perception of nursing educators and students about field trip as a teaching method in community health nursing

Abstract

3]. Educational field trips (EFTs) are also helpful for teachers. It clarify, establish, correlate, coordinate accurate concepts, and enable them to make learning more effective, interesting, meaningful and bright as well. [1,4]. Moreover, these trips will also increase the efficiency of staff in teaching and changing students' attitudes about providing services to the community. A focused, well-planned field trip especially in community nursing can be the perfect approach that introduces new skills and health related concepts to students. Therefore, field trips should be designed in line with the educational objectives so participants can easily make connections between the focus of the field trip and the concepts they are learning in the educational program [ 5]. In fact, if a field trip not planned well in advance, it will end in confusion and will be a waste of time and efforts. When planning and organizing a successful field trip, three important stages should

Full text

Perception of Nursing Educators and Students about Field Trip as a
Teaching Method in Community Health Nursing
Ahlam Mahmoud Mohamed1, Eman Ahmed Elkaluby1
1Lecturer, Community Health Nursing, Faculty of Nursing, Alexandria University, Egypt
Corresponding Author: Dr. Eman Ahmed El-Kaluby
Abstract: Background: Varieties of teaching methods play an important role in nursing students’ acquisition of
competencies during their clinical rotations. Field trip is a visit to a place outside the lecture halls which is designed to
achieve certain objectives, which cannot be achieved by using other means. Aims: to determine nursing educators and
students’ perception about field trip as a teaching method in community health nursing & assess for the causes behind
students’ high absence during field trips Study Design: Descriptive design was used to carry out this study. Study
setting: The study was conducted at the Faculty of Nursing, Alexandria University. Study tools: Three tools were used
for data collection namely: Tool I: Students’ Field Trip experience assessment Questionnaire, Tool II: Nursing
Students’ Field Trip Perception Assessment Questionnaire and Tool III: Nursing educators’ Field Trip Perception
Assessment Questionnaire. Study subjects: consisted of 218 undergraduate nursing students and 22 community health
nursing educators. Results: Only 6% of the students had attained all the visits without absenteeism. There were a lot of
reasons behind the students’ high absence as receiving negative impression from their colleagues about worthlessness
of the field trip, unavailability of method of transportation for far trip sites and contradicting time of visit with their
working shifts at private hospitals. Moreover, there is a significant relation between nursing educators’ and students’
perceived value of field trips and community health nursing curriculum, learning process (effective learning),
students’ skills development and the beneficial for the community and nursing profession. Conclusion Nursing
students and nursing educators had perceived positive value regarding field trips benefits to community and nursing
profession, students’ skills development, learning process and finally to nursing curriculum. Moreover, the value of
field trip to community and nursing profession were the most valued category rated by both undergraduate nursing
students and their nursing educators. While, the least valued category, rated by both nursing students and their nursing
educators, was the value of field trip to nursing curriculum. Recommendations: Enhance students’ high attendance
through their motivation for example the nursing educators can offer special certificate for the highest attendance,
moreover utilize new technology as recoding films, live videos to confront several barriers as environmental related
barriers
Keywords: Field visit, Experience Based Learning, Low attendance, Nursing Higher Education
INTRODUCTION
Students are the main clients of higher education and they also the central part of learning process. Therefore,
they are not only required quality education but also effective and latest means of learning [1]. Field trip as one of the
teaching methods was introduced in 1827 by George Shillibeer for a Quaker school at Abney Park in Stoke Newington,
London, United Kingdom. Field trip was considered as a flexible approach to providing meaningful learning
opportunities in the community [2]. The use of educational field trips has long been a major part of community health
nursing educational program where students visit the community and places of public health importance. Visiting these
places provides unique opportunities for learning that are not available within the four walls of the lecture halls [2,3].
Field trips are valuable experiences for students because they have a lasting impact that goes beyond the learning of
facts. They allow students to connect to knowledge content in personally relevant ways that promotes lifelong learning.
[3]. Educational field trips (EFTs) are also helpful for teachers. It clarify, establish, correlate, coordinate accurate
concepts, and enable them to make learning more effective, interesting, meaningful and bright as well. [1,4]. Moreover,
these trips will also increase the efficiency of staff in teaching and changing students’ attitudes about providing services
to the community.
