{"paper_id":"09004ff0-8f07-48cd-8c19-10ee867712cf","body_text":"Learning dynamics during clinical handover: A qualitative study among final year students in central region nursing colleges, Malawi | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Learning dynamics during clinical handover: A qualitative study among final year students in central region nursing colleges, Malawi Lydia Nkhoma, Baxter Chirambo, Florence Lungu, Thokozani Bvumbwe, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4732263/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Jul, 2025 Read the published version in BMC Nursing → Version 1 posted 11 You are reading this latest preprint version Abstract BACKGROUND : Clinical handover is the transfer of essential information, professional responsibility and authority for care of the patient from one health care provider to another. Clinical handover not only ensures patient safety and continuity of care but also provides learning opportunity for nursing students. Effective learning during clinical handover allows smooth transition of final year nursing students into practice. The aim of the study was to explore the dynamics of learning during handover among final year nursing students in central region nursing colleges. METHODS : A qualitative descriptive phenomenology study was done among final year nursing students in central region nursing colleges in Malawi. Purposive sampling method was used to recruit 15 participants for the study. Data in this study was collected using focus group discussions utilizing a focused group discussion guide. Data analysis was done manually using Colaizzi’s (1978) seven step approach. RESULTS : In this study, effective learning during clinical handover evolved around active involvement of student and teacher, comprehensive content and pedagogical knowledge of the clinical teacher and the conducive learning environment. Teaching strategies like question and answer, discussions and lecture method were among the most utilized teaching methods during handover. Shared knowledge, maximized learning opportunities and diversity were identified as facilitating factors to student learning. However lack of knowledge, poor time management, poor relationships between nurses and students as well as poor attitudes towards handover were among the most attributable barriers to student learning during handover. CONCLUSION : For students to maximize the teaching and learning opportunities that clinical handover offers, interventions like ensuring time management during clinical handover, promoting good work relationships, good clinical handover attendance, improved clinical teacher content/pedagogical knowledge and promoting self-initiated learning among students should be encouraged. Clinical handover Clinical teacher Learning Student BACKGROUND Clinical handover is one of the best open forums for teaching and learning during clinical practice [ 1 ]. It is a regular occurrence during patient care with approximately more than 4,000 clinical handovers happening in a typical teaching hospital per day [ 2 , 3 ]. It involves the transfer of essential information, professional responsibility and authority for care of the patient in varying quantities, between shifts or locations, from one health care provider to another [ 4 , 5 ]. Effective clinical handover is paramount in ensuring patient’s safety and continuity of care [ 6 , 4 ]. In Malawi handover is often performed in three ways; the verbal handover in nursing station, written handover in the report book (read in conference room) and handover at patient bedside. The structured verbal and written handover is highly recommended as it provides opportunity for clarity where others don’t understand. It is associated with higher information retention, encourages team work, reduce work related stress and guarantees job satisfaction [ 7 ]. Clinical handover also provides an opportunity for a multidisplinary team to share notes and discuss a program of care for patients. While patient safety remains the critical focus of clinical handover, learning is a secondary function of a clinical handover [ 8 ]. Learning during clinical handover may be informal thus opportunistic, implicit and reflective or formal whereby teaching and learning is deliberately organized [ 9 ]. The handover experience offers students with insights into clinical practice, patient care management, communication skills as well as teamwork. Final year nursing students involvement in handover further prepare them for their future roles as competent and confident nurses however the nursing education component is not being fully utilized during clinical handover in most clinical sites. Sometimes clinical handovers are conducted too casually such that students do not learn to the extent that students strongly feel that handovers they engaged in are of no educational value to their training [ 10 ]. Despite the great potential for maximum learning during clinical handover, creating capacity for teaching and learning during handover is challenging [ 11 , 12 , 13 ]. Evidence shows that regardless of the benefits of streamlining learning within the flow of daily work and patient care amidst busy clinical environment, learning moments during handover tend to be underutilized and neglected [ 13 , 10 ]. The study findings will help to scrutinize how effective current educational practices in clinical handover prepare students in practice. It will also highlight the opportunities and challenges that students encounter in integrating theory to practice in clinical area as well as highlighting skills in clinical handover that enhance patient outcomes like effective communication. The findings will also help in curriculum development and improvement of educational strategies in nursing programs. The article therefore explains final year nursing student’s educational journey on learning during clinical handover, exposing how they participate in clinical handover, motivating factors and challenges they face as well as recommendations for optimizing learning opportunities during clinical handover. METHODS AIM The aim of this study was to explore learning dynamics during clinical handover among final year students in Central region nursing colleges, Malawi. RESEARCH APPROACH AND DESIGN The study employed qualitative approach, utilizing Husserl’s descriptive phenomenology design. STUDY SETTING The study was conducted at Daeyang and Nkhoma nursing colleges in the central region of Malawi. Nkhoma College of Nursing and Midwifery offers diploma in nurse-midwife technician program whilst Deayang Nursing College trains registered nurses and midwives at both diploma and degree level. STUDY POPULATION The study targeted 67 final year students at Daeyang Nursing College and 51 final year nursing students at Nkhoma College of Nursing and Midwifery. SAMPLING The study used purposive sampling approach. The study required information from students who had enough and wide experience overtime. INCLUSION AND EXCLUSION CRITERIA Inclusion criteria; (1) final year nursing student (2) have had experience on the following clinical handovers; the verbal handover in nursing station, written handover in the report book (read in conference room) and handover at bedside. Exclusion criteria; nursing students in first and second year. SAMPLE SIZE The study conducted two focused group discussions, one at each of the selected nursing colleges thus Deayang Nursing College and Nkhoma College of nursing and midwifery comprising of 7 and 8 students respectively, making a total of 15 participants. DATA COLLECTION INSTRUMENT A focused group discussion guide with open ended questions was used. Probes were used as needed to clarify the meaning of responses and encourage in depth descriptions. The guide was in English language. The tool was developed by the researcher guided by the study objectives. Expert’s opinion was sought to validate the focused group discussion guide. DATA COLLECTION Data in this study was collected using a focus group discussion. Two focus group discussions were done, one at each selected nursing college. To acknowledge and set aside biases during data collection, the researcher used reflective diary so that all prior knowledge/experience with the phenomenon are kept in check (bracketing). The researcher first had private meetings with the participants in designated rooms where the aims of the study, the type of data, procedures and eligibility criteria were explained. The meeting enabled participants to ask questions and give consent. No participant declined to participate in the focus group discussions. The researcher was the moderator and facilitated as well as controlled the focus group discussion. To ensure anonymity, the group members were assigned pseudonyms. The participants gave permission to use an audio-recorder during data collection. An assistant helped with taking notes during the discussion and recording the deliberations using a recorder. The focus group discussion approximately took 45 minutes. The recorded and transcribed responses were stored in a locked drawer and only the researcher and the research supervisors had access to them. To ensure privacy and protection of the soft copy findings, data documents were archived in a password-protected file. The responses were also coded. DATA ANALYSIS The recorded focused group discussions were transcribed verbatim by the researcher. Data was analyzed manually using Colaizzi’s (1978) seven step approach. Firstly, the researcher read the transcripts for both focus group discussions more than three times to familiarize herself with the collected data. The researcher then extracted the phrases and statements that precisely described experiences of students on learning during handover from the transcripts and gave to peers for verification. Correct meanings were then derived from the significant statements and discussion with peers was done so as to avoid misinterpretation of the participant’s views. Findings were then presented as themes and subthemes supported with verbatim statements. The researcher utilized the emergent themes, subthemes and the formulated meanings to give a comprehensive description of the dynamics of learning during handover among nursing students then the description was narrowed down so that only essential aspects of the phenomenon is discussed. Finally the participants confirmed their experiences. RESULTS The analysis of data yielded five themes which are; Clinical handover learning moments, Student teaching and learning strategies, facilitators to learning during clinical handover, barriers to learning during clinical handover and improvement strategies for maximum learning(see Table 1 ). THEMES AND SUBTHEMES Table 1 summary of themes and subthemes which emerged from the analysis of data THEME SUBTHEMES Clinical Handover learning moments Student involvement Student teaching and learning strategies Question and answer, Discussions, Lecture method Facilitators to learning during handover Comprehensive sharing of knowledge Clinical Handovers’ wider range of scope Maximized learning opportunity Barriers to learning during handover Poor time management Limited space/environment Lack of knowledge Poor handover attendance Poor nurse/student interpersonal relationships Clinical teachers’ acquisition of updated knowledge/skills and attitudes. Improvement strategies Nurse/students’ dedication to learning. Strengthening interpersonal relationships. HANDOVER LEARNING MOMENTS The focus group discussions revealed that most students gained knowledge/skills by being involved during clinical handover. Participants reported that in some hospitals it is mandatory for students to attend and read reports during clinical handovers. Participants gave the following account: ‘ Students that were on day/night shift are often the ones who present the general conditions of patients that were in the wards for that shift ’ (D participant 4). ‘ As students we are expected to give handovers and answer different questions on how we managed our patients when we are on night duty. Senior nurses actually tell us to read the report during clinical handover ’ (N Participant 3) Students have been cultivated to take clinical handovers as part of their duty; they have a responsibility to give an account of the patient care after a shift. The participants further explained their involvement in clinical handovers as exciting; ‘ Students are always given the first chance to give clinical handover report and make presentations and not qualified nurses, such that questions and comments will first be directed to students then later to qualified nurses so everyone will be involved in the learning and its really funny.’ (D Participant 1) Student are priotised during clinical handovers and are given a chance to express themselves which makes them excited as they feel they are part of the team. The participants indicated that they are also involved by being given tasks. Different tasks may be given to students to stimulate learning. This is illustrated in the following excerpts: ‘…. Clinical teachers share different conditions to students to make presentations on, during handover ...’ (D Participant 1) ‘ We are given a lot of presentations as our assignment especially in conditions that we have shown lack of knowledge so that we find out more about such conditions .’ (D Participant 5) ‘ Students are involved by being given topics to present at morning handover. ’ (N Participant 8) Students not only attend handovers but are also given a chance to teach others by presenting on different conditions. Other tasks that the participants were given was to care for the patients who have been discussed in clinical handover. A participant said: ‘… students may be told; ‘you take care of the patient then you give us feedback on what you have done for the patient’ (D Participant 2) Students are assigned patients to care for and then give a report. The participants also got involved in clinical handover by taking part in clinical handover deliberations. Some participants said the following in this regard; ‘ Students are given a chance to ask questions; for example we may inquire what lead to a patient’s death or how the patient was managed .’ (D Participant 4) ‘ The matron and the in-charges make sure that every student participates in the clinical handovers and they also encourage us to ask questions and give us assignments. Different questions/assignments are directed to different groups of students in accordance with their level for example the seniors may be asked about the management of a lady who is having vaginal bleeding at 24weeks pregnancy (D Participant 1) However, other participants mentioned that they were sometimes not involved in clinical handovers, as indicated below; ‘…..the qualified staff were not involving students during clinical handovers, sometimes they would do clinical handovers earlier than the usual time such that student would find that they have finished handover session by the time they arrive’ (N Participant 2) ‘ Other qualified nurses would not show any regard of the presence of students during clinical handovers and were not involving us .’ (N Participant 1) ‘ Sometimes they would just discuss amongst themselves (qualified staff) not regarding students’ (N Participant 5) The sentiments demonstrate that the students were not happy when they were not involved during clinical handovers. They felt sidelined. TEACHING STRATEGIES USED DURING HANDOVER Further findings of the study demonstrated that different clinical teachers used unique teaching strategies during handovers to foster learning. Other clinical teachers utilized question and answer when teaching during clinical handovers. The following excerpts provide participants’ experiences with questioning and answer teaching strategy; ‘ In morning clinical handovers, students meet conditions that they are not familiar with, so when more questions are asked to the one presenting on a condition and explanations are made on the condition, as students we gain more and we later refer back to our notes and this helps us to understand the condition practically/better ’ (D Participant 2) ‘ As students we are also asked a lot of questions during clinical handover, sometimes we may want to answer the questions but we lack the information, so these questions motivates us to be able to reflect and find out more about the conditions’ (D Participant 3) ‘ During clinical handovers, students are often asked a lot of questions, because of that, students are prompted to read more to avoid embarrassment that comes by failing to answer questions in clinical handovers. In this way students greatly improve and they eventually become competent ’ (D Participant 1) ‘….so as students we are asked questions which prompt us to search/find more, for example on internet or student notes .’ (D Participant 4) Students are asked questions during clinical handover, this make them eager to learn as such they search for more information by studying their classroom notes or using the internet. Other students also study in order to avoid embarrassment that comes due to failure to answer questions. Despite the good teaching moments explained above, some participants expressed their dissatisfaction with the method by describing how question and answer teaching strategy affect their learning. Participants expressed the following sentiments; ‘…. If a student fails to answer a question they are punished by either being given a presentation to make or are told to go into the hospitals library to read whilst their friends have gone to the ward. For slow students this exercise may take them the whole day meaning that they have failed to go to the ward on this day … ’ (N Participant 7) ‘…others clinical teachers do not respond politely to students whenever they ask questions for example they would say; ‘in which year are you? You are in final year and you don’t know anything about that?’ (D Participant 4) ‘ Qualified staff don’t answer students politely, for example when a student ask a question, they may say ‘knowledge is expensive’ and they do not answer the question. (N Participant 3) ‘…. whenever students ask questions they don’t respond, they will ask the one asking what they think and then give them as an assignment to present. We are not against assignments however when often times questions turn to assignments students refrain from asking because they are afraid they will be given an assignment instead of an answer.’ (N Participant 3) Students feel other clinical teachers intimidated them when they asked questions. Clinical teachers resorted to giving students punishment instead of teaching the students, others opted to responding harshly while others gave assignments. Participants also mentioned discussions as one of the frequently used teaching strategy. Participants remarked; ‘ We gain much knowledge during (morning) clinical handovers; this is so because different medical/surgical conditions are discussed during handovers such that when we go to our respective wards we are interested/motivated to take part in the management of patients with different conditions that were discussed during the handovers ’ (D Participant 7) ‘ sometimes other conditions are not explained properly in class but during clinical handovers we are able to relate and gain more understanding because during discussions there are explanations that help us create a picture of something like ‘aaa so this is how it is’ this also help us to probe more’ (D Participant 4) ‘…the discussions and the questions that follow, help us to learn even more’ (N Participant 3) ‘ I like discussions with facts; so when colleagues debate on the best management of a client in handovers I become more interested and at the end I learn something from the discussions.’ (N Participant 5) Students felt that they learnt a lot when discussions were used during clinical handover. The focused group discussions also revealed that discussions enable students to immediately practice and evaluate what they have learnt. Participants had this to say; ‘ During clinical handover students are taught about different conditions, then are instructed to provide direct care to patients who have been reported as having the said /discussed condition. ’ (D Participant 6) ‘ During clinical handovers students may also be assigned to take care of patients that are discussed. This provide a chance to students to provide quality care to patients because they know they eventually will have to give a report/feedback on how the patient is progressing. Such assignment enables students to gain more knowledge .’