Deaf-Blindness through the Voices and Experiences of Parents and Educators.

This qualitative study used the experiences of parents and educators to explore the developmental processes and behaviors of deafblind people of different ages and with different etiologies. It also explored which strategies of intervention and care employed by parents and educators best promote and stimulate the abilities and the autonomy of deafblind people. Eligible parents and educators were identified and recruited from the New York Parents Association for Deafblind and the Helen Keller National Center on Long Island using purposeful sampling. Seven mothers, one father, and two educators were interviewed using a narrative method. Data analysis was performed using Heideggerian hermeneutic phenomenology. The themes that emerged concern communication, expression of emotions, sense of self and external reality, autonomy, and the sphere of educational intervention. This research goes beyond existing knowledge on the syndromes/disabilities related to deafblindness, focusing instead on the combinations of varying degrees of hearing and sight deprivation.

The hidden curriculum in nursing education: a scoping study.

CONTEXT: The hidden curriculum is a learning dimension made up of culturally acquired, unintended lessons. Although nurse educators are not fully aware of it, through the hidden curriculum students are prepared for adult professional roles, internalising professional values and developing a professional identity. However, academic nursing education has paid relatively scarce attention to it. The objective was to map the nursing education literature about the hidden curriculum and to identify and verify to which of the four areas suggested by Hafferty (institutional policies, resource allocation decisions, institutional slang and evaluation) it refers. METHODS: A scoping study was conducted. In July 2018, a search was performed in MEDLINE/PubMed, Scopus, EBSCO/ Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library databases, without time or language restrictions. Two authors independently performed the selection of studies, which followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart. Data charting was conducted with both an analytical and a narrative approach. RESULTS: The study included 18 articles, 13 of which were published during the last 5 years. A total of 12 were research articles, 10 of which used qualitative methodology. Regarding the area of analysis, all four areas could be identified within nursing education literature. The most widely explored area proved to be institutional policies, mentioned by 15 articles, predominantly to highlight the negative effect of the hidden curriculum. Some relational aspects, attributed to the hidden curriculum within nursing literature, belong to the informal curriculum. CONCLUSIONS: The hidden curriculum in nursing education remains a largely overlooked topic. It appears to be a broader concept than that theorised by Hafferty, often also encompassing the informal curriculum. Furthermore, the literature reviewed mostly highlights the negative consequences of the hidden curriculum, such as the difficulty of transmitting professional values and ethics. Conversely, future researchers should concentrate on its positive consequences as a way to limit the loss of professional values.

Adaptation and validation of the Caregiver Burden Inventory in Spinal Cord Injuries (CBI-SCI).

DESIGN: Validation cross-sectional study. OBJECTIVES: Even though caregiver burden (CB) represents a well-recognised concern among caregivers of people with a spinal cord injury (SCI), there are no specific questionnaires designed for its evaluation. This study aimed to assess the psychometric properties of the Caregiver Burden Inventory in Spinal Cord Injury (CBI-SCI), which was modified from its original version, and specifically its construct and reliability. SETTING: Multicentre study in four urban spinal units across Italy. The CBI-SCI was administered to family caregivers in outpatient clinics. METHODS: CBI-SCI was administered in a toolset composed of a sociodemographic questionnaire, the Family Strain Questionnaire-Short Form (FSQ-SF), the Short Form-36 (SF-36), and the Modified Barthel Index (MBI). The CBI-SCI construct validity was assessed through an exploratory factor analysis. The internal consistency of the questionnaire was examined using Cronbach's alpha (α) coefficient for the total scale and its subscales. Concurrent validity was evaluated performing Pearson's correlation coefficient with all instruments included in the toolset. RESULTS: The CBI-SCI was administered to 176 participants from February 2016 to September 2017. Factor analysis highlighted the five-factored structure of the questionnaire. The total scale Cronbach's α was 0.91 (p < 0.001). All the five subscales of CBI-SCI showed an acceptable internal consistency, ranging from 0.76 to 0.91 (p < 0.001). Pearson's correlation coefficients of the CBI-SCI with all the administered instruments were statistically significant (p < 0.001), showing congruent relations. CONCLUSION: The CBI-SCI, due to its validity and reliability, may represent a valuable instrument to evaluate the CB longitudinally in SCI.

