Undergraduate nursing students' strategies for coping with their first clinical placement: Descriptive survey study

The effect of an educational orientation tour on anxiety of nursing students before their first clinical training: a quasi-experimental study

BACKGROUND

The first clinical experience in a hospital setting can be highly stressful for nursing students, often leading to significant anxiety. Addressing this issue requires effective interventions to help students transition smoothly into their clinical practice. This study aimed to evaluate the impact of an educational tour on preclinical anxiety among first-year nursing students.

METHODS

This quasi-experimental study was conducted in 2024 in Tehran. A total of 72 s-semester nursing students were selected through convenience sampling and assigned to either the control group (n = 37) or the intervention group (n = 35). Before the start of clinical training, the intervention group participated in an educational tour of the hospital, conducted by the researcher, while the control group received no intervention. Data were collected using the Spielberger State-Trait Anxiety Inventory (STAI) one week before the clinical training and after its completion.

RESULTS

After completing the clinical training, the mean trait anxiety score was 34.28 ± 7.89 in the control group and 31.30 ± 6.70 in the intervention group. However, an independent t-test revealed that the difference in post-intervention trait anxiety scores between the two groups was not statistically significant (p = 0.089). In contrast, the mean state anxiety score after the intervention was 36.14 ± 7.38 in the control group and 31.21 ± 6.86 in the intervention group, demonstrating a significant reduction in anxiety levels among students who participated in the educational tour (p = 0.005).

CONCLUSION

The findings suggest that an educational tour can effectively reduce preclinical anxiety among first-year nursing students, making it a valuable strategy for improving their transition into hospital-based clinical training.

Nurturing Resilience and Healing from Within: The Impact of an 8-Week Yoga Program on Nursing Students

Background/Objectives: Nursing students encounter significant stress due to the demanding nature of their academic and clinical training, negatively impacting their mental health and overall wellbeing. Self-care strategies, such as yoga, have been suggested to effectively manage stress and promote resilience. Despite the growing recognition of the importance of self-care in nursing education, there is limited research on the specific benefits of yoga. This study aimed to explore the experiences and perceived benefits associated with undergraduate nursing students' participation in an 8-week yoga study. Methods: A qualitative study using a hermeneutic phenomenological approach was conducted. Participants were Baccalaureate nursing students from an Australian university. Data were collected through semi-structured interviews and analysed using reflexive thematic analysis. Reporting methods followed the consolidated criteria for reporting qualitative research guidelines. Results: Among the 14 students who participated, three main themes emerged: "Me Time", highlighting the importance of prioritising self-care; "Slowing Down," emphasising the psychological benefits of yoga; and "Self-Acceptance," reflecting personal growth and improved self-awareness. Participants reported reduced stress, improved mood, and enhanced physical and mental wellbeing. Conclusion: Students who participated in yoga were positively impacted through greater stress management and wellbeing. As nursing students transition into the workplace, the ability to manage stress and maintain mental wellbeing becomes even more critical. The high-pressure environment of healthcare settings can exacerbate stress, leading to burnout and decreased job satisfaction. By incorporating self-care practices such as yoga into their routine, nursing students can develop resilience and coping mechanisms that will benefit them as students and throughout their careers.

How many is enough? Justifying sample size in descriptive quantitative research

BACKGROUND

Descriptive quantitative researchers often use surveys to collect data about a group or phenomenon. Determining the required sample size in descriptive surveys can pose a challenge as there is no simple 'formula' by which to calculate an appropriate sample. However, when a sample is too small the study may fail to answer the research question and too many responses can create resource implications.

AIM

To explore considerations regarding the justification of adequate sample size in descriptive quantitative research.

DISCUSSION

Several considerations may assist quantitative descriptive researchers in examining the appropriateness and justification of sample size. Response rates can guide decision-making around the proportion of the target population who respond. Additionally, consideration of any validated tools, the spread or responses and types of analysis can guide sampling decisions.

CONCLUSION

The strategies in this article provide a considered approach to justifying sample size in descriptive quantitative research. Factors such as response rates and analytical considerations provide a transparent means of justifying an adequate sample.

IMPLICATIONS FOR PRACTICE

Providing clear justification for the sample size within descriptive quantitative research demonstrates a robust research approach and optimises resource use.

Comparison of first-year nursing students' GAD-7 scores: a pilot study focusing on Generation Z

BACKGROUND

In a post-pandemic landscape, Generation Z (Gen Z) nursing students are increasingly facing mental health challenges, notably anxiety. This study investigated these challenges among first-year nursing students.

AIMS

The primary objective was to assess self-reported anxiety levels in first-year undergraduate nursing students, focusing on Gen Z, before or at the onset of their initial clinical placement post-pandemic.

METHODS

Employing a cross-sectional design, this study used the Generalized Anxiety Disorder-7 (GAD-7) questionnaire to evaluate anxiety levels. It encompassed first-year nursing students from various fields at a university in North East England, considering generational differences, field of nursing, and demographic variables.

FINDINGS

Results indicated anxiety levels among generational groups, with Gen Z students exhibiting extreme variations. Notably, students in Mental Health Nursing reported less anxiety than their counterparts in other nursing fields. The study also sheds light on the ramifications of the COVID-19 pandemic on student mental health.