(D Participant 2) ‘ Ordering students what ought to be done on a patient is helpful because whatever students practically do they don’t really forget. It also help students to gain experience and it provides an opportunity to ask more questions hence increased understand. ’ (N Participant 2) Students are able to integrate theory into practice soon after discussions. However other participants were not happy with the tasks. A participant narrated; ‘Students are not supposed to be given tasks outside of their objectives for that day because this affects learning. Qualified staff have to acknowledge that this is a student and they have to be handled as such’ (N Participant 4). Students have their daily objectives, tasks assigned to them may deter them from achieving theirs. Participants also expressed that they were being taken advantage of during clinical handover as the nurses relinquished most of their responsibilities to them. Participants shared their experiences; ‘ In other form of clinical handover like bedside….for example if there is a discussion and then members want to know the immediate vital signs, qualified personnel take advantage of students by giving us tasks like to get vital signs kit to check vital signs but the discussions continues so by the time the student arrives, the clinical handover has already been done, other educative discussions about the patient have finished and the student was left out’ (N Participant 5) ‘ Clinical handover process has to be improved. Students have to be given priority to learn. Hospitals have to remember that students are there to learn and not to cover shortage for instant sending students on unnecessary errands during learning have to be minimized so that students concentrate on their learning’ (N Participant 5) Students felt that instead of learning during clinical handover, they were being misused in the ward to do the routine work of the qualified nurses. The other method that participants mentioned was lecture method. Participants indicated that they learnt during their clinical handover through presentations. Participants expressed their contentment; ‘ …..they teach students using power point presentations. During power point presentations students learn a lot for example causes of illnesses or their management’ (N Participant 4) ‘ …they use power point presentations when teaching students to facilitate understanding .’ (D Participant 4) ‘ The teaching strategies that they use are very effective because they are well detailed. For example if they want to present on pneumonia it means they will describe the disease, its causes, management and complications and this helps us know how to handle real patients’ (N Participant 3) ‘ I like the presentations that happen at the morning clinical handovers. I always look forward to handover time because presentations that are done sometimes new topics are taught or they are presentations that I did not understand in class ‘(N Participant 1) Most participants’ views indicated that presentations during clinical handovers were effective in their learning. FACILITATORS TO STUDENT LEARNING DURING HANDOVER Focused group discussions showed that sharing of information repeatedly during clinical handover initiates learning. A participant had this to say; ‘Clinical handovers give us the chance to hear the information/learn about a condition several times such that the information easily stick in our heads and we are able to understand and utilize it practically.’ (D Participant 3) Students acknowledged that information shared several times aided in retention The focus group discussions also showed that clinical handovers provide a platform for nursing students to be exposed to comprehensive new information during handover. Students’ testified to consistent up to date information that clinical handover provides: ‘ In our profession things change each and every day, mostly classroom information is outdated so we usually find different management of conditions in the clinical area so during clinical handovers new information is learnt. ’ (D Participant 4) ‘ Handover helps us learn new things that have been introduced or recently changed. For example in class we learnt of different dosing of clients with pre eclampsia and eclampsia but when we are here we have learnt that it was reviewed and the dosing is the same now. (N Participant 2) ‘… We are able to learn new things that were not taught in class. Sometimes it also helps us to understand better the topic/conditions that were difficult to understand during classroom learning. ’ (N Participant 6) Clinical handover helps us to add to the body of knowledge that we got in class… (D Participant 3) Students get refreshed with new knowledge during clinical handovers. The study also revealed that clinical handover education caters a wider scope in which several skills are addressed which are of paramount importance in learning. Some of the skills that the focused group discussions discovered was communication. The following narration illustrates this; ‘…Some students are afraid to speak to a group of people, clinical handover may help such students. I have noted that if one makes a mistake today when giving handover, colleagues correct them and they improve next time. ’ (D Participant 1) Students can learn communication skills which helps build their confidence. Furthermore findings also indicated that there is maximized learning during clinical handover. Participants commented that students are able to learn more on conditions that they failed to learn during their previous allocations; ‘ … a student doing midwifery is able to learn more about a condition and its management in medical surgical nursing which they were unable to learn from during their stipulated allocation, so clinical handovers redeem such times since most clinical handovers include all cadres and all departments .’ (D Participant 3) ‘ Clinical handovers help us to learn conditions that we had no opportunity to experience/learn about during other allocations because a lot of conditions are discussed during clinical handover.’ (N Participant 2) Students acknowledged that handover can redeem lost learning opportunity. BARRIERS TO STUDENT LEARNING DURING HANDOVER The participants indicated lack of guidelines as one of the barriers on learning during clinical handover. The following excerpt illustrates; ‘…some facilities do not offer systematic clinical handovers they simply make it short and inconsistent, this makes it hard for student learning .’ (D Participant 4) Students fail to learn when clinical handover is unsystematic. The focus group discussions also revealed that environment can affect learning during clinical handover. This is what was said; ‘ …. I suggest a special place be created in the wards for clinical handovers so that student maximize their learning during clinical handovers .’ (N Participant 5) Students suggested that a designated room/place would help to maximize learning during clinical handover. Participants also mentioned time management as one of the barriers. Participants remarked; ‘…lack of time management. I remember one time the morning clinical handover was supposed to start at 7;30am but then most workers came at 7;40am or others at 8am and then maybe there is a presentation, so instead of giving that presentation 20mins,they give 10 minutes, this affects the delivery of the presentations as well as follow up questions or comments.’ (D Participant 7) Students felt that poor time management affect subsequent activities like learning. In addition, the participants reported that nurse/student relationship was a barrier to learning during clinical handover. The following excerpts provide participants’ explanations; ‘.. As students we are also affected by the attitudes of in charges/matrons. The way qualified nurses approach students when they have made a mistake is not good, they instil fear and this affects them psychologically. This makes students fail to ask them questions.’ (D Participant 6) ‘...During bedside handover, sometimes the qualified nurses don’t speak respectfully to student especially when they have not done something well. It becomes embarrassing to students as this is done in front of patients .’ (N Participant 8) Students observed that qualified nurses were rude to them and had bad attitudes towards them. Furthermore, participants highlighted that other students were not comfortable to learn/ attend clinical handover because of unprofessional conduct of clinical teachers. A participant explained; ‘….the issues of intimate relationships affect student learning. There are some in charges or other colleagues we meet in hospital they like asking students out a lot, so we know how relationships work its either you are committed physically or psychologically. It becomes even too difficult when you refuse to be in relationship with them. They sometimes refuse to sign for you for the procedure you have done and when its clinical handover time as a student you may fail to freely participate thus affecting your learning .’ (D Participant 6) Students complained that romantic/sexual advancements affected learning during clinical handover. The focused group discussion further reported poor clinical handover attendance as a barrier to learning during clinical handover. Most qualified nurses or nursing in charges don’t attend clinical handovers. Participants said the following in this regard; ‘… Most nurses don’t go for clinical handovers, this affect the quality of clinical handovers such that the students even fail to ask questions because there is nobody who can respond to the questions especially when it’s only the students who are available. ’ (D Participant 5) Another commented: ‘ Lack of interest by qualified medical practitioners to attend morning report. It reached a point in whereby a report was suspended that today because as a senior was just alone with students in the morning report. This affects student learning as it reduces the motivation of students to attend and participate in the morning clinical handover (D Participant 3) Students noted that qualified personnel do not patronize clinical handover and this has implications on their learning during clinical handover. In addition, participants mentioned that the other barrier is lack of knowledge by clinical teachers. One of the participants’ very disappointed expressed this: ‘… they are unable to even properly fill the partograph….This makes the students lose trust, they may not even ask such nurses when they have questions’ (D Participant 1) ‘… Knowledge of clinical personnel also matters. When students sense that their clinical teachers have less knowledge or skills they are demotivated to attend the handover because they feel they may not gain the necessary information from them.’ (N Participant 4) Quotes above demonstrate luck of trust by students to learn from other clinical teachers whom they perceive to lack knowledge. IMPROVEMENT STRATEGIES Participants shared some suggestions for maximizing learning during clinical handover. Participants revealed a need for clinical teachers to acquire updated knowledge and skills, they suggested the following: ‘Nurses and clinicians should have enough and updated knowledge which they will be able to share to students. This may be done by regular trainings. This is essential for students to gain proper knowledge skills and attitudes.’ (D Participant 4) Participants also reported that nurses and students have to be dedicated to learning, this is what was said; ‘ Qualified nurses should be dedicated to their work and should be willing to help/teach students. (D Participant 6) ‘ Students have to initiate their own learning. They should have objectives and must approach the qualified nurses to help them achieve their objectives/care for patients that were discussed during clinical handover (N Participant 5) However a suggestion on self-initiated learning received a lot of criticism. Participants expressed their concerns; ‘ I disagree on student own initiative. Sometimes it depends on the qualified staff that is available, others have bad attitudes towards students so even if you plan to learn if there is a qualified staff who will not listen to you, you don’t attempt to ask rather you wait for another day (N Participant 3) ‘ I also disagree with student own initiative. Sometimes students have well written and planned objectives but qualified staff disrupt this by asking students to do other tasks and students are afraid to refuse because they are afraid to be labelled as rude or others may inform the lecturers’ (N Participant 6) Students feel that nurses should be motivated to make handover experience educative and memorable for students however when it was suggested that students should improve, students gave a lot of excuses. Participants also suggested the need for involvement on presence of staff during clinical handover. Sentiments were expressed as follows; ‘ Participation of in charges and other qualified nurses in the morning clinical handover is important. This reassures students that if they ask questions, they will be answered properly .’ (D Participant 3) ‘ The presence of highly ranked health personnel like the matron and the District Health Officer during handovers boost morale …... ’ (D participant 1) Participants suggested improvement in terms of communication and professionalism. Participants remarked; ‘ Students should be treated with respect too. Qualified nurses should mind their language as they communicate with students so that they are fit psychologically to be able to help patients properly .’ (D Participant 3) ‘ When doing clinical handovers, the qualified nurses should speak to students respectfully taking into consideration that sometimes patients are also there ’ (N Participant 7) ‘ Qualified staff should stop underrating students. Students can contribute a lot too but they are afraid that if they ask a question or make a comment they question will turn into an assignment or may be insulted by being told they are not smart or are rude’ (N Participant 3) ‘When students ask questions the qualified staff should be able to simply reply because that will not only help the student but other qualified staff as well .’ (N Participant 2) ‘ Nurses as well as students need to stick to code of conduct, Students become shy to go ask somebody who once wanted to be their girlfriend/boyfriend yet they still have to help patients together so it becomes hard to lender quality services. ’ (D Participant 5) DISCUSSION This study explored learning dynamics during clinical handover for final year students in Central region nursing colleges, Malawi. The findings of the study revealed that students gain knowledge during clinical handover by getting involved. Students participate by attending or performing clinical handover. Different tasks are given to students during clinical handover to stimulate learning by doing [ 14 ].The finding is in line with a study on student nurses’ engagement in learning which noted that active involvement helps students to become more effective, current, knowledgeable as well as independent thinkers and problem solvers [ 15 ]. These findings are also consistent with results of a study by [ 16 ], which highlighted that students’ learning to a large extent is dependent upon student participation. Student involvement implies an investment of physical and psychological energy in learning [ 17 ]. Students who actively get involved in clinical handover sessions, do not only receive information but they also contribute in discussions during clinical handover. Observing and participating in handovers exposes students to real life clinical decision making processes [ 17 ]. Students retain information better when actively involved than just passively listening. This is because they understand the context behind decisions made during clinical handover and the knowledge gained may be applied in future clinical scenarios too. This is attributed to the discussions that happen during clinical handover which enables students to think critically about patient’s condition, plan of care and potential outcomes by asking questions, seeking clarifications and exploring different perspectives. [ 17 ] argues that students who are frequently involved in an activity are more likely to learn academically and develop personally. In this study, attending and performing clinical handover was mandatory in other clinical sites, this therefore place students at an advantage to learn. Students level of involvement /participation change with time, this affects learning quality and quantity [ 17 ]. Therefore, the researchers recommend that students ought to be committed during clinical handover learning so that they are able not only to understand what is taught (quality) but also be able to grasp more information (quantity). The study further indicated that students are considered part of the clinical team as they are given the opportunity to contribute during clinical handovers. [ 18 ] argued that students should feel welcomed in the clinical area so that they easily adapt and professionally associate with clinical staff. However, students also mentioned that in some instances they were not involved in clinical handovers, which made them feel sidelined. This is related to the finding in a study to explore nursing students’ handover involvement during their clinical rotations and associated factors, where nursing students reported no involvement in clinical handover during rotations. The study further explained that limited opportunities for clinical handover involvement prevents students’ sense of becoming part of the team, affects socialization and their identity development [ 19 ]. This is because students may feel that they are not important and cannot contribute to the team. This study also found that different teaching strategies are utilized during clinical handover. It was revealed that clinical teachers used more students centered teaching strategies like discussions and question and answer (66.6%) than teacher centered approach for example lecture method (33.3%). This finding is in contrast with the findings by [ 20 ] who found that traditional teaching methods and learning styles still dominated in nursing making it difficult for students to become critical thinkers. The finding is of great significance now that student centered approach is encouraged. [ 21 ] concur as he encourages ‘problem posing’ to learners. He agrees that student centered teaching strategies help in empowering learners to become effective decision makers. Similarly, [ 22 ], described student centered approach as an education that raises students’ consciousness and their creative power. Findings of this study revealed that the clinical teachers used question and answer to involve and teach students during clinical handover. Clinical teachers asked a lot of questions during clinical handover in order to seek clarity on patient assessments or condition as well as to find out student level of knowledge while students often asked questions to gain knowledge where they did not know or understand. These findings are in line with a study which highlighted that teachers ask questions to facilitate and assess student’s knowledge while students asked questions to clarify assumptions or when there is knowledge gap [ 23 ]. In support of the findings, a study by [ 24 ] indicated that during clinical handover, knowledge and experience can be shared by asking questions. Similarly, other research findings have also shown that oral clinical handover provide an opportunity for students to take part in professional discussions by either asking or answering questions [ 25 , 26 ]. Furthermore, [ 9 ], found that the use of educational questions was an essential communication strategy to promote learning. The knowledge gap during clinical handover may further be filled by seeking information through questions [ 27 ]. It is thus important that the students are encouraged to ask questions during clinical handover so that their education needs are met. Questioning promotes critical thinking during clinical handover since students are required to analyze patient data, priotise information and understand the plan of care [ 28 ]. Critical thinking is necessary for nurses as they are expected to make decisions about complex healthcare needs [ 23 ]. However this was not the case with the current study. This