medical students towards competency-oriented is a matter which is yet to be studied in a fundamental and systematic way Therefore, there should be scientific studies on this issue Chapter RATIONALE FOR CLINICAL PRACTICE MANAGEMENT UPON DIRECTION OF DEVELOPING CAPACITY OF MEDICAL STUDENTS 2.1 Clinical practice activities for medical students upon direction of capacity building 2.1.1 Concept Clinical practice of medical students is a process of implementing actions, putting theory into practice, including the activities of talking and taking care of patients in order to collect sufficient information to make a diagnosis, specific care and treatment plans for patients in accordance with their needs to alleviate the patients' diseases, suffering or disabilities 2.1.2 Developing capacity of medical students Medical students have diverse majors, in this thesis, we only study nursing students "Capacity is a combination of unique psychological attributes or personal psychosocial qualities that act as an individual internal condition, facilitating a certain form of activity to well perform." The capacity development of medical students (nursing students) is a change in the direction of promoting the unique psychological attributes or personal psychological qualities that act as an individual internal condition, facilitating for the good implementation of nursing activities by students * Some competencies that need to be developed for medical students (nursing students) According to Decision No 1352/QD - BYT on 24 April, 2012 on the competency standards of nursing in Vietnam, the capacity of nursing students is also determined the basis of competency standards of nursing in Vietnam, which includes the following basic competencies: Capacity of caring practice; Capacity of professional management and development; Capacity of professional practice in accordance with law and nursing ethics 1) Capacity of caring practice Students need to know the health and illness status of the patients Students have the ability to make decisions about appropriate care plans for the patients’ illnesses and needs 2) Capacity of career management and development Along with the capacity to practice caring for patients, in the clinical practice process in the hospital, nursing students also need professional management and development competencies This competency is reflected in the following specific aspects: Students need to be able to manage, record and use medical records in accordance with regulations; Students need to be able to manage patient care; Students need to be able to manage, operate and use medical equipment effectively 3) Capacity of professional practice in accordance with laws and nursing ethics Besides the capacity to practice patient care, professional management and development, nursing students also need to be able to work in accordance with laws and professional ethics It is the ability to carry out professional activities in accordance with the legal regulations of the medical sector and the nation’s laws for medical sectors, as well as the ethical standards for nursing This capacity manifests itself in the following specific aspects: Students practice in accordance with laws; Students practice in accordance with nursing ethical standards 2.1.3 Clinical practice activities upon direction of developing capacity of medical students (nursing students) 2.1.3.1 Concept Clinical practice activities upon direction of developing capacity of medical students is a process of implementing actions, putting theory into practice, including the activities of talking and taking care of patients, which helps promote the unique psychological attributes or personal psychological qualities that act as an individual internal condition, facilitating for the good implementation of nursing activities by students 2.1.3.2 Some characteristics of nursing students Nursing training is a sector in the human resource training system for health care Nursing students are trained to assist doctors, pharmacists, technicians, and other staff in the health care system to perform health care in accordance with the needs of the sick To perform the above tasks, nursing students must have the following necessary qualities: Love for a job, medical ethics; carefulness, high sense of responsibility; patience, ability to handle pressure; ability to learn and acquire knowledge 2.1.3.3 Content of clinical practice activities upon direction of developing capacity of medical students a Practice taking care of patients: Learn about the patient's health and illness: Read the patient's medical record; Implement the technique of taking vital signs and record on the vital function monitoring sheet; Communicate with patients, relatives of patients; Collect data and comments; Perform care for patients: Instruct patients to take medications as prescribed, on time, in the right way; Implement specialized surgical care techniques such as taking care of wound drainage, infected wounds, artificial anal sphincter, skin avulsions ; Perform communication activities with patients; b Practice professional management and development during clinical practicum Manage, record, and use medical records in line with regulations; Manage patient care work; Manage, operate and use medical equipment effectively; Use appropriate financial resources to taking care of patients effectively; Establish a safe and efficient working environment; Strengthen scientific research activities c Practice professional capacity development in accordance with laws and nursing ethics Work in accordance with the laws; Work in accordance with nursing ethics 2.2 Clinical practice management upon direction of developing capacity of medical students 2.2.1 Management Management is the directed, purposeful, planned, and systematic impact of the managing subject on the managed object 2.2.1.2 Functions of management Planning, organizing, implementing, directing, evaluating 