CONCLUSIONS

The study underscores the necessity for bespoke support systems in educational and clinical environments, particularly for Gen Z students. It advocates for comprehensive strategies in universities and clinical settings to nurture nursing students' emotional health, thereby enhancing their resilience and long-term career prospects.

Preparedness for a first clinical placement in nursing: a descriptive qualitative study

BACKGROUND

A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students' perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students' emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience.

METHODS

The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews (n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically.

RESULTS

Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants' feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students' expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers.

CONCLUSIONS

This unique study of first-year postgraduate entry-to-practice nursing students' perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students' narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Coping strategies used by undergraduate first-year nursing students during transition from basic to higher education: a qualitative study

BACKGROUND

The undergraduate first year of a nursing program is regarded as a difficult and challenging part of the nursing course, due to the variation experienced in the transition from basic to higher education compared to other first-year courses. This causes stress, which could contribute to students' lack of coping with the transition to the university. These challenges call for coping strategies to ensure resilience among this cohort of undergraduate nursing students.

METHODS

An exploratory descriptive qualitative research design was adopted to assess the coping mechanisms used by first-year nursing students during transition from basic to higher education. Data was gathered through four online focus group discussions which were conducted using the Microsoft Teams app, with participants purposefully selected from the two campuses where the study was conducted. The focus group discussions were recorded and transcribed verbatim for analysis. Data was analysed by the researcher and the co-coder using qualitative content data analysis.

FINDINGS

Three categories emerged from the data: experiences of transition from basic to higher education, coping with transition from basic to higher education, and recommendations for coping with transition from basic to higher education. Participants expressed that they use the following six coping strategies during the transition from basic to higher education: adaptive coping, appraisal-focused coping, emotion-focused coping, problem-focused coping, social coping, and seeking help from mentors.

CONCLUSIONS

Transition from basic to higher education is challenging for undergraduate first-year nursing students. The study suggests that there is a need to standardize and contextualize the support measures for undergraduate first-year nursing students during their transition from basic to higher education in order to enhance their ability to cope.

Trajectory of change in perceived stress, coping strategies and clinical competence among undergraduate nursing students during clinical practicum: a longitudinal cohort study

BACKGROUND

Clinical practicum is crucial for strengthening nursing students' clinical competence. However, nursing students often experience considerable stress during clinical practicum, and so they employ coping strategies to alleviate it. There is almost no empirical evidence on the change trajectory of perceived stress, coping strategies, and clinical competence among nursing students during a one-year clinical practicum. This study aimed to investigate the trajectory of change in perceived stress, coping strategies, and clinical competence among undergraduate nursing students during a one-year clinical practicum.

METHODS

This study used a longitudinal cohort design. Undergraduate nursing students were recruited from a science and technology university in Taiwan to participate from February 2021 to January 2022. Perceived stress, coping strategies, and clinical competence among students in basic training practicum (T1), advanced training practicum (T2), and comprehensive clinical nursing practicum (T3) were surveyed by using the Perceived Stress Scale (PSS), Coping Behaviour Inventory (CBI), and Clinical Competence Scale (CCS). PSS, CBI, and CCS in T1, T2, and T3 were compared using a generalized estimating equation (GEE) to deal with correlated data. The level of statistical significance was set at α = 0.05.

RESULTS

A total of 315 undergraduate nursing students completed the questionnaire. The study results show that the overall perceived stress of the students is the highest in T2 and the lowest in T3. The main source of stress of the students is 'taking care of patients' at T1 and 'lack of professional knowledge and skills' at T2 and T3. Students' perceived stress in 'taking care of patients' gradually decreases over time. The four coping strategies of CBI, which are 'stay optimistic', 'problem-solving', 'transference' and 'avoidance' in this order, remain the same ranking in three surveys.The main stress coping strategy used by students is 'stay optimistic', while the coping strategy 'avoidance' is used more frequently in T2 than in T1 and T3. Students' mean scores of the overall clinical competence and in the 'general nursing' and 'management' subscales in T3 are higher than those in T1 and T2. However, their mean scores in 'self-growth' and 'positivity' subscales are the highest in T1 and the lowest in T2.

CONCLUSIONS

The results show that through experiential learning in clinical practicum at different stages time after time, students' overall perceived stress is the lowest and their overall clinical competence is the highest in T3. The main coping strategy used when students managed stress is 'stay optimistic'. According to the results, we suggest that clinical educators provide students with appropriate guidance strategies at different stages of stress and continue to follow up the clinical competence and retention rates of these nursing students in the workplace in the future.

Coping strategies and social support in nursing students during clinical practice: A scoping review

AIM

To identify the coping strategies and social support received by nursing students during clinical practice.

DESIGN

Scoping review.

METHODS

Primary studies on coping strategies and social support, in full text, in English, French, Spanish or Portuguese and published in 2018 or later were included. Search was carried out in January 2023 on EBSCOhost, PubMed, SciELO, ScienceDirect, OpenAIRE, MedNar Search, WorldWideScience and the references of previously selected articles.

RESULTS

A total of 24 studies were identified. Seven studies mentioned social support as a useful strategy and several instruments were identified that allow measurement.