study reveals the teaching strategy being used by the clinical teachers is the basic question and answer strategy other than the Socratic questioning strategy which target high level questions and is used as a teaching and learning strategy to facilitate the critical thinking skills of students. This finding is consistent with the finding in a study to investigate questioning skills of clinical facilitators who support the learning of undergraduate nursing students, which found that nursing facilitators in the clinical setting ask students’ predominaly low level questions [ 29 ]. Furthermore, other studies also show that educators more often ask lower level questions in a teaching /learning context [ 30 , 31 ]. This implies that student level of clinical judgment, decision making and critical thinking in this study is not being targeted and therefore can affect patient care and smooth transition of final year students into becoming competent nurses. The educators may ask low level questions because they lack clinical education training, lack awareness and even the educator’s own lack of critical thinking. Therefore, the researchers recommend that clinical teachers should be taught how to frame questions for students that require application, analysis, synthesis and evaluation. Clinical teachers have to use question and answer as a teaching method because it can help improve students’ communication skills as students learn how to articulate issues. Furthermore, question and answer strategy can aid in finding out if individual students have grasped what has been taught and can guide teachers the areas to be emphasized or repeated. Although the method has several advantages, this study found that there are some challenges associated with implementing the method during handover. Some of the challenges highlighted by the participants were; unnecessary punishments which followed when the students fail to answer questions, disrespectful comments made by qualified members of staff to embarrass students and unnecessary assignments given to students when they seek clarifications. The findings are in line with a study that demonstrated that students felt offended by doctors who reprimanded them due to their failure to answer questions even though they did know the answers [ 18 ]. There are also several factors that may affect the degree to which staff and students ask questions during handover which are; existing hierarchies, staff relationships and limited opportunity or time [ 32 ]. However effective communication maybe achieved during clinical handover by fostering staff assertiveness and respect [ 33 , 34 ]. The study findings also indicated that poor relationships had the ability to affect/hinder students from asking questions due to the negative consequences that followed for example being belittled. Clinical teachers ought to treat students with respect, and should help create an atmosphere for students which is friendly to aid learning. Where possible, prompt explanations on patient management should be done to minimize errors. It is necessary also that during question and answer, the questions should be clear and minimize jargons as much as possible to avoid hindrance of information transfer, keeping in mind also that during handovers students of different levels are being taught at the same time so grasping of information may vary. Clinical teachers understand that there may be uneven participation during handover, not all students can ask or answer questions, and others feel uncomfortable to answer questions as they are shy. This may affect the effectiveness of the method. This study has also shown that students are able to learn more through discussions. This is in line with a study finding which aimed at comparing the effectiveness of lecture method and discussion on knowledge regarding selected communicable diseases (Dengue and Malaria) among nursing students, which found that discussions improves knowledge and student participation [ 35 ]. Discussions help students to learn by developing social skills through interaction with others (communication) and obtaining new knowledge. These skills can help students to be able to defend ones opinion, assessing as well as evaluating other people’s views [ 36 ]. During discussions in clinical handover, students are encouraged to participate and share in decision making. Students participate in discussions during clinical handover by answering or asking questions, taking part in case based studies as well as through peer discussions where senior students mentor junior students through shared experiences and insights. During discussions students apply theoretical knowledge in a practical context. Discussions during handover embraces a variety of clinical illnesses or issues. This study indicates that students were willing to apply what had been discussed in management of the patients as they would care for the patients who had been discussed during clinical handover. This is in line with the study done by [ 9 ] which found that teaching and learning moments may be facilitated by the preparedness of the learner. This study findings revealed that lecture method is one of the strategies that is also used in teaching and learning during handover. Students were contented with lecture method because it created opportunities for learning new materials. This is consistent with the study findings that the lecture method is the best teaching method for immediate knowledge retention for nursing students and it is most favorite method for most students [ 37 ]. The finding in this study could probably be because students do not have to put more effort during learning as much work is done by the teacher. However, other studies had different findings too, whereby lecture method was not welcomed by students as it does not provide ground for student’s development and satisfaction. [ 38 , 39 ]. Lecture method has the ability to transfer important information and concepts to a large group of people [ 40 ]. However the major disadvantage of the lecture teaching strategy is that it is not very effective for the development of critical thinking skills required in medical related fields like nursing [ 38 ]. [ 41 ] emphasized that lecture method has no significant effect of critical thinking abilities of student. While the lecture method is effective in transmitting information during clinical handover, it is necessary to use it in conjunction with interactive element for example questions, brief discussions, videos or handouts and the teacher should encourage identification of areas for need for clarity or explanations. This study findings also revealed that there are several facilitators to student learning during clinical handover. Clinical handover enabled students to learn and be supplied with new information consistently (Comprehensive exposure to new information).It involves sharing information about different patients with different illnesses, which ensures that members present constantly share new trends of illnesses and their treatment guidelines. This is in line with findings from a study by [ 42 ] which demonstrated that teachers can facilitate students’ learning by providing up to date information. The new and relevant information shared during clinical handover helps students to copy and deal with ongoing tasks, projects or patient conditions and this helps in reduction of errors in provision of care. Students may also utilize the information to excel academically. Sharing of knowledge during clinical handover may motivate students to attend clinical handovers thus an opportunity to learn more. Students may have knowledge gaps due to different clinical exposures, educational background or experience levels. The gaps can include the clinical manifestations of an illness or its management. This study found that clinical handover help students to understand the content covered in class better (Gap bridging opportunity) this is because there is some repetition of conditions being discussed during clinical handover which give students ample time to learn and keep up to date with their studies. Similarly, [ 43 ] indicated that knowledge loss is minimized if an activity is repeated thus enhanced learning. This ensures individual knowledge depositions which can further be expanded. It is easy for students to forget when theoretical knowledge is not being used for a long time, therefore clinical teachers should encourage students to attend clinical handover to keep them active by reinforcing application of theory into practice. The study also revealed that learning during clinical handover caters a wider scope. Skills like communication which is of paramount importance in learning is addressed during clinical handover. Communication is necessary for career development. Students in this study revealed that others lacked communication skills however with time they had improved as they kept practicing during handover. These findings are consistent with results of a study by [ 44 ] which revealed that effective communication skills in nursing practice are not inborn, can be learned and enhanced. The study findings are also in consistency with [ 45 ] who found that most students lack communication skills necessary for effective learning in the clinical area. Several studies also noted that most nursing students have low self-confidence, this therefore results in fear and anxiety such that communication in nursing students is impaired [ 46 , 47 ]. A lot of nursing students do not go through formal education to learn how to perform handover rather on job training represents the main learning strategy [ 48 ]. This finding is consistent with what [ 49 ] and [ 50 ] found that communication training is not a priority in nursing education such that few nursing programs offer systematic instruction or clinical handover education to students though much is expected of them after graduation .Consequently,[ 51 ], found that without structured clinical handover education, nursing students become inactive recipients during clinical handover. Ensuring effective performance and optimal learning during clinical handover should be one of the priorities of nursing education [ 52 ]. It is necessary for final year nursing students and junior staff to be trained on how to give and receive clinical handover before they lead or initiate them [ 53 ]. The clinical teacher therefore has to ensure that a platform is set during clinical handover where students are taught effective communication techniques. [ 54 ] suggested the use of simulation and structured clinical handover techniques prior to clinical placement which has shown to increase student confidence to engage in clinical handovers during their clinical placements. Simulation based clinical handover has proven to reduce medical errors and preventable adverse outcomes [ 55 ].Similarly, [ 56 ] recommended the use of ISBARR (Identify, Situation Background Assessment, Recommendation and Repeat) to help address student’s perceived anxiety and confidence levels associated with clinical handover reports. The study further found that clinical handover helped students redeem their lost time and opportunity to learn on different procedures/illnesses, for example students on midwifery practice could learn medical/surgical conditions which they never had some opportunity to practice on during their practical experience. Learning during handover may be informal thus opportunistic, implicit and reflective or formal whereby teaching and learning is deliberately organized [ 9 ]. In opportunistic learning clinical teachers take advantage of a situation or condition that has been presented/reported, to teach more on a condition/disease thus engaging students in learning and one example is use of case-based teaching. [ 57 ] noted that students are stimulated to critically think by being exposed to different scenarios which facilitates the identification of omissions and the ability to rectify gaps. Reflective clinical handover learning involves making ones learning a more conscious process whereby critical thinking skills are developed by analyzing experiences to improve future performance. An example is when a case that has been presented/discussed during handover leave members thinking/contemplating on their own clinical practice as compared to the one presented during the handover [ 9 ]. Implicit learning also happen during clinical handover where by members share experiences and due to the repeated exposures to different cases not seen by members themselves, learning takes place [ 9 ]. Clinical handovers provide an opportunity for students to observe and learn how experienced professionals communicate, prioritize information and make decisions [ 18 ]. Therefore the researchers recommend that nurses should make sure that at any available time students are taught during clinical handover. This study also revealed that there are barriers to student learning during handover. It found that the learning environment played a role in learning in many ways. Learning environment incorporates conditions that both enable and constrain learning [ 58 ]. Findings of this study has revealed that there is no systematic process that is followed during clinical handover in Malawi such that handover is done haphazardly. These findings are not unique to Malawi alone. The evidence of a lack of a consistent or systematic approach to handover practice, was also found in an Irish healthcare where there was general absence of institutional policy and training on clinical handover [ 59 ]. Clinical handover communication protocols assist nurses to organize the clinical handover report and to present the patient’s information systematically thus minimizing miscommunications and misunderstandings during clinical handover which can result in errors consequently putting patients at risk [ 5 , 60 , 61 , 62 ]. Furthermore communication structures with well detailed patients information provides a chance for clarification of care to both the incoming and outgoing nurses for example through asking questions [ 63 ]. In addition, clinical handover communication structure promotes unity and collaboration of interdisciplinary clinical teams and hospital staff at different levels of hierarchy [ 63 ]. However, standardized handover tools also have some limitations, which include; some level of inconsistency observed even when used by experienced nurses [ 64 ] as well as presence of errors despite utilization of standardized tools. In this study nothing was asked about the effectiveness of the clinical handover tools since they are not available. The ISBAR (Identify, Situation, Background, Assessment, and Recommendation) clinical handover tool is internationally recommended standardized tool for conducting clinical handover [ 65 ]. The ISBAR also improves communication, completeness of data and enhances information sharing [ 66 ]. Study findings also indicated that participants felt it was necessary for the clinical handover to be done at a specified place. This finding supports earlier findings of [ 59 ] which demonstrated that other locations like the ward/nurses station or busy clinical departments like emergency department alters handover effectiveness due to many interruptions. Similarly, [ 67 ] noted that physical constraints like lack of dedicated or sufficient space affected communication during handover. Participants in this study felt that a special area should be put aside in the ward specifically for handover, however, changes may not always be easy, for example other suggestions may sound unrealistic (due to lack of resources) or may be in conflict with hospital protocols (for example that handovers must be performed at a patient’s bedside at a hospital whose protocol stipulates verbal/written handover in a conference room) [ 68 ]. This study also revealed lack of time management as a barrier to learning during clinical handover. It was found that poor time management affects other activities or the clinical handover process. This is in line with findings from a study by [ 1 ] who highlighted time constraints as a major barrier to clinical handover. Similarly, several studies, showed that impaired time management and time pressures, resulted in irrelevant, less detailed and rushed reports [ 69 , 48 ]. Students complained that learning moments like presentations were substituted with clinical handover reports, which affected their learning. If time is limited, it is more likely that there is not going to be teaching and learning because members will be more interested in the safety of patients and their subsequent care [ 1 ] other than student teaching and learning. [ 9 ], emphasized time management as an important element that helps efficiency clinical handover as well as chance for teaching and learning. During clinical handovers time has to be observed. Choosing a leader to guide clinical handovers helps to ensure that deliberations are done in a timely manner [ 70 ]. This study revealed that student/nurse relationships are not good because of bad attitudes that other nurses have towards students. Several other studies have reported negative working relationships between nursing students and clinical staff [ 71 , 72 ]. Similarly, [ 73 ] highlighted unfriendliness, bad attitude, hostility as some behaviors that deny the students opportunities to learn. Furthermore, study by [ 74 ] found that poor relationships may lead to frustration and demotivation thus, negatively affecting students learning. In addition, [ 75 ] revealed that clinical teachers who are verbally offensive in clinical settings impede student learning by creating an intimidating environment which causes students to shun away from performing procedures in the ward. The clinical teachers negative attitude towards students, especially registered nurses who are also key due to the role they play in clinical teaching deter communication and interaction between them [ 76 , 44 ]. Clinical staff belittling and insensible behaviors towards students like shouting at students in front of other staff members and patients when they make mistakes or gossiping about them also leads to reduced confidence [ 77 ]. These disheartening behaviors towards nursing students are not only done by nurses but physicians as well [ 76 ]. The study by [ 78 , 79 ] reported that student nurses learn easily when they are involved and work closely with a clinical teacher who is motivated to work with students and constantly supports and encourages learning. Students feel confident and motivated to learn in an environment where they are respected, recognized, supported and regarded as part of the team [ 74 ] .Students should be treated with love and kindness other than shouting at them when they have not done a procedure properly [ 71 ]. Whenever students make mistakes or are unable to perform procedures, it is the responsibility of clinical teachers to professionally correct them and not shame them [ 18 ]. The study finding also indicated that sexual relationship advancement has the potential to hinder learning during handover. Therefore it is necessary that clinical teachers and students should observe professionalism. The study also found that most nurses don’t attend clinical handovers, this consequently affects student attendance and participation too. The researchers views the presence of highly ranked nursing officials like the chief nursing officers, district nursing officers as an opportunities for students to gain high level knowledge/skills and attitudes considering that these nurses have a wide range of experience. The researcher therefore recommends that all relevant staff should be present at clinical handovers, although this proves extremely difficult, especially in emergency departments. [ 69 ] found that multidisciplinary representation at handovers facilitates sharing of information and learning. Another finding revealed that some qualified nurses do not have enough knowledge such that students lose trust in them. This finding is supported by [ 80 ] whose study established that some clinical teachers lacked the relevant skills to facilitate student learning. It should be noted that the presence and interaction with a registered nurse in the ward does not guarantee effective teaching and learning of students [ 81 ]. These results are also consistent with those reported in a study done in Iran where students felt unsatisfied with clinical assessment and evaluations because they were done by those clinical teachers whom they felt had limited knowledge and experience [ 82 ]. [ 83 ] highlighted that clinical teachers with limited skills cannot be effective role models. Clinical teachers’ knowledge, skills and attitudes are crucial in students’ clinical learning [ 84 ]. STUDY LIMITATIONS The study was conducted in one region of the country meaning that transferability of the results might not be possible since it may not be a representative of the experience of all students on learning during handover. There is therefore a need to extend the study to all regions. Data collection was done in week of peace (Examinations preparation week) at one college, the researcher could not extend the period because the students were finishing school as soon as they finished the examinations .This meant having focused group discussions with extremely busy participants. This could therefore affect or influence rushed responses from the participants. CONCLUSION Clinical handovers’ educative value cannot be overemphasized. Learning during clinical handover evolves around member involvement, Pedagogical knowledge, content knowledge as well as the environment (physical, psychological, social). To maximize learning during handover several strategies are proposed; clinical teacher knowledge, skill and attitude improvement, student/nurse dedication to learning and strengthening of mutual relationships between clinical teachers and students. Declarations ACKNOWLEDGEMENT The authors would like to express their appreciation to the study participants for sparing their time to take part in the study. AUTHOR CONTRIBUTION L.N conceptualized the study and collected data. L.N, B.C and F.L worked on data analysis and interpretation. L.N, B.C, F.L, T B and BCM made conceptual contribution to the manuscript and edited the manuscript. B.C and F.L also played oversight and supervision roles. All authors contributed to the completion of this manuscript and have read and approved it. FUNDING The study received no funding. DATA AVAILABILITY The data is available with the corresponding author and may be made available upon request. ETHICS APPROVAL AND CONSENT TO PARTICIPATE Ethical approval was sought from the Research Ethics Committee of Mzuzu University reference number MZUNIREC/DOR/23/71. The researcher also asked for permission to conduct the study from Deayang and Nkhoma colleges’ authority. The participants voluntarily consented to participate in the study by signing a written informed consent form and were free to withdraw from the study at any time without any consequences. CONSENT FOR PUBLICATION Not applicable COMPETING INTEREST The authors declare no competing interests References Klaber RE, Macdougall CF. Maximising learning opportunities in handover. Archives of Disease in Childhood-Education and Practice. 