2.2.2 Concept of clinical practice management upon direction of developing capacity of medical students (nursing students) Clinical practice management in the direction of developing capacity of medical students (nursing students) is a directed, purposeful, planned and systematic impact of managing subjects to students during the course of action of putting theory into practice, talking and taking care of patients, in order to develop the capacity of caring practice; capacity of professional management and development; capacity of professional practice in accordance with laws and nursing ethics 2.2.3 Managing subjects in clinical practice management upon direction of developing capacity of medical students Managing subjects are collectives or individuals that are assigned with tasks and direct or indirect power in leading, managing education and training students during clinical practice The main subjects that manage the clinical practice activities of medical students (nursing students) are: University leaders (mainly the university principal), the leaders of the nursing department, faculties of the university The direct managing subject is the hospital where students perform their clinical practice Specifically, it is the departments and doctors who directly guide nursing students during their clinical practicum These subjects are related as follows: The university principal directs the nursing department and other departments to develop a clinical practice plan for students (goals, requirements, content, time, and results of clinical practice) 2.2.4 Content of clinical practice management upon direction of developing capacity of medical students (nursing students) From the content and process of clinical practice activities of medical students and from the basic functions of management, we identify the content of clinical practice management in the direction of developing capacity of medical students (nursing students) 2.2.4.1 Managing the clinical practice objectives in the direction of developing students’ capacity a Clinical practice knowledge student fosters a correct and complete awareness of the clinical practice, this activity will be carried out with seriousness, positive attitude and good quality On the contrary, when a student fosters an incorrect and incomplete awareness of clinical practice, this activity will be carried out with lack of seriousness, inadequate and low quality attitude 2.3.6 Attitude of students towards clinical practice activities Attitude of students towards clinical practice activities is a decisive factor of students' clinical practice activities When a student has a positive and enthusiastic attitude, they will perform clinical practice activities with good quality Chapter PRACTICAL RESULTS OF CLINICAL PRACTICE MANAGEMENT UPON DIRECTION OF DEVELOPING CAPACITY OF MEDICAL STUDENTS 3.1.Practical research design and methodology 3.1.1 Research areas and subjects 3.1.1.1 Research areas This study was conducted at universities with nursing majors in Ho Chi Minh City Including: University of Medicine and Pharmacy at Ho Chi Minh city; Hong Bang International University; Nguyen Tat Thanh University The three hospitals include: Army Hospital 115; University Medical Center of Ho Chi Minh City; Binh Dan Hospital 3.1.1.2 Research subjects The number of participants surveyed by questionnaire is 360 people, including: Managers: 35 people, lecturers: 115 people, students: 200 people The number of participants surveyed by in-depth interviews is 55 people, including managers (of universities and faculties), lecturers: 15 people; Doctors mentoring students at the hospital: 10 people; Nursing students: 30 people 3.1.1.3.Research design 1) Phase of designing research instruments - Aim: Develop research instruments (questionnaires, in-depth survey outline) -Time: From January 2017 to January 2018 -Content:1) Design questionnaire for university leaders and lecturers; 2) Design 04 in-depth interview outlines for university leaders, lecturers, students, and doctors mentoring students during their clinical practicum 2) Phase piloting investigation -Aim: To determine the compatibility and reliability of the questionnaire so that necessary corrections can be made to unsatisfactory questions -Time: April 2017 3) Phase of official investigation -Aim: Find out the current situation of clinical practice management, the factors affecting clinical practice management and information on social demographic characteristics such as gender; age; academic level; years of working; working position; University name -Time: From May 2017 to August 2017 4) Phase of data procession and thematic writing 11 -Aim: Form and systematize result tables as a basis for data analysis, writing and finalization of theme -Time: From September 2017 to present 3.1.1.4 Research methods The main research methods are: survey by questionnaire; in-depth interview; Process data by mathematical statistics -Data processing by the method of doing survey by questionnaire Based on actual data obtained with the average score of the whole scale = 3.28; Standard deviation = 0.52 We divide the levels of the rating scale as follows: High level: ≥Average score ≥ 4.32; Relatively high: 4.32 > Average score ≥ 3.80; Average: 3.80 > Average score ≥ 2.76; Relatively low: 2.76 >Average score ≥ 2.24; Low: 2.24 > ĐTB ≥ 2) Method of in-depth survey Collect, complete and clarify information gained from large-scale surveys to better understand the current situation of clinical practice management upon direction of developing students’ capacity; factors affecting the status of clinical practice management upon direction of developing students’ capacity and some personal information of the surveyed people 3) Method of data processing by mathematical statistics The data collected after the official survey is processed by SPSS statistical program with Window operating