CONCLUSIONS

Few studies establish a direct relationship between the effectiveness of coping strategies with stressful situations. Positive coping strategies are associated with effective stress management. The relationship between social support and stress reduction is scarcely addressed.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Stressful situations can have an impact on students' health and on the quality of care. Nursing schools and healthcare institutions must work together in programmes to improve students coping abilities.

IMPACT

This review addressed coping strategies used by nursing students during clinical practice. A set of relevant coping strategies were identified that can be used by teachers to improve students' outcomes.

REPORTING METHOD

The review was performed according to Preferred Reporting Items for Scoping Reviews (PRISMA-ScR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

How Does a Group Reflection Intervention (Schwartz Rounds) Work within Healthcare Undergraduate Settings? A Realist Review

Introduction

Schwartz Rounds ("Rounds") are a confidential group reflection forum, increasingly adopted to support pre-registration healthcare students. This realist review aims to understand what the available literature and key informant interviews can tell us about Rounds in this setting, asking what works, for whom, in what circumstances, and why?

Methods

Published literature discussing Rounds in undergraduate settings were analysed using realist methods to describe how, for whom and in which contexts Rounds work. Four key informants were interviewed using realist methods, to further develop, test and refine a programme theory of Rounds in undergraduate settings.

Results

We identified five core features and five contextual adaptations.Core: Rounds provide a reflective space to discuss emotional challenges; Rounds promote an open and humanised professional culture; Rounds offer role-modelling of vulnerability, enabling interpersonal connectedness; Rounds are impactful when focused on emotional and relational elements; Rounds offer reflective insights from a wide range of perspectives.Contextual adaptations: Rounds allow reflection to be more engaging for students when they are non-mandatory; perceptions of safety within a Round varies based on multiple factors; adapting timing and themes to students' changing needs may improve engagement; resonance with stories is affected by clinical experience levels; online adaptation can increase reach but may risk psychological safety.

Discussion

Schwartz Rounds are a unique intervention that can support healthcare students through their pre-registration education. The five "core" and five "contextual adaptation" features presented identify important considerations for organisations implementing Rounds for their undergraduates.

Entry to practice nursing students' experiences of debriefing during clinical practice: A qualitative meta-synthesis

OBJECTIVES

The objectives of this review were to identify, explore and synthesize existing evidence in the literature of nursing students' experiences of debriefing in their clinical practice placements.

DESIGN

Qualitative meta-synthesis.

DATA SOURCES

Databases included Cumulative Index of Nursing and Allied Health Literature, Education Resources Information Centre, Medical Literature Analysis and Retrieval System Online, and Scopus. Qualitative studies were considered for inclusion if published in English, reporting primary data analysis including experiences of nursing students. The final search was conducted on 22 October 2021, no time limit was applied.

REVIEW METHODS

Qualitative studies were identified and appraised. Across the included studies, authors' themes and metaphors, and participant quotes were inductively analysed and interpreted, then expressed in the synthesis.

RESULTS

Three new themes representing nursing students' experiences of debriefing were constructed. Theme one, 'It didn't happen formally, but I needed it', included students expressing the value of, and wanting to be involved in, debriefing to gain validation, reassurance, and guidance. Theme two, 'I had to release it and it helped' included students' positive experiences of debriefing with another student, nurse, or confidant, through various modalities. These experiences affirmed they were not alone in their feelings, which provided relief, confidence, and new ways of thinking and practicing. Theme three, 'Strengthened clinical experience and learning', included students feeling debriefing supported their awareness and understanding of practice and increased participation in clinical experiences. This awareness and understanding provided an opportunity for students to explore, and reflect on, the impact of patient care.

CONCLUSIONS

Through debriefing student nurses found relief, confidence, and new ways of thinking through a shared understanding. Debriefing supported student learning and the clinical-academic education team had a key role in creating this opportunity.

Nursing students' experiences and expectations of clinical learning: A qualitative study

BACKGROUND

Clinical learning is an important component of nursing education that can support the development of competence. Nursing students have expectations before clinical learning, however if these expectations are not matched with their experiences, then development can be hampered.

OBJECTIVE

To explore nursing students' expectations and experiences of their clinical learning experiences.

DESIGN

Qualitative descriptive design.

SETTINGS

The study was conducted at a large teaching hospital in Namibia.

PARTICIPANTS

Fifteen first to fourth year undergraduate nursing students who were allocated to a teaching hospital in Namibia.

METHODS

The participants were purposively sampled among the teaching hospital's undergraduate nursing students. Data were collected between June to November 2021 through in-depth, semi-structured interviews that lasted between 35 and 45 min each. Data were analyzed using thematic analysis.

RESULTS

The data analysis identified four themes: clinical outlook and role, supporting/role modelling, clinical teaching and learning, and linking theory and practice.

CONCLUSION

The expectations and experiences of nursing students regarding the clinical environment were mixed. The findings demonstrated the need to moderate students' expectations, as well as to reorganize the clinical learning environment to enhance students' learning. Further studies should look at the standardization of student expectations based on the context of their clinical learning environment, and how this can improve learning experiences.

