Happy to help/happy to be here: Identifying components of successful clinical placements for undergraduate nursing students

Preceptor's experience in supervising undergraduate nursing students in mental health: A qualitative study

Preceptorship is considered an essential component in undergraduate nursing student's clinical placement, especially those in speciality units such as mental health. During the preceptorship relationship students are granted the opportunity to work alongside experienced nurses in the ward observing their interactions with patients and other professionals. In addition, students are able to build clinical confidence and competence. There is currently a gap in the literature around the preceptorship experience in the mental health clinical environment which warrants further exploration. The aim of this study was to explore the experiences of Registered Nurses precepting undergraduate nursing students during mental health clinical placements. A qualitative, exploratory approach was performed. A total of eight registered nurses working in an acute in-patient mental health unit in a large regional hospital, were recruited and interviewed using a semi-structured interview technique. Thematic analysis was utilised to analyse the data resulting in the development of four overarching themes; (1) Time consuming and additional workload, (2) creating a safe environment, (3) providing and receiving feedback and (4) precepting is not a choice, it is an expectation. The results highlighted that preceptoring students was considered to be an extra workload that required significant time and effort. Preceptors also expressed concerns about student safety, emphasised the importance of feedback and acknowledged preceptorship as an expectation of registered nurses working in mental health. These findings underscore the necessity for further research to delve deeper into the experience of preceptors in mental health settings.

Factors Influencing Nursing Student Learning During Clinical Placements: A Modified Delphi Study

BACKGROUND

Factors identified as important to nursing student clinical learning include the environment, the clinical facilitator, and student human factors.

METHOD

A modified Delphi study generated clinical nurse educators' expert consensus of the importance of factors that influence student learning during clinical placements. Short-answer questions exploring facilitation of learning were also provided.

RESULTS

Thirty-four nurse educators participated in the first round, and 17 nurse educators participated in the second round. Final consensus of at least 80% agreement was reached for all factors. Enablers of student learning included a positive workplace culture, student attitude, and clear communication between facilitator and student. Barriers to student learning included lack of time for teaching, short placement duration, and poor student and facilitator attitude.

CONCLUSION

Further investigation is needed on how these factors are addressed during placements including a review of the quality of resources provided to students and clinical facilitators for student learning. [J Nurs Educ. 2023;62(6):333-341.].

Experiences of registered nurses supporting nursing students during clinical placement using a facility-based model: A mixed methods study

BACKGROUND

An ageing workforce and increased vacancies has seen a steady growth in nursing student enrolments. This has created a need to re-think how to optimise existing clinical placement opportunities while ensuring quality student experiences and staff satisfaction in their support role.

OBJECTIVES

To provide insights into the experiences and satisfaction levels of Registered Nurses who supported nursing students during clinical placement using a facility-based model.

DESIGN

A quasi-experimental design.

SETTINGS

Three wards in an acute care facility and Primary and Community Health within the Southwest of Sydney, New South Wales, Australia.

PARTICIPANTS

Participants included Registered Nurses/Midwives, Facility-based liaison support staff, and Nurse Managers.

INTERVENTION

Within the 24/7 facility-based model, each nursing student was allocated to one Registered Nurse for the duration of the clinical placement period. The pair was rostered to complete the same day, evening, night, and weekend shifts.

METHODS

A cross-sectional survey related to staff satisfaction was administered to participants at two time points: (a) prior to the commencement of the intervention (baseline survey); and (b) at the completion of the intervention. Following the intervention participants were invited to a focus group or an individual interview.

RESULTS

There were no statistically significant changes in the levels of staff satisfaction from baseline to post-intervention; with personal fulfilment scoring the highest and workload the lowest. Staff who worked in the Primary and Community Health settings were less satisfied with this model of student support. Overall, most participants reported high personal satisfaction, professional growth and development opportunities yet acknowledged this came at a cost, with an increased workload.

CONCLUSIONS

Participants were satisfied with the facility-based model in supporting student learning on clinical placement. The model is fit for purpose however it does need to be tailored to the contextual needs of nurses working in Primary and Community settings.

Sources of Stress and Coping Behaviors among Nursing Students Throughout Their First Clinical Training

Introduction

Clinical training allows nursing students to acquire and strengthen their psychomotor abilities, which is an important component of nursing education. The clinical components of nursing training programs were much more demanding than the academic ones.

Purposes

The purpose of this study was to examine sources of stress-related and coping behaviors during first clinical training among nursing students in the Arab American University.

Methods

The study was cross-sectional and conducted with a convenience sample of 266 participants of nursing students. Data collection was performed by "Perceived Stress Scale and the Coping Behavior Inventory." The data were analyzed by using the descriptive, that is, frequency and percentage, mean, and standard deviation.

Results

The results revealed that the perceived stress mean was 41.2 (SD = 19.5). The main stressors were taking care of the patients (M = 11.4 ± 0.85) and teachers and nursing staff (M = 8.32 ± 5.3). Coping behaviors mean was (M = 29.0 ± 15.2). The main coping behavior was problem-solving (M = 9.5 ± 5.6).

Conclusion

The study confirmed that students perceived moderate levels of stress in their first clinical training, and the most common sources of stress were taking care of the patients and teachers and nursing staff. However, the main coping behavior was problem-solving.

A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English-speaking countries

AIM

The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice.

BACKGROUND

Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future.

DESIGN

A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Scoping Review extension (PRISMA-ScR) guidelines.

RESULTS

One hundred fifty-five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation.

CONCLUSION

There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work-ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work-ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence-based.

Lessons learned from clinical course design in the pandemic: Pedagogical implications from a qualitative analysis

AIMS

The purpose of this study was to examine clinical pedagogy based on experiences of changes and adaptations to clinical courses that occurred in nursing education during the pandemic. Beyond learning how to manage nursing education during a pandemic or other crisis, we uncover the lessons to be learned for overall improvement of nursing education.

DESIGN

Qualitative descriptive analysis using semi-structured interview data with baccalaureate nursing students.

METHODS

Data were collected in the spring of 2021 using semi-structured interview with 15 participants. Transcribed text was analysed using thematic content analysis. The COREQ checklist was used to guide our reporting.

RESULTS

Three themes were identified related to course design in clinical courses for nursing students: the role and limitations of simulation, competency evaluations and career implications. Students expressed some concern over not 'finishing hours', loss of in-person clinical experiences and their reduced exposure to different clinical settings.

CONCLUSION

To prepare work-ready nurses, educators need to keep in mind the trends, issues and demands of future healthcare systems. Simulation may have been a temporary measure to achieve clinical competence during the pandemic but needs to be of high-quality and cannot meet all the expected learning outcomes of clinical courses. Exposure to different patients, families and communities will ensure that the future nursing workforce has experience, socialization, competence, and desire to work in various clinical settings. Competency evaluation similarly needs to be robust and objective and consider the role and perception of hours completed.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. Participants were nursing students.