A focused, well-planned field trip especially in community nursing can be the perfect approach that introduces
new skills and health related concepts to students. Therefore, field trips should be designed in line with the educational
objectives so participants can easily make connections between the focus of the field trip and the concepts they are
learning in the educational program [ 5]. In fact, if a field trip not planned well in advance, it will end in confusion and
will be a waste of time and efforts. When planning and organizing a successful field trip, three important stages should
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ISSN: 2208-2670
Volume-3 | Issue-4 | April,2017
4

be included and catching the clinical educators attention to follow: pre-trip, trip, and post-trip[ 6].Community health
nurses play many important roles such as coordinator, manager, and educator to promote health of entire population, as
effective coordinators must familiarize themselves with different resources available in the community as they are in a
better position to facilitate care through appropriate referrals and follow up [7,8].Moreover, through these visits nursing
students can realize the referral process. So, they should be aware of different resources and real services and activities
provided at their community and utilize them for referral to assist their clients/patients and families through transitions
across the continuum of care. Proper referral can decrease efforts and decrease clients waste of time and decrease
unrelated doctor visits [ 9]. Although field trip is a great learning experience (Experience Based Learning )to achieve
this important role of community health nurse, both students and their educators may face some barriers/difficulties
during it including; large student numbers, funding limitations, liability, inclement weather, lack of safety issues, time
constraints, and administrative policies barriers [10]. Thus, this study aimed to determine nursing educators and
students’ perception regarding the value of field trip visits as a teaching method in community health nursing course
and identify the common Barriers that face both students’ and nursing educators during Field Trips.
Significance of the study:
Community nursing students receive 15 weeks of field training: within these weeks the staff along with
students visited about eight field trips as water purification and sewage treatment sources, Dar Elhanan School for
mental disability, Physical Rehabilitation Center, Alexandria Regional Center for Women’s Health, food factories,
chest dispensary, leprosarium (Leprosy control unit) and fever hospital for infectious diseases. These field trips have
great influence on the development of the attitude, knowledge, skills of students who engage into community nursing
[10 ].
These settings are also, the place where both the theoretical and practical components of the community health
nursing curriculum can be integrated and transformed into professional skills and attitudes [11]. For example through
visiting food companies students were explained practical issues of food sanitation process and the personal health of
workers and can identify the environmental health hazards and occupational safety practices. In addition, visiting a
school for child with mental disability (Dar Elhanan), and physical rehabilitation center the students are expected to
identify the needs and the effective methods to easily deal with those children and identify the services provided for
them.
They also visited Alexandria regional center for women health to realize its different services for women, in
chest dispensary visit students realize its services and understand the tuberculin test and the concept of directly
observed therapy (DOTs) for T.B patients. Moreover, visiting leprosarium (Leprosy control unit) is as an example of
infectious skin diseases. Moreover they observed the steps of water purification and process sewage treatment as an
example of environmental sanitation. Finally, through visiting fever hospital students can identify the most common
infectious diseases and how to prevent it and they relize the concept of infection control.
However attending field trips were linked positively to desirable learning outcomes, it was noticed from the
students’ attendance sheet, there was a higher absenteeism rate especially during field trips’ days and there was lack of
commitment from students to attain. Previous researches tried to highlight different causes for students’ absenteeism for
example students might consider these visits as a ‘break’ or time for ‘fun,’ and be unproductive. They might feel that
supervision is lacking, lose their motivation to actively participate or they may identify a gap between theory and
practice, and feel negatively about the visit period[ 12,13,14] That is why the study was also focusing to identify the
causes behind students’ high absence during field trips along the semester 2016-2017.
Aims of the study
The study aimed to
- Identify undergraduate nursing students’ and nursing educators’ perceptions regarding the value of field trip as
a teaching method in community health nursing.
- Identify the common barriers that face both students’ and nursing educators during field Trips
- Assess for the causes behind students’ high absence during field trips.
Research questions:
- What are the undergraduate nursing students’ perceptions regarding the value of field trip as a teaching method
in community health nursing course?
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- What are the nursing educators’ perceptions regarding the value of field trip as a teaching method in
community health nursing?
- What are the perceived barriers that face under graduate-students’ and nursing educators during field trip?
- What are the causes behind students’ high absence during field trips?
MATERIALS AND METHOD
Materials
Research design:
A descriptive research design was used to carry out the study.
Study setting: The study was carried out in the Faculty of Nursing at Alexandria University. Faculty of Nursing
Alexandria University was the first accredited faculty since 2010 and it has the accreditation for the second time by
2016. It serves Alexandria Governorate, Egypt. The study at the faculty covered by nine departments that equip the
candidate by the essential knowledge and skills needed to serve the community. Community health nursing department
prepares the students to be able to maintain community health promotion that can be provided by health education
through healthy messages.
Study subjects:
The target population for this research was nursing students who were studying in the above-mentioned setting
during the academic year 2016-2017. All the eligible students registered in the community health nursing department at
the end of the 2nd semester of the academic year 2016-2017 were included in the study. The total sample size was 218
students and 22 nursing educators that had previously participated in conducting or supervisory of field trip with
students.
Tools of data collection:
In order to collect the necessary data for the study, three tools were used.