Perspectives of nursing students on challenges of e-learning during early stages of the COVID-19 pandemic

BACKGROUND

 E-learning is becoming an important approach to teaching and learning in higher education institutions, including nursing training. Despite that, there are students who were never introduced to e-learning prior to the coronavirus disease 2019 (COVID-19) pandemic. Their challenges in relation to e-learning could differ from those of other students who had experienced the platform before, especially against the backdrop of the COVID-19 pandemic that brought an abrupt change in the approach to teaching, learning and assessment.

OBJECTIVES

 This study explored and described university nursing students' challenges in relation to e-learning during the early stages of the COVID-19 pandemic in a resource-constrained setting.

METHOD

 Qualitative exploratory and contextual design was used. The sample consisted of 17 participants who were conveniently selected, and data were collected by means of two focus groups and five individual interviews. Data analysis followed a qualitative content analysis process.

RESULTS

 The five categories emanated from analysis are e-learning mode not suitable for practical components, challenges related to assessment of learning, connectivity issues, e-learning is a lonely journey and computer illiteracy and limited skills for the use of e-learning.

CONCLUSION

 Nursing students' challenges regarding e-learning during the early stages of the COVID-19 pandemic related to the learning of practical components, assessment, connectivity, a lack of interaction with peers and a lack of the skills required to operate e-learning tools.Contribution: The findings have implications for international, regional and local contexts in helping to develop support systems and preparing students to use e-learning when it is introduced abruptly.

Back to Clinical Training during the COVID-19 Pandemic: Perspective of Nursing Students

INTRODUCTION

The COVID-19 pandemic has affected many areas of life, including the formation of nursing students. After the COVID-19 crisis, learning during clinical training created different challenges. Nursing schools are responsible for ensuring that structures are in place to facilitate coping in the changed clinical setting. This study aimed to analyze nursing students' perceptions during clinical training while caring for COVID-19 patients.

MATERIAL AND METHODS

A qualitative phenomenological study that explored nursing students' perceptions of learning in clinical settings with COVID-19 patients was performed. A total of 15 semi-structured face-to-face interviews were conducted with nursing students who carried out their clinical practices in COVID-19 units during February and April 2022.

RESULTS

Through content analysis, categorization, and the method of comparison constant, four categories emerged: feelings, challenges, coping methods, and clinical practices. The students had to learn to "work" with fear and uncertainty and self-manage the emotional burden using different coping techniques to deal with learning during their practices. Interacting with professors and clinical tutors during the clinical practice were positive experiences.

CONCLUSIONS

This study constituted an opportunity to build new and adapted educational approaches for teachers to train nursing students to deal with their emotions and thoughts in future pandemic situations.

Coping with the Experience of Bad Sleep and Fatigue Associated with the Nursing Clinical Practicum

Nursing students experience anxiety during clinical practicum, which may interfere with their learning of clinical practice. This study explored the practicum anxiety symptom experience of clinical nursing students. The methodology was mixed research design consist of questionnaire and a qualitative research design following a grounded theory approach. Research data were gathered via theoretical sampling from 37 female college nursing students practicing in a Central Taiwan hospital and analyzed using the content analysis method. The mean age of the subjects was 20.7 ± 1.35 years old. The practicum-related anxiety symptom experience was made up of core dimensions associated with the nursing clinical practicum, such as bad sleep and fatigue, and covered six themes. Students first encountered anxiety-inducing situations in the clinical setting, and then they began coping through self-adaptation and teachers' help. In cases of coping failure, students began to have a bad sleep in the night and then felt tired and fatigued all day. These themes became a repeating cycle during the clinical practicum. This conceptual model shows that students experienced bad sleep and fatigue as a result of anxiety symptoms during the clinical practicum. Bad sleep and fatigue are critical anxiety symptoms for nursing students in clinical practice. Nursing teachers should pay attention to bad sleep and fatigue in nursing students and help students to improve their mental and physical health.

Concerns of Prelicensure Nursing Students Before a Maternal-Newborn Clinical Rotation

OBJECTIVE

To describe the concerns of prelicensure nursing students before their clinical rotation in the maternal-newborn setting.

DESIGN

Qualitative descriptive design with one open-ended survey question.

SETTING/PROBLEM

A private U.S. Midwest master's entry prelicensure nursing program. Students' concerns before beginning a maternal-newborn clinical rotation have not been fully explored in the literature and may differ from those reported by students in other clinical rotations. If not addressed, these concerns could negatively affect the clinical learning experience and hinder student success.

PARTICIPANTS

Prelicensure nursing students enrolled in the Nursing Care of Women and Newborns course at an urban graduate college of nursing.

INTERVENTION/MEASUREMENTS

On the first day of the course, students were asked to write on an index card their most pressing concern related to their upcoming maternal-newborn rotation. Participation was voluntary and anonymous. Course directors analyzed the responses for themes and further divided them by setting: labor and birth, newborn, postpartum, generalized (concerns across maternal-newborn clinical areas), and miscellaneous (nonclinical concerns).