A Multisite Assessment of Saudi Bachelor Nursing Students' Perceptions of Clinical Competence and Learning Environments: A Multivariate Conceptual Model Testing

Background: It is thought that students’ perceptions of educational and clinical learning environments improve the effectiveness of curricula and professional standards. It is essential to examine the educational and clinical learning environments in which nursing students learn, as well as how nursing students evaluate particular factors of these environments. Objectives: The objectives of this study were to (1) identify nursing students’ perceptions on professional competence and learning environments in the classroom and clinical settings and (2) test a hypothetical model of variables that influence and predict students’ perceptions of learning environments and professional competencies. Methods: The study employed a descriptive cross-sectional methodological design. Five hundred and eighteen undergraduate nursing students were recruited from three Saudi Arabian universities using a convenient sampling technique. Using valid and reliable self-reported questionnaires, including the Dundee Ready Educational Environment Measure (DREEM), the modified Clinical Learning Environment Inventory (CLEI), and the Nurse Professional Competence Scale-Short (NPCS-SF), data were collected. Results: Perceptions of professional competence and learning environments were positive among nursing students. With satisfactory fit indices, the final model found that students’ perceptions of clinical competence were significantly predicted by their perceptions of the clinical environment (B = 0.43, p < 0.001), students’ perceptions of university environments (B = 0.29, p < 0.001), ward type (B = 0.12, p < 0.001), and students’ year of study (B = 0.11, p < 0.001). The students’ perceptions of clinical environments were significantly predicted by their perceptions of the university environment (B = 0.31, p < 0.001), gender (B = 0.13, p < 0.001), students’ year of study (B = 0.12, p < 0.001), and ward type (B = 0.11, p < 0.001). Moreover, the students’ perceptions of the university environment were significantly predicted by gender (B = 0.11, p < 0.001) and length of training (B = 0.12, p < 0.001). Conclusions: A range of factors might influence students’ perceptions of their professional competence and learning environments. Improving the learning environments and clinical experiences of students could enhance their clinical competence. This study’s findings provide evidence for how to enhance the learning environments in the classroom and clinical settings in order to improve students’ clinical competence, which will ultimately result in better patient outcomes. It is a top priority for nursing educators all around the world to improve classroom and clinical learning settings that foster students’ learning and professional competencies.

A supportive clinical learning environment for undergraduate students in health sciences: An integrative review

BACKGROUND

The clinical learning environment is a platform where theory and practice should be integrated in a safe environment. However, many students experience the clinical learning environment as "stress provoking", because this environment is not always supportive.

OBJECTIVE

The aim of the article is to report on a study that synthesized the evidence on strategies for providing a supportive clinical learning environment for undergraduate students in health sciences.

DESIGN

The integrative review followed the methodology of Whittemore and Knafl (2005).

DATA SOURCES AND REVIEW METHODS

We searched MEDLINE with Full Text, CINAHL with Full Text, Academic Search Ultimate, PsycINFO, Health Source: Nursing/Academic Edition, ERIC, Africa-Wide Information, OpenDissertations, CAB Abstracts, MasterFILE Premier, SocINDEX with Full Text, SPORTDiscus with Full Text and PsycARTICLES. Other data sources included grey literature and reference lists. The filtering process, quality appraisal and data extraction were carried out by at least two independent reviewers. Thematic analysis was used to analyse the data.

RESULTS

The search yielded 500 studies, of which nine studies met the inclusion criteria. The generated data culminated in a clinical learning environment mindmap that highlights, firstly, a network of carefully selected supporters who may have specific clinical responsibilities while supporting undergraduate students in clinical learning. Secondly, the relationship between the student, student supporter and clinical staff should create a sense of belonging, self-efficacy and self-directedness. This relationship is influenced by the roster, the ratio of students to student supporters, and appropriate learning opportunities. Thirdly, higher education institutions and healthcare providers should support students and student supporters through formal partnerships.

CONCLUSIONS

The synthesis of the evidence provided new insights regarding creating and maintaining supportive clinical learning environment strategies for undergraduate students in health sciences. These strategies may be implemented in innovative ways to provide students with the best clinical learning opportunities.

Development of the Student Nurse Subjective Evaluation of Completed Clinical Practice Placement Instrument

BACKGROUND

Instruments that measure clinical learning environments have lacked rigorous methodological approaches in their development and validity.

METHOD

Development research using a survey design approach was conducted for an instrument to evaluate the quality of nursing students' clinical practice placement.

RESULTS

The development and validity of the Student Nurse Subjective Evaluation of Completed Clinical Practice Placement (SNEP) resulted in a 40-item instrument to evaluate nursing students' experience of their completed clinical practice placement. Adequate level of model fit was indicated (χ²[719] = 1909.47, p < .001) for the confirmatory factor analysis (χ²/df = 2.66, comparative fit index = 0.92, Tucker-Lewis Index = 0.92, and root-mean-square error of approximation = 0.07). Standardized factor loadings were high, ranging from 0.68 to 0.95.

CONCLUSION

The SNEP was designed and validated incorporating the perspective of various nurse stakeholders and can be used in both research and clinical learning environments. [J Nurs Educ. 2022;61(10):559-569.].

Effect of online versus in-person clinical experiences on nursing student's competency development: A cross-sectional, quasi-experimental design

BACKGROUND

Clinical experience is an important component of nursing education, yet placements in agencies are hard to secure, and evaluation of outcomes challenging. The shift to virtual, online clinical courses during the pandemic created the conditions of a natural experiment.

OBJECTIVES

To compare differences in outcomes between an in-person and online design for a family and community health clinical course.

DESIGN

Quasi-experimental, 2-group, cross-sectional study.

METHODS

Competency evaluations were reviewed from a baccalaureate nursing program in Canada from 19 students who completed an in-person clinical, and 32 students who completed an online clinical. Quantitative analysis compared competencies achieved, interest in community health nursing, and linguistic analysis of unstructured narratives using natural language processing.

RESULTS

There are differences in competency evaluations for in-person versus online community clinical courses, and potential implications for future interest in community health. Natural language processing detected differences in content and psychological processes between the two groups.

CONCLUSIONS

Nursing programs could apply this methodology to track impact of changes to clinical course design on achievement of competencies. There are important differences in outcomes between online and in-person clinical courses.

Stress levels of nursing students: A systematic review and meta-analysis

CONTEXT

Nursing students experience psychosocial stress in their workplace. Available statistics are at variance, and hence, the need to know the overall prevalence of psychosocial stress among nursing students.

AIMS

This study aimed to determine the prevalence of psychosocial stress among nursing students through meta-analysis.