Tool I: Students’ Field Trip experience assessment Questionnaire this was developed by the researchers after
reviewing recent literature to collect necessary data from the students it includes two Parts; Part I: Students’ Socio-
demographic Characteristics that included data related student's age, gender, marital status, and place of residence. Part
II: Students’ Field trip related experience including; number of visits attended along the semester and reasons behind
their absence from field trips, common barriers and factors that face them during field trips, factors that help in
maintaining high students' attendance rate to field trips.
Tool II: Nursing Students’ field trip Perception Assessment Questionnaire. It is a 21-item questionnaire that uses a
3-point Likert scale. This was developed by the researchers after reviewing recent literature to identify the student's
perception regarding the value of field trips as a teaching method in community health nursing; This tool covering 4
subcategories namely the value of field trip in relation to nursing curriculum, Learning process(effective
learning), students’ skills development and community and nursing profession. each student asked to respond to
21statements by using a 3- point Likert self-rating scale which ranged from (0) disagree (2) agree. The reliability test
for the questionnaire was done, using Cronbach`s alpha that measured the degree of reliability. It showed a high
reliability of the total score of the test, Alpha = 0.874.
Tool III: Nursing Educators’ field trip Perception Assessment Questionnaire.
this was developed by the researchers after reviewing recent literature to collect necessary data from the nursing
educators it includes 3 parts Part I: Nursing Educators’ Socio-demographic Characteristics it included data related
nursing educators’ age, gender, marital status, place of residence and years of experience. Part II: This part was
covering Field trip related barriers. Part III: including Nursing educators’ Perception. This part contains 21-item
questionnaire that uses a 3-point Likert scale. This was developed by the researchers after reviewing recent literature to
identify nursing educators’ perception regarding the value of field trips visits as a teaching method in community health
nursing; This tool covering 4 subcategories namely the value of field trip in relation to nursing curriculum,
Learning process (effective learning), students’ skills development and community and nursing profession. The
reliability test for the questionnaire was done, using Cronbach`s alpha that measured the degree of reliability. It showed
a high reliability of the total score of the test, Alpha = 0.852.
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Methods
Administrative process:
- Permission to conduct the study was obtained from the Dean of the faculty and from the head of community health
nursing department.
Content validity:
- After reviewing the recent literature, the three tools were developed by the researchers. The tools were validated by
juries of five experts in the field of community health nursing and nursing education. Their suggestions and
recommendations were taken into consideration.
Pilot study:
- A pilot study was carried out on 20 students from the first semester students, and 2 clinical educators (not included
in the study) in order to ascertain the relevance, clarity, and applicability of the tools, test wording of the questions
and estimate the time required for filling the questionnaire. Based on the obtained results, the necessary
modifications were done
Fieldwork:
- The researchers fully explained the purpose, nature and significance of the study for every respondent (students and
health educators) to obtain their acceptance to participate in the study and to the head of community health nursing
department to get better cooperation during implementation phase of the research. The questionnaire was handed to
the nursing educators while they were on duty and to nursing students during their classes’ time. The way of
answering was explained to them. The time consumed to fill the questionnaires ranged from 15-20 minutes.
- Data were collected by the researchers over one month (May 2017).at the end of the semester to ascertain that the
students had finished the scheduled field trips visits
Statistical analysis:
- Data entry and statistical analysis were performed using the statistical package for social studies (SPSS), version
20.Suitable descriptive statistics were uses such as frequencies, percentages for qualitative variables, means, and
standards deviations for quantitative variables.
- The level of significance selected for this study was p-value equal to or less than 0.05.
Scoring System:
Tool II Students’ Perception Assessment Questionnaire: Each student asked to respond to 21 statements by using a
3- point Likert self-rating scale which ranged from (0) disagree to (2) agree. The total score for each category; ranged
from 0 to 6 points for value to curriculum; while ranged from 0 to 12 points for value to learning process and effective
learning, ranged from 0 to 16 points for value to students’ skills development, and finally range d from 0 to 8 points for
value to community and nursing profession. The higher score for each subcategory indicates higher perceived value of
the field trip.
Tool III Nursing Educators’ Perception Assessment Questionnaire. Each educator was asked to respond to
21statements by using a 3- point Likert self-rating scale which ranged from (0) disagree(2) agree. The total score for
each category; ranged from 0 to 6 points for value to curriculum; while ranged from 0 to 12 points for value to learning
process and effective learning, ranged from 0 to 16 points for value to students’ skills development, and finally ranged
from 0 to 8 points for value to community and nursing profession. The higher score indicates higher perceived value of
the field trip
Ethical considerations
- Informed written consent was obtained from all students and nursing educator after providing an appropriate
explanation about the purpose of the study and the nature of the research.
- The confidentiality and anonymity of students’ and nursing educators’ responses, volunteer participation and the
right to refuse to participate in the study were emphasized to the students and nursing educators as well.