RESULTS

A total of 130 concerns were reported by 125 students. Of these concerns, 47% (n = 62) were related to labor and birth, and 4.6% (n = 6) were related to caring for newborns; 40% (n = 51) were general clinical concerns, and 8.5% (n = 11) were of a nonclinical nature. No students in this study expressed concern about being assigned to care for individuals on the postpartum unit. Although some concerns were similar to those reported previously in the literature, others were unique to the maternal-newborn setting.

CONCLUSION

Prelicensure nursing students have concerns that are unique to the maternal-newborn setting. When student concerns are known before clinical rotations, course faculty, clinical instructors, and staff nurses can adapt strategies to reduce stress and improve the clinical learning environment for students so that they can be successful.

Coping strategies and stressors of nursing students in the care of sex trafficking victims

During their clinical practice, nursing students face a number of complex clinical situations, which may include treating victims of sex trafficking. These clinical experiences can lead to stress for the nursing students, which may hinder their learning process. Nonetheless, there is very little educational training provided in nursing programmes on this topic. The objective of this study was to identify the coping strategies and stressors perceived by nursing students in the care of sex trafficking victims. A pre-post study of a single group was carried out. The TREND guidelines were followed. The Perceived Stress Scale (PSS) and Coping Behavior Inventory (CBI) were used for data collection. On the PSS, the average scores were lower after the intervention in all dimensions, except related to teachers and nursing staff and peers and daily life. Statistically significant differences were found when comparing the results of the total average score of the PSS and the time of measurement (pre/post-intervention) (t(106) = 38.811; P < 0.001). Regarding the Coping Behavior Inventory, the average scores in each dimension increased after the intervention, except transference behaviours. Statistically significant differences were found when comparing the total average score of the questionnaire and the time of measurement (Z = -13.357; P < 0.001). The total stress levels and coping strategies of nursing students in caring for victims of sex trafficking improved significantly after the intervention. Nursing educators should promote the training of future nursing professionals as a potential effective strategy for the rapid identification and adequate care of sex trafficking victims.

Effect of Progressive Muscle Relaxation Exercise on Anxiety among Nursing Students in Pediatric Clinical Training

INTRODUCTION

Pediatric nursing students are expected to work hard to help children realize their full potential by giving care, knowing their growth process, and being responsive to their needs. Students should be able to communicate effectively and solve problems. Nurses who care for pediatric patients experience compassion fatigue as well as moderate to severe levels of work-related stress. The purpose of this study was to investigate the effect of progressive muscle relaxation exercise on anxiety among nursing students during pediatric nursing clinical training.

METHODS

A quasi-experimental, pre-post study was conducted in the faculty of nursing at the Arab American University/Palestine. The sample of the study consists of 60 nursing students enrolled in the pediatric nursing course were selected through convenience sampling. This study was conducted on one group of nursing students that received Jacobson's progressive muscle relaxation exercise for five consecutive days per week for two weeks before entering the clinical environment. The S-anxiety scale (STAI Form Y-1) was applied to collect data before and after the intervention.

RESULTS

The magnitude of anxiety after the progressive muscle relaxation exercise was greater reduced than before (t (59) = 21.1, P < 0.05). There was less anxiety post the program (M = 1.34 ± 0.36) than pre- program (M = 2.83 ± 0.35).

CONCLUSION

The study findings indicated the positive influence of progressive muscle relaxation exercise on nursing students' anxiety levels in pediatric clinical settings. As a result, it is recommended that teaching programs on this approach be conducted for nursing students at nursing schools prior to the commencement of pediatric clinical practice in order to lessen anxiety.

Resilience, professionalism, and reflective thinking: The three-legged stool of health professional and teacher education students’ fieldwork practice / Resilienz, Professionalität und reflektierendes Denken: die drei Säulen für das Praktikum von Studierenden der Gesundheitsberufe und der Lehrerbildung

Background

Fieldwork is a core element of health professional and education student training that is often a professional registration and practice requirement. There are many personal, social, and professional factors that impact on students’ fieldwork performance. The impact of professionalism, resilience, and reflective thinking on fieldwork performance is not well described in the literature.

Aim

To examine the relationship between health professional and teacher education university students’ perceptions of professionalism, resilience, reflective thinking and their links to fieldwork performance.

Methods

Ten focus group interviews were conducted with university undergraduate or master's students across four disciplines: occupational therapy (n = 18), pharmacy (n = 6), social work (n = 38), and education (n = 16). Thematic analysis was used to identify codes and categories in focus group transcripts. Commonalities of ideas and constructs were identified and interpreted to create meaningful themes.

Results

Six themes were identified. Fieldwork placement created real-world opportunities for developing technical and nontechnical skills, professional acclimatization, psychosocial traits, and behaviors for coping with the transition from student to proto-professional. However, these outcomes had consequences related to bridging the gap between university course theory and the reality of the workplace, adapting to cultural differences and local practice as well as seeking their own resources, supports, and learning.

Conclusion

Despite the personal, professional, and practical challenges of fieldwork, students independently establish mental models of professionalism, resilience, and reflective thinking, which support their fieldwork performance. However, developing these mental models should be underpinned by theory, and coordinated university and industry supports should be provided to augment this process.

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.