MATERIALS AND METHODS

PubMed, Cochrane, Web of Science, CNKI, and China Biomedical Literature Service System were searched for articles. Search terms include "psychosocial stress," "nursing students." Articles were included if they used validated psychosocial stress assessment instruments. Of the 15 articles with data on stress prevalence, 8 met all inclusion criteria. Each article was independently reviewed by the authors and relevant data were abstracted. Statistical analysis was done using Revman 4.1.

RESULTS

Overall, the average score for stress among nursing students was 3.70 (95% confidence interval [CI]: [3.33, 4.06]) based on the analyzed 15 articles with a sample size of 9202.

CONCLUSION

This study showed that the stress level of intern nursing students was mainly moderate.

Factors influencing nursing students' continued success in a baccalaureate nursing program in Indonesia

Background

Holistic admission processes are needed to promote diversity in nursing students. Previous research had identified different variables related to the average grade point at the end of the first semester. There is a need to examine if those variables are associated with ongoing student success.

Objective

The purpose of this study was to analyze experience, attributes, and academic variables for an association with nursing student success. Student success was defined as being an active student at the end of the first year and at the end of the second year of a baccalaureate nursing program in Indonesia.

Methods

Binary logistic regression analysis was used to determine what relationship, if any, the variables had with student success, measured at the end of the first and second academic years. The data of 341 nursing students enrolled in August 2018 was analyzed.

Results

The variables accounted for 40.3% of the variance at the end of the first year and 24.3% of the variance at the end of the second year. There was a significant (p < .05) relationship between being enrolled at the end of the first year and 1) academic variables of first semester grade point average and the admission score of Raven's Advanced Progressive Matrices, and 2) attribute variables of reason for entering nursing and brief calling presence scale. A significant relationship was found between being enrolled at the end of the second year and the attribute variable of grit score. No variables had a strong correlation with other variables.

Conclusion

Holistic admission processes and promoting student success can create the future of the nursing workforce. Improving the diversity in admitted nursing students will enhance the diversity in the nursing workforce. To promote the success of all students, a variety of support interventions will need to be developed. As students' calling and grit may play a role in student success, a better understanding is needed. In addition, more research is needed to explore how developing calling and grit throughout the nursing program can impact student success.

If the public can vaccinate, why not students? Review of a student nurse placement in a mass vaccination centre

Delivery of the COVID-19 vaccine has been made possible in part through the use of mass vaccination centres (MVCs). The primary legal framework underpinning the MVC programme is a national protocol enabling registered and non-registered healthcare workers to contribute to the safe and effective administration of the vaccine. The national protocol provided a vehicle for an innovative supervised student nurse placement within an MVC in south Wales. This placement, for undergraduate pre-registration student nurses, formed part of a service improvement project. Through student feedback prior to, and following, the short placement, the learning was unequivocal in terms of knowledge and skills acquisition related to safe and effective vaccine administration, with students providing clear feedback on the positive nature of the placement experience. A placement within an MVC offers a rich educational experience for student nurses, which as yet appears to be underutilised across the UK.

Student satisfaction level, clinical learning environment, and tutor participation in primary care clinical placements: An observational study

BACKGROUND

Competence evaluations in the clinical setting represent approximately 50% of the nurse training process. Factors, such as perceived learning environment and clinical nurse participation, may influence nursing student satisfaction during clinical placements.

OBJECTIVE

To evaluate the relationship between the levels of nursing student satisfaction with clinical placements, the clinical learning environment, and the level of nurse tutor participation.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

We included 61 nursing students and 45 clinical nurses from 35 primary care centres assigned to the Universitat Jaume I.

VARIABLES AND DATA COLLECTION

We assessed the overall level of student satisfaction with clinical placements, students' perception of the learning environment, tutors' level of participation, and socio-demographic variables.

DATA ANALYSIS

We performed a descriptive analysis of the study sample, as well as correlation and simple linear regression analyses. Questionnaire results were analysed depending on the nature of the variables.

RESULTS

The students' perception of the learning environment was 4.39 ± 0.48 points out of 5. The overall satisfaction level was 8.89 ± 1.22 points out of 10. Tutor participation level in students learning was 3.91 ± 0.58 points out of 5.

CONCLUSIONS

Both student perception of the learning environment in the clinical setting and their overall level of satisfaction with clinical placements in the primary care centres were considered high. Tutors were participative, but poorly satisfied.

Effect of Progressive Muscle Relaxation Exercise on Anxiety Reduction Among Nursing Students During Their Initial Clinical Training: A Quasi-Experimental Study

The study is to examine the effect of progressive muscle relaxation exercise on anxiety of nursing students during their initial clinical experience. A quasi-experimental, pre-post study was carried out in the Arab American University. A convenience sample consists of 90 first-year nursing students were chosen. A progressive muscle relaxation exercise for five days per week was conducted on one group of nursing students. Students’ anxiety was measured by S-anxiety scale (STAI Form Y-1) at pre and post the intervention. The severity of anxiety reduction was greater post the exercise (t (89) = 30.783, P = .001).

Enablers of the interpersonal relationship between registered nurses and students on clinical placement: A phenomenological study

AIM/OBJECTIVE

The aim of this qualitative study was to explore the lived experiences (nature and extent) of the interpersonal relationship between RNs and students during clinical placement.

BACKGROUND

In Australia, as elsewhere, nursing students' clinical placements are facilitated and supervised by registered nurses (RNs). There is evidence of positive teaching and learning interactions between RNs and students influencing student placement outcomes. Comparatively, little is known about the value of interpersonal relationships between RNs and students in the contribution to positive placement experiences.

DESIGN

A descriptive phenomenological approach was used to investigate the interpersonal relationship between RNs and students from the perspective of the lived experience of the RN.

METHOD

In depth, semi-structured interviews were conducted with ten RNs and analysed using Colaizzi's seven-step analytical approach.

RESULTS

Study findings revealed that RNs are committed to building positive interpersonal relationships with students to enhance learning and achieve successful clinical learning outcomes. Positive relationships are enabled through factors encompassing three overarching themes; Getting to know the student is essential; Effective communication is a reciprocal process, and Mutuality of engagement and commitment is critical. Vital to the relationship was the capacity to know the student, communicate with them openly and effectively, and have a mutually engaging, committed relationship with them.

CONCLUSIONS

The establishment of positive interpersonal relationships is important to the RNs who facilitate and supervise the clinical learning of nursing students for meaningful learning and successful student outcomes. Key findings included that getting to know the student is essential, effective communication is a reciprocal process, and mutuality of engagement and commitment is critical to building a positive relationship. Findings can be utilised to advise professional development for RNs who work with students on clinical placement with regard to the importance of developing positive interpersonal relationships with students and the characteristics that enable that to occur. The primacy of the relationship, brought about through RNs requirement to facilitate student clinical learning needs acknowledgement. Also, the importance of the interpersonal relationship for RNs and students needs recognition by both, to help them achieve success in clinical placements through effective interpersonal and professional relationships which promote good learning opportunities.

