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Leadership and management: exploring culture shock in clinical settings in Brunei Darussalam

02 December 2024
Volume 32 · Issue 12 (1)

Abstract

Background/Aims

For midwifery students, differences between the academic and clinical settings may cause culture shock, as a result of the dynamic and demanding nature of clinical practice. This study explored culture shock among midwifery students during clinical attachments in Brunei Darussalam, as they developed leadership and management skills.

Methods

Through written essays, 43 university students shared their perspectives on factors contributing to culture shock, challenges hindering clinical learning, and suggestions for how to enhance the learning experience. Their essays were analysed thematically.

Results

Culture shock resulted from a lack of familiarity with the clinical environment, role confusion related to leadership and poor communication and adaptability skills. The participants emphasised the importance of a gradual introduction to leadership, and advocated for more practical, hands-on learning.

Conclusions

Further research is needed to investigate additional strategies for improving students’ readiness in developing their leadership and managerial skills.

Implications for practice

Educators and clinical policymakers must collaborate to improve student preparation for clinical practice. Educators should address clinical challenges, while clinical policymakers should invest in training for staff to effectively mentor students.

Leadership and management are part of the core foundational skills required for all midwives, as they dictate the ability to provide quality patient care (International Confederation of Midwives, 2023). Leadership in midwifery requires mastery of skills such as critical thinking, delegation, prioritisation, and problem solving. In contrast, management skills require proficiency in resource management, staffing and providing training for newly graduated midwives or midwifery students. These skills not only enhance an individual's professionalism and proficiency in delivering quality patient care but also contribute to better team performance, and improved teamwork, morale and team dynamics (Beiboer et al, 2023). This, in turn, leads to more positive outcomes for patients, including women, children and families.

Graduating midwives are expected to lead healthcare teams in their units. This necessitates strong leadership skills, such as critical thinking, decision making and effective communication. Being a good leader and manager requires extensive exposure and early training in the clinical setting. This prepares students for the dynamic nature of the role. Early exposure fosters familiarity with the ever-changing demands of leadership and management, enabling midwifery students to embrace these roles more adaptively and efficiently upon graduation. However, limited training or experience in the clinical setting can leave midwifery students unprepared, leading to ‘culture shock’, where they feel overwhelmed by unexpected challenges (Mitha et al, 2021). Culture shock is defined as a feeling of disorientation, inadequacy and anxiety caused by the significant differences between the academic environment and the realities of the clinical setting (Mustafa, 2022). This feeling is common among midwifery students, who may be given significant leadership and management responsibilities with little preparation or understanding of their expected roles and responsibilities (Mustafa, 2022).

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