Nurses' Experience of Body Nursing Care: A Qualitative Study.

As a practice, nursing centers on patients' bodies and how they live the experience of illness and disability through their bodies (embodiment). International nursing studies conducted on the topic of body care primarily include theoretical studies, whereas empirical studies remain sparse. The aim of this study was to describe nurses' perceptions of the role of their bodies and the bodies of patients during body care. This study used a descriptive phenomenological study based on Husserl's philosophical perspective. A purposive sample of 11 Italian registered nurses representing the highest level of nursing education, different clinical experience levels, and different clinical specialties were interviewed. Data were collected between July 2015 and September 2015. Open-ended interviews were analyzed using Giorgi's descriptive phenomenological method. Lincoln and Guba's strategies were used to ensure the trustworthiness of the data. In addition to the overarching theme, "Body care is the heart of nursing," 4 major themes with 13 subthemes emerged from the data. The 4 major themes were as follows: (1) "Body care encompasses the essence of person"; (2) "Body care touches the heart of person"; (3) "The body generates opposite strategies of care"; and (4) "In time, the body 'nourishes' the helping relationship." Nurses considered body and embodiment concepts central to nursing. Body care is treated as an experience with extraordinary emotional contents, allowing nurses to discover the essentials of human nature.

Teaching resilience and vulnerability to nursing students using films: A qualitative study.

BACKGROUND: There is a limited tradition of using films in healthcare education, although it is constantly developing. Further, to understand complex concepts, such as vulnerability and resilience, is fundamental to improving nursing education. OBJECTIVE: This study aims to explore how a combined approach, using films and expert patients, could influence nursing education on the topics of vulnerability and resilience. METHODS: A qualitative descriptive study was carried out. Reflective writings of eight bache- lor's degree students during the first semester of the second year were analysed through a con- tent analysis methodology. RESULTS: Two main themes emerged: 1) To face up to vulnerability through resilience expe- riences, with three sub-themes: active behaviours to cope with disability; carrying the heavy load of vulnerability; using resilience as a new beginning; 2) Students' difficulties and perspectives on caring vulnerable people, with two sub-themes: awkwardness of facing vulnerability; and walk together to overcome disability CONCLUSIONS: The use of films, enhanced by the lived experiences of expert patients, would improve the learning in the new generation of nursing students that are actually more involved in the use of innovative learning strategies. The adoption of new ways to teach complex con- cepts to bachelor degree nursing students is pivotal to simplify theories and to establish a posi- tive connection between nursing students and educators. The education system should consider that, only through emotionally strong educational strategies, is possible to foster an endu- ring emotional knowledge in students.

"Hosting" an implantable cardioverter defibrillator: A phenomenological inquiry.

Implantable cardioverter defibrillators (ICDs) can reduce unexpected cardiac mortality, but they also have a dramatic impact on a patient's quality of life. We aimed to explore ICD recipients' experiences in order to foster improvements in the quality of care. Analyses were done using a descriptive phenomenological method, based on qualitative interview data from a purposive sample of 20 ICD recipients. Four main themes emerged: living with fear; relying on technology; knowing about the ICD and how to live with it; and coping with the effects of the ICD on daily life. ICD recipients lived in a constant state of fear due to the presence of the device and the uncertainty related to the potential electrical shocks it could deliver. This fear was compounded by changes that severely affected the quality of their daily life. ICD recipients felt they were always on the brink of death, and that although they received sufficient technical information they did not feel they received meaningful information to help them accept, live with, and cope with the device. Emotional information and support, rather than technical information, must be provided to ICD recipients to give them the ability to cope with the everyday threats they perceive because of the device. Qualitative evidence may help professionals tackle known threats to patients' quality of life and increase the quality of care.

Caring for Dying Patient and Their Families: The Lived Experiences of Nursing Students in Italy.

BACKGROUND: The literature from recent decades persistently suggests that nurses are not adequately trained in caring for the dying. Numerous studies call for enhanced education in end-of-life care. OBJECTIVE: To explore student nurses' experience of caring for dying persons and their families and how this experience was influenced by their undergraduate education, with a view to improving end-of-life training. METHODS: Narrative interviews were administered to a purposive sample of 18 undergraduate students at Turin University's School of Nursing and analyzed following Giorgi's qualitative phenomenological methodology. RESULTS: The students' accounts featured 4 main themes: emotions and feelings, reactions and coping strategies, growth in personal and professional awareness, and the professional nursing model. Students reporting positive experience of end-of-life care in clinical settings displayed the expected learning outcomes for undergraduate nursing education. CONCLUSION: This study's strength lies in the fact that it draws on student nurses' lived experience to assess training in end-of-life care. It confirms the need to invest in targeted end-of-life education and support for nursing students.