What Helps, What Hinders? Undergraduate Nursing Students' Perceptions of Clinical Placements Based on a Thematic Synthesis of Literature

Introduction

Clinical placements are a mandatory component of nursing students’ education internationally. Despite clinical education being a key to nursing students’ achievement of nursing competencies, few studies have reviewed students’ narratives to describe their experiences of learning during clinical placement. Such studies may be important in offering a deeper insight into clinical learning experiences than quantitative surveys.

Methods

A systematic thematic synthesis of qualitative studies between 2010 and June 2020 was conducted. English language studies that offered a thematic analysis of undergraduate nursing students’ experiences of learning during placement were sought. A search was made of five databases PubMed, Ovid Medline, CinahlPlus, SCOPUS, and Google Scholar. The study was guided by the ENTREQ statement for enhancing transparency in reporting the synthesis of qualitative research.

Results

Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as “Preparation,” “Welcomed and wanted” and “Supervision experiences”. A conceptual model of clinical placement elements conducive to nursing students’ learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed.

Conclusion

The conceptual model presents positive elements that influence students’ clinical placement experiences of learning. This model may provide a framework to guide professional development programs and strategies to support students and supervisors alike, an important step forward in moving beyond the current clinical placement rhetoric.

Undergraduate student nurses' experiences of their community placements

BACKGROUND

Community nursing placements play an increasingly important part in the undergraduate nursing students learning experience as a greater proportion of health care delivery is set to migrate to community care settings. Therefore, nursing education programmes and health services must ensure that student nurses are exposed to high quality community placements that provide suitable learning experiences for students to acquire the skills and knowledge required for the health service of the future.

OBJECTIVES

This qualitative evidence synthesis examines undergraduate nursing students' experiences of community nursing placements from 1996 to date.

DESIGN

Qualitative Evidence Synthesis, Thematic synthesis.

DATA SOURCES

CINHAL, EMBASE, ProQuest, Medline, Embase, Scopus, Psycinfo.

REVIEW METHODS

A systematic search across electronic databases was carried out to identify all available existing evidence relevant to the search question. Data was extracted and synthesised through thematic synthesis to identify and interpret emerging themes.

RESULTS

Six qualitative studies were included in the data, from these three themes were identified. The first of these highlighted the important influence of the community nursing teams and mentor on the students' placement experience. The second theme highlights the students' professional development as a result of their community placements and finally the third theme explores the students' perceptions of the essence of caring in the community.

CONCLUSION

The community provides valuable learning experiences of nursing from an alternative perspective, enhancing professional development and understanding of the nurse patient relationship. Mentorship and inclusion in teams are key factors that influence students' experiences and this working environment is useful for teaching about holistic care that is person and family centered. Role modeling is enhanced by the pace and proximity of the mentoring relationship.

The uncontrollability of relational indifference in blended workgroups

Purpose

This paper aims to examine how temporaries’ experience and perception of encounters with permanent members’ relational indifference affect the social relations in blended workgroups.

Design/methodology/approach

Constructivist grounded theory study based on 15 semi-structured interviews with first- and third-year nursing students in clinical internships at somatic hospital wards was used.

Findings

The authors identified two themes around organizational alienation. Temporaries expected and hoped to experience resonance in their interactions with permanent members, which drove them to make an extra effort when confronted with permanents’ relational indifference. Temporaries felt insignificant, meaningless and unworthy, causing them to adopt a relationless mode of relating, feeling alienated and adapting their expectations and hopes.

Practical implications

Relational indifference is, unlike relational repulsion, problematic to target directly through intervention policies as organizations would inflict a more profound alienation on temporaries.

Originality/value

Unlike previous research on blended workgroups, which has predominantly focused on relational repulsion, this paper contributes to understanding how relational indifference affects temporaries’ mode of relating to permanent.

Nursing students' experience with clinical placement in nursing homes: a focus group study

Background

A renewed interest in nursing homes as clinical placement settings for nursing students has been prompted by the growing healthcare needs of an ageing population. However, if future nurses are to be enthusiastic about working in this healthcare context, it is essential that higher education institutions that educate nurses and nursing homes that provide placement experiences to students do so with a supportive, positive, and enriched approach.

Methods

To explore first-year nursing students’ placement experience in nursing homes, we conducted an exploratory qualitative study in three city-based nursing homes in western Norway. Thirteen first-year nursing students participated in the study. Three focus group interviews were conducted to explore the students’ placement experiences. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR).

Results

The analysis describes five themes relating to first-year students’ placement experience in nursing homes; (1) variations in utility of pre-placement orientation and welcome at placement site; (2) a challenging learning environment; (3) spending considerable placement time with non-registered nurses; (4) considerable variability in supervision practices; and (5) a vulnerable and demanding student role.

Conclusions

The research provides insight into the contextual characteristics encountered by first-year students that influence the quality of their placement experiences. Consequently, these characteristics impede access to important role models who lend support to a student’s growth and professional development, preventing full utilisation of the learning potential offered in nursing homes. Hence, we propose that targeted efforts are warranted to foster positive placement experiences and enhance students’ clinical education in nursing homes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00690-4.

Nursing students' evaluation of clinical practice placements using the Clinical Learning Environment, Supervision and Nurse Teacher scale - A systematic review

OBJECTIVES

To review undergraduate nursing students' perceptions of the quality of their clinical placement experiences by means of surveys conducted using the Clinical Learning Environment Supervision and Nurse Teacher questionnaire.

DESIGN

Systematic review of English language studies published between 2014 and 2020, in any clinical setting, utilising data collected in the decade 2010 to 2020.

DATA SOURCES

Structured searches were conducted in CinahlPlus, Ovid Medline, Scopus, PubMed and Google Scholar.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses framed the review.

RESULTS

A total of 111 records were screened, after which 21 studies met criteria for inclusion. Studies were centred on students in Sweden and in 15 other countries. Students' ratings of 'Experience' were positive across five scale subdimensions with means 3.0-3.95 of a possible 5 (overall mean 75.4%). 'Satisfaction' across seven studies was rated highly (mean 4.16 of 5) 83.2% agreement. The highest rated subdimension was Supervisory relationship, with the Role of the Nurse Teacher rated lower and inconsistently. The underlying elements are discussed.

CONCLUSION

Although students' Experience and Satisfaction were rated highly averaging over 75%, there is still room for improvement. Further research is needed to examine how students perceive various components of 'satisfaction' within clinical learning environments because this can be seen as the primary measure of program quality. Research using experimental and observational study designs is needed to compare ways of preparing clinical teachers and reporting measurable learning outcomes for models of supervision that are applicable in varied clinical learning environments.