system, version 20.0 The parameters and statistical operations used in this study include: Data representing the situation are analyzed by statistics describing average point, standard deviation, frequency Comparing the data and variables is performed by using ANOVA analysis and post-hoc test if the F result of ANOVA is statistically significant 3.2 Current situation of clinical practice activities upon direction of developing capacity of medical students 3.2.1 Awareness about clinical practice activities upon direction of developing students’ capacity 3.2.1.1 Awareness of the role and importance of clinical practice activities upon direction of developing students’ capacity The results of the survey on the awareness of the role and importance of clinical practice activities upon direction of developing students’ capacity show that with the average score of 3.33, the university leaders and lecturers evaluate the role and importance of clinical practice activities upon direction of developing students’ capacity at the average level and nearly at the relatively high level 3.2.1 Students’ awareness of the role and importance of clinical practice activities upon direction of developing students’ capacity The survey with university leaders and lecturers about students’ awareness of the role and importance of clinical practice in the direction of developing students’ capacity shows the results of the average level, quite near the relatively high level, with the average score of 3.37 3.2.2 Clinical practice activities upon direction of developing students’ capacity 3.2.2.1 Nursing students practice patient care 12 The contents of patient care practice of nursing students are assessed as the average level with the average score of 3.31 (from the surveyed university leaders and lecturers) 3.2.2.2.Nursing students practice professional management and development during their clinical practicum The current situation of developing the capacity of professional management and development for nursing students, with the average score of 3.31 and standard deviation of 0.601, are assessed as the average level 3.2.2.3 Nursing students practice working in accordance with laws and professional ethics during their clinical practicum Practice working in accordance with laws and professional ethics was not highly evaluated, only at average level with the average score of 3.26 3.2.2.4 General assessment of clinical practice activities in the direction of developing students’ capacity Table 1:Current situation of clinical practice activities of nursing students No Content Average Standard score deviation (AS) (SD) Awareness of the role and importance of clinical practice 3.33 0.728 activities to nursing students Students’ awareness of the role and importance of 3.37 0.736 clinical practice activities to themselves The practice of patient care by nursing students 3.31 0.585 The practice of professional management and 3.31 0.601 development by nursing students The practice of working in accordance with laws and 3.19 0.618 professional ethics by nursing students Mean score 3.30 0.653 The mean AS of nursing students’ clinical practice is 3.30, which shows that this activity is evaluated at an average level by the surveyed university leaders and lecturers This means that the nursing students in the survey sample have performed clinical practice activities at adequate level, but not yet well, still have many limitations Opinions vary when collected to evaluate this activity, but the level of variability is not high (SD = 0.653) 3.2.2 Clinical practice activities in the direction of developing students’ capacity when compared with variables Research results show that, in general, there is no statistically significant difference between university leaders and lecturers in assessing the actual clinical practice of nursing students (P> 0.05) There was no difference between men and women in the overall assessment of clinical practice activities of nursing students (p = 0.125) 3.3 Current situation of clinical practice management in the direction of developing capacity of medical students 13 The actual situation of clinical practice management in the direction of developing capacity of medical students is analyzed through these following points: 3.3.1 Managing the clinical practice objectives in the direction of developing students’ capacity 3.3.1.1 Manage knowledge objectives for nursing students The results of the survey on the management of clinical practice in the direction of developing students’ capacity in terms of knowledge are evaluated at an average level with AS = 3.18 It can be seen that the leaders of the medical universities in the survey manage the clinical practice objectives in the direction of developing students' capacity in terms of knowledge at an average level, not too good, not too bad 3.3.1.2 Manage attitude objectives for nursing students When assessing the management of attitude objectives for students during their clinical practicum, the surveyed leaders and lecturers claim that the implementation of these objectives is only at an average level with AS = 3.08 3.3.1.3 Manage skill objectives for nursing students Compared to the management of knowledge and attitude objectives, the management of skill objectives for students during their clinical practice seems to be a little higher The average score is 3.26 compared to 3.18 and 3.08 However, this is still at the average level 3.3.2 Managing clinical practice content in the direction of developing students’ capacity 3.3.2.1 Manage to develop the capacity of patient care for nursing students With AS = 3.23 and SD = 0.618, it shows that managing students in terms of understanding about the health and illness of the patient is only at an average level In other words, for this management content, the university principal has met the requirements of students' clinical practice, but is still at a limited level