[Organizational features influencing health worker's fulfillment in an Alzheimer center and in a nursing home]. / Le caratteristiche organizzative che influenzano il benessere lavorativo degli operatori di un Centro Alzheimer e di una RSA.

OBJECTIVES: The pursuit of the best working conditions and of a rewarding job are pivotal elements in care process cause working satisfaction plays a main role to further the positive treatments outcome. METHODS: Anonymous questionnaires were administered to 59 subjects (10 nurses and 49 health workers) operating in two different institutions, an Alzheimer centre and a nursing home, in order to describe their personal sensation about work's gratification. RESULTS: Our research shows up, in both institutions, a satisfying perception about working conditions, learning and educational opportunities, teamwork and individual skills recognition. CONCLUSIONS: Patients' behavioural disorders and hard relationship with families are source of strain and stress for both groups. The rest home staff complain about the unsuitable environmental conditions which make difficult the managing of particular minor behavioural disorders like wonderings, escapes and falls. Elements as salary and balance between work and free time are relevant for both groups but not adequate to fulfill their expectations if work recognition and individual daily efforts appreciation are lacking.

Living with and treating rare diseases: experiences of patients and professional health care providers.

We explored the experiences of illness of patients suffering from rare diseases and of the health professionals who care for them at the Center for the Interregional Coordination of Rare Diseases of Piedmont and Valle d'Aosta in Italy. The research was carried out between 2010 and 2011. We collected qualitative data from 22 patients and 12 health professional health care providers. The interviews were analyzed using the Colaizzi phenomenological approach. We identified five themes from the narratives of the patient participants--dealing with disease development, living with the disease, everyday living, relating to others, and relations with health care providers--and four themes from the professional health care participants--dealing with the disease, dealing with expectations, building relationships, and being operators in the context. The study has raised awareness about the issue of rare diseases and it provides some useful considerations for improving services.

[The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature]. / L'uso della scrittura espressiva nei percorsi di cura dei pazienti oncologici per la riduzione del distress emozionale: analisi della letteratura.

AIM: The emotional distress represents one of the symptoms most frequently reported in the cancer patient in therapy, increasing the risk of developing a disease depressive. Through the analysis of the literature we want to assess whether the use of expressive writing on cancer patients in their care pathway compared to the use of writing neutral reduces emotional distress. METHOD: The bibliographic search was conducted using the databases CINAHL, PubMed, Cochrane Library and PsycInfo. RESULTS: The results of research conducted on 7 randomized controlled trials, including 3 pilot studies have shown after expressive writing sessions (experimental group) versus neutral writing (control group) a significant reduction in distress in the experimental group early stages of cancer (p = 0,0183); in patients with a diagnosis of metastatic assigned to the group expressive writing there was a statistically significant relevance in the reduction of mood disorders (p = 0,03).Were determined statistically significant group differences also with respect to some measure on the quality of sleep (p = 0,04). The expressive writing did not produce significant reductions in psychological distress and improvements in physical health (p > 0,20) in patients diagnosed with metastatic disease of long duration and, in the palliative care there have been results of feasibility for poor adherence at follow-up. CONCLUSION: From the results it is evident that the strategies of expressive writing improves the management of the disease, reduce the physical and psychological symptoms related to the tumor while reducing the emotional distress in patients at an early stage of the disease.

The effectiveness of the quality program Pac-IficO to improve pain management in hospitalized cancer patients: a before-after cluster phase II trial.