2009 Aug 1; 94 (4):118-22. Alert SE. Inadequate hand-off communication. Sentinel event alert. 2017;58 (1):6. Clinical Excellence Commission. (2019). Clinical Handover. (PD2019_020). Seada AM, Bayoumy SA. 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Ebrahimi H, Hassankhani H, Negarandeh R, Gillespie M, Azizi A. Emotional support for new graduated nurses in clinical setting: A qualitative study. Journal of caring sciences. 2016 Mar;5(1):11. Mamaghani EA, Rahmani A, Hassankhani H, Zamanzadeh V, Campbell S, Fast O, Irajpour A. Experiences of Iranian nursing students regarding their clinical learning environment. Asian nursing research. 2018 Sep 1;12(3):216-22 Truong TH. Vietnamese nursing students' perceptions of their clinical learning environment: A cross-sectional survey (Doctoral dissertation, Queensland University of Technology). Doyle K, Sainsbury K, Cleary S, Parkinson L, Vindigni D, McGrath I, Cruickshank M. Happy to help/happy to be here: Identifying components of successful clinical placements for undergraduate nursing students. Nurse education today. 2017 Feb 1;49:27-32 Schmiedeknecht K, Perera M, Schell E, Jere J, Geoffroy E, Rankin S. Predictors of workforce retention among Malawian nurse graduates of a scholarship program: a mixed-methods study. Global Health: Science and Practice. 2015 Mar 1;3 (1):85-96. Jahanpour F, Azodi P, Azodi F, Khansir AA. Barriers to practical learning in the field: a qualitative study of Iranian nursing students’ experiences. Nursing and midwifery studies. 2016 Jun;5 (2). Bvumbwe T, Malema A, Chipeta M. Registered nurses’ experiences with clinical teaching environment in Malawi. Baraz S, Memarian R, Vanaki Z. Learning challenges of nursing students in clinical environments: A qualitative study in Iran. Journal of education and health promotion. 2015 Jan 1;4(1):52. Kemp P, Gilding M, Seewooruttun K, Walsh H. A work-based learning approach for clinical support workers on mental health inpatient wards. Nursing Standard. 2016 Sep 14;31 (3). Bifftu BB, Dachew BA, Tiruneh BT, Ashenafie TD, Tegegne ET, Worku WZ. Effective clinical teaching behaviors views of nursing students and nurse educators at University of Gondar, Northwest Ethiopia: Cross-sectional institution based study. Journal of caring sciences. 2018 Sep; 7 (3):119. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 15 Jul, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 27 Aug, 2024 Reviews received at journal 27 Aug, 2024 Reviews received at journal 26 Aug, 2024 Reviewers agreed at journal 16 Aug, 2024 Reviewers agreed at journal 06 Aug, 2024 Reviewers agreed at journal 05 Aug, 2024 Reviewers invited by journal 05 Aug, 2024 Editor invited by journal 17 Jul, 2024 Editor assigned by journal 17 Jul, 2024 Submission checks completed at journal 17 Jul, 2024 First submitted to journal 12 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4732263\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":338650342,\"identity\":\"dbeee8d2-cec7-4beb-b13d-14dd966afea1\",\"order_by\":0,\"name\":\"Lydia Nkhoma\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYBACPgYGgwMMDAkJQDbjgw9Ako2dgBY2JC3MhjNAIsxEaGGAamGT5gEJEdQikbzxwM8daXn8YocfG9v82ibPx8zA+OFjDj4taQUHe8/kFEvOTjN8nNt327CNmYFZcuY2fFpyDA7wtlUkbridYGyc23ObEaiFjZmXgJaDf8Fa0r9JW/bctidKy2HethyglhwzaYYftxMJa+F5VnBYti0tcebsnGLD3obbyW3MjM14/cLPnrz549u25MR+6fSND378uW07v7354IePeLQwCCQgcRjbwGQDHvUgaw4g8/7gVzwKRsEoGAUjEwAA/M1UP+qXuwAAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Mzuzu University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Lydia\",\"middleName\":\"\",\"lastName\":\"Nkhoma\",\"suffix\":\"\"},{\"id\":338650343,\"identity\":\"a4ae525c-290a-457f-a50f-990f57a48e0c\",\"order_by\":1,\"name\":\"Baxter Chirambo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Mzuzu University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Baxter\",\"middleName\":\"\",\"lastName\":\"Chirambo\",\"suffix\":\"\"},{\"id\":338650345,\"identity\":\"a779fd9f-88bc-4f5a-a682-ca6fcb038f5f\",\"order_by\":2,\"name\":\"Florence Lungu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Mzuzu University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Florence\",\"middleName\":\"\",\"lastName\":\"Lungu\",\"suffix\":\"\"},{\"id\":338650349,\"identity\":\"409d011b-9919-45f0-a00a-9f8b5345d066\",\"order_by\":3,\"name\":\"Thokozani Bvumbwe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Mzuzu University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Thokozani\",\"middleName\":\"\",\"lastName\":\"Bvumbwe\",\"suffix\":\"\"},{\"id\":338650351,\"identity\":\"b3a25901-82a4-4644-9197-580203e77945\",\"order_by\":4,\"name\":\"Balwani Chingatichifwe Mbakaya\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Balwani\",\"middleName\":\"Chingatichifwe\",\"lastName\":\"Mbakaya\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-07-12 18:46:32\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4732263/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4732263/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12912-025-03590-z\",\"type\":\"published\",\"date\":\"2025-07-15T15:57:36+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":87219349,\"identity\":\"5755e92b-5add-41fc-b546-a6ff304d229b\",\"added_by\":\"auto\",\"created_at\":\"2025-07-21 16:04:18\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":725118,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4732263/v1/e00c9318-93ad-4fa1-a2c1-6604cd669fbb.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Learning dynamics during clinical handover: A qualitative study among final year students in central region nursing colleges, Malawi\",\"fulltext\":[{\"header\":\"BACKGROUND\",\"content\":\"\\u003cp\\u003eClinical handover is one of the best open forums for teaching and learning during clinical practice [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. It is a regular occurrence during patient care with approximately more than 4,000 clinical handovers happening in a typical teaching hospital per day [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. It involves the transfer of essential information, professional responsibility and authority for care of the patient in varying quantities, between shifts or locations, from one health care provider to another [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Effective clinical handover is paramount in ensuring patient\\u0026rsquo;s safety and continuity of care [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. In Malawi handover is often performed in three ways; the verbal handover in nursing station, written handover in the report book (read in conference room) and handover at patient bedside. The structured verbal and written handover is highly recommended as it provides opportunity for clarity where others don\\u0026rsquo;t understand. It is associated with higher information retention, encourages team work, reduce work related stress and guarantees job satisfaction [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Clinical handover also provides an opportunity for a multidisplinary team to share notes and discuss a program of care for patients.\\u003c/p\\u003e \\u003cp\\u003eWhile patient safety remains the critical focus of clinical handover, learning is a secondary function of a clinical handover [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Learning during clinical handover may be informal thus opportunistic, implicit and reflective or formal whereby teaching and learning is deliberately organized [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. The handover experience offers students with insights into clinical practice, patient care management, communication skills as well as teamwork. Final year nursing students involvement in handover further prepare them for their future roles as competent and confident nurses however the nursing education component is not being fully utilized during clinical handover in most clinical sites. Sometimes clinical handovers are conducted too casually such that students do not learn to the extent that students strongly feel that handovers they engaged in are of no educational value to their training [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eDespite the great potential for maximum learning during clinical handover, creating capacity for teaching and learning during handover is challenging [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Evidence shows that regardless of the benefits of streamlining learning within the flow of daily work and patient care amidst busy clinical environment, learning moments during handover tend to be underutilized and neglected [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. The study findings will help to scrutinize how effective current educational practices in clinical handover prepare students in practice. It will also highlight the opportunities and challenges that students encounter in integrating theory to practice in clinical area as well as highlighting skills in clinical handover that enhance patient outcomes like effective communication. The findings will also help in curriculum development and improvement of educational strategies in nursing programs.\\u003c/p\\u003e \\u003cp\\u003eThe article therefore explains final year nursing student\\u0026rsquo;s educational journey on learning during clinical handover, exposing how they participate in clinical handover, motivating factors and challenges they face as well as recommendations for optimizing learning opportunities during clinical handover.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eAIM\\u003c/h2\\u003e \\u003cp\\u003eThe aim of this study was to explore learning dynamics during clinical handover among final year students in Central region nursing colleges, Malawi.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRESEARCH APPROACH AND DESIGN\\u003c/h2\\u003e \\u003cp\\u003eThe study employed qualitative approach, utilizing Husserl\\u0026rsquo;s descriptive phenomenology design.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSTUDY SETTING\\u003c/h2\\u003e \\u003cp\\u003eThe study was conducted at Daeyang and Nkhoma nursing colleges in the central region of Malawi. Nkhoma College of Nursing and Midwifery offers diploma in nurse-midwife technician program whilst Deayang Nursing College trains registered nurses and midwives at both diploma and degree level.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSTUDY POPULATION\\u003c/h2\\u003e \\u003cp\\u003eThe study targeted 67 final year students at Daeyang Nursing College and 51 final year nursing students at Nkhoma College of Nursing and Midwifery.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSAMPLING\\u003c/h2\\u003e \\u003cp\\u003eThe study used purposive sampling approach. The study required information from students who had enough and wide experience overtime.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eINCLUSION AND EXCLUSION CRITERIA\\u003c/h2\\u003e \\u003cp\\u003e \\u003cb\\u003eInclusion criteria;\\u003c/b\\u003e (1) final year nursing student (2) have had experience on the following clinical handovers; the verbal handover in nursing station, written handover in the report book (read in conference room) and handover at bedside.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eExclusion criteria;\\u003c/b\\u003e nursing students in first and second year.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSAMPLE SIZE\\u003c/h2\\u003e \\u003cp\\u003eThe study conducted two focused group discussions, one at each of the selected nursing colleges thus Deayang Nursing College and Nkhoma College of nursing and midwifery comprising of 7 and 8 students respectively, making a total of 15 participants.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDATA COLLECTION INSTRUMENT\\u003c/h2\\u003e \\u003cp\\u003eA focused group discussion guide with open ended questions was used. Probes were used as needed to clarify the meaning of responses and encourage in depth descriptions. The guide was in English language.\\u003c/p\\u003e \\u003cp\\u003eThe tool was developed by the researcher guided by the study objectives. Expert\\u0026rsquo;s opinion was sought to validate the focused group discussion guide.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDATA COLLECTION\\u003c/h2\\u003e \\u003cp\\u003eData in this study was collected using a focus group discussion. Two focus group discussions were done, one at each selected nursing college. To acknowledge and set aside biases during data collection, the researcher used reflective diary so that all prior knowledge/experience with the phenomenon are kept in check (bracketing).\\u003c/p\\u003e \\u003cp\\u003eThe researcher first had private meetings with the participants in designated rooms where the aims of the study, the type of data, procedures and eligibility criteria were explained. The meeting enabled participants to ask questions and give consent. No participant declined to participate in the focus group discussions.\\u003c/p\\u003e \\u003cp\\u003eThe researcher was the moderator and facilitated as well as controlled the focus group discussion. To ensure anonymity, the group members were assigned pseudonyms. The participants gave permission to use an audio-recorder during data collection. An assistant helped with taking notes during the discussion and recording the deliberations using a recorder. The focus group discussion approximately took 45 minutes. The recorded and transcribed responses were stored in a locked drawer and only the researcher and the research supervisors had access to them. To ensure privacy and protection of the soft copy findings, data documents were archived in a password-protected file. The responses were also coded.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDATA ANALYSIS\\u003c/h2\\u003e \\u003cp\\u003eThe recorded focused group discussions were transcribed verbatim by the researcher. Data was analyzed manually using Colaizzi\\u0026rsquo;s (1978) seven step approach. Firstly, the researcher read the transcripts for both focus group discussions more than three times to familiarize herself with the collected data. The researcher then extracted the phrases and statements that precisely described experiences of students on learning during handover from the transcripts and gave to peers for verification. Correct meanings were then derived from the significant statements and discussion with peers was done so as to avoid misinterpretation of the participant\\u0026rsquo;s views.\\u003c/p\\u003e \\u003cp\\u003eFindings were then presented as themes and subthemes supported with verbatim statements. The researcher utilized the emergent themes, subthemes and the formulated meanings to give a comprehensive description of the dynamics of learning during handover among nursing students then the description was narrowed down so that only essential aspects of the phenomenon is discussed. Finally the participants confirmed their experiences.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eThe analysis of data yielded five themes which are; Clinical handover learning moments, Student teaching and learning strategies, facilitators to learning during clinical handover, barriers to learning during clinical handover and improvement strategies for maximum learning(see Table \\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTHEMES AND SUBTHEMES\\u003c/h2\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003esummary of themes and subthemes which emerged from the analysis of data\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTHEME\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSUBTHEMES\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eClinical Handover learning moments\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStudent involvement\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStudent teaching and learning strategies\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuestion and answer, Discussions, Lecture method\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eFacilitators to learning during handover\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eComprehensive sharing of knowledge\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eClinical Handovers\\u0026rsquo; wider range of scope\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMaximized learning opportunity\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBarriers to learning during handover\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor time management\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLimited space/environment\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLack of knowledge\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor handover attendance\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor nurse/student interpersonal relationships\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eClinical teachers\\u0026rsquo; acquisition of updated knowledge/skills and attitudes.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eImprovement strategies\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNurse/students\\u0026rsquo; dedication to learning.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStrengthening interpersonal relationships.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eHANDOVER LEARNING MOMENTS\\u003c/h2\\u003e \\u003cp\\u003eThe focus group discussions revealed that most students gained knowledge/skills by being involved during clinical handover. Participants reported that in some hospitals it is mandatory for students to attend and read reports during clinical handovers.\\u003c/p\\u003e \\u003cp\\u003eParticipants gave the following account:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eStudents that were on day/night shift are often the ones who present the general conditions of patients that were in the wards for that shift\\u003c/em\\u003e\\u0026rsquo; (D participant 4).