The assessment of different aspects varies The average score ranged from 2.64 to 3.78 - from low level to nearly relatively high level 3.3.2.2 Manage to develop the capacity of professional management and development for nursing students Managing students in the management, recording, and using of medical records according to the university regulations is assessed at the average level, with AS = 3.26 and SD = 0.657 Thus, university presidents in the survey manage students in terms of managing, recording, and using medical records according to regulations only at the average level, still have many limitations 3.3.2.3 Manage to develop the capacity of working in accordance with laws and professional ethics With the AS = 3.29 and SD = 0.57, it shows that managing students in terms of working in accordance with laws is assessed at an average level, quite close to the relatively high level This means that, the Principal only meets the requirements of students' clinical practice at a moderate level in terms of the management of students’ working in accordance with laws, but does not fulfil the requirements of clinical practice management for nursing students 3.3.3 Managing facilities for clinical practice in the direction of developing students’ capacity 14 Managing facilities for clinical practice is an important requirement for students because facilities along with humans determine the success of care and treatment for patients In order for the facilities to be effectively used for treating and taking care of patients, they must be well managed by both the leaders and students, including the principal and the school administrators 3.3.4 Managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity When it comes to managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity., the principals in the survey is assessed at an average level, nearly close to the relatively high level This means that the management of examination and evaluation has drawn concern among principals, met the requirements of clinical practice but only at the average level with certain limitations 3.3.5 A general assessment on the clinical practice management in the direction of developing students’ capacity The results of the general assessment on clinical practice management in the direction of developing students’ capacity are shown in the following table: Table 2: A general assessment on the clinical practice management in the direction of developing students’ capacity No Management content AS SD Managing the clinical practice objectives in the direction of 3,17 0,647 developing students’ capacity Managing clinical practice content in the direction of 3,32 0,624 developing students’ capacity Managing facilities for clinical practice in the direction of 3.32 0.730 developing students’ capacity Managing the examination and assessment of clinical practice 3.35 0.712 activities in the direction of developing students’ capacity Mean Score 3,29 0,678 The data in the above table shows that in general, the current situation of clinical practice management in the direction of developing students’ capacity is at average level, with the mean AS = 3.29; mean SD = 0.678 3.3.6 Correlations among the aspects of clinical practice management in the direction of developing students’ capacity The results of Correlations among the aspects of clinical practice management are shown in the following tables Table 3: Correlations among the aspects of clinical practice management Management aspect (1) Managing the clinical p practice objectives (1) r N Managing clinical p practice content (2) r N (2) 350 809** 000 350 15 (3) 350 (4) (5) Managing facilities for clinical practice (3) Managing the examination and assessment of clinical practice (4) General situation of clinical practice (5) p r N p r N 725** 000 350 638** 000 797** 000 350 717** 000 350 350 350 p r N ** 873 000 350 963 000 350 ** 350 615** 000 877 000 350 350 ** 822** 000 350 350 The research results show that, in general, all aspects of management status and the general management status have positive and tightly correlated relationships with each other (r = 0.615 to r = 0.963; p < 0.001) In particular, managing the clinical practice objectives and managing clinical practice content has the strongest correlation among the four management aspects (r = 0.809, p = 0.000) 3.3.7 Clinical practice management in the direction of developing capacity of medical students: Compared with variables Research results show that, in general, there is no statistically significant difference between university leaders and lecturers in terms of the status of clinical practice management (P>0.05) Thus, it can be said that the level of clinical practice management of nursing students is the same for lecturers and managers 3.3.8 Assessment of clinical practice activities and clinical practice management in the direction of developing capacity of students 3.3.8.1 Strengths Managers and lecturers in the survey are aware of the role and importance of clinical practice upon direction of developing students' capacities at the average level, close to relatively high level Students have been aware of the role and importance of clinical practice upon direction of developing students’ capacity In terms of practical nursing students have met the requirements of the universities and hospitals, but the level is not really high There are still certain limitations Nursing students during their clinical practice quite often exchange information about patients to their instructors to find more appropriate treatment and gain experience during their clinical practice Nursing students during their clinical practice have followed the provisions of the law and medical ethics Clinical practice management in the direction of developing capacity of medical students at universities in Ho Chi Minh City has met the requirements of clinical practice management, but at an average