Using Invitational Theory to Examine Nursing Students' Experiences of Their Learning Environment

AIM

The aim of this study was to test Purkey's invitational theory to evaluate unique aspects of the learning environment in nursing education.

BACKGROUND

Faculty evaluate student learning but rarely students' unique experiences within learning environments.

METHOD

This interpretive phenomenological analysis explored students' perceptions of their prelicensure learning environments. Twelve participants from two private bachelor of science in nursing programs were interviewed about their experiences.

RESULTS

Students' perceptions of what helped (invited) their learning and hindered (disinvited) their learning included thematic aspects of learning environments based on Purkey's theory: people, places, processes, policies, and programs. Findings illustrate facets of the learning environment often not considered by educators in planning learning environments most conducive to student learning.

CONCLUSION

Purkey's theory is a plausible framework for nurse educators to evaluate learning environments from students' perspectives and may provide valuable data about the unique milieu that promotes or hinders successful learning.

Quizzing – a hazing ritual in workgroups

Purpose

This paper aims to examine how newcomers’ experience and perception of their exposure to the hazing ritual “quizzing” affects their mode of relating to the workgroup.

Design/methodology/approach

Two illustrative cases are selected from a constructivist grounded theory study based on 15 semi-structured interviews with nursing students in clinical internships at somatic hospital wards.

Findings

As newcomers to the nursing profession, nursing students are exposed to experienced insiders’ hazing ritual “quizzing” during their internship at Danish hospitals. “Quizzing” is a public ceremony performed by an experienced insider, e.g. a daily or clinical supervisor. The ritual continues until a bystander intervenes even though the newcomer admits not knowing the answers. “Quizzing” is being met with repulsion and represents a deviation from expectations of social inclusion, civilized behavior and hope of resonance. It leaves newcomers feeling alienated and makes them adopting a repulsive mode of relating to the workgroup.

Originality/value

This paper applies Hartmut Rosa’s resonance theory and theories of workplace hazing to explore how workgroup hazing affects newcomers’ mode of relating to workgroups.

Psychometric properities of the Polish version of clinical learning environment inventory

Background

Clinical experience is a crucial activity for nursing students. The way students` perceive clinical placement exerts an immense influence on the learning process. This study aims to test the psychometric properties of a 19-item version of the Clinical Learning Environment Inventory under Polish clinical conditions.

Method

For this study, Discriminant validity and Cronbach’s alpha reliabilities were computed. In order to measure content validity, the criterion validity Generalized Self Efficacy Scale and the Life Orientation Test - Revised were used.

Results

Cronbach’s Alpha for the Clinical Facilitator Support of Learning Scale and the Satisfaction with Clinical Placement scale is 0.949 and 0.901, respectively. The Spearman’s rank correlation coefficient indicates the existence of a positive correlation between the students’ satisfaction with clinical placement and their [overall] life optimism. Age correlates negatively with perceived teacher support and positively with satisfaction with clinical placement. The sense of self-efficacy correlates negatively with their satisfaction with clinical placement. Clinical Learning Environment Inventory − 19 could be a useful tool to evaluate the quality of the clinical learning process in Polish conditions.

Nursing degree students' clinical placement experiences in Australia: A survey design

AIM

This study aimed to evaluate Australian nursing students' views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).

BACKGROUND

Clinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.

DESIGN

A survey design was used with a contemporary survey tool- the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.

METHODS

A total of 1263 nursing students completed the Placement Evaluation Tool (PET) - 19 items (rated 1-5), one global rating (rated 1-10) - following placement in three Australian States (July 2019-February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.

RESULTS

The total PET mean score was 78.3% with 29.8% being 'extremely satisfied' (10 out of 10 - Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.

CONCLUSIONS

Whilst students' clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.

Initial Clinical Practicum Stress among Nursing Students: A Cross-Sectional Study on Coping Styles

Nursing students experience various stressors during their initial clinical practicum. As these stressors negatively affect learning and performance, coping strategies are essential. Therefore, this research study explored the relationship between coping styles and stress levels using a cross-sectional study with a convenience sample of 184 nursing students. Clinical practicum stress and coping styles were assessed via electronic questionnaires, and the data were analyzed using descriptive statistics, t-tests, and variance analyses. The highest score for clinical practice stress was for the practical education environment and practical work burden. The total stress score differed significantly according to coping style (t = −2.36, p = 0.020), and the total stress score of the passive coping group was higher. Among the sub-categories of stress, the scores of the education environment (t = −2.68, p = 0.008) and having undesirable role models (t = −2.14, p = 0.034) were significantly higher in the passive coping group. Although practical work burden was the highest stress factor in the active coping style group, the stress on the environment was highest in the passive coping group. The findings show that professors and clinical educators should recognize the various coping styles and incorporate different teaching methods in the clinical setting.

Exploratory Factor Analysis of the Indonesian Version of the Clinical Learning Environment, Supervision, and Nurse Teacher Scale (CLES + T)

BACKGROUND AND PURPOSE

The purpose of this article is to describe an evaluation of psychometric properties of the Indonesian version of the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES + T) scale, a scale that measures nursing students' perceptions of their clinical learning environment.

METHODS

The CLES + T was completed by 292 nursing students. Inter-item correlations, exploratory factor analysis, Cronbach's alpha, and evidence of validity were used to examine reliability and validity.

RESULTS

Four factors were extracted that explained 58% of the variance. Cronbach alphas ranged from .86-.95. Wording to describe different titles of supervisors was unclear to some of the participants.

CONCLUSION

The Indonesian version of the CLES + T is a reliable version. More research is needed to clarify some of the wording.

"I found it daunting": An exploration of educational needs and experiences of mental health student nurses working with children and adolescents with eating disorders