Understanding the Expectations of Nursing Students Following the First Clinical Internship: A Qualitative Study

The objective of this study was to describe how nursing students' expectations are achieved after the first clinical internship. A longitudinal qualitative study using purposive sampling was used in a public nursing school in Barcelona, Spain. Fifteen nursing students attending their internship for the first time. Data were collected in 2019 using semi-structured interviews until data saturation was reached. Interviews were conducted before and after the completion of the first clinical internship. The data were analyzed using the thematic analysis method. The students experienced some negative issues they did not think about, such as excessive homework, feeling a worker, not a student, loneliness, and learnings influenced by chance. Positive assessments of the accessibility of the placement location and the experience of the clinical instructor have a powerful influence on the student, allowing for the assessment and integration of the student in the health team. The practical learning is mediated by chance in terms of center, service, teacher, and clinical instructor assigned. It is crucial to establish consensual measures among all the actors involved to facilitate the objectivity of teaching and learning.

The challenges of "learning on the go": A qualitative study of final-year Spanish nursing students incorporated to work during the first Covid-19 pandemic

BACKGROUND

The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students.

OBJECTIVES

To explore the perspectives of a group of final-year nursing students who were hired on the basis of a relief contract for health professionals during the first COVID-19 outbreak, regarding their learning process and their mixed role as students and novice nurses.

DESIGN

A qualitative exploratory study was conducted.

SETTINGS

The Nursing Department of the European University of Madrid, and the Red Cross College of Nursing.

PARTICIPANTS

Eighteen nursing students were recruited, aged between 18 and 65 years old, enrolled in the fourth year of Nursing Studies and who were hired under a relief contract for health professionals during the pandemic.

METHODS

Purposive sampling was used. Semi-structured, in-depth interviews were carried out using a question guide. Interviews were conducted in a private video chat room platform. Also, a thematic, inductive analysis was performed. This study was conducted according to the Consolidated Criteria for Reporting Qualitative Research and the Standards for Reporting Qualitative Research.

RESULTS

Four specific themes emerged: a) The students' role during the relief contract; b) The learning process during the pandemic; c) Barriers to learning; and d) A unique learning opportunity. The students had an undefined mixed role, which hindered their skills and activities. Learning was self-directed, sometimes through trial and error, and through experiencing critical events. Time constraints and having to learn under pressure were experienced as difficulties for learning. Nevertheless, this was a unique professional learning opportunity. The students learned to be organized and effective, acknowledge their limitations, gain confidence, face their fears, and mature.

CONCLUSIONS

These results can help inform nurse training programs and improve the organization and incorporation of nurses in health care facilities during the COVID-19 pandemic.

Nursing students' evolving professional values: Capturing their journey through co-operative inquiry

AIM/OBJECTIVE AND BACKGROUND

Despite a worldwide emphasis in nursing codes of practice that state nurses must uphold professional values to be caring and compassionate, evidence continues to emerge of poor-quality care standards. Existing literature attests to a tendency to deteriorating caring values as students' progress through their nursing programme. In response, one university in England exposed pre-registration nursing students to a values-based curriculum which embedded Todres et al.'s (2009) Humanising Values Framework.

DESIGN AND METHODS

This paper describes the later stages of a co-operative inquiry, where students as participants explore their evolving values around person-centred approaches to care as they engaged with clinical practice. Data were collected between 2013 and 2016.

RESULTS AND CONCLUSION

Findings reveal how students developed their confidence and resilience in the face of situations that challenged their value base by internalising a humanised approach to care. They demonstrated this in practice by using problem-based coping strategies, peer and mentor support. Engagement with a curriculum based on humanistic philosophy encouraged students as participants to feel confident in the practice of person-centred care.

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.

Factors Influencing SDL Readiness and Self-Esteem in a Clinical Adult Nursing Practicum after Flipped Learning Education: Comparison of the Contact and Untact Models

This study aimed to evaluate the effects of a flipped learning contact model and a flipped learning “untact” model with Korean nursing students undergoing a clinical practicum, and to examine the factors of self-directed learning readiness and self-esteem considering these learning models. The participants included 85 students. Participants were randomly allocated to two models. This study measured self-directed learning readiness, self-esteem, learner motivation, professor–student and clinical instructor–student interactions, confidence in performing core skills, participating in online activities, clinical practice stress, and the friendliness of the two models. Participants’ characteristics were analyzed using frequencies and percentages, and between-group differences regarding characteristics were analyzed using the χ² test, independent t-test, and one-way ANOVA with a Scheffe test. This study conducted independent t-tests for comparison of the between-group adjusted mean difference of the pretest and posttest scores. The influence of the dependent variables on self-directed learning readiness and self-esteem was measured using a stepwise multiple regression method. Among the two models in the practicum, the flipped-mastery contact model (FMCM) showed higher self-directed learning (SDL) readiness and professor–student interaction than those of the flipped-mastery untact model (FMUM) after the clinical practicum was completed. The three influencing factors of SDL readiness were FMCM, learner motivation, and ward friendliness, with an explanatory power of 31.6% (F = 13.96, p < 0.001). Learner motivation, professor–student interaction, and ward friendliness influenced self-esteem, with an explanatory power of 54.7% (F = 34.86, p < 0.001).