RESULTS
Table (1) represents personal characteristics of nursing students and faculty educators. The majority of students
(90.8%) were single and aged 20 to less than 25 years and more than half of them were female and about one fifth of
them live in rural areas. The table also shows that majority of the nursing educators were female and majority of them
aged 25 to less than 40 years old with equal percent about two fifths of them aged 25 years, moreover, one half of the
them had 5 to less than 10 years of experience.
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Table (1): Distribution of the Studied Subjects According to Their Personal Characteristics
Personal Characteristics
Students (n.218)
Nursing Educators (n.22)
no.
%
no.
%
Sex
Male
95
43.6
1
4.5
Female
123
56.4
21
95.5
Age (years)
20 to less than 25
198
90.8
0
0.0
25 to Less than 30
20
9.2
9
40.9
30 to less than 40
0
0.0
9
40.9
40 and more
0
0.0
4
18.2
Mean±SD
22.1±1.1
32.8±13.6
Marital status
Single
198
90.8
5
22.7
Married
15
6.9
17
77.3
Divorced
2
.9
0
0.0
Widow
3
1.4
0
0.0
Place of residence
Rural
42
19.3
0
0.0
Urban
176
80.7
22
100.0
Years of experiences
Less than 5 years
7
31.8
5 to less than 10 years
11
50.0
10 years and more
4
18.2
Mean±SD
9.1±5.6
Table (2) illustrates the general overview regarding students’ field trips experience. Only one third of students had
committed to attend most of visits (7-8 visits) and only 6% of the students had attained all the visits without
absenteeism. Students had stated a lot of reasons behind their absence as they heard from their colleagues about the
worthlessness of the visit, contradicting time of visit with their working shifts at private hospitals, far site and
unavailability of method of transportation from faculty to visit site. Moreover about one tenth (12%) stated their
absence because of fear to get infection from certain visits
Table (2): Distribution of Nursing Students according to Field Trip Related Experience
Students’ Field Trip Experience
No. (n.218)
%
Number of visits attended
1-3 visits
83
38.1
4-6 visits
63
28.9
7-8 visits
72
33.0
#Reasons behind absence
-Didn’t absent
13
6.0
n.205
Heard from colleagues that it is not useful
50
24.5
No transportation from faculty
45
22.0
Far site
45
22.0
Personal reasons/ work conditions
39
19.0
Study load
27
13.1
Difficult to get objective in short time
22
10.7
Fear from getting infection
25
12.0
# More than one answer
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Table (3) shows that, there is a significant relation between nursing educators’ and students’ perception regarding the
extent value of field trips to community health nursing curriculum (F:14.685, P: ˂0.001*). Majority (95.4%) of
nursing educators as compared to less than half (45%) of students thought that, field trips give a practical approach to
community nursing curriculum. More than three quarters(77.2%) of educators compared to two fifths (43.1%) of
students agreed that field trips enrich and expand the curriculum.. Moreover, near three quarters (72.7%) of educators
versus near one third (30.7%) of students thought that field trip can help and be used as an introduction or conclusion
to a theoretical unit/lecture . The table also reveals that, there is a significant relation between nursing educators’ and
students’ perception regarding the extent value of field trips in promotion of effective learning(learning process) ( F:
12.112, P: 0.001). As majority (95.5%) of educators versus less than half (47.3%) of students thought that field trips
make learning more interesting as it provide real experiences, Making learning more effective rather than reading was
reported by 86.4% of educators versus one half of students(51.8%). 86.4%of educators versus 34.8% of nursing
students’ were in agreement that, field trips meet the needs of different learning styles, Facilitate the learning of
abstract concepts was perceived by 81.9% of educators versus 48.1 % of students while more than three quarters
(77.2%)of educators as compared to 44% of students agreed that field trips helps to overcome some teaching
problems/difficulties.
Table (3): Nursing Students and Nursing Educators’ Perception regarding the Value of Field Trip to Nursing
Curriculum and Learning Process
F: ANOVA test P: P value of ANOVA Test *Significance at P ≤0.0
The Value of Field Trips
as Perceived by Nursing
Students and Nursing
Educators
Students (n.218)
Nursing Educators(n.22)
Disagree
Neutral
Agree
Disagree
Neutral
Agree
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
Nursing Curriculum
Give practical approach
for the curriculum
55
25.3
65
29.8
98
45
1
4.5
0
0.0
21
95.4
Field trips enrich and
expand the curriculum.
50
23
74
33.9
94
43.1
1
4.5
4
18.2
17
77.2
It can be used as an
introduction or a
conclusion to a unit
68
31.2
83
38.1
67
30.7
5
22.7
1
4.5
16
72.7
Mean ±SD of the total
percent
71.0±23.0
90.4±17.5
Test of significance (P value) F:14.685 (P: ˂0.001*)
The value of field trips and Learning process (Effective Learning)
Making learning more
interesting
46
21
69
31.7
103
47.3
1
4.5
0
0.0
21
95.5
Provide real experiences
50
22.9
62
28.4
106
48.7
2
9
0
0.0
20
90.9
Making learning more
effective rather than just
reading
37
17
68
31.2
113
51.8
3
13.6
0
0.0
19
86.4
Meet the needs of
different learning styles of
students
61
28
81
37.2
76
34.8
3
13.6
0
0.0
19
86.4
Facilitate the learning of
abstract concepts.