WHAT IS KNOWN ABOUT THE SUBJECT?: A therapeutic relationship with a professional who displays an informed approach has a positive effect on outcomes for young people presenting with an eating disorder. There is a dearth of research available on the student mental health nurse experience of working with young people with an eating disorder both internationally and from the Republic of Ireland. Within this limited literature, nursing students were found to hold more negative perceptions towards this group than more experienced clinicians. The causes of eating disorders are complex, which make education and support to understand the individual with an eating disorder essential. Within the Republic of Ireland, child and adolescent mental health historically has received very little attention in the undergraduate mental health nursing curriculum. WHAT DOES THE STUDY ADD TO EXISTING KNOWLEDGE?: Findings from this study recommend that a set of guidelines are made available for students to feel more confident in their role. It is suggested that this resource would include the therapeutic skills to engage the young person with an eating disorder. A specialist clinical placement has been identified as the most appropriate time to consider the development of a study day or days to facilitate learning of the skills and therapeutic techniques to work with adolescents. Application of these skills would occur within the clinical learning environment under supervision and guidance of the clinical preceptor. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Specialized training for student mental health nurses working with this group will enhance confidence and competence levels in forming therapeutic relationships, thereby improving outcomes for those attending the services. Better student experience may also enhance future nursing recruitment into this area. Students need additional support in managing these often complex and ambivalent presentations and their own fears or stigma around people with an eating disorder. This is recommended as taking the form of reflective practice during the placement. There is a need for nursing management to support nurses in their role as preceptor. This would involve protected time for preceptors to engage the student nurse in clinical education and reflective practice. ABSTRACT: Introduction There is limited attention given to child and adolescent mental health in the undergraduate mental health nursing curriculum within the Republic of Ireland. There is a dearth of research available on specifically the student mental health nurse experience both internationally and from the Republic of Ireland. Aim To explore factors that impact on the experience of mental health student nurses working with adolescents who present with eating disorders. Method This qualitative descriptive study was conducted through individual semi-structured interviews with n = 4 mental health student nurses. Data were then subjected to a schematic content analysis. Results The participants experienced developing therapeutic relationships with this group as a challenging process. They believed that the theoretical component of the undergraduate programme facilitated them in their understanding but did not prepare them to engage therapeutically with these adolescents. Discussion Preceptors are identified as the main source of support but improvements to the clinical learning environment would enhance the learning experience. Implications for practice Support for the role of the preceptor in the specialist clinical setting in the form of training and protected time to engage students in clinical education and reflection was suggested as a method to enhance the clinical learning environment.

Nursing students' views and satisfaction of their clinical learning environment in Singapore

Aims

This study aims to investigate final-year nursing students' actual perception of their clinical learning environment in Singapore.

Design

Descriptive cross-sectional survey.

Methods

An online survey based on the clinical learning environment inventory (CLEI; "Actual" version) was administered to final-year (third year) nursing students (N = 301) in a polytechnic in Singapore between May-July 2018.

Results

Most nursing students reported moderate satisfaction with their clinical learning environment, reflecting their positive (although not strongly positive) perceptions. Among the six constructs of the CLEI, the higher scores of the constructs of "Personalization" and "Task orientation" implied their greater contribution to the positive view. Conversely, the lower scores of "Individualization" and "Innovation" implied their lesser contribution. Additionally, the positive correlation between "satisfaction" and the other five CLEI constructs was found to be statistically significant.

Undergraduate nurses' perception of the nursing practice environment in university hospitals: A cross-sectional survey

OBJECTIVE

To describe the psychometric properties of the Practice Environment Scale of the Nursing Work Index (PES-NW) among undergraduate nurses and to compare their perceptions of the nursing practice environment by academic year and unit type.

BACKGROUND

Despite the fact that nursing students develop most of their undergraduate learning and training in the nursing practice environment, their perception about it has not been considered to date.

METHODS

The psychometric properties were analysed on a sample of 180 undergraduate nurses. Data collection was carried out in 2018. Data were analysed using percentages, frequencies, mean, standard deviation and Mann-Whitney U test. Factor structure was evaluated with exploratory factor analysis, and reliability was evaluated with Cronbach's alpha.

RESULTS

Psychometric analysis showed an adequate construct validity and reliability for the PES-NWI. Cronbach's Alpha was 0.884. Undergraduate nurses perceived most hospitals as favourable, scoring the 'Nurse-physician relationships' factor highest and 'Staffing and resource adequacy' factor lowest.

CONCLUSION

The PES-NWI is a valid and reliable instrument that could be applied in future research to explore nursing students' perceptions of the nursing practice environment.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers are responsible for supervising and ensuring that the nursing practice environment at university hospitals meets the necessary criteria to support the workplace learning of undergraduate nurses.

Nursing and midwifery students' experiences and perception of their clinical learning environment in Malawi: a mixed-method study

Background

The clinical learning environment is an important part of the nursing and midwifery training as it helps students to integrate theory into clinical practice. However, not all clinical learning environments foster positive learning. This study aimed to assess the student nurses and midwives' experiences and perception of the clinical learning environment in Malawi.

Methods

A concurrent triangulation mixed methods research design was used to collect data from nursing and midwifery students. Quantitative data were collected using a Clinical Learning Environment Inventory, while qualitative data were collected using focus group discussions. The Clinical Learning Environment Inventory has six subscales of satisfaction, involvement, individualisation, innovation, task orientation and personalisation. The focus group interview guide had questions about clinical learning, supervision, assessment, communication and resources. Quantitative data were analysed by independent t-test and multivariate linear regression and qualitative data were thematically analysed.

Results

A total of 126 participants completed the questionnaire and 30 students participated in three focus group discussions. Satisfaction subscale had the highest mean score (M = 26.93, SD = 4.82) while individualisation had the lowest mean score (M = 18.01, SD =3.50). Multiple linear regression analysis showed a statistically significant association between satisfaction with clinical learning environment and personalization (β = 0.50, p = < 0.001), and task orientation (β =0.16 p = < 0.05). Teaching and learning resources, hostile environment, poor relationship with a qualified staff, absence of clinical supervisors, and lack of resources were some of the challenges faced by students in their clinical learning environment.

Conclusion

Although satisfaction with clinical learning environment subscale had the highest mean score, nursing and midwifery students encountered multifaceted challenges such as lack of resources, poor relationship with staff and a lack of support from clinical teachers that negatively impacted on their clinical learning experiences. Training institutions and hospitals need to work together to find means of addressing the challenges by among others providing resources to students during clinical placement.

How do the attitudes of therapeutic radiographers affect students' learning during practice placement?

INTRODUCTION

Practice placements are essential for radiotherapy students to learn and embed the necessary skills for practice; thus, each placement should afford an optimum learning experience. A key finding from the Phase 3 student arm of recent doctoral research suggests that for some students an optimum learning experience is not guaranteed. Using students' own words, this paper seeks to increase radiographers' awareness of how their behaviours can affect students' placement learning, and aims to help improve the placement learning experience for both.

METHOD

A three-phase, U.K.-wide, mixed methods study was conducted. In the Phase 3 student arm, qualitative data were gathered via focus groups/interviews from volunteer student radiographers. Data were transcribed, manually coded, and analysed thematically by the Researcher using the applied research methodology Framework Analysis.

RESULTS

The analysed data were complimentary to radiographers, overall, but common themes were identified criticising certain of their attitudes and behaviours. Students exhibited fragility in response to perceived negative attitudes and behaviours, and failed to develop resilience in response to further similar experiences. This had a negative effect on their placement learning. Positive attitudes from radiographers enhanced students' placement learning. The placement experiences of radiotherapy students are consistent with those of other AHP and nursing students identified in the literature.