\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eAs students we are expected to give handovers and answer different questions on how we managed our patients when we are on night duty. Senior nurses actually tell us to read the report during clinical handover\\u003c/em\\u003e\\u0026rsquo; (N Participant 3)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents have been cultivated to take clinical handovers as part of their duty; they have a responsibility to give an account of the patient care after a shift.\\u003c/p\\u003e \\u003cp\\u003eThe participants further explained their involvement in clinical handovers as exciting;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eStudents are always given the first chance to give clinical handover report and make presentations and not qualified nurses, such that questions and comments will first be directed to students then later to qualified nurses so everyone will be involved in the learning and its really funny.\\u0026rsquo;\\u003c/em\\u003e (D Participant 1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudent are priotised during clinical handovers and are given a chance to express themselves which makes them excited as they feel they are part of the team.\\u003c/p\\u003e \\u003cp\\u003e The participants indicated that they are also involved by being given tasks. Different tasks may be given to students to stimulate learning. This is illustrated in the following excerpts:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u0026hellip;. \\u003cem\\u003eClinical teachers share different conditions to students to make presentations on, during handover\\u003c/em\\u003e ...\\u0026rsquo; (D Participant 1)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eWe are given a lot of presentations as our assignment especially in conditions that we have shown lack of knowledge so that we find out more about such conditions\\u003c/em\\u003e.\\u0026rsquo; (D Participant 5)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eStudents are involved by being given topics to present at morning handover.\\u003c/em\\u003e\\u0026rsquo; (N Participant 8)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents not only attend handovers but are also given a chance to teach others by presenting on different conditions.\\u003c/p\\u003e \\u003cp\\u003eOther tasks that the participants were given was to care for the patients who have been discussed in clinical handover.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eA participant said: \\u0026lsquo;\\u0026hellip; \\u003cem\\u003estudents may be told; \\u0026lsquo;you take care of the patient then you give us feedback on what you have done for the patient\\u0026rsquo;\\u003c/em\\u003e (D Participant 2)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents are assigned patients to care for and then give a report.\\u003c/p\\u003e \\u003cp\\u003eThe participants also got involved in clinical handover by taking part in clinical handover deliberations. Some participants said the following in this regard;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eStudents are given a chance to ask questions; for example we may inquire what lead to a patient\\u0026rsquo;s death or how the patient was managed\\u003c/em\\u003e.\\u0026rsquo; (D Participant 4)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eThe matron and the in-charges make sure that every student participates in the clinical handovers and they also encourage us to ask questions and give us assignments. Different questions/assignments are directed to different groups of students in accordance with their level for example the seniors may be asked about the management of a lady who is having vaginal bleeding at 24weeks pregnancy\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e(D Participant 1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eHowever, other participants mentioned that they were sometimes not involved in clinical handovers, as indicated below;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip;..the qualified staff were not involving students during clinical handovers, sometimes they would do clinical handovers earlier than the usual time such that student would find that they have finished handover session by the time they arrive\\u0026rsquo;\\u003c/em\\u003e (N Participant 2)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eOther qualified nurses would not show any regard of the presence of students during clinical handovers and were not involving us\\u003c/em\\u003e.\\u0026rsquo; (N Participant 1)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eSometimes they would just discuss amongst themselves (qualified staff) not regarding students\\u0026rsquo;\\u003c/em\\u003e (N Participant 5)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe sentiments demonstrate that the students were not happy when they were not involved during clinical handovers. They felt sidelined.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTEACHING STRATEGIES USED DURING HANDOVER\\u003c/h2\\u003e \\u003cp\\u003eFurther findings of the study demonstrated that different clinical teachers used unique teaching strategies during handovers to foster learning. Other clinical teachers utilized question and answer when teaching during clinical handovers.\\u003c/p\\u003e \\u003cp\\u003eThe following excerpts provide participants\\u0026rsquo; experiences with questioning and answer teaching strategy;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eIn morning clinical handovers, students meet conditions that they are not familiar with, so when more questions are asked to the one presenting on a condition and explanations are made on the condition, as students we gain more and we later refer back to our notes and this helps us to understand the condition practically/better\\u003c/em\\u003e\\u0026rsquo; (D Participant 2)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eAs students we are also asked a lot of questions during clinical handover, sometimes we may want to answer the questions but we lack the information, so these questions motivates us to be able to reflect and find out more about the conditions\\u0026rsquo;\\u003c/em\\u003e (D Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eDuring clinical handovers, students are often asked a lot of questions, because of that, students are prompted to read more to avoid embarrassment that comes by failing to answer questions in clinical handovers. In this way students greatly improve and they eventually become competent\\u003c/em\\u003e\\u0026rsquo; (D Participant 1)\\u003c/p\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip;.so as students we are asked questions which prompt us to search/find more, for example on internet or student notes\\u003c/em\\u003e.\\u0026rsquo; (D Participant 4)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents are asked questions during clinical handover, this make them eager to learn as such they search for more information by studying their classroom notes or using the internet. Other students also study in order to avoid embarrassment that comes due to failure to answer questions.\\u003c/p\\u003e \\u003cp\\u003eDespite the good teaching moments explained above, some participants expressed their dissatisfaction with the method by describing how question and answer teaching strategy affect their learning. Participants expressed the following sentiments;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip;. If a student fails to answer a question they are punished by either being given a presentation to make or are told to go into the hospitals library to read whilst their friends have gone to the ward. For slow students this exercise may take them the whole day meaning that they have failed to go to the ward on this day \\u0026hellip;\\u003c/em\\u003e\\u0026rsquo; (N Participant 7)\\u003c/p\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip;others clinical teachers do not respond politely to students whenever they ask questions for example they would say; \\u0026lsquo;in which year are you? You are in final year and you don\\u0026rsquo;t know anything about that?\\u0026rsquo; (D Participant 4)\\u003c/em\\u003e \\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eQualified staff don\\u0026rsquo;t answer students politely, for example when a student ask a question, they may say \\u0026lsquo;knowledge is expensive\\u0026rsquo; and they do not answer the question.\\u003c/em\\u003e (N Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u0026hellip;.\\u003cem\\u003ewhenever students ask questions they don\\u0026rsquo;t respond, they will ask the one asking what they think and then give them as an assignment to present. We are not against assignments however when often times questions turn to assignments students refrain from asking because they are afraid they will be given an assignment instead of an answer.\\u0026rsquo;\\u003c/em\\u003e (N Participant 3)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents feel other clinical teachers intimidated them when they asked questions. Clinical teachers resorted to giving students punishment instead of teaching the students, others opted to responding harshly while others gave assignments.\\u003c/p\\u003e \\u003cp\\u003e Participants also mentioned discussions as one of the frequently used teaching strategy. Participants remarked;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eWe gain much knowledge during (morning) clinical handovers; this is so because different medical/surgical conditions are discussed during handovers such that when we go to our respective wards we are interested/motivated to take part in the management of patients with different conditions that were discussed during the handovers\\u003c/em\\u003e\\u0026rsquo; (D Participant 7)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003esometimes other conditions are not explained properly in class but during clinical handovers we are able to relate and gain more understanding because during discussions there are explanations that help us create a picture of something like \\u0026lsquo;aaa so this is how it is\\u0026rsquo; this also help us to probe more\\u0026rsquo; (D Participant 4)\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026lsquo;\\u0026hellip;the discussions and the questions that follow, help us to learn even more\\u0026rsquo;\\u003c/em\\u003e (N Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eI like discussions with facts; so when colleagues debate on the best management of a client in handovers I become more interested and at the end I learn something from the discussions.\\u0026rsquo;\\u003c/em\\u003e (N Participant 5)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents felt that they learnt a lot when discussions were used during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eThe focused group discussions also revealed that discussions enable students to immediately practice and evaluate what they have learnt. Participants had this to say;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eDuring clinical handover students are taught about different conditions, then are instructed to provide direct care to patients who have been reported as having the said /discussed condition.\\u003c/em\\u003e\\u0026rsquo; (D Participant 6)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eDuring clinical handovers students may also be assigned to take care of patients that are discussed. This provide a chance to students to provide quality care to patients because they know they eventually will have to give a report/feedback on how the patient is progressing. Such assignment enables students to gain more knowledge\\u003c/em\\u003e.\\u0026rsquo;(D Participant 2)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eOrdering students what ought to be done on a patient is helpful because whatever students practically do they don\\u0026rsquo;t really forget. It also help students to gain experience and it provides an opportunity to ask more questions hence increased understand.\\u003c/em\\u003e\\u0026rsquo; (N Participant 2)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents are able to integrate theory into practice soon after discussions.\\u003c/p\\u003e \\u003cp\\u003e However other participants were not happy with the tasks. A participant narrated;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026lsquo;Students are not supposed to be given tasks outside of their objectives for that day because this affects learning. Qualified staff have to acknowledge that this is a student and they have to be handled as such\\u0026rsquo;\\u003c/em\\u003e (N Participant 4).\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents have their daily objectives, tasks assigned to them may deter them from achieving theirs.\\u003c/p\\u003e \\u003cp\\u003eParticipants also expressed that they were being taken advantage of during clinical handover as the nurses relinquished most of their responsibilities to them. Participants shared their experiences;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eIn other form of clinical handover like bedside\\u0026hellip;.for example if there is a discussion and then members want to know the immediate vital signs, qualified personnel take advantage of students by giving us tasks like to get vital signs kit to check vital signs but the discussions continues so by the time the student arrives, the clinical handover has already been done, other educative discussions about the patient have finished and the student was left out\\u0026rsquo;\\u003c/em\\u003e (N Participant 5)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eClinical handover process has to be improved. Students have to be given priority to learn. Hospitals have to remember that students are there to learn and not to cover shortage for instant sending students on unnecessary errands during learning have to be minimized so that students concentrate on their learning\\u0026rsquo;\\u003c/em\\u003e (N Participant 5)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents felt that instead of learning during clinical handover, they were being misused in the ward to do the routine work of the qualified nurses.\\u003c/p\\u003e \\u003cp\\u003e The other method that participants mentioned was lecture method.\\u003c/p\\u003e \\u003cp\\u003e Participants indicated that they learnt during their clinical handover through presentations. Participants expressed their contentment;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003e\\u0026hellip;..they teach students using power point presentations. During power point presentations students learn a lot for example causes of illnesses or their management\\u0026rsquo;\\u003c/em\\u003e(N Participant 4)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003e\\u0026hellip;they use power point presentations when teaching students to facilitate understanding\\u003c/em\\u003e.\\u0026rsquo; (D Participant 4)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eThe teaching strategies that they use are very effective because they are well detailed. For example if they want to present on pneumonia it means they will describe the disease, its causes, management and complications and this helps us know how to handle real patients\\u0026rsquo;\\u003c/em\\u003e (N Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eI like the presentations that happen at the morning clinical handovers. I always look forward to handover time because presentations that are done sometimes new topics are taught or they are presentations that I did not understand in class\\u003c/em\\u003e \\u0026lsquo;(N Participant 1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eMost participants\\u0026rsquo; views indicated that presentations during clinical handovers were effective in their learning.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eFACILITATORS TO STUDENT LEARNING DURING HANDOVER\\u003c/h2\\u003e \\u003cp\\u003eFocused group discussions showed that sharing of information repeatedly during clinical handover initiates learning. A participant had this to say;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;Clinical handovers give us the chance to hear the information/learn about a condition several times such that the information easily stick in our heads and we are able to understand and utilize it practically.\\u0026rsquo;\\u003c/em\\u003e (D Participant 3)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents acknowledged that information shared several times aided in retention\\u003c/p\\u003e \\u003cp\\u003eThe focus group discussions also showed that clinical handovers provide a platform for nursing students to be exposed to comprehensive new information during handover. Students\\u0026rsquo; testified to consistent up to date information that clinical handover provides:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eIn our profession things change each and every day, mostly classroom information is outdated so we usually find different management of conditions in the clinical area so during clinical handovers new information is learnt.\\u003c/em\\u003e\\u0026rsquo; (D Participant 4)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eHandover helps us learn new things that have been introduced or recently changed. For example in class we learnt of different dosing of clients with pre eclampsia and eclampsia but when we are here we have learnt that it was reviewed and the dosing is the same now.\\u003c/em\\u003e (N Participant 2)\\u003c/p\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip; We are able to learn new things that were not taught in class. Sometimes it also helps us to understand better the topic/conditions that were difficult to understand during classroom learning.\\u003c/em\\u003e\\u0026rsquo; (N Participant 6)\\u003c/p\\u003e\\u003cp\\u003e \\u003cem\\u003eClinical handover helps us to add to the body of knowledge that we got in class\\u0026hellip;\\u003c/em\\u003e \\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e(D Participant 3)\\u003c/h2\\u003e \\u003cp\\u003eStudents get refreshed with new knowledge during clinical handovers.\\u003c/p\\u003e \\u003cp\\u003eThe study also revealed that clinical handover education caters a wider scope in which several skills are addressed which are of paramount importance in learning. Some of the skills that the focused group discussions discovered was communication. The following narration illustrates this;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip;Some students are afraid to speak to a group of people, clinical handover may help such students. I have noted that if one makes a mistake today when giving handover, colleagues correct them and they improve next time.\\u003c/em\\u003e\\u0026rsquo; (D Participant 1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents can learn communication skills which helps build their confidence.\\u003c/p\\u003e \\u003cp\\u003eFurthermore findings also indicated that there is maximized learning during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eParticipants commented that students are able to learn more on conditions that they failed to learn during their previous allocations;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo; \\u0026hellip;\\u003cem\\u003ea student doing midwifery is able to learn more about a condition and its management in medical surgical nursing which they were unable to learn from during their stipulated allocation, so clinical handovers redeem such times since most clinical handovers include all cadres and all departments\\u003c/em\\u003e.\\u0026rsquo; (D Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eClinical handovers help us to learn conditions that we had no opportunity to experience/learn about during other allocations because a lot of conditions are discussed during clinical handover.\\u0026rsquo;\\u003c/em\\u003e (N Participant 2)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents acknowledged that handover can redeem lost learning opportunity.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eBARRIERS TO STUDENT LEARNING DURING HANDOVER\\u003c/h2\\u003e \\u003cp\\u003e The participants indicated lack of guidelines as one of the barriers on learning during clinical handover. The following excerpt illustrates;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026lsquo;\\u0026hellip;some facilities do not offer systematic clinical handovers they simply make it short and inconsistent, this makes it hard for student learning\\u003c/em\\u003e.