45
20.7
68
31.2
105
48.1
1
4.5
3
13.6
18
81.9
Overcome some teaching
problems/difficulties
47
21.6
75
34.4
96
44
4
18.1
1
4.5
17
77.2
Mean ±SD
of the total percent
74.6±22.6
91.9±16.5
Test of significance (P value): F: 12.112, (P:0.001*)
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Table (4) reveals that, there is a significant relation between nursing educators’ and students’ perception regarding
value of field trip in students’ skills development (F: 10.581, P:0.001). All educators and slightly more than half
nursing students agree that field trip help in building students’ memories as students cannot forget what they saw,
moreover majority (95.5%) of educators as compared to more than half (53.2%) of students agree that field trips help
students to develop various skills as it promote their cooperation and social skills with each other. In addition more
than ninety percents of educators as compared to near half of students agree that field trip Strengthen observation skills
by immersing students into sensory activities, Increase awareness regarding different professional skills, Help students
to think outside the box. The same table shows also that, there is a significant relation between nursing educators’ and
students’ perception regarding the beneficial of field trip to the community and nursing profession (F: 11.853, P:0.001)
as majority of nursing educators (95.4%) as compared to more than half of nursing students (57.8%) agreed that field
trips help in coordination between different community resources and they agreed also that this will help clients in the
referral process to right places, both nursing educators and students agreed that field trip will help nursing profession in
its marketing especially some people are not aware of nursing profession.
Table (4) Study Subjects’ Perception Regarding the Value of Field Trip to Students’ Skills Development and to
Community &Nursing Profession
The Value of Field Trips as
Perceived by Study Subjects
Students(n.218)
Nursing Educators(n.22)
Disagree
Neutral
Agree
Disagree
Neutral
Agree
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
Students’ skills development
Building positive memories ,students
cannot forget what they saw
29
13.3
66
30.3
123
56.4
0
0
0
0.0
22
100
Promote cooperation and social skills
32
14.7
70
32.1
116
53.2
1
4.5
0
0.0
21
95.4
Strengthen observation skills by
immersing students into sensory
activities
39
17.9
74
33.9
105
48.2
1
4.5
0
0.0
21
95.4
Increase awareness regarding
different professional skills
33
15.1
73
33.5
112
51.4
1
4.5
1
4.5
20
90.9
Help students to think outside the
box
33
15.2
69
31.7
116
53.2
1
4.5
1
4.5
20
90.9
Help students investigate possible
careers for nursing
41
18.8
73
33.5
104
47.7
1
4.5
3
13.6
18
81.8
Help students to develop leadership
qualities
50
22.9
61
28.0
107
49.1
5
22.7
5
22.7
12
54.5
Increase self confidence
47
21.5
64
29.4
107
49.1
11
50.0
10
45.4
1
4.5
Mean ±SD of the total percent
77.1±20.4
91.7±14.3
Test of significance (P value)
F: 10.581 (P:0.001*)
Beneficial to the community and Nursing Profession
Coordination and mutual benefits
from different community
35
16
57
26.1
126
57.8
1
4.5
0
0.0
21
95.4
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The Value of Field Trips as
Perceived by Study Subjects
Students(n.218)
Nursing Educators(n.22)
Disagree
Neutral
Agree
Disagree
Neutral
Agree
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
organization
Help clients through referral process
to the right place
34
15.6
68
31.2
116
53.2
1
4.5
1
4.5
20
90.9
Aware different facilities with
nursing profession( Marketing)
40
18.4
58
26.6
120
55
1
4.5
2
9.1
19
86.3
Expand student's awareness about
different community resources
44
20.2
61
28.0
113
51.8
1
4.5
1
4.5
20
90.9
Mean ±SD of the total percent
78.0±22.8
95.1±15.0
Test of significance (P value)
F:11.853 (P:0.001*)
F: ANOVA test P: P value of ANOVA Test * Significance at P ≤0.05
Figure (1) indicates that the value of field trip to community and nursing profession were the most valued category
rated by both undergraduate nursing students and their nursing educators. While, the least valued category, rated by
both nursing students and their nursing educators, was the value of field trip to nursing curriculum.