CONCLUSION

Increasing radiographers' awareness of the negative and positive effects of their behaviours and attitudes will help improve students' placement learning experience. Students' resilience may be improved by teaching them coping strategies to use on placement.

IMPLICATIONS FOR PRACTICE

The retention of radiotherapy students is an urgent concern for the radiotherapy profession therefore it is important to take steps to improve it. Enhancing students' placement experience may contribute to increased retention.

Nursing students' first-time experiences in pediatric clinical practice in Taiwan: A qualitative study

BACKGROUND

A pediatric nursing practicum is essential in equipping students with basic knowledge of theory, professional attitudes, and skills for the clinical setting. However, students often face multiple challenges in the practicum due to gaps between theory and practice.

PURPOSE

To describe nursing students' first-time experiences in pediatric clinical practice in Taiwan.

METHODS

A phenomenological approach with purposive sampling was used. Twenty participants were interviewed individually, in person, within a month of completion of a pediatric nursing practicum. Interviews were semi-structured and digitally recorded. Data analysis followed Colaizzi's methods; epochs (bracketing) focused analysis on students' experiences and maintained objectivity.

FINDINGS

Three themes and related subthemes emerged: (a) orienting to the pediatric unit (becoming familiar with common treatments and surroundings in the pediatric unit; recognizing people in the unit); (b) encountering challenges in pediatric and family-centered care (navigating communication between child and families; student nurse-patient relationships: maintaining a good rapport with children and their families; being prepared for quick role changes); (c) translating knowledge into clinical practice thoughtfully (providing desirable and correct responses for children and their families; providing a safe and friendly environment for children and their families).

CONCLUSIONS

Student nurses engaged in a variety of care practices necessitated by patients' differing ages, developmental levels, and family needs. Ensuring students' successful completion of the demanding pediatric practicum, including innovative communication, technical skills, and role transitions, is challenging yet achievable.

CLINICAL RELEVANCE

Gaining a fuller understanding of nursing students' experiences in the pediatric nursing practicum can assist nursing professionals in preparing students to provide competent care for children and their families.

Examining mental health clinical placement quality using a self-determination theory approach

Nursing clinical placements provide a unique opportunity for students to develop and hone the skills and knowledge that will be used upon graduation in their future professional practice. There is an on-going inquiry into elements that may facilitate better leaning outcomes in a variety of teaching and learning settings, including clinical experiences. Using a Self-Determination Theory approach, this study examined whether undergraduate nursing students would benefit from immersion in an autonomy-supportive clinical setting. Using a two-group pre and post-test design, students were classified into either an autonomy-supportive or comparison clinical placement cohort and measured on their learning using the Mental Health Clinical Placement Survey. Results of a repeated measures multivariate analysis of variance indicated a significant difference on some of the measures of learning housed within the Mental Health Clinical Placement Survey with students in the autonomy-supportive group reporting higher scores at the post-test time point. Findings support the value that teaching and learning in an autonomy-supportive setting has, on the skills and educational development of students.

The psychometric validation of the quality practical experience (QPE) instruments (nurses and student nurse) to evaluate clinical supervision of undergraduate student nurses

It is important to evaluate stakeholder feedback regarding any change to a clinical supervision model to maintain quality. The Quality Practical Experience (QPE) instruments offer both the nurse on the ward involved with supervising student learning and the student nurse the opportunity to evaluate their satisfaction with the supervision model. This paper reports on the evaluation of the construct validity and the reliability of the QPE instruments measuring nurse and nursing student satisfaction with the clinical supervision model. Methodological design for the reliability and validation of a measuring instrument. The nurse and the student QPE instruments were tested with convenience samples of 488 nurses and 1116 student nurses, respectively. Psychometric tests included internal reliability, test-retest reliability and factor analyses. Exploratory factor analysis for both QPEs supported a three-factor solution; the nurse QPE explained 48% and student nurse QPE 45% of variance. Internal reliability and test-retest reliability were stable over time (nurse QPE ICC = 0.82; student nurse QPE ICC = 0.71). Both QPE instruments were found to be valid and reliable. Feedback from all stakeholders involved with supporting student nurses during clinical placement is important.

Turnover prevention: The direct and indirect association between organizational job stressors, negative emotions and professional commitment in novice nurses

Aims

Getting insight in the most crucial organizational job stressors for novice nurses' professional commitment and whether the job stressors are mediated through negative emotions.

Design

The study used an observational cohort design.

Methods

Organizational job stressors were derived from 580 diary entries by 18 novice nurses combined with measures on emotions and commitment. The diaries were collected from September 2013–September 2014.

Results

Path modelling revealed that lack of support from colleagues, negative experiences with patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions. Other indirectly and negatively related organizational job stressors to commitment were complexity of care, lack of control and work‐life imbalance; only conflicting job demands, and lack of control related to professional commitment directly.

Conclusion(s)

To enhance professional commitment, it is important to reduce negative emotions in novice nurses by collegial support in dealing with negative experiences with patients, complexity of care and existential events and to prevent lack of control and an imbalance between private life and work. Nurse supervisors and managers can encourage nurses to share negative patient experiences, issues related to complexity of care and existential events.

Impact

Considering the worldwide nursing shortage and early turnover, more understanding is needed about how negative emotions mediate the relationship between organizational negative job stressors and professional commitment and the relative impact of organizational job stressors to professional commitment. The study stresses the importance of a supportive role of supervisors and nurse managers to improve the work environment and hence increase novice nurses' commitment and retention.

Jordanian Nursing Student and Instructor Perceptions of the Clinical Learning Environment

Background Training within clinical areas is a vital part of nursing education. In order to effectively modify and facilitate such training, it is important to understand the perceptions of nursing educators and students about what constitutes effective practices.

OBJECTIVE

This study explores perceptions of Jordanian nursing students and clinical instructors related to clinical training and the learning environment.

DESIGN

Interpretative phenomenological qualitative approach was used in this study.

METHOD

semi-structured focus group interviews in two Jordanian Universities Results: The study identified four themes focused on the experiences of these participants. Themes were attributes of clinical training placement, attributes of clinical instructors, attributes of clinical nursing curriculum and student's attributes. The first theme had two subthemes "Structure and nature of clinical placement" and "Nurses' collaboration".

CONCLUSION

The study recommendations are: nursing schools should plan students' clinical experience taking into consideration the challenges associated with these attributes.

Evaluating the learning environment of nursing students: A multisite cross-sectional study

BACKGROUND

Identifying students' experiences of the university and clinical learning environments informs quality improvement of courses.

OBJECTIVES

To investigate undergraduate nursing students' perceptions of their education environment and the facilitators and barriers to learning, during university and clinical experiences.

DESIGN

Multi-site cross-sectional survey.

SETTING

Four universities in Vietnam.

PARTICIPANTS

Undergraduate nursing students (n = 891).