\\u0026rsquo; (D Participant 4)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents fail to learn when clinical handover is unsystematic.\\u003c/p\\u003e \\u003cp\\u003eThe focus group discussions also revealed that environment can affect learning during clinical handover. This is what was said;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo; \\u003cem\\u003e\\u0026hellip;. I suggest a special place be created in the wards for clinical handovers so that student maximize their learning during clinical handovers\\u003c/em\\u003e.\\u0026rsquo; (N Participant 5)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents suggested that a designated room/place would help to maximize learning during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eParticipants also mentioned time management as one of the barriers. Participants remarked;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip;lack of time management. I remember one time the morning clinical handover was supposed to start at 7;30am but then most workers came at 7;40am or others at 8am and then maybe there is a presentation, so instead of giving that presentation 20mins,they give 10 minutes, this affects the delivery of the presentations as well as follow up questions or comments.\\u0026rsquo;\\u003c/em\\u003e (D Participant 7)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents felt that poor time management affect subsequent activities like learning.\\u003c/p\\u003e \\u003cp\\u003eIn addition, the participants reported that nurse/student relationship was a barrier to learning during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eThe following excerpts provide participants\\u0026rsquo; explanations;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;..\\u003cem\\u003eAs students we are also affected by the attitudes of in charges/matrons. The way qualified nurses approach students when they have made a mistake is not good, they instil fear and this affects them psychologically. This makes students fail to ask them questions.\\u0026rsquo;\\u003c/em\\u003e (D Participant 6)\\u003c/p\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;...During bedside handover, sometimes the qualified nurses don\\u0026rsquo;t speak respectfully to student especially when they have not done something well. It becomes embarrassing to students as this is done in front of patients\\u003c/em\\u003e.\\u0026rsquo; (N Participant 8)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents observed that qualified nurses were rude to them and had bad attitudes towards them.\\u003c/p\\u003e \\u003cp\\u003eFurthermore, participants highlighted that other students were not comfortable to learn/ attend clinical handover because of unprofessional conduct of clinical teachers. A participant explained;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip;.the issues of intimate relationships affect student learning. There are some in charges or other colleagues we meet in hospital they like asking students out a lot, so we know how relationships work its either you are committed physically or psychologically. It becomes even too difficult when you refuse to be in relationship with them. They sometimes refuse to sign for you for the procedure you have done and when its clinical handover time as a student you may fail to freely participate thus affecting your learning\\u003c/em\\u003e.\\u0026rsquo; (D Participant 6)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents complained that romantic/sexual advancements affected learning during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eThe focused group discussion further reported poor clinical handover attendance as a barrier to learning during clinical handover. Most qualified nurses or nursing in charges don\\u0026rsquo;t attend clinical handovers. Participants said the following in this regard;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u0026hellip;\\u003cem\\u003eMost nurses don\\u0026rsquo;t go for clinical handovers, this affect the quality of clinical handovers such that the students even fail to ask questions because there is nobody who can respond to the questions especially when it\\u0026rsquo;s only the students who are available.\\u003c/em\\u003e\\u0026rsquo; (D Participant 5)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eAnother commented:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eLack of interest by qualified medical practitioners to attend morning report. It reached a point in whereby a report was suspended that today because as a senior was just alone with students in the morning report. This affects student learning as it reduces the motivation of students to attend and participate in the morning clinical handover\\u003c/em\\u003e (D Participant 3)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents noted that qualified personnel do not patronize clinical handover and this has implications on their learning during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eIn addition, participants mentioned that the other barrier is lack of knowledge by clinical teachers.\\u003c/p\\u003e \\u003cp\\u003eOne of the participants\\u0026rsquo; very disappointed expressed this:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u0026hellip; \\u003cem\\u003ethey are unable to even properly fill the partograph\\u0026hellip;.This makes the students lose trust, they may not even ask such nurses when they have questions\\u0026rsquo;\\u003c/em\\u003e (D Participant 1)\\u003c/p\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;\\u0026hellip; Knowledge of clinical personnel also matters. When students sense that their clinical teachers have less knowledge or skills they are demotivated to attend the handover because they feel they may not gain the necessary information from them.\\u0026rsquo;\\u003c/em\\u003e (N Participant 4)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eQuotes above demonstrate luck of trust by students to learn from other clinical teachers whom they perceive to lack knowledge.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec20\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eIMPROVEMENT STRATEGIES\\u003c/h2\\u003e \\u003cp\\u003eParticipants shared some suggestions for maximizing learning during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eParticipants revealed a need for clinical teachers to acquire updated knowledge and skills, they suggested the following:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cem\\u003e\\u0026lsquo;Nurses and clinicians should have enough and updated knowledge which they will be able to share to students. This may be done by regular trainings. This is essential for students to gain proper knowledge skills and attitudes.\\u0026rsquo; (D Participant 4)\\u003c/em\\u003e \\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eParticipants also reported that nurses and students have to be dedicated to learning, this is what was said;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eQualified nurses should be dedicated to their work and should be willing to help/teach students.\\u003c/em\\u003e (D Participant 6)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eStudents have to initiate their own learning. They should have objectives and must approach the qualified nurses to help them achieve their objectives/care for patients that were discussed during clinical handover\\u003c/em\\u003e (N Participant 5)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eHowever a suggestion on self-initiated learning received a lot of criticism. Participants expressed their concerns;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eI disagree on student own initiative. Sometimes it depends on the qualified staff that is available, others have bad attitudes towards students so even if you plan to learn if there is a qualified staff who will not listen to you, you don\\u0026rsquo;t attempt to ask rather you wait for another day\\u003c/em\\u003e (N Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eI also disagree with student own initiative. Sometimes students have well written and planned objectives but qualified staff disrupt this by asking students to do other tasks and students are afraid to refuse because they are afraid to be labelled as rude or others may inform the lecturers\\u0026rsquo;\\u003c/em\\u003e (N Participant 6)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudents feel that nurses should be motivated to make handover experience educative and memorable for students however when it was suggested that students should improve, students gave a lot of excuses.\\u003c/p\\u003e \\u003cp\\u003eParticipants also suggested the need for involvement on presence of staff during clinical handover. Sentiments were expressed as follows;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eParticipation of in charges and other qualified nurses in the morning clinical handover is important. This reassures students that if they ask questions, they will be answered properly\\u003c/em\\u003e.\\u0026rsquo; (D Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eThe presence of highly ranked health personnel like the matron and the District Health Officer during handovers boost morale \\u0026hellip;...\\u003c/em\\u003e\\u0026rsquo; (D participant 1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003e Participants suggested improvement in terms of communication and professionalism. Participants remarked;\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eStudents should be treated with respect too. Qualified nurses should mind their language as they communicate with students so that they are fit psychologically to be able to help patients properly\\u003c/em\\u003e.\\u0026rsquo; (D Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eWhen doing clinical handovers, the qualified nurses should speak to students respectfully taking into consideration that sometimes patients are also there\\u003c/em\\u003e\\u0026rsquo; (N Participant 7)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eQualified staff should stop underrating students. Students can contribute a lot too but they are afraid that if they ask a question or make a comment they question will turn into an assignment or may be insulted by being told they are not smart or are rude\\u0026rsquo;\\u003c/em\\u003e(N Participant 3)\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026lsquo;When students ask questions the qualified staff should be able to simply reply because that will not only help the student but other qualified staff as well\\u003c/em\\u003e.\\u0026rsquo; (N Participant 2)\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;\\u003cem\\u003eNurses as well as students need to stick to code of conduct, Students become shy to go ask somebody who once wanted to be their girlfriend/boyfriend yet they still have to help patients together so it becomes hard to lender quality services.\\u003c/em\\u003e\\u0026rsquo; (D Participant 5)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThis study explored learning dynamics during clinical handover for final year students in Central region nursing colleges, Malawi. The findings of the study revealed that students gain knowledge during clinical handover by getting involved. Students participate by attending or performing clinical handover. Different tasks are given to students during clinical handover to stimulate learning by doing [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].The finding is in line with a study on student nurses\\u0026rsquo; engagement in learning which noted that active involvement helps students to become more effective, current, knowledgeable as well as independent thinkers and problem solvers [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. These findings are also consistent with results of a study by [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], which highlighted that students\\u0026rsquo; learning to a large extent is dependent upon student participation. Student involvement implies an investment of physical and psychological energy in learning [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eStudents who actively get involved in clinical handover sessions, do not only receive information but they also contribute in discussions during clinical handover. Observing and participating in handovers exposes students to real life clinical decision making processes [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Students retain information better when actively involved than just passively listening. This is because they understand the context behind decisions made during clinical handover and the knowledge gained may be applied in future clinical scenarios too. This is attributed to the discussions that happen during clinical handover which enables students to think critically about patient\\u0026rsquo;s condition, plan of care and potential outcomes by asking questions, seeking clarifications and exploring different perspectives.\\u003c/p\\u003e \\u003cp\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e] argues that students who are frequently involved in an activity are more likely to learn academically and develop personally. In this study, attending and performing clinical handover was mandatory in other clinical sites, this therefore place students at an advantage to learn. Students level of involvement /participation change with time, this affects learning quality and quantity [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Therefore, the researchers recommend that students ought to be committed during clinical handover learning so that they are able not only to understand what is taught (quality) but also be able to grasp more information (quantity).\\u003c/p\\u003e \\u003cp\\u003eThe study further indicated that students are considered part of the clinical team as they are given the opportunity to contribute during clinical handovers. [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e] argued that students should feel welcomed in the clinical area so that they easily adapt and professionally associate with clinical staff. However, students also mentioned that in some instances they were not involved in clinical handovers, which made them feel sidelined. This is related to the finding in a study to explore nursing students\\u0026rsquo; handover involvement during their clinical rotations and associated factors, where nursing students reported no involvement in clinical handover during rotations. The study further explained that limited opportunities for clinical handover involvement prevents students\\u0026rsquo; sense of becoming part of the team, affects socialization and their identity development [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. This is because students may feel that they are not important and cannot contribute to the team.\\u003c/p\\u003e \\u003cp\\u003eThis study also found that different teaching strategies are utilized during clinical handover. It was revealed that clinical teachers used more students centered teaching strategies like discussions and question and answer (66.6%) than teacher centered approach for example lecture method (33.3%). This finding is in contrast with the findings by [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e] who found that traditional teaching methods and learning styles still dominated in nursing making it difficult for students to become critical thinkers. The finding is of great significance now that student centered approach is encouraged. [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e] concur as he encourages \\u0026lsquo;problem posing\\u0026rsquo; to learners. He agrees that student centered teaching strategies help in empowering learners to become effective decision makers. Similarly, [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e], described student centered approach as an education that raises students\\u0026rsquo; consciousness and their creative power.\\u003c/p\\u003e \\u003cp\\u003eFindings of this study revealed that the clinical teachers used question and answer to involve and teach students during clinical handover. Clinical teachers asked a lot of questions during clinical handover in order to seek clarity on patient assessments or condition as well as to find out student level of knowledge while students often asked questions to gain knowledge where they did not know or understand. These findings are in line with a study which highlighted that teachers ask questions to facilitate and assess student\\u0026rsquo;s knowledge while students asked questions to clarify assumptions or when there is knowledge gap [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. In support of the findings, a study by [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e] indicated that during clinical handover, knowledge and experience can be shared by asking questions. Similarly, other research findings have also shown that oral clinical handover provide an opportunity for students to take part in professional discussions by either asking or answering questions [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. Furthermore, [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], found that the use of educational questions was an essential communication strategy to promote learning. The knowledge gap during clinical handover may further be filled by seeking information through questions [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. It is thus important that the students are encouraged to ask questions during clinical handover so that their education needs are met.\\u003c/p\\u003e \\u003cp\\u003eQuestioning promotes critical thinking during clinical handover since students are required to analyze patient data, priotise information and understand the plan of care [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]. Critical thinking is necessary for nurses as they are expected to make decisions about complex healthcare needs [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. However this was not the case with the current study. This study reveals the teaching strategy being used by the clinical teachers is the basic question and answer strategy other than the Socratic questioning strategy which target high level questions and is used as a teaching and learning strategy to facilitate the critical thinking skills of students. This finding is consistent with the finding in a study to investigate questioning skills of clinical facilitators who support the learning of undergraduate nursing students, which found that nursing facilitators in the clinical setting ask students\\u0026rsquo; predominaly low level questions [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. Furthermore, other studies also show that educators more often ask lower level questions in a teaching /learning context [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. This implies that student level of clinical judgment, decision making and critical thinking in this study is not being targeted and therefore can affect patient care and smooth transition of final year students into becoming competent nurses. The educators may ask low level questions because they lack clinical education training, lack awareness and even the educator\\u0026rsquo;s own lack of critical thinking. Therefore, the researchers recommend that clinical teachers should be taught how to frame questions for students that require application, analysis, synthesis and evaluation.\\u003c/p\\u003e \\u003cp\\u003eClinical teachers have to use question and answer as a teaching method because it can help improve students\\u0026rsquo; communication skills as students learn how to articulate issues. Furthermore, question and answer strategy can aid in finding out if individual students have grasped what has been taught and can guide teachers the areas to be emphasized or repeated.