Students' perceptions of learning and change in the psychiatric clinical setting.

In an attempt to augment our understanding of how students learn, we employed an open-ended questionnaire to elicit students' and pre- and post-experience thoughts and feelings about their psychiatric nursing clinical activities. The questionnaire also asked students to identify specific factors that helped bring about change in their initial thoughts and feelings. Analysis of these data revealed that students overwhelmingly identified clinical experience and self-awareness as the primary change-producing factors, and lecture/readings/assignments, teachers, and peers as secondary. We, therefore, must infer that it is at the experiential and cognitive level that learning is most likely to occur, and it would seem that the "raw" components (assignments, teachers, and peers) provide the stimulus for students to reorganize previous perceptions to integrate then with their newly acquired perceptions in the promotion of learning/change. This finding has implications for the role of the clinical instructor as she or he attempts to enhance the experiential learning process. The perceptions of the students in this study suggest that learning occurs primarily through experience and self-awareness within the context of a structured environment. The implication would seem to be that in the clinical setting the instructor needs to go beyond the didactic role of the traditional teacher to a more facilitative managerial role in the promotion of student learning. Whether or not the student perceives the clinical instructor as a central figure in the learning/change process is of minor importance. Of prime importance is that the instructor assumes the responsibilities inherent in this managerial role and creates an experiential milieu in which learning objectives can be more optimally fulfilled.