BACKGROUND: Cancer-related pain continues to be a major healthcare issue worldwide. Despite the availability of effective analgesic drugs, published guidelines and educational programs for Health Care Professionals (HCPs) the symptom is still under-diagnosed and its treatment is not appropriate in many patients. The objective of the study is to evaluate the efficacy of the Pac-IFicO programme in improving the quality of pain management in hospitalised cancer patients. METHODS/DESIGN: This is a before-after cluster phase II study. After the before assessment, the experimental intervention - the Pac-IFicO programme - will be implemented in ten medicine, oncology and respiratory disease hospital wards. The same assessment will be repeated after the completion of the intervention. The Pac-IFicO programme is a complex intervention with multiple components. It includes focus group with ward professionals for identifying possible local obstacles to optimal pain control, informative material for the patients, an educational program performed through guides from the wards, and an organisational intervention to the ward. The primary end-point of the study is the proportion of cancer patients with severe pain. Secondary end-points include opioids administered in the wards, knowledge in pain management, and quality of pain management. We plan to recruit about 500 cancer patients. This sample size should be sufficient, after appropriate statistical adjustments for clustering, to detect an absolute decrease in the primary end-point from 20% to 9%. DISCUSSION: This trial is aimed at exploring with an experimental approach the efficacy of a new quality improvement educational intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02035098.

[Taking care of foreign users: what training is needed for the healthcare workers at the Municipal Health and Science Agency of Torino?]. / Assistere l'utenza straniera: quale bisogno formativo per gli operatori sanitari dell'Azienda Città della Salute e della Scienza di Torino?

INTRODUTION: Immigration is growing and immigrants' presence is important also in the health care system, thereby services reorientation and a multicultural approach are needed. OBJECTIVE: To explore health care professionals' training needs of Turin Azienda Città della Salute e della Scienza in taking care of foreign users. METHODS: An ad hoc 4-sections questionnaire was built: (1) Knowledge, attitudes and perceptions; (2) Lived and Training; (3) Improvement in cultural competence; (4) Socio-demographic data. Questions were dichotomous (yes/no), closed and short open. Doctors, nurses, speech therapists and support staff of the "Head and Neck" Department were involved. RESULTS: One hundred seventy-six operators answered (75%). Less than 20% (n=34) knew the normative concerning immigrants' health services use; tubercolosis, venereal diseases and AIDS were believed to be the most frequent diseases in foreign users. Female sex (p=0.008) and allied health care profile (trend p=0051) were significantly associated to consider clients' values important, while a previous training was associated to the need of improving their knowledge (p=0.0002). The most important training needs were: meaning of illness and care, perception of prevention, hygiene and self-care practices and perception of care. Among the most effective strategies: lecture and discussion, group work and filmography. CONCLUSION: The analysis shows the main needing education areas and the training strategies which operators considered more effective.

[Profiles and evaluation process: what integration? Experience of the Local Health Agency TO2 of Turin]. / Il profilo di posto e il processo di valutazione: quale integrazione? Esperienza dell'Azienda Sanitaria TO2 di Torino.

INTRODUCTION: The Service of Health Professions of this facility (TO2 of Turin) aimed during the 2010 to devise/develop a new evaluation tool for the new employees , trying to fit them with the profiles set up the previous year. METHODS: The conceptual model of reference for the construction of working drafts of the grids was inspired by the special insert edition of "L'infermiere" in 2007, a literature review was carried out and a number of internal meeting within 6 of the Service of health Professions were set up. A working group were set up - 93 people - as well as indicators were developed to monitor and implementation of the instruments. Once the drafts of the standard tools were made, working groups started to improve the tools provided under the supervision of a tutor. Finally half way through an evaluation was carried out using a questionnaire. CONCLUSION: The new template leads a number of problems which were later sorted out also with the support of tutors.

Therapeutic education to cancer patients: experiences of Italian nurses.

INTRODUCTION: Therapeutic patient' education is a complex process requiring a proper level of communication between the patient and the healthcare professional. Nurses play a key role in providing the patients and their families with educational activities. OBJECTIVE: This paper is the report of a study which investigates the experiences of some Italian nurses with regards to their role in therapeutic education to cancer patients. METHODS: Qualitative research. Semi-structured interviews were carried out with 52 nurses working in different Local Health Service Units of two northern Italy regions: Piedmont and Valle d'Aosta. To identify categories and items arising from the data, the researchers used a qualitative content analysis. RESULTS: The interview format was classified into six main categories: a) Patient education as daily care activity; b) Relevance of communication and dialogue for educational purposes; c) Relative usefulness of written information; d) Therapeutic education recording; e) Patients' feedbacks as a tool for assessing therapeutic education; and f) Difficult communication. CONCLUSIONS: The experience of nurses in terms of their professional role in therapeutic education for cancer patients shows the steady presence of educational activities carried out in a non-planned way. This research confirms the need to launch educational interventions for nurses. IMPLICATIONS FOR PRACTICE: It is essential to implement an action plan to promote opportunities of professional training in the field since among the most frequent reasons for project failure in therapeutic education is the lack of expert human resources.