level, still need more effort The management content that is highest evaluated is the management of examination and evaluation of clinical practice activities in the direction of developing students’ capacity 3.3.8.2 Weaknesses University managers and lecturers in the survey hold that students were aware of the role and importance of clinical practice in the direction of capacity development, but the awareness level is not high The practice content of patient care has been assessed at the average level by managers and lecturers The practice of patient only 16 meets the requirements of the university and hospital at an adequate level Students need to try harder and make more effort The practice of professional management and development capacity of nursing students meets the requirements at a moderate level, still has certain limitations The lowest evaluated content in the clinical practice is recording and preserving medical records and documents in accordance with standards of care practice Developing the capacity of working in accordance with laws and professional ethics is limited Regarding the management of developing the capacity of professional management and development of nursing students, the content that is lowest evaluated is the management of clinical practice objectives upon direction of developing students’ capacity 3.3.8.3 Reasons for weaknesses Clinical practice activities and clinical practice management upon direction of capacity development for nursing students are limited due to the following objective and subjective reasons: Clinical practice upon direction of developing students’ capacity is a difficult activity for students, with many pressures and challenges It is the activity of caring for patients, supporting doctors in the treatment process Clinical practice of nursing students is directly related to the life and health of patients A small number of students are not fully aware of the role and importance of clinical practice upon direction of developing students’ capacity Therefore, in the course of clinical practice, these students not try their best for their work 3.4 Actual situation of the factors affecting the clinical practice upon direction of developing students’ capacity 3.4.1 The influence of subjective factors All subjective factors considered in this study influence on the clinical practice management in the direction of developing university students' capacity at the level of "highly influence" (AS = 3.84; SD = 0.600) Among the subjective factors considered in this research, the factor "Management capacity of nursing department leaders" has the most influence on clinical practice management in the direction of capacity development in the survey(AS = 3.95; SD = 0.695) 3.4.2 The influence objective factors All of the objective factors considered in this study have influence on the clinical practice management in the direction of developing university students' competencies at the level of "highly influence” (AS = 3.58; SD = 0.413) Chapter SOLUTIONS FOR CLINICAL PRACTICE MANAGEMENT IN THE DIRECTION OF DEVELOPING CAPACITY OF MEDICAL STUDENTS 4.1 Principles of proposing management solutions Proposing solutions clinical practice management in the direction of developing capacity of medical students (nursing students) are based on the following principles: Scientific integrity; Feasibility; Ensuring inheritance and development; Practicality; Systematic integrity 17 4.2 Solutions for clinical practice management in the direction of developing capacity of nursing students From the results of theoretical and practical research, as well as the above principles, we propose a number of solutions for managing clinical practice activities in the direction of developing capacity of medical students, as follows: 4.2.1 Solution 1: Organize activities to raise awareness of managers, lecturers and students about the role and position of clinical practice upon direction of developing nursing students' capacity 4.2.1.1 Objective of the solution This solution aims to organize education and propaganda activities to raise awareness of managers, lecturers and students about the role and position of clinical practice in the direction of developing capacity of nursing students, thereby improving the quality and efficiency of students’ clinical practice 4.2.1.2 Content of the solution Raising awareness of managers, lecturers and students of the nursing department about reinforcing theoretical knowledge during the course of clinical practice, including: Knowledge about patient care (Knowledge about the health and illness status of the patient; appropriate care for disease and patient’s needs; priorities in patient care ) 4.2.1.3 Method of implementing the solution The principal of the medical university with nursing major directs the related departments to disseminate to the staff of the departments about organizing propaganda activities on the role and position of clinical practice upon direction of developing nursing students’ capacity to all lecturers of the university 4.2.1.4 Conditions for implementing the solution This education and propaganda activity to raise awareness for lecturers needs to have a synchronous combination of the University council, the Party committee, the trade union, the Communist youth union, and the student association of the university Lecturers need to have a sense of self-awareness and a high sense of responsibility 4.2.2 Solution 2: Develop criteria for clinical practice management of medical universities in the direction of developing capacity of nursing students 4.2.2.1 Objective of the solution This solution aims to develop criteria for clinical practice management of medical universities in the direction of developing capacity of nursing students 4.2.2.2 Content of the solution This solution has contents with 12 criteria and 36 specific indicators Content 1: Medical university works with