METHODS

Between May and August 2016, Vietnamese versions of the Dundee Ready Education Environment Measure (Nursing) and the modified Clinical Learning Environment Inventory measured students' perceptions of university and clinical environments respectively. Two additional open-ended questions elicited perceptions of facilitators and/or barriers to clinical learning.

RESULTS

The university environment was rated as needing improvement and significant differences between universities and year of study detected. University environment mean scores were significantly higher in second year students compared with those in the third or fourth years of study. Active teaching and interpersonal relationships at university were rated positively. Overall, clinical environment scores were mid-range and second year students' mean scores were significantly higher than third or fourth years. Clinical placements greater than four weeks duration had significantly higher mean score than two week placements.

CONCLUSIONS

Evaluation of university and clinical experiences assists with identifying potential areas of interruption to nursing students' transfer of learning. In both learning environments, Vietnamese students' experiences were similar to those experienced in Western countries in that interpersonal relationships with teachers and ward staff were key factors perceived to influence learning. A notable difference in this study was the hospital environment in Vietnam had features unique to this country that interrupted students' transfer of learning. Globally it is a priority for nurse educators to facilitate both on and off campus environments that promote students' learning. Assessing these environments is a useful strategy for quality improvement of courses.

Has anyone seen the student? Creating a welcoming practice environment for students

A person's introduction to a new environment, whether they are a patient or a student, is critical. Although patients have the 'Hello my name is …' campaign to make them less anxious when entering a clinical setting, there is no equivalent for students. Making both patients and students welcome is essential to establishing a rapport and a sense of belonging at a time when each can feel at their most vulnerable. This can influence their journey into something that is positive or negative. This article explores some practical measures that can be adopted to create a welcoming practice environment for students.

Factors influencing the practice of new graduate nurses: A focused ethnography of acute care settings

AIM

To explore the influence of an acute care setting on competency deployment of new graduate nurses (NGNs) from a competency-based undergraduate programme.

BACKGROUND

In the last 15 years, nursing education has shifted to competency-based education (CBE). Few studies have focused on how NGNs from these reformed programmes use the competencies they have developed. To be paradigmatically coherent with the nature of a competence, studies should also examine how context influences nursing practice and competency deployment.

DESIGN

A focused ethnography of three acute care units from one academic hospital in Canada.

METHODS

Purposive and snowball sampling strategies were used to recruit 19 participants: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) and nurse managers (n = 4). Data were collected through individual interviews, focus groups, observation and documentation. Data were analysed according to Roper and Shapira (Ethnography in nursing research. Thousand Oaks, CA: Sage Publications, 2000) ethnographic nursing analysis framework.

RESULTS

Organisational and individual factors were identified as influencing NGNs' competency deployment. Organisational factors are orientation, stability, workload and the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial education; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognise nursing expertise.

CONCLUSION

One way to smooth the transition from academic to clinical settings for NGNs is by offering transition or orientation programmes that will provide them with stability and a reduced workload, allowing them to progressively deploy their competencies.

RELEVANCE TO CLINICAL PRACTICE

Organisational and individual factors influence how new graduate nurses deploy their competencies. Clinical educators and nurse managers can help new nurses by acting on these factors. This study conforms to the COREQ Research Reporting Guidelines for qualitative studies.

Challenges to the provision of clinical education in nursing

Objective: To outline and discuss the challenges inherent in providing clinical education for undergraduate nursing students.Design: Discussion paper.Discussion: The primary goal of undergraduate nursing education is the preparation of graduates able to function as newly registered nurses in acute hospital, primary care, continuing care and mental health settings. Clinical practice is a critical yet complex and challenging component of students' professional development.Conclusions: It is argued that different models for clinical learning are appropriate for different contexts and stages of student development. Nursing needs, however, to be fully cognisant of the importance of collaborative development underpinned by adequate funding and to be aware of the often invisible impacts of neoliberal policies and priorities on health and education.

Learning experience of nursing students in a clinical partnership model: An exploratory qualitative analysis

BACKGROUND

Clinical teaching models are crucial for nursing students' learning experiences as students learn and socialise in a complex clinical context. An innovative clinical partnership model, employing hospital-based clinical teachers to provide supervision and university teachers to liaise with students, has been developed to facilitate clinical teaching and enhance learning experiences.

OBJECTIVES

The study aims to explore nursing students' learning experiences under this clinical partnership model.

DESIGN

An exploratory qualitative study using focus group interviews.

PARTICIPANTS

Twenty-eight pre-registration nursing students at undergraduate and postgraduate level participated in this study.

METHODS

Students formed four groups with each consisting of six to eight students. Semi-structured interviews were conducted to explore students' experiences and perceptions of clinical learning in the clinical partnership model. The data analysis was guided by an inductive approach using content analysis.

RESULTS

The narrative data relates to the clinical learning environment and experience. Nursing students found the clinical partnership model provided a conducive learning context facilitating their adaption to the new environment and integration with the healthcare team. Though students spent time developing mutual understanding with their clinical teachers, they were satisfied with the ample opportunities to practise and learn from their teachers. They appreciated the fact that teachers enriched their learning through bridging the theory-practice gap and acting as role models.

CONCLUSION

The clinical partnership model enriches students' learning experiences. It provides a student-centred learning approach and supportive clinical environment which engages nursing students in learning.

The clinical environment: A facilitator of professional socialisation

Background

Competencies of health care workers, including nurses, often do not meet the health needs of populations. The clinical learning environment (CLE) is vital in socialising neophyte student nurses to display the desired competencies. Student nurses are however confronted with challenges, especially in the CLE, during this process.

Aim

This article shares three validated guidelines to support professional nurses and nurse educators in facilitating appropriate professional socialisation of student nurses in the CLE.

Setting

The study was conducted in an 832-bed academic hospital and nine nursing education institutions (NEIs) that offered the nursing programme concerned in a province in South Africa.

Method

A sequential, exploratory, mixed-methods study was conducted and qualitative data were collected from two purposive samples, consisting of seven focus group interviews and field notes. Five themes that emerged from the integrated data guided the instrument design to collect data quantitatively from 277 educators. Experts validated 10 guidelines to a set of criteria, which was developed combining all data.

Results

Qualitative and quantitative research evidenced that the CLE mostly did not support student nurses during professional socialisation. A few role models’ behaviour was noteworthy, while student supervision was inadequate. The CLE was stressful, lacked in resources, marked by uncoordinated student placement, insufficient communication and inadequate preparation of student nurses. This evidence informed the development of the guidelines.

Conclusions

The guidelines were (1) the empowerment of role models through reflective practice, (2) capacity building of professional nurses and nurse educators as clinical supervisors by means of intervention strategies and (3) adopting a multifaceted approach in the creation of a positive CLE. These guidelines could facilitate appropriate professional socialisation of student nurses.