Figure (1) The value of field trip as perceived by Study Subjects
Table (5) shows the main difficulties/ and problems that which may affect achieving the field trip objectives outcome
as perceived by both nursing educators and nursing students during field trips. By ranking these difficulties, initially
majority of educators were focusing on students’ related causes such as lacking the students’ interest in the field trip
that may affect on their attendance, lack of their participation lack of student participation in planned activities. Lack of
student professional behaviors during the trip as well as their large numbers equally was stated by 3 fifth (59.1%) of the
educators. While slightly less than half (45.5%) of educators added that Lack students understanding the trip objectives
lack of student adherence to safety rules and regulations during the visit. No commitment to do their post field trip
activity. Then the educators focused to other difficulties as faculty related causes as Lacking of facilities and resource (
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e.g. faculty Transportations, etc..) and lack of coordination between faculty staff and site visit staff. This was followed
by other environmental retard factors as (raining). On the other hand students focused on faculty related and
environmental causes. Environmental causes as Lacking of facilities and resource ( e.g. faculty Transportations,
etc..)(66.1%). equal percentage 56.9% of students mentioned environmental related causes such as weather changes ,
presence of rains and Lack of safety issues at the field site. Students ‘related causes was mentioned also by more than
half of nursing students (lacking of their interest and understanding the field trip objectives) .
Table (5): Common problems /difficulties that Face Students and their Educators during Field Trips.
#Common problems / difficulties
Students (n.218)
Educators (n.22)
No.
%
No.
%
Lack of student interest.
122
56.0
18
81.8
lack of student participation in planned activities
52
23.9
16
72.7
Large students' numbers
57
26.1
13
59.1
lack of student professional behaviors
40
18.3
13
59.1
Lack students understanding the trip objectives
119
54.6
10
45.5
lack of student adherence to safety rules & regulations
66
30.3
10
45.5
No commitment to do post field trip activity/ follow up
80
36.7
10
45.5
Lack of facilities and resource ( e.g. Transportations, etc.
144
66.1
10
45.5
Unorganized visit as lack of coordination between faculty
staff and site visit staff
77
35.3
9
40.9
Environmental factors (rains)
124
56.9
7
31.8
lack of students opportunities to discuss their concerns
with site staff
70
32.1
5
22.7
Lack of safety issues at the field site
124
56.9
2
9.1
# More than one answer
Table (6) illustrates that all students and nursing educators agreed that when the field trips involved less risks to
students health is important factor/motives that help students to achieve high attendance rate to the field trips.
Moreover, While majority of educators as compared to more than half (55.5% ) of students agreed that, having
interactive activities inside the visit, presence of interesting lessons to catch students attention and link the field trip
with their curriculum is considered another factor that help to increase their attendance. More than two thirds (69.9%)
of students agreed that when the field trip is costless and easily reached are another factor encouraging them to attend
the visit. On the other hand, 91.8% of students compared to 40.1% of their nursing educators agreed that receiving gifts
from the site visit was another motive for students attendance, the table also shows significant relation between nursing
educators’ and students’ perception regarding factors/motives helping in high students attendance to field trips (F:
:7.004 /P:0.009).
Table (6) Distribution of the Study Subjects according to their Perception regarding Factors that Helping in
High Attendance to Field Trip by Nursing Students
Factors helping in high students
'attendance rate
Students (n.218)
Educators (n.22)
Disagree
Neutral
Agree
Disagree
Neutral
Agree
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
Field trips involve less risks to the
student health
0
0
0
0
218
100
0
0
0
0
22
100
When The field trips have valuable
interactive activities. (The staff at the
site conduct interesting lesson, to catch
students’ attention )
36
16.5
61
28.0
121
55.5
1
4.5
0
0.0
21
95.5
Field trips tied and linked to
curriculum
36
16.5
61
28.0
121
55.5
1
4.5
0
0.0
21
95.5
International Journal For Research In Health Sciences And Nursing
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12

Factors helping in high students
'attendance rate
Students (n.218)
Educators (n.22)
Disagree
Neutral
Agree
Disagree
Neutral
Agree
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%
Previous Good experience from their
colleagues
37
16.9
63
28.9
118
54.1
2
9.1
0
0.0
20
90.9
If the site visit provide educational
materials
42
19.2
61
28.0
115
52.7
2
9
0
0.0
20
90.9
Field trip is connected to students'
absenteeism
60
27.5
69
31.7
89
40.8
1
4.5
1
4.5
20
90.9
Field trip is costless especially for
students
36
16.5
32
14.7
150
69.9
1
4.5
4
18.2
17
77.2
If the site visit is easily reached by
students
36
16.5
32
14.7
150
69.9
2
9.1
0
0.0
20
90.9
Receiving gifts from the site visit
2
0.9
16
7.3
200
91.8
7
31.8
6
27.3
9
40.9
Mean ±SD of the total percent
76.7±19.2
87.8±13.8
Test of significance (P value) F:7.004 (P:0.009*)
F: ANOVA test P: P value of ANOVA Test *Significance at P ≤0.05
DISCUSSION
Field trips provide a wealth of learning opportunities that enhanced student’s knowledge and awareness of the
available services in the community (Cummins et al, 2009). Positive perception among both students and their
educators are generally affecting the successfulness of this method of teaching. Therefore, the current study aimed to
assess the perception of nursing educators and students about the value of field trip as teaching method in community
health nursing. In practical way, there are a scarcity of researches regarding the value of field visit as one of the
important teaching methods, especially in nursing, in order to examine both the strengths and weakness of this method
[15,16].