hospital in developing knowledge, academic attitude and occupational skills for nursing students during their clinical practice Content 2: Medical university works with hospital in managing clinical practice activities of students at the hospital upon direction of developing students’ capacity 18 Content 3: Medical university works with hospital in managing students in using facilities for their clinical practice upon direction of developing students’ capacity Content 4: Medical university works with hospital in examining and evaluating clinical practice activities upon direction of developing students' capacity 4.2.2.3 Method of implementing the solution To implement the above contents and criteria, attention should be paid to these following aspects: The principal of the medical university with nursing major directs the related departments to disseminate to the staff and lecturers of the university about the above contents and criteria so that staff and lecturers are fully aware of the importance and need of these contents and criteria in implementing clinical practice activities for nursing students 4.2.2.4 Conditions for implementing the solution The implementation of these criteria should have a synchronous combination of the University council, the Party committee, the trade union, the Communist youth union, and the student association of the university Medical universities work closely with the hospitals where students perform clinical practice activities to develop criteria, as well as evaluate the effectiveness and feasibility of the criteria to make necessary adjustments which are compatible with the actual situation 4.2.3 Solution 3: Develop the capacity of working in accordance with laws and professional ethics for nursing students in their clinical practice 4.2.3.1 Objective of the solution This solution aims to develop the capacity of working in accordance with laws and professional ethics for nursing students in their clinical practice activities so that students during their clinical practice time and in the future work in accordance with laws, as well as nursing ethics in particular and medical ethics in general 4.2.3.2 Content of the solution Guiding students to work well with the regulations of the Ministry of Health on clinical practice for medical students in general and nursing students in particular Students should strictly follow these rules while performing the treatment and patient care in the hospital Students need to fully and seriously comply with the regulations of the Ministry of Health on clinical practice, the regulations on treatment and patient care of the hospital where students practice clinical activities These are the rules of patient care, using medical equipment, and being on daily duty 4.2.3.3 Method of implementing the solution The principal directs departments of the medical university to work with the hospital where nursing students practice clinical activities in guiding students to strictly comply with these regulations while performing treatment and care for patients 4.2.3.4 Conditions for implementing the solution 19 Principals of medical universities need to have clear and strong guidance, regular attention to the content of developing the capacity of working in accordance with laws and professional ethics for nursing students during their clinical practice 4.2.4 Solution 4: Implement the content of clinical practice for nursing students upon direction of developing students’ capacity 4.2.4.1 Objective of the solution Managing the content of clinical practice in the direction of developing students’ capacity is the most important management issues to principals of medical universities with nursing majors 4.2.4.2 Content of the solution Managing students in patient care practice: In this regard, universities and hospitals need to monitor students and help them have the ability to communicate with patients and patients' relatives; as well as the ability to explain to patients their health status 4.2.4.3 Method of implementing the solution The principal directs the nursing departments to work with the hospital to manage students in studying and practicing patient care The head of the nursing department is the one who directly organizes the learning about patient care activities for students 4.2.4.4 Conditions for implementing the solution The principal and university council need to pay close attention in directing the nursing departments to implement the content of clinical practice of nursing students in the direction of developing students’ capacity Nursing departments should fully implement the instructions of the university principal on the implementation of clinical practice in the direction of developing students’ capacity for nursing students 4.2.5 Solution 5: Organize training and practice activities to fostering in students the high sense of making progress in developing capacity during clinical practice 4.2.5.1 Objective of the solution The high sense of making progress in developing capacity during clinical practice is not only a decisive factor for the results of clinical practice, but it also affects the efficiency of clinical practice management upon direction of developing students’ capacity 4.2.5.2 Content of the solution The school needs to enhance developing in students the high sense of making progress in their learning and practice, considering it as a value that the university needs to foster during the training process and culture building in the university This is reflected in the following aspects: The will to overcome all difficulties in learning to obtain the necessary knowledge for clinical practice and future careers; The will to gain new knowledge, master new patient care methods of modern medicine, and grasp the necessary skills of patient care 4.2.5.3 Method of implementing the solution 20 The principal of the school directs the nursing departments to work with