Stress and Coping Strategies Among Malawian Undergraduate Nursing Students

PURPOSE

Stress among nursing students has been widely investigated across the globe, and evidence suggests that nursing programs are stressful. Students from resource constrained contexts, such as Malawi, often find it difficult and over stressing to be socialized into the nursing profession. However, this area has not been adequately investigated in Malawi. The aim of the study was to investigate stress and its coping strategies among nursing students in Malawi.

METHODS

This was a quantitative study which used a descriptive cross-sectional design that included 102 students in years 2, 3 and 4. Data were collected using the adapted standard tools (Perceived Stress Scale and Adaptive Version of the Nurse Stress Scale) to comprehensively measure levels of stress categorised as clinical, academic and external. The brief Cope was used to measure common coping strategies. Independent samples t test and ANOVA were run at 5% level of significance to analyze the data.

RESULTS

Moderate levels of stress were perceived by this sample. Academic category contributed to more stress than clinical and external sources. Lecturers, clinical teachers and nursing staff were the major contributors of stress among students. Similarly, high levels of stress were found among year 2 and self-sponsored students. In terms of coping strategies, active coping and planning were the common coping strategies. However, substance use was also recorded as a coping strategy.

CONCLUSION

The study revealed that although nursing students face various challenges in under-resourced environments, teachers and clinical staff highly contribute towards stress. It was then established that stress among nursing students' can be contained by initiating stress reduction interventions. There is also need to further investigate the extent of substance use as it suggests that some students have not been able to cope with current stress levels hence resorting to use of substances.

Meaningful learning actualized through a perinatal continuity of care experience

Leaders in nursing education embrace innovative, real-world learning environments that transform today's generation of nursing students into critical thinkers. Scheduling exclusive child-bearing practicums are challenging due to staffing, time, and maternal client presentation. Utilizing transformative learning theory a perinatal continuum of care clinical learning experience evolved. This paper will discuss the qualitative, descriptive study of Bachelor of Science in Nursing students in rural, Midwestern United States who completed maternal/infant didactic, high-fidelity simulation, and real-world experiences relative to women during the perinatal period. Participants (n = 50) consisted of third-semester baccalaureate nursing students enrolled in the maternal/infant course. Data were collected from students' reflective journal blogs at the end of the semester. The aim of this study was to identify the outcomes of students learning through this perinatal experience. Three themes emerged from this study: self-analysis, critical thinking, and self-efficacy. Students' reflection indicated that through this comprehensive clinical experience, they developed a new self-awareness. Students noted that the experience was unique to any they had encountered. The perinatal assignment provided an opportunity for professional growth in this specialty area due to the interface of theory, simulation, and clinical applications expounded in the reflective clinical blog throughout the experience.

Nursing student-patient relationship - a 10-year comparison study in Finland

Objective This study aimed to describe and compare the group-level findings from 2005-2006 and 2015-2016 regarding students' and patients' views of the nursing student-patient relationship and associated factors. Methods The data were in both cases collected using Student-Patient Relationship Scales. The data were analysed statistically. Results In both student cohorts, authoritative and facilitative student-patient relationships were reported by the students more frequently than mechanistic relationships. Authoritative relationships were most common in both patient cohorts, whereas facilitative relationships had become more frequent than mechanistic relationships. A positive change of views in the student and patient cohorts was found in factors associated with the relationship. Conclusion In order to strengthen a clinical learning culture that reflects a facilitative student-patient relationship, further research is needed on the processes and outcomes of that relationship.

Nursing student-patient relationship and related factors-A self-assessment by nursing students

AIMS AND OBJECTIVES

To describe the nursing student-patient relationship in terms of three types of relationships-mechanistic, authoritative and facilitative-and analyse the factors related to the type of relationship.

BACKGROUND

As future professionals, nursing students have a central role in facilitating patient autonomy while working in partnership with patients. Supporting student-patient relationship throughout the nursing education may result in positive outcomes for both students and patients.

DESIGN

A cross-sectional study.

METHODS

The data were collected from a convenience sample of Finnish nursing students using a structured web survey. Statistical data analysis was performed using chi-square test, two-sample t test, one-way analysis of variance and multinomial logistic regression. The STROBE Statement - Checklist for cross-sectional studies was used (Appendix S1).

RESULTS

Students most often assessed their relationship with the patients as facilitative, followed by authoritative and mechanistic relationships. The results revealed three predictors for facilitative relationship: students' older age, long enough contact time with the patient and higher competence in ensuring quality. In authoritative and facilitative relationships, students had significantly more positive perceptions of the contextual factors and consequences of the relationship and higher ratings of self-assessed competence levels than students in a mechanistic relationship.

CONCLUSIONS

It seems that the facilitative student-patient relationship is connected to the professional competence of nursing students, especially in the area of ensuring the quality of patient care. Therefore, sustaining clinical learning environments and pedagogical approaches that value and support facilitative relationships in students' clinical learning should be enhanced.

RELEVANCE TO CLINICAL PRACTICE

Efforts aimed at contributing to facilitative student-patient relationships have a crucial role in shaping students' competency and in promoting high-quality patient care. Thus, supervision of students organised around establishing mutual student-patient relationships with the preceptors acting as facilitators will benefit both students and patients.