Although the primary aim of student’s attendance of field trip is to increase their learning opportunities in line
with the international trends and encourage them to have the ability to integrate theory into practice [15] , the results of
the current study revealed that few percentage of the students had attained all the visits without absenteeism and only
one third of students had committed to attend most of the planned visits (7-8 visits) in the semester.
The reasons behind lack of commitment to attend the planned visits must be clearly understood in order to be
considered in the planning process. Each educator has to know why their students absent. In this regard, the studied
students declared that transportation, far site of the recommended trip, and time constrain as a reason behind their
absence. Nearly the same finding was documented by (Syed et al, 2013) who found that transportation barriers are
often cited as barriers to healthcare access[17].
Furthermore, the studied students in the current study listed that fear from getting infection especially in
certain trip as Leprosium, chest dispensary and fever hospital trip are the reasons behind their absence. In this regard a
study done by Myers B, Jones L ,declared that high levels of anxiety especially among those who attend the novel,
unfamiliar settings of field trips playing a vital role in decrease the students attendance rate and also they added that,
when individuals experience high levels of anxiety, learning cannot take place [18]. These results may explain why the
studied students in the current study are afraid from getting infection. So, the educators have to help their students to
subside their fear and anxiety by equip them with enough knowledge regarding how they will protect themselves as
well as understand mode of transmission of infection. Myers B, Jones L , added that field trip organizers need to make
participants feel comfortable and safe at the location of the field trip to reduce their anxiety level[18].
Additionally, emotional reaction and in adequate readiness of the students affecting their perception of the
value and importance of the clinical training (Jamshidi et al, 2016), [19] in this regard, the current study showed that
there is a significant relation between the educators and students’ perception regarding the extent value of field trips to
community health nursing, where the majority of educators reported that field trips give a practical approach to
community nursing this finding go on line with Anderson et al study (2003) and Mitchie (1998) who revealed that
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13

the vast majority of teachers were approved that field trips were highly valuable educational experiences for their
students. [20,21] .
The idea behind field trip experiential learning is to contextualize knowledge in order to develop a deeper
understanding of theoretical knowledge and make a conjunction between this theory and practice. Field trip provides
real-world experience, increases the quality of education, and improves the social relations, outside of the four walls of
a classroom [2]. These findings confirmed by the studied students in the current study since they stated that, after
attending Leprosium field trip they acquire more knowledge and observe real cases of leprosy than the theoretical part
presented in the skin diseases lecture. Nearly the same findings reported in the results of Malarvizhi et al study (2017)
as they revealed that the majority of the students gave their feedback that the fieldtrip was a real experience [2] .
Unfortunately, the current study showed that only two fifths of students agreed that field trips enrich and
expand the curriculum as they reported that they perform Mantox test at chest dispensary trip which enrich their
knowledge regarding Tuberculosis diagnostic test and others added that they acquire knowledge from Dar-Elhanan trip
which provide services for children with special needs especially regarding their role in develop the exceptional child
skills. These findings agreed with Cummins et al (2009) [15]. Furthermore, Poonruksa (2007) who examine the third
year nursing student's opinions towards the integration of field trip in mental health and psychiatric nursing practicum
at Thailand found that, the students reported that they gain more benefits from this field trip as they gain knowledge
that they cannot read from the book or learn from teacher in the class [16] .
Additionally, field trip facilitates the learning of abstract concepts, motivate students through increased interest
and curiosity and increases student-student and student-teacher social interaction 2, In this regard the current study
found that the majority of the educators and around half of students were agree that field trips facilitate the learning of
abstract concepts, since the students declared that “their field trip to water company help them to understand the steps
of water purification process”, they reported also that “Dar -El Hanan field trip help them to deal with children with
special needs and arouse their curiosity and interest to search about autistic child (causes, signs and symptoms, how to
deal with them)”. In this regard Jamilu (2012) reported that field trip objectives are intended to increase the interest
of the students to get more understanding of the learned topic [22].
Field trip also add a benefit regard students’ skills development through memorization, where Rickinson
(2004) ,declared that fieldwork have a positive impact on long term memory due to the memorable nature of the
fieldwork setting, effective fieldwork and residential experience in particular, can lead to individual growth and
improvements in social skills [23]. The results of the present study revealed that all of the studied educators and
slightly more than half the students agree that field trip help in building students’ memories, that agreed by Wilson
(2011) who documented that field trips enhance student's memory as the students have been found to remember what
they learn in trips for many years [3] . More importantly, there can be reinforcement between the affective and the
cognitive, with each influencing the other and providing a bridge to higher order learning Rickinson (2004) [23].