\\u003c/p\\u003e \\u003cp\\u003eAlthough the method has several advantages, this study found that there are some challenges associated with implementing the method during handover. Some of the challenges highlighted by the participants were; unnecessary punishments which followed when the students fail to answer questions, disrespectful comments made by qualified members of staff to embarrass students and unnecessary assignments given to students when they seek clarifications. The findings are in line with a study that demonstrated that students felt offended by doctors who reprimanded them due to their failure to answer questions even though they did know the answers [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. There are also several factors that may affect the degree to which staff and students ask questions during handover which are; existing hierarchies, staff relationships and limited opportunity or time [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. However effective communication maybe achieved during clinical handover by fostering staff assertiveness and respect [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. The study findings also indicated that poor relationships had the ability to affect/hinder students from asking questions due to the negative consequences that followed for example being belittled.\\u003c/p\\u003e \\u003cp\\u003eClinical teachers ought to treat students with respect, and should help create an atmosphere for students which is friendly to aid learning. Where possible, prompt explanations on patient management should be done to minimize errors. It is necessary also that during question and answer, the questions should be clear and minimize jargons as much as possible to avoid hindrance of information transfer, keeping in mind also that during handovers students of different levels are being taught at the same time so grasping of information may vary. Clinical teachers understand that there may be uneven participation during handover, not all students can ask or answer questions, and others feel uncomfortable to answer questions as they are shy. This may affect the effectiveness of the method.\\u003c/p\\u003e \\u003cp\\u003eThis study has also shown that students are able to learn more through discussions. This is in line with a study finding which aimed at comparing the effectiveness of lecture method and discussion on knowledge regarding selected communicable diseases (Dengue and Malaria) among nursing students, which found that discussions improves knowledge and student participation [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. Discussions help students to learn by developing social skills through interaction with others (communication) and obtaining new knowledge. These skills can help students to be able to defend ones opinion, assessing as well as evaluating other people\\u0026rsquo;s views [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eDuring discussions in clinical handover, students are encouraged to participate and share in decision making. Students participate in discussions during clinical handover by answering or asking questions, taking part in case based studies as well as through peer discussions where senior students mentor junior students through shared experiences and insights. During discussions students apply theoretical knowledge in a practical context. Discussions during handover embraces a variety of clinical illnesses or issues. This study indicates that students were willing to apply what had been discussed in management of the patients as they would care for the patients who had been discussed during clinical handover. This is in line with the study done by [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e] which found that teaching and learning moments may be facilitated by the preparedness of the learner.\\u003c/p\\u003e \\u003cp\\u003eThis study findings revealed that lecture method is one of the strategies that is also used in teaching and learning during handover. Students were contented with lecture method because it created opportunities for learning new materials. This is consistent with the study findings that the lecture method is the best teaching method for immediate knowledge retention for nursing students and it is most favorite method for most students [\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]. The finding in this study could probably be because students do not have to put more effort during learning as much work is done by the teacher. However, other studies had different findings too, whereby lecture method was not welcomed by students as it does not provide ground for student\\u0026rsquo;s development and satisfaction. [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eLecture method has the ability to transfer important information and concepts to a large group of people [\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. However the major disadvantage of the lecture teaching strategy is that it is not very effective for the development of critical thinking skills required in medical related fields like nursing [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]. [\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e] emphasized that lecture method has no significant effect of critical thinking abilities of student. While the lecture method is effective in transmitting information during clinical handover, it is necessary to use it in conjunction with interactive element for example questions, brief discussions, videos or handouts and the teacher should encourage identification of areas for need for clarity or explanations.\\u003c/p\\u003e \\u003cp\\u003eThis study findings also revealed that there are several facilitators to student learning during clinical handover. Clinical handover enabled students to learn and be supplied with new information consistently (Comprehensive exposure to new information).It involves sharing information about different patients with different illnesses, which ensures that members present constantly share new trends of illnesses and their treatment guidelines. This is in line with findings from a study by [\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e] which demonstrated that teachers can facilitate students\\u0026rsquo; learning by providing up to date information.\\u003c/p\\u003e \\u003cp\\u003eThe new and relevant information shared during clinical handover helps students to copy and deal with ongoing tasks, projects or patient conditions and this helps in reduction of errors in provision of care. Students may also utilize the information to excel academically. Sharing of knowledge during clinical handover may motivate students to attend clinical handovers thus an opportunity to learn more. Students may have knowledge gaps due to different clinical exposures, educational background or experience levels. The gaps can include the clinical manifestations of an illness or its management. This study found that clinical handover help students to understand the content covered in class better (Gap bridging opportunity) this is because there is some repetition of conditions being discussed during clinical handover which give students ample time to learn and keep up to date with their studies. Similarly, [\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e] indicated that knowledge loss is minimized if an activity is repeated thus enhanced learning. This ensures individual knowledge depositions which can further be expanded. It is easy for students to forget when theoretical knowledge is not being used for a long time, therefore clinical teachers should encourage students to attend clinical handover to keep them active by reinforcing application of theory into practice.\\u003c/p\\u003e \\u003cp\\u003eThe study also revealed that learning during clinical handover caters a wider scope. Skills like communication which is of paramount importance in learning is addressed during clinical handover. Communication is necessary for career development. Students in this study revealed that others lacked communication skills however with time they had improved as they kept practicing during handover. These findings are consistent with results of a study by [\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e] which revealed that effective communication skills in nursing practice are not inborn, can be learned and enhanced. The study findings are also in consistency with [\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e] who found that most students lack communication skills necessary for effective learning in the clinical area. Several studies also noted that most nursing students have low self-confidence, this therefore results in fear and anxiety such that communication in nursing students is impaired [\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eA lot of nursing students do not go through formal education to learn how to perform handover rather on job training represents the main learning strategy [\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]. This finding is consistent with what [\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e] and [\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e] found that communication training is not a priority in nursing education such that few nursing programs offer systematic instruction or clinical handover education to students though much is expected of them after graduation .Consequently,[\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e], found that without structured clinical handover education, nursing students become inactive recipients during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eEnsuring effective performance and optimal learning during clinical handover should be one of the priorities of nursing education [\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e]. It is necessary for final year nursing students and junior staff to be trained on how to give and receive clinical handover before they lead or initiate them [\\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e]. The clinical teacher therefore has to ensure that a platform is set during clinical handover where students are taught effective communication techniques.\\u003c/p\\u003e \\u003cp\\u003e[\\u003cspan citationid=\\\"CR54\\\" class=\\\"CitationRef\\\"\\u003e54\\u003c/span\\u003e] suggested the use of simulation and structured clinical handover techniques prior to clinical placement which has shown to increase student confidence to engage in clinical handovers during their clinical placements. Simulation based clinical handover has proven to reduce medical errors and preventable adverse outcomes [\\u003cspan citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e].Similarly, [\\u003cspan citationid=\\\"CR56\\\" class=\\\"CitationRef\\\"\\u003e56\\u003c/span\\u003e] recommended the use of ISBARR (Identify, Situation Background Assessment, Recommendation and Repeat) to help address student\\u0026rsquo;s perceived anxiety and confidence levels associated with clinical handover reports.\\u003c/p\\u003e \\u003cp\\u003eThe study further found that clinical handover helped students redeem their lost time and opportunity to learn on different procedures/illnesses, for example students on midwifery practice could learn medical/surgical conditions which they never had some opportunity to practice on during their practical experience. Learning during handover may be informal thus opportunistic, implicit and reflective or formal whereby teaching and learning is deliberately organized [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. In opportunistic learning clinical teachers take advantage of a situation or condition that has been presented/reported, to teach more on a condition/disease thus engaging students in learning and one example is use of case-based teaching. [\\u003cspan citationid=\\\"CR57\\\" class=\\\"CitationRef\\\"\\u003e57\\u003c/span\\u003e] noted that students are stimulated to critically think by being exposed to different scenarios which facilitates the identification of omissions and the ability to rectify gaps.\\u003c/p\\u003e \\u003cp\\u003eReflective clinical handover learning involves making ones learning a more conscious process whereby critical thinking skills are developed by analyzing experiences to improve future performance. An example is when a case that has been presented/discussed during handover leave members thinking/contemplating on their own clinical practice as compared to the one presented during the handover [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. Implicit learning also happen during clinical handover where by members share experiences and due to the repeated exposures to different cases not seen by members themselves, learning takes place [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eClinical handovers provide an opportunity for students to observe and learn how experienced professionals communicate, prioritize information and make decisions [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Therefore the researchers recommend that nurses should make sure that at any available time students are taught during clinical handover.\\u003c/p\\u003e \\u003cp\\u003eThis study also revealed that there are barriers to student learning during handover. It found that the learning environment played a role in learning in many ways. Learning environment incorporates conditions that both enable and constrain learning [\\u003cspan citationid=\\\"CR58\\\" class=\\\"CitationRef\\\"\\u003e58\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eFindings of this study has revealed that there is no systematic process that is followed during clinical handover in Malawi such that handover is done haphazardly. These findings are not unique to Malawi alone. The evidence of a lack of a consistent or systematic approach to handover practice, was also found in an Irish healthcare where there was general absence of institutional policy and training on clinical handover [\\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e59\\u003c/span\\u003e]. Clinical handover communication protocols assist nurses to organize the clinical handover report and to present the patient\\u0026rsquo;s information systematically thus minimizing miscommunications and misunderstandings during clinical handover which can result in errors consequently putting patients at risk [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR60\\\" class=\\\"CitationRef\\\"\\u003e60\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e]. Furthermore communication structures with well detailed patients information provides a chance for clarification of care to both the incoming and outgoing nurses for example through asking questions [\\u003cspan citationid=\\\"CR63\\\" class=\\\"CitationRef\\\"\\u003e63\\u003c/span\\u003e]. In addition, clinical handover communication structure promotes unity and collaboration of interdisciplinary clinical teams and hospital staff at different levels of hierarchy [\\u003cspan citationid=\\\"CR63\\\" class=\\\"CitationRef\\\"\\u003e63\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eHowever, standardized handover tools also have some limitations, which include; some level of inconsistency observed even when used by experienced nurses [\\u003cspan citationid=\\\"CR64\\\" class=\\\"CitationRef\\\"\\u003e64\\u003c/span\\u003e] as well as presence of errors despite utilization of standardized tools. In this study nothing was asked about the effectiveness of the clinical handover tools since they are not available. The ISBAR (Identify, Situation, Background, Assessment, and Recommendation) clinical handover tool is internationally recommended standardized tool for conducting clinical handover [\\u003cspan citationid=\\\"CR65\\\" class=\\\"CitationRef\\\"\\u003e65\\u003c/span\\u003e]. The ISBAR also improves communication, completeness of data and enhances information sharing [\\u003cspan citationid=\\\"CR66\\\" class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eStudy findings also indicated that participants felt it was necessary for the clinical handover to be done at a specified place. This finding supports earlier findings of [\\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e59\\u003c/span\\u003e] which demonstrated that other locations like the ward/nurses station or busy clinical departments like emergency department alters handover effectiveness due to many interruptions. Similarly, [\\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e] noted that physical constraints like lack of dedicated or sufficient space affected communication during handover. Participants in this study felt that a special area should be put aside in the ward specifically for handover, however, changes may not always be easy, for example other suggestions may sound unrealistic (due to lack of resources) or may be in conflict with hospital protocols (for example that handovers must be performed at a patient\\u0026rsquo;s bedside at a hospital whose protocol stipulates verbal/written handover in a conference room) [\\u003cspan citationid=\\\"CR68\\\" class=\\\"CitationRef\\\"\\u003e68\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study also revealed lack of time management as a barrier to learning during clinical handover. It was found that poor time management affects other activities or the clinical handover process. This is in line with findings from a study by [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] who highlighted time constraints as a major barrier to clinical handover. Similarly, several studies, showed that impaired time management and time pressures, resulted in irrelevant, less detailed and rushed reports [\\u003cspan citationid=\\\"CR69\\\" class=\\\"CitationRef\\\"\\u003e69\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]. Students complained that learning moments like presentations were substituted with clinical handover reports, which affected their learning. If time is limited, it is more likely that there is not going to be teaching and learning because members will be more interested in the safety of patients and their subsequent care [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] other than student teaching and learning. [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], emphasized time management as an important element that helps efficiency clinical handover as well as chance for teaching and learning. During clinical handovers time has to be observed. Choosing a leader to guide clinical handovers helps to ensure that deliberations are done in a timely manner [\\u003cspan citationid=\\\"CR70\\\" class=\\\"CitationRef\\\"\\u003e70\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThis study revealed that student/nurse relationships are not good because of bad attitudes that other nurses have towards students. Several other studies have reported negative working relationships between nursing students and clinical staff [\\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR72\\\" class=\\\"CitationRef\\\"\\u003e72\\u003c/span\\u003e]. Similarly, [\\u003cspan citationid=\\\"CR73\\\" class=\\\"CitationRef\\\"\\u003e73\\u003c/span\\u003e] highlighted unfriendliness, bad attitude, hostility as some behaviors that deny the students opportunities to learn. Furthermore, study by [\\u003cspan citationid=\\\"CR74\\\" class=\\\"CitationRef\\\"\\u003e74\\u003c/span\\u003e] found that poor relationships may lead to frustration and demotivation thus, negatively affecting students learning.\\u003c/p\\u003e \\u003cp\\u003eIn addition, [\\u003cspan citationid=\\\"CR75\\\" class=\\\"CitationRef\\\"\\u003e75\\u003c/span\\u003e] revealed that clinical teachers who are verbally offensive in clinical settings impede student learning by creating an intimidating environment which causes students to shun away from performing procedures in the ward. The clinical teachers negative attitude towards students, especially registered nurses who are also key due to the role they play in clinical teaching deter communication and interaction between them [\\u003cspan citationid=\\\"CR76\\\" class=\\\"CitationRef\\\"\\u003e76\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]. Clinical staff belittling and insensible behaviors towards students like shouting at students in front of other staff members and patients when they make mistakes or gossiping about them also leads to reduced confidence [\\u003cspan citationid=\\\"CR77\\\" class=\\\"CitationRef\\\"\\u003e77\\u003c/span\\u003e]. These disheartening behaviors towards nursing students are not only done by nurses but physicians as well [\\u003cspan citationid=\\\"CR76\\\" class=\\\"CitationRef\\\"\\u003e76\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe study by [\\u003cspan citationid=\\\"CR78\\\" class=\\\"CitationRef\\\"\\u003e78\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR79\\\" class=\\\"CitationRef\\\"\\u003e79\\u003c/span\\u003e] reported that student nurses learn easily when they are involved and work closely with a clinical teacher who is motivated to work with students and constantly supports and encourages learning. Students feel confident and motivated to learn in an environment where they are respected, recognized, supported and regarded as part of the team [\\u003cspan citationid=\\\"CR74\\\" class=\\\"CitationRef\\\"\\u003e74\\u003c/span\\u003e] .Students should be treated with love and kindness other than shouting at them when they have not done a procedure properly [\\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e]. Whenever students make mistakes or are unable to perform procedures, it is the responsibility of clinical teachers to professionally correct them and not shame them [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe study finding also indicated that sexual relationship advancement has the potential to hinder learning during handover. Therefore it is necessary that clinical teachers and students should observe professionalism.