Clinical placement anxiety in undergraduate nursing students: A concept analysis

OBJECTIVE

The primary aim of this review was to complete an in-depth analysis of clinical placement anxiety in undergraduate nursing students. Our overall goal was to establish a strong foundation for clinical education strategies and future research on clinical placement anxiety in nursing education.

DESIGN & METHODS

We utilized Walker and Avant's systematic 8-step approach to concept analysis as a framework to develop a comprehensive understanding of clinical placement anxiety in undergraduate students.

DATA SOURCES

A review of existing literature on clinical placement anxiety was conducted using the electronic databases of PubMed, CINAHL, and PsychInfo, as well as a grey literature and snowball search. Search terms included clinical placement, clinical experience, nursing students, undergraduate nursing students, and anxiety.

RESULTS

The literature search resulted in 81 articles that met the inclusion criteria. Five defining attributes were identified: a vague or unknown threat, psychological-emotional responses, psychological-cognitive responses, physiological responses, and unfamiliar environments or situations. Antecedents, consequences, and empirical referents of the concept were also highlighted.

CONCLUSIONS

Insights gleaned from this concept analysis may enhance the ability of clinical nursing educators to effectively prevent and manage student anxiety in the clinical setting. By contextualizing anxiety, we have also validated the importance of further exploration of the anxiety experienced by undergraduate nursing students during their clinical experiences. Thus, this concept analysis establishes the foundation for educational strategies, as well as future research in nursing education.

Relationships between reality shock, professional self-concept, and nursing students' perceived trust from nursing educators: A cross-sectional study

BACKGROUND

Nursing students establish their professional role through clinical practice. However, during the first clinical practice, they might experience reality shock given the gap between theory and practice, which could negatively influence their professional self-concept. Furthermore, nursing educators in clinical practice play an important role in improving nursing students' clinical experience.

OBJECTIVES

To examine the relationship between nursing students' reality shock and professional self-concept, and to examine the associations of perceived trust from nursing educators with nursing students' reality shock and professional self-concept.

DESIGN

A cross-sectional, descriptive correlational study.

SETTING

Nursing schools in one metropolitan area and three cities in South Korea.

PARTICIPANTS

Data were collected from 184 nursing students who experienced their first clinical practice in preceding four weeks of data collection.

METHODS

Surveys assessing participants' characteristics, reality shock, professional self-concept, and perceived trust from nursing educators were conducted. A hierarchical regression analysis was performed to examine the relationship between reality shock and professional self-concept, and the relationships between perceived trust from nursing educators and nursing students' reality shock and professional self-concept.

RESULTS

Nursing students' reality shock was negatively related to their professional self-concept. Perceived interpersonal relationship with nursing educators was positively related to professional self-concept and negatively related to the experienced reality shock. Furthermore, this negative relationship decreased when reality shock was combined with perceived interpersonal relationship with nursing educators.

CONCLUSIONS

Nursing students' reality shock during their first clinical practice may be negatively associated with the establishment of their professional self-concept. However, students' reality shock could be reduced by enhancing their interpersonal relationship with the nursing educator, which might reduce the negative association of reality shock with professional self-concept. Therefore, nursing educators should develop skills to establish interpersonal relationships with students to positively influence students' clinical adaptation.

Stressors and coping of nursing students in clinical placement: A qualitative study contextualizing their resilience and burnout

The aim of this study was to explore the stressors and coping of nursing students with differing levels of resilience and burnout during clinical placement. A qualitative descriptive study was conducted with twenty-four final-year baccalaureate nursing students, who were identified in the quantitative phase of the study as having scores indicating either: a) low resilience and high burnout; or b) high resilience and low burnout. Ten focus group interviews were conducted using a semi-structured interview guide. A thematic analysis of the data identified two main themes: a) stressors arising from the students aligning their expectations with the demands of the clinical placement (i.e., practice demands in busy wards, striving for learning opportunities, and discovering the social rules), and b) coping as a process of fitting into the ward culture. Those students with high resilience and low burnout scores had self-directed goals and coped by using self-regulation strategies. Those with low resilience and high burnout adopted external orientation and self-blame strategies. As suggested by the findings, the following approaches are recommended: offering interventions to enable students to fit actively into the clinical environment; encouraging engagement in reflection to facilitate self-awareness; and encouraging flexible use of personal and external resources.

Impact of Socio-Emotional Skills On The Performance of Clinical Nursing Practices

Aim To analyze the Socio-emotional (SE) skills of the students in the Nursing Degree, and their relationship with their clinical practice in hospital centers. Methods Cross-sectional descriptive study of a sample of 91 nursing students. SE skills were analyzed through self-administered questionnaires, and the clinical practices through the instrument "Clinical Practices Evaluation Notebook". Findings The students obtained medium and high scores in the SE skills and in the clinical practices. Most of the SE skills had a positive and statistically significant relationship (p < 0.05) between them. A relationship was observed between SE skills with performance in clinical practices, through a multiple linear regression. Discussion It is suggested that the development of the SE skills of the nursing students within the Nursing degree curriculum has an influence on their performance during their clinical practices. Conclusion The SE skills are a potential predictor of the performance of the nursing students in clinical practices.