Field trip also, orient the students regarding the different community resources and services to whom they can
refer their clients, the current study showed that the majority of the studied educators and more than half of the
students were agree that field trip expand their awareness about different community resources this was ascertain by
Malarvizhi et al (2017) who investigate the outcome of experienced based learning (field trip) as a learning technique
in gaining knowledge among graduate and post graduate nursing students and found that the students reported that they
gained invaluable experience about services which are available in their community2 . The same findings were reported
by Poonruksa (2007) also [16].
There are different factors that influence the frequency of conducting field trips as logistic constraints,
financial limitations, lack of time, insufficient support from the faculty management, rigidness of the faculty curriculum
and disruptive behavior of the students [24]. In this regard the results of the current study revealed that lacking facilities
and resource affecting the proper conduction of field trips especially transportation facilities.
Number of the students per group during the trip also affecting the trip successfulness rate, Behrendt and
Franklin (2014) added that time lost trying to organize the large group during the field trip affecting the trip
conduction [25]. In this regard from the educator perspectives in the present study, lack of student professional
behaviors during the trip “inappropriate student’s comment during the visit” and their large numbers “large number
lead to noise and hinder them to listen the explanation at trip site” lead to failure of the trip in achieving its objectives.
A special concern must be provided for the educational objectives of conducting field trip. In community
health nursing clear objectives of the field trip are the key of success of such trip in achieving the required effect on the
students learning experience [1] . As any type of educational program component, field trips should be designed to
cover specific educational objectives [18]. Hence slightly less than half of the educators in the current study added that
lack of students understanding for the trip objectives lead to lack of their attendance, since some of the students see
field trip as funny experiences and not related to their educational objectives so they gave it less priority. So, it is highly
important to orient the students regarding the trip objectives in order to avoid their misperception of it as a journey.
International Journal For Research In Health Sciences And Nursing
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According to Akubuilo (2010) field-trip is a method of teaching that involves taking the students on an
excursion outside the classroom for the purpose of making relevant observation necessary for understanding of the
topic under study and enable the student obtaining scientific, technological and vocational information [26].
To sum up, nursing educators and the students have to know that, if a field trip not planned well in advance
will end in confusion and will be a waste of time and money. So field trip should be planned as a cooperative activity
involving full students participation under the teacher’s supervision (Shakil et al, 2011) [27].
CONCLUSION:
The study concluded that nursing students and nursing educators had perceived positive value regarding field
trips benefits to community and nursing profession, students’ skills development, learning process and finally to
nursing curriculum. Moreover, the value of field trip to community and nursing profession were the most valued
category rated by both undergraduate nursing students and their nursing educators. While, the least valued category,
rated by both, was the value of field trip to nursing curriculum. There are a lot of barriers/difficulties that may face both
students and their nursing educators in achieving the field trip objectives outcome, those barriers and difficulties were
mainly related to Students themselves, faculty and environmental related factors. There were a lot of reasons behind the
students ‘high absence from the field trip as receiving negative impression from their colleagues about worthlessness of
the field trip, unavailability of method of transportation for Far trip sites and contradicting time of visit with their
working shifts at private hospitals
RECOMMENDATION
Based on the findings of the present study the following recommendations were suggested;
1- Enhance students’ high attendance through their motivation for example nursing educators can offer special
certificate for the highest attendance.
2- Although field trip have shown to facilitate students to integrate practical learning with theoretical content this
area requires further development from the nursing educators. thus In service training program is needed for
nursing educators about Field trip planning model (pre trip, trip, post rip related activities and responsibilities of
both nursing educators and students)
3- The field trip should be combined with educational content focusing on development of personal skills (self
control) and team building activities such as working together to complete educational projects
4- Integrate field trip learning with theoretical content in seminar presentation during class time (planned seminar on
the activities as a part of field trip course content to help students link between field trip learning with theoretical
part
5- To decrease negative impression that transferred to nursing students from their colleagues, Conducting post field
trip discussion to allow students to share their feedback
6- Utilize new technology as recoding films, live videos about site visit to confront several barriers as environmental
related barriers
7- Further study is needed to assess the long term retention of knowledge through traditional methods versus field
trip
8- Some factors included in this study need more in-depth researches such as the effect of students’ work status on
their academic achievements and their study duties’ commitment.
Acknowledgement
The authors would like to express their appreciation to the studied students and nursing educators who devote their
time to participate in this research.
Conflict of interest
The authors declared that they have no conflict of interest.
Author contribution
All authors were part of the initial design of the research. They shared in collected and analyzed the data, wrote
and edited the final version of the text of the manuscript and formatted it and submitted it for publication.
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