Towards personalized care for persons with spinal cord injury: a study on patients' perceptions.

OBJECTIVE/BACKGROUND: A newly designed Spinal Cord Unit (SCU) was set up at the Orthopedic Traumatology Center (OTC), Turin, Italy, in July 2007. With the relocation of the SCU came the need to reorganize and improve the delivery of its services. The study reported here is a preliminary part of a project entitled 'Experimentation and evaluation of personalized healthcare for patients with spinal cord injury', which is a component of an overarching program of targeted research into healthcare funded by the Piedmont Region in 2006. The aim of this study was to assess the perception of care by patients with spinal cord injury (SCI) by collecting important data in order to determine whether an integrated and personalized care pathway could be effective both in hospital and in a rehabilitation setting. DESIGN: Qualitative research study. The interview format was based on a narrative approach. METHODS: Qualitative in-depth semi-structured interviews were conducted with 21 patients with SCI. Qualitative content analysis was used to identify categories and themes arising from the data. RESULTS: Six main categories emerged from the perspectives of patients: expectations of rehabilitation care, impact and welcome, relationship with nurses and their involvement in treatment, relationship with physical therapists and participation in rehabilitation programs, relationship with physicians and their availability and attendance, and imparting of information on injury and rehabilitation outcomes. Care was the aspect new patients admitted to the SCU found most important. When closer relationships with staff formed, the healthcare professionals became an essential support. Patients with SCI commonly stated that receiving explicit information was necessary for accepting their condition. CONCLUSIONS: Analysis of the patients' perceptions revealed a wealth of details on their experience in the SCU and the need for flexible planning of care time in particular. Incorporating the patients' perceptions into a new care model could increase professionals' awareness of patients' needs and provide a useful basis for constructing a personalized care plan.

[Nursing managers: study to assess the expectations of nursing coordinators in a Northern Italian Hospital]. / Il dirigente del Servizio Infermieristico: inchiesta sulle attese dei coordinatori infermieristici di un'ASL piemontese.

In modern health-care , nursing managers play a strategic role in improving the quality of care and the skills of carers, since management and leadership strategies are known to be decisive in the deployment of resources and professional development. The aim of this study is to present the opinions and expectations of nursing coordinators regarding their managerial role. During the creation of a nursing service unifying the management of 3 local health authorities in Northern Italy, with different organizational and professional features, nursing coordinators were asked to fill in a questionnaire. Results showed that a priority aspect of the managerial role is to assess the appropriateness of care and the use of resources Their answers showed that they hoped for a style of management founded on aspects related to clinical government. For the style of leadership, they emphasized dedication to work, participation of staff in decision-making, group information and providing support in areas needing improvement. Although the study was territorial , it confirmed international guide-lines regarding the policies which give value to investments in the quality of organization and can be considered a point of reference for planning and creating future nursing services.

Nursing students' perspectives of dance movement therapy to learn relational skills: A qualitative description study.

BACKGROUND: Nursing students are expected to develop communication and relational skills during their undergraduate education, and the literature on art-based methods for teaching these skills is growing. Art-based education seems to be a promising method for teaching relational skills, especially embodied and performing arts. Dance Movement Therapy has been used previously to learn relational skills, but never in undergraduate nursing students. AIM: To describe how first-year undergraduate nursing students experienced the learning of communication and relational skills through a Dance Movement Therapy workshop. SETTINGS & PARTICIPANTS: First-year undergraduate nursing students who completed a two-session Dance Movement Therapy workshop. DESIGN & METHODS: This study utilised a Qualitative Description design. Data were gathered from students' reflective journals (n = 226 journals, 113 students) and analysed with a thematic analysis approach. RESULTS: Three themes were identified: learning happens through the experience of competences, learning happens through corporeality, and learning takes time. The first theme describes how students experienced theoretical concepts through workshop games. "Learning happens through corporeality" focuses on the role of the body during Dance Movement Therapy games as a medium for learning. "Learning takes time" describes students' evolution during the workshop, both within and between sessions, and the graduality of comprehension and learning. CONCLUSIONS: The findings of this study suggest that Dance Movement Therapy can be an applicable methodology for nursing students to learn communication and relational skills. Most of the relational skills and non-verbal communication components were explored and strengthened during the workshop. Students were also able to create links between theoretical concepts and nursing practice. Nurse educators may want to consider using Dance Movement Therapy to teach communication and relational skills.