the hospital where students conduct clinical practice in educating students to build and develop professional capacity in clinical practice for students It is the will to overcome difficulties in managing medical records, in professional development, and in continuous patient care 4.2.5.4 Conditions for implementing the solution Principal, university council, and the Party committee of the university should regularly pay attention to fostering the high sense of making progress in nursing students Nursing faculties and functional departments of the university should seriously implement training and practice activities in order to develop in students the high sense of making progress in developing capacity during clinical practice under the direction of school leaders 4.2.6 Solution 6: Strengthen collaboration between university and hospital in the implementation of clinical practice in the direction of developing students’ capacity 4.2.6.1 Objective of the solution This solution aims to improve the effectiveness of the collaboration between the Principal, the departments, the nursing faculty of the medical university and the hospital during the implementation of clinical practice for students 4.2.6.2 Content of the solution First, develop a plan and program of collaboration between the university and the hospital to implement clinical practice activities for nursing students upon direction of developing students’ capacity Second, the university works with the hospital to organize clinical practice activities for nursing students in the direction of developing students’ capacity 4.2.6.3 Method of implementing the solution The principal directs departments of the universities to work with the hospital where nursing students practice clinical activities to develop a plan and a program of collaboration between the university and the hospital to implement clinical practice activities for nursing students upon direction of developing students’ capacity 4.2.6.4 Conditions for implementing the solution The implementation of the proposed solutions requires the medical university with nursing students and the hospital where the students practice clinical activities to fully comply with the provisions of law, the provisions of the Ministry of Health on the clinical practice of medical students in general and nursing students in particular These rules are the basis for carrying out solutions to clinical practice and clinical practice management 4.2.8 The relationship between the solutions The solutions have a dialectical relationship with each other, interact with each other, complement each other in improving the efficiency of clinical practice management in the direction of developing capacity of nursing students Solution is the basis for the other solutions to be implemented 21 The implementation of solution will help the other solutions to be better implemented, especially the implementation of solution 4: Focus on managing the content of the clinical practice of nursing students in the direction of developing students’ capacity Solution facilitates the management of solution 4; and The implementation of solution will facilitate the organization of solutions 1; 2; 3; and 4.3 The necessity and feasibility of the solutions The results of the survey show that university leaders, lecturers and doctors evaluated the proposed solutions at a relatively high level with AS = 4.08, a relatively high level of necessity This shows that these solutions are necessary for the clinical practice management upon direction of developing students’ capacity 4.4 Test results of one solution The thesis chooses solution for testing, which is "Developing the capacity of working in accordance with laws and professional ethics for nursing students in their clinical practice" - Pre-test results With AS = 3.98, it shows that university managers, lecturers and students evaluate the capacity of working in accordance with laws and professional ethics at a relatively high level -Post-test results After testing applying the solution, university managers, lecturers, doctors mentoring nursing students, and students assessed the capacity of working in accordance with laws and professional ethics at a relatively high level, with AS = 4.03 and SD = 0.46 Differences in the evaluation of different aspects of nursing students' ability to work in accordance with laws and professional ethics are minor Most of the aspects were assessed at a relatively high level with AS = 4.04 -Comparison between pre-test results and post-test results Test results show the mean average score of 4.03, which means that the capacity of working in accordance with laws and professional ethics of nursing students after the trial is more effective than before In most aspects, the post-test results are higher than pre-test ones Thus, the empirical hypothesis has been proved CONCLUSION AND RECOMMENDATIONS 1.Conclusion From the results of theoretical and practical research, some conclusions can be drawn: - Theoretical implications: Clinical practice management in the direction of developing capacity of medical students (nursing students) is the oriented, purposeful, planned and systematic impact of management subjects to students during the course of action to put theory into practice of actual taking care of patients in order to develop the capacity of patient care; 22 professional management and development; working in accordance with laws and professional ethics for students The content of clinical practice management in the direction of developing capacity of medical students (nursing students) includes: Managing the clinical practice objectives in the direction of developing students’ capacity; Managing clinical practice content in the direction of developing students’ capacity; Managing facilities for clinical practice in the direction of developing students’ capacity; Managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity -Practical implications: The university administrators and lecturers in the survey were aware of the role and importance of clinical practice in the direction of developing students’ capacity at an average level Overall assessment of the actual clinical practice of nursing students is at the average level This means that the nursing students in the survey have performed clinical practice at an adequate level, not yet high, still have many limitations Overall assessment of the current situation of clinical practice management in the direction of developing students’ capacity is at the average level This means that clinical practice management upon direction of developing students’ capacity at medical universities in the survey has met the management requirements of clinical practice for nursing students, but at an average level, still needs more effort Of the four contents of clinical practice management upon direction of developing students’ capacity, the difference in the evaluation of different contents is minor The highest evaluated content is "Managing the examination and assessment of clinical practice activities in the direction of developing students’ capacity " All aspects of the current management situation are positively and closely related to each other The research results show that, in general, there is no statistically significant difference between managers and lecturers, between men and women in assessing the status of clinical practice management All factors in the study have a significant impact on the management of this activity In particular, the subjective factor group are assessed to have a higher level of influence than the objective factor group From the research results, the thesis proposes solutions for managing clinical practice activities in the direction of developing students’ capacity The test results show that the university administrators, lecturers and doctors assessed the necessity and feasibility of the proposed solutions at a relatively high level This shows that these solutions are necessary for clinical practice management in the direction of developing students’ capacity The trial results show that the capacity of working in accordance with laws and professional ethics has been better than before applying the solution In most aspects, 23 the post-test results are higher than pre-test results Thus, the empirical hypothesis has been proved Recommendations 2.1 To Ministry of Health As a management body that directly manages medical universities about programs and professional quality training for medical students in general and nursing students in particular, the Ministry of Health needs to have more specific instructions on clinical practice for nursing students (content, form, requirements of clinical practice) The Ministry of Health may consider the criteria that the thesis has proposed for clinical practice management upon direction of developing students’ capacity to become the official criteria for the clinical practice management upon direction of developing nursing students’ capacity at medical universities 2.1 To medical universities with nursing majors Principals and university councils need to increase propaganda activities to raise awareness for university managers and lecturers about the role and importance of clinical practice in the direction of developing students’ capacity Nursing faculty with its lecturers need to pay more attention to the training on knowledge, attitudes and skills so that students can conduct clinical practice activities upon direction of capacity development with good results and meet the training requirements of the university 2.2 To hospitals where nursing students clinical practice Hospital leaders and doctors who directly mentor students in clinical practice should create favorable conditions and help students to develop their competencies during clinical practice This assistance should be demonstrated in many activities, such as when students manage medical records, perform patient care, practice according to the laws and nursing ethics The hospital should work with the medical university to manage students during clinical practice at the hospital, objectively assess students' clinical practice to help the training of nursing students in the university more effective 2.3 To nursing students Students should try to learn from clinical practice activities to reinforce the knowledge they have learned for their careers in the future Students need to have a positive attitude during their clinical practice by following the strict observance of time, the regulations of the Ministry of Health and University on clinical practice Students also need to fully comply with the hospital's rules about clinical practice 24 THESIS RELATED PUBLICATION 1.Phan Hoang Trong (2019), Capacity for clinical placement of nursing student, Journal of Social Psychology, vol 4, 57 – 68 2.Phan Hoang Trong (2019), Current situation of clinical practice upon direction of developing capacity of medical students, Journal of Social Psychology, vol 4, 57 – 68 Phan Hoang Trong (2019), The Reality of managing clinical practice upon direction of developing capacity of medical student, Journal of Social Psychology, vol 11, 112019 ... Pharmacy at Ho Chi Minh city; Hong Bang International University; Nguyen Tat Thanh University The three hospitals include: Army Hospital 115; University Medical Center of Ho Chi Minh City; Binh Dan... 3.2.3.Limiations of study areas: This study was conducted at universities/ colleges with nursing majors in Ho Chi Minh City, namely University of Medicine and Pharmacy at Ho Chi Minh city; Hong Bang International... GRADUATE ACADEMY OF SOCIAL SCIENCES Supervisors: Assoc Prof Dr Nguyen Thi Hoa Assoc Prof Dr Nguyen Sy Thu Examiner 1: Assoc Prof Dr Nguyen Xuan Thuc Examiner 2: Dr Nguyen Thi Yen Thoa Examiner
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