\\u003c/p\\u003e \\u003cp\\u003eThe study also found that most nurses don\\u0026rsquo;t attend clinical handovers, this consequently affects student attendance and participation too. The researchers views the presence of highly ranked nursing officials like the chief nursing officers, district nursing officers as an opportunities for students to gain high level knowledge/skills and attitudes considering that these nurses have a wide range of experience. The researcher therefore recommends that all relevant staff should be present at clinical handovers, although this proves extremely difficult, especially in emergency departments. [\\u003cspan citationid=\\\"CR69\\\" class=\\\"CitationRef\\\"\\u003e69\\u003c/span\\u003e] found that multidisciplinary representation at handovers facilitates sharing of information and learning.\\u003c/p\\u003e \\u003cp\\u003eAnother finding revealed that some qualified nurses do not have enough knowledge such that students lose trust in them. This finding is supported by [\\u003cspan citationid=\\\"CR80\\\" class=\\\"CitationRef\\\"\\u003e80\\u003c/span\\u003e] whose study established that some clinical teachers lacked the relevant skills to facilitate student learning. It should be noted that the presence and interaction with a registered nurse in the ward does not guarantee effective teaching and learning of students [\\u003cspan citationid=\\\"CR81\\\" class=\\\"CitationRef\\\"\\u003e81\\u003c/span\\u003e]. These results are also consistent with those reported in a study done in Iran where students felt unsatisfied with clinical assessment and evaluations because they were done by those clinical teachers whom they felt had limited knowledge and experience [\\u003cspan citationid=\\\"CR82\\\" class=\\\"CitationRef\\\"\\u003e82\\u003c/span\\u003e]. [\\u003cspan citationid=\\\"CR83\\\" class=\\\"CitationRef\\\"\\u003e83\\u003c/span\\u003e] highlighted that clinical teachers with limited skills cannot be effective role models. Clinical teachers\\u0026rsquo; knowledge, skills and attitudes are crucial in students\\u0026rsquo; clinical learning [\\u003cspan citationid=\\\"CR84\\\" class=\\\"CitationRef\\\"\\u003e84\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cdiv id=\\\"Sec22\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSTUDY LIMITATIONS\\u003c/h2\\u003e \\u003cp\\u003eThe study was conducted in one region of the country meaning that transferability of the results might not be possible since it may not be a representative of the experience of all students on learning during handover. There is therefore a need to extend the study to all regions.\\u003c/p\\u003e \\u003cp\\u003eData collection was done in week of peace (Examinations preparation week) at one college, the researcher could not extend the period because the students were finishing school as soon as they finished the examinations .This meant having focused group discussions with extremely busy participants. This could therefore affect or influence rushed responses from the participants.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eClinical handovers\\u0026rsquo; educative value cannot be overemphasized. Learning during clinical handover evolves around member involvement, Pedagogical knowledge, content knowledge as well as the environment (physical, psychological, social). To maximize learning during handover several strategies are proposed; clinical teacher knowledge, skill and attitude improvement, student/nurse dedication to learning and strengthening of mutual relationships between clinical teachers and students.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eACKNOWLEDGEMENT\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors would like to express their appreciation to the study participants for sparing their time to take part in the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAUTHOR CONTRIBUTION\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eL.N conceptualized the study and collected data. L.N, B.C and F.L worked on data analysis and interpretation. L.N, B.C, F.L, T B and BCM made conceptual contribution to the manuscript and edited the manuscript. B.C and F.L also played oversight and supervision roles. All authors contributed to the completion of this manuscript and have read and approved it.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFUNDING\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study received no funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDATA AVAILABILITY\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data is available with the corresponding author and may be made available upon request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEthical approval was sought from the Research Ethics Committee of Mzuzu University reference number\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eMZUNIREC/DOR/23/71. The researcher also asked for permission to conduct the study from Deayang and Nkhoma colleges\\u0026rsquo; authority.\\u0026nbsp;The participants voluntarily consented to participate in the study by signing a written informed consent\\u0026nbsp;form and were free to withdraw from the study at any time without any consequences.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCONSENT FOR PUBLICATION\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCOMPETING INTEREST\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no competing interests\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eKlaber RE, Macdougall CF. Maximising learning opportunities in handover. Archives of Disease in Childhood-Education and Practice. 2009 Aug 1; 94 (4):118-22.\\u003c/li\\u003e\\n \\u003cli\\u003eAlert SE. Inadequate hand-off communication. Sentinel event alert. 2017;58 (1):6.\\u003c/li\\u003e\\n \\u003cli\\u003eClinical Excellence Commission. (2019). Clinical Handover. (PD2019_020).\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eSeada AM, Bayoumy SA. Effectiveness of handoff educational program on nurses interns\\u0026rsquo; knowledge, and communication competence. Am. J. Nurs. Sci. 2017 Nov 24;6:467-77.\\u003c/li\\u003e\\n \\u003cli\\u003eAlberta David N, Idang Neji O, Jane E. Nurse handover and its implication on nursing care in the university of Calabar teaching hospital, Calabar, Nigeria. Int J Nur Care. 2018;2(3):1-9\\u003c/li\\u003e\\n \\u003cli\\u003eMalone L, Anderson J, Manning J. Student participation in clinical handover\\u0026ndash;an integrative review. Journal of Clinical Nursing. 2016 Mar;25(5-6):575-82.\\u003c/li\\u003e\\n \\u003cli\\u003eBhabra G, Mackeith S, Monteiro P, Pothier DD. An experimental comparison of handover methods. The Annals of The Royal College of Surgeons of England. 2007 Apr;89(3):298-300.\\u003c/li\\u003e\\n \\u003cli\\u003eBradley.S., Egan, J \\u0026amp; Hennin M (2018) \\u003cem\\u003ePediatric team handover: a time to learn?\\u003c/em\\u003e \\u003ca href=\\\"http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2018/vol-131-no-1476-8-june-2018/7586\\\"\\u003ehttp://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2018/vol-131-no-1476-8-june-2018/7586\\u003c/a\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003eOoi A, Bradley S, Mukherjee S, Stafford K, Henning MA. Facilitating educational experiences in a paediatric handover: A qualitative case study. Journal of Paediatrics and Child Health. 2020 Sep;56(9):1426-31.\\u003c/li\\u003e\\n \\u003cli\\u003eSadideen H, Hamaoui K, Saadeddin M, Cogswell L, Goodacre T, Jefferis T. Handover practice amongst core surgical trainees at the Oxford School of Surgery. Journal of Educational Evaluation for Health Professions. 2014 Feb 28;11\\u003c/li\\u003e\\n \\u003cli\\u003eReynolds LM, Attenborough J, Halse J. Nurses as educators: creating teachable moments in practice. Nursing Times. 2020;116(2):25-8.\\u003c/li\\u003e\\n \\u003cli\\u003eAttenborough J, Abbott S, Brook J, Knight RA. Everywhere and nowhere: work-based learning in healthcare education. Nurse Education in Practice. 2019 Mar 1;36:132-8\\u003c/li\\u003e\\n \\u003cli\\u003eBasheer H, Allwood B, Lindsell CM. Never too busy to learn\\u0026ndash;how the modern team can learn together in the busy workplace. Royal College of physicians, 2018. Available: file. C:/Users/2919684/Downloads/Never% 20too% 20busy% 20to% 20learn_ report% 20FINAL _ 0_ 0.;20(1).\\u003c/li\\u003e\\n \\u003cli\\u003eDornan T, Tan N, Boshuizen H, Gick R, Isba R, Mann K, Scherpbier A, Spencer J, Timmins E. How and what do medical students learn in clerkships? Experience based learning (ExBL). 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Nursing students\\u0026apos; involvement in shift-to-shift handovers: Findings from a national study. Nurse Education Today. 2019 Apr 1;75:13-21.\\u003c/li\\u003e\\n \\u003cli\\u003eSubhan MS. \\u003cem\\u003eCurrent pedagogical teaching strategies being used by educators at the KwaZulu-Natal College of Nursing campuses across varied subjects and their views regarding innovative methodologies\\u003c/em\\u003e (Doctoral dissertation).\\u003c/li\\u003e\\n \\u003cli\\u003eFreire P. Pedagogy of the oppressed. InToward a sociology of education 2020 Mar 10 (pp. 374-386). Routledge.\\u003c/li\\u003e\\n \\u003cli\\u003eKalsoom S, Kalsoom N, Mallick RJ. From banking model to critical pedagogy. UMT Education Review. 2020 Jun 12;3(1):25-44.\\u003c/li\\u003e\\n \\u003cli\\u003eIshtiaq M, Gul R, Holt J, Babar M. Questioning Training and Critical Thinking of Undergraduate Students of Health and Social Sciences: A Scoping Review. 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Perth ,WA:Department of Health Retrieved from http://www.health.wa.gov.au/circularnew/pdfs/13048.pdf\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eMalone L, Anderson J, Manning J. Student participation in clinical handover\\u0026ndash;an integrative review. Journal of Clinical Nursing. 2016 Mar;25 (5-6):575-82.\\u003c/li\\u003e\\n \\u003cli\\u003eStarmer AJ, Spector ND, Srivastava R, West DC, Rosenbluth G, Allen AD, Noble EL, Tse LL, Dalal AK, Keohane CA, Lipsitz SR. Changes in medical errors after implementation of a handoff program. New England Journal of Medicine. 2014 Nov 6;371(19):1803-12.\\u003c/li\\u003e\\n \\u003cli\\u003eKostiuk S. Can learning the ISBARR framework help to address nursing students\\u0026rsquo; perceived anxiety and confidence levels associated with handover reports? . Journal of Nursing Education. 2015 Oct 1;54 (10):583-7.\\u003c/li\\u003e\\n \\u003cli\\u003eDeravin L, Anderson J. Transfer of responsibility and accountability of patient care. 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Journal of PeriAnesthesia Nursing. 2016 Feb 1;31(1):63-72\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003ePun J. Factors associated with nurses\\u0026rsquo; perceptions, their communication skills and the quality of clinical handover in the Hong Kong context. BMC nursing. 2021 Jun 11;20(1):95.\\u003c/li\\u003e\\n \\u003cli\\u003ePun J, Chan EA, Eggins S, Slade D. Training in communication and interaction during shift-to-shift nursing handovers in a bilingual hospital: A case study. Nurse Education Today. 2020 Jan 1;84:104212\\u003c/li\\u003e\\n \\u003cli\\u003eEggins S, Slade D, Geddes F. Effective communication in clinical handover. From Research to Practice. 2016\\u003c/li\\u003e\\n \\u003cli\\u003eWorld Health Organization (WHO). WHO collaborating centre for patient safety solutions 2007. Communication during Patient Hand-Overs. Patient Safety Solutions. 2017.\\u003c/li\\u003e\\n \\u003cli\\u003eBreuer RK, Taicher B, Turner DA, Cheifetz IM, Rehder KJ. Standardizing postoperative PICU handovers improves handover metrics and patient outcomes. Pediatric critical care medicine. 2015 Mar 1;16(3):256-63\\u003c/li\\u003e\\n \\u003cli\\u003eLiu W, Manias E, Gerdtz M. Medication communication between nurses and patients during nursing handovers on medical wards: a critical ethnographic study. International journal of nursing studies. 2012 Aug 1;49(8):941-52.\\u003c/li\\u003e\\n \\u003cli\\u003eSlade D, Pun J, Murray KA, Eggins S. Benefits of health care communication training for nurses conducting bedside handovers: An Australian hospital case study. The Journal of Continuing Education in Nursing. 2018 Jul 1;49(7):329-36\\u003c/li\\u003e\\n \\u003cli\\u003eWatson BM, Jones L, Cretchley J. Time as a key topic in health professionals\\u0026rsquo; perceptions of clinical handovers. Global qualitative nursing research. 2014 Oct 14;1:2333393614550162\\u003c/li\\u003e\\n \\u003cli\\u003ePun JK, Matthiessen C, Williams G, Slade D. 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Asian nursing research. 2018 Sep 1;12(3):216-22\\u003c/li\\u003e\\n \\u003cli\\u003eTruong TH. \\u003cem\\u003eVietnamese nursing students\\u0026apos; perceptions of their clinical learning environment: A cross-sectional survey\\u003c/em\\u003e (Doctoral dissertation, Queensland University of Technology).\\u003c/li\\u003e\\n \\u003cli\\u003e\\u0026nbsp;Doyle K, Sainsbury K, Cleary S, Parkinson L, Vindigni D, McGrath I, Cruickshank M. Happy to help/happy to be here: Identifying components of successful clinical placements for undergraduate nursing students. Nurse education today. 2017 Feb 1;49:27-32\\u003c/li\\u003e\\n \\u003cli\\u003eSchmiedeknecht K, Perera M, Schell E, Jere J, Geoffroy E, Rankin S. Predictors of workforce retention among Malawian nurse graduates of a scholarship program: a mixed-methods study. Global Health: Science and Practice. 2015 Mar 1;3 (1):85-96.\\u003c/li\\u003e\\n \\u003cli\\u003eJahanpour F, Azodi P, Azodi F, Khansir AA. Barriers to practical learning in the field: a qualitative study of Iranian nursing students\\u0026rsquo; experiences. Nursing and midwifery studies. 2016 Jun;5 (2).\\u003c/li\\u003e\\n \\u003cli\\u003eBvumbwe T, Malema A, Chipeta M. Registered nurses\\u0026rsquo; experiences with clinical teaching environment in Malawi.\\u003c/li\\u003e\\n \\u003cli\\u003eBaraz S, Memarian R, Vanaki Z. Learning challenges of nursing students in clinical environments: A qualitative study in Iran. Journal of education and health promotion. 2015 Jan 1;4(1):52.\\u003c/li\\u003e\\n \\u003cli\\u003eKemp P, Gilding M, Seewooruttun K, Walsh H. A work-based learning approach for clinical support workers on mental health inpatient wards. Nursing Standard. 2016 Sep 14;31 (3).\\u003c/li\\u003e\\n \\u003cli\\u003eBifftu BB, Dachew BA, Tiruneh BT, Ashenafie TD, Tegegne ET, Worku WZ. 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Journal of caring sciences. 2018 Sep; 7 (3):119.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-nursing\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"nurs\",\"sideBox\":\"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/nurs/default.aspx\",\"title\":\"BMC Nursing\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Clinical handover, Clinical teacher, Learning, Student\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4732263/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4732263/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBACKGROUND\\u003c/strong\\u003e: Clinical handover is the transfer of essential information, professional responsibility and authority for care of the patient from one health care provider to another. Clinical handover not only ensures patient safety and continuity of care but also provides learning opportunity for nursing students. Effective learning during clinical handover allows smooth transition of final year nursing students into practice. The aim of the study was to explore the dynamics of learning during handover among final year nursing students in central region nursing colleges.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMETHODS\\u003c/strong\\u003e: A qualitative descriptive phenomenology study was done among final year nursing students in central region nursing colleges in Malawi. Purposive sampling method was used to recruit 15 participants for the study. Data in this study was collected using focus group discussions utilizing a focused group discussion guide. Data analysis was done manually using Colaizzi’s (1978) seven step approach.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRESULTS\\u003c/strong\\u003e: In this study, effective learning during clinical handover evolved around active involvement of student and teacher, comprehensive content and pedagogical knowledge of the clinical teacher and the conducive learning environment.\\u003c/p\\u003e\\n\\u003cp\\u003eTeaching strategies like question and answer, discussions and lecture method were among the most utilized teaching methods during handover. Shared knowledge, maximized learning opportunities and diversity were identified as facilitating factors to student learning. However lack of knowledge, poor time management, poor relationships between nurses and students as well as poor attitudes towards handover were among the most attributable barriers to student learning during handover.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCONCLUSION\\u003c/strong\\u003e: For students to maximize the teaching and learning opportunities that clinical handover offers, interventions like ensuring time management during clinical handover, promoting good work relationships, good clinical handover attendance, improved clinical teacher content/pedagogical knowledge and promoting self-initiated learning among students should be encouraged.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Learning dynamics during clinical handover: A qualitative study among final year students in central region nursing colleges, Malawi\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-08-12 10:49:43\",\"doi\":\"10.21203/rs.3.rs-4732263/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-08-27T15:47:25+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-08-27T14:53:56+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-08-26T09:17:08+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"482470521048766965710274719516416827\",\"date\":\"2024-08-16T07:41:57+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"313239666848298532342413253855643229171\",\"date\":\"2024-08-06T09:27:35+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"177126691132825042401654579498727612070\",\"date\":\"2024-08-05T12:11:34+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-08-05T12:01:58+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2024-07-17T14:24:38+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-07-17T14:18:22+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-07-17T14:18:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Nursing\",\"date\":\"2024-07-12T18:45:12+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-nursing\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"nurs\",\"sideBox\":\"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/nurs/default.aspx\",\"title\":\"BMC Nursing\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"5ada6121-7e53-4a90-9cd5-6df305532f51\",\"owner\":[],\"postedDate\":\"August 12th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-07-21T16:01:39+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-4732263\",\"link\":\"https://doi.org/10.1186/s12912-025-03590-z\",\"journal\":{\"identity\":\"bmc-nursing\",\"isVorOnly\":false,\"title\":\"BMC Nursing\"},\"publishedOn\":\"2025-07-15 15:57:36\",\"publishedOnDateReadable\":\"July 15th, 2025\"},\"versionCreatedAt\":\"2024-08-12 10:49:43\",\"video\":\"\",\"vorDoi\":\"10.1186/s12912-025-03590-z\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12912-025-03590-z\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4732263\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4732263\",\"identity\":\"rs-4732263\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}