Dealing with the patient's body in nursing: nurses' ambiguous experience in clinical practice.

The core of nursing in western countries is interaction with the patient and with his/her body in particular. As all nursing practices revolve around caring for the patient's body, nurses need to understand the frailty of the body, the intimacy surrounding it, the story it tells, as well as the discomfort and difficulties both illness and close contact can generate in the nurse-patient relationship. With this study, we wanted to explore the ward experiences of a small group of nurses in their day-to-day interaction with patients and their bodies, to highlight their perceptions and possible difficulties in providing care. We collected qualitative data from in-depth interviews with 14 nurses working in departments of general internal medicine, neurology, and geriatrics. The interviews were conducted between April and June 2006 and interpreted using an interpretive phenomenological approach. Analysis of the interview transcripts revealed that while the nurses recognize the centrality of the body in nursing, they also expressed a certain ambiguity toward it: being able to improve a patient's well-being through attentive care to the body is a major source of job satisfaction, but various coping and defense strategies are deployed to overcome care-giving situations that elicit avoidance or refusal reactions to the patient's body.

Barriers and facilitators of education provided during rehabilitation of people with spinal cord injuries: A qualitative description.

BACKGROUND: After a spinal cord injury (SCI), individuals must acquire their maximum level of independence before returning to their previous social and working conditions. The education provided during rehabilitation is one of the basic but complex aspects that influence the health perspectives of people with SCI. Gaining the perspective of SCI survivors experienced barriers and resources to enhance the education process may assist healthcare professionals in understanding this complex aspect of their practice. Through a qualitative descriptive analysis, this study aimed to identify the perceived barriers and facilitators of education provided during the rehabilitation of individuals with SCI. METHODS: A purposive sample of 22 adults with SCI and at least six months of home experience was recruited. Participants were assigned into four mini focus groups according to their level of independence. The focus groups were audio-recorded, transcribed verbatim, and analysed using a thematic analysis. RESULTS: Three themes were identified: the readiness to education, the individual characteristics, and the environmental and social characteristics influencing education. Participants perceived education to be an ongoing process made up of consecutive phases, each of which had to be overcome before participants felt ready to reappraise their health and well-being. This process was affected by individual, environmental, and social factors. CONCLUSIONS: Education is constantly provided by all members of the rehabilitation team. These must stress the relevance of the contents presented, increase SCI survivors' motivation to set achievable goals, and consider filling the gap that the patients perceive between rehabilitation centres and available community resources. The findings of this study promote the design of structured educational programmes, increasing knowledge, and improve the health perspective of SCI survivors, their families, and providers.

Nursing profession and nurses' contribution to nursing education as seen through students' eyes: A qualitative study.

The behavior of clinical instructors, as observed by students, deeply influences their professional development. When instructors behave unprofessionally, they risk undermining the professional growth students gain from their clinical placement experience. Clinical instructors need to be aware of how their behavior can affect the students' learning process and the contributions they make to clinical nursing education. A qualitative study was performed to describe the nursing profession as perceived by students who observed their clinical instructors' behaviors during the clinical experience. In-depth interviews of nursing students were conducted until data saturation was attained. Sixteen interviews were analyzed using an inductive content analysis methodology. The nursing profession was described by the participants through five themes as follows: the helping relationship, technical role, professional growth, working group, and contradictions and conflicts. Several examples of unprofessional behaviors on the part of the clinical instructors were reported by the respondents. The nursing profession, as perceived by nursing students, does not always reflect their expectations and their ideas related to professionalism. Universities and schools of nursing should ascertain that clinical instructors are prepared to educate students. Faculty should clearly state to students what they can expect from the clinical experience, namely, preparing students to face real working environments that do not always reflect educational philosophies.