Clinical placement anxiety in undergraduate nursing students: A concept analysis

The Effect of Forgiveness and Resilience on Anxiety, Depression and Stress in Nursing Students

Purpose: To examine the effects of forgiveness and resilience on anxiety, depression, and stress in nursing students. Design: Cross-sectional correlational study. Methods: The convinient sample of the study consisted of 383 nursing students. Results: Significant predictors of nursing students' anxiety levels were experiencing an event where they could not forgive themselves or others and resilience. Significant predictors of nursing students' depression levels were gender, income level, experiencing an event where they could not forgive themselves or others, resilience, and self-forgiveness. Significant predictors of nursing students' stress levels were experiencing an event where they could not forgive themselves or others, resilience, and forgiveness of others. Conclusion: An increase in the level of self-forgiveness in nursing students reduced depression symptoms, and an increase in the level of forgiveness of others decreased stress symptoms. An increase in the level of resilience reduced symptoms of anxiety, depression, and stress. Female gender and a middle level of income reduced symptoms of depression. Interventions that increase forgiveness and resilience should be integrated into the curriculum to reduce nursing students' psychological symptoms in the context of holistic nursing.

Effectiveness of interventions for the prevention or management of workplace violence in student nurses during clinical placement: A systematic review

AIM

To systematically investigate the effectiveness of interventions for managing workplace violence experienced by registered nursing students during clinical placement.

DESIGN

A systematic review of experimental studies.

METHODS

The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The key search concepts such as "Nursing students", "Education", "workplace violence", "clinical placement" and "clinical study" were inspected to identify relevant articles (Appendix A). Two independent reviewers completed screening, critical appraisal and data extraction. Due to heterogeneity among the included studies, results were synthesized narratively.

DATA SOURCES

MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate Analytics), Scopus (Elsevier), Embase (Ovid), Cochrane CENTRAL, ERIC (ProQuest), ProQuest Central and ProQuest Social Science Premium Collection were searched from inception to 27th February 2023.

RESULTS

A total of 13 studies were included in this review. The predominant intervention for managing workplace violence experienced by registered nursing students during clinical placements was education. Approaches varied among studies and included didactic teaching, e-learning, role-playing and simulation practice. The included studies showed uncertain improvements in registered nursing students' confidence, coping skills, knowledge, competence and self-efficacy in dealing with workplace violence during clinical placements. Only one study assessed the incidence rate of workplace violence and found that a multi-faceted intervention involving both staff and students decreased the incidence.

CONCLUSION

Given the heterogeneity of educational interventions, the effect of interventions for managing workplace violence during students' clinical placement is uncertain. To address this gap, high-quality, proactive and combined interventions at both institutional and organizational levels are needed.

The Effects of Immersive Virtual Reality on Nursing Student Anxiety

ABSTRACT

High levels of stress are common for nursing students and can lead to poor health, poor school performance, and uncivil behavior. This pilot study aimed to evaluate the effects of an immersive virtual reality (IVR) relaxation experience on perceived anxiety among prelicensure nursing students. A convenience sample of 20 baccalaureate students participated in an IVR meditation session. Participants recorded pre and post anxiety levels, blood pressure, and heart rates. Results indicated reduced anxiety levels in students who used IVR relaxation. Students' heart rates and blood pressures decreased significantly.

Experiences of Intern Nurses Returning From Distance Education to Clinical Practice During the COVID-19 Pandemic: A Qualitative Study

RATIONALE

The present study aimed to understand the experiences of intern nurses returning to clinical practice after a year-long distance education during the pandemic.

METHODS

The study was conducted using the qualitative content analysis method. The participants were 32 intern nurses. The data included specific narratives on the experience of intern nurses returning from distance education to clinical practice during the pandemic. Data were collected through a total of four focus group interviews. Data analysis was conducted using an inductive qualitative analysis approach.

RESULTS

The content analysis identified three main categories. The category 'Feelings during Clinical Practice' included the subcategories 'fear', 'uncertainty' and 'intolerance'. The category 'Challenges during Clinical Practice' included the subcategories 'sleep problems', 'alienation from clinical placement', 'lack of knowledge and experience', 'hospital staff', 'difficulty reaching nurse educator' and 'lack of protective equipment'. The category 'Suggestions for Clinical Practice' included the subcategories 'psychological support', 'case discussion and academic counselling' and 'protective equipment support'.

CONCLUSIONS

The study revealed that intern nurses faced various challenges in clinical settings following their year-long distance education. The results may help nurse educators understand the experiences of intern nurses returning to clinical practice after a year-long distance education and determine the teaching strategies to be followed in specific situations like pandemics in the future.

Exploring the thoughts and feelings of novice speech-language pathology students: A qualitative investigation

PURPOSE

To explore the thoughts and feelings of novice Australian speech-language pathology students about undertaking their first therapy placement.

METHOD

Data was collected with Australian novice graduate-level speech-language pathology students immediately prior to their first therapy placement via open-ended responses to two questions on a questionnaire. The data was analysed using inductive qualitative content analysis.

RESULT

265 students participated in the study. Data analysis led to the construction of two themes: "I hope that my placement will support me on my way to becoming a confident speech-language pathologist" and "I hope my clients do well, but I fear that I might be inadequate". The analysis of these results led to the development of guidelines for supporting novice students on clinical placement.

CONCLUSION

Novice speech-language pathology students are keen to apply their knowledge to authentic clinical cases but are concerned about their own personal circumstances and whether they will receive sufficient support during their placement. An enhanced understanding of students' concerns and hopes may help practice educators implement appropriate support strategies.

Resilience of nursing students: A concept analysis study

OBJECTIVES

This study aimed to identify attributes of resilience among nursing students.

DESIGN

The concept analysis method was used.

DATA SOURCES

Literature reviews from the past 10 years were searched in Science Direct, Cumulative Index to Nursing and Allied Health Literature, PubMed, and the Wiley online library. The literature search database and review period were determined after verification of validity by five experts (nursing professors). The inclusion criteria for the literature review were that the paper must be written in English, and the abstract or title of the paper should have included attributes of nursing students' resilience. Exclusion criteria were papers written in languages other than English, papers that did not include the attributes of resilience of nursing students, and duplicate papers. Seventeen studies were included in the analysis.

RESULTS

Resilience among nursing students comprised three attributes and 28 sub-attributes. The three attributes were individual, educational, and situational. Individual attributes included personal competency characteristics (e.g., self-confidence and self-efficacy) and consisted of 15 sub-attributes. Educational attributes included characteristics related to academic and clinical practicum (e.g., coping with academic work pressure) and consisted of seven sub-attributes. Situational attributes comprised characteristics that changed according to circumstances (e.g., coping with increased levels of patient acuity during the crisis), such as the COVID-19 pandemic and social support from significant others, and consisted of six sub-attributes.

CONCLUSIONS

This study identified resilience attributes reflecting the characteristics of nursing students and recent situational changes. Consequently, tools to assess resilience should be developed based on study findings and utilized in various studies aimed at enhancing the resilience of nursing students.

Interventions to enhance the core competencies of clinical nursing preceptors: a protocol for a systematic review

INTRODUCTION

Clinical nursing preceptors (CNPs) teach nursing skills to students in real medical scenarios and develop their professionalism. The adequacy of CNPs' teaching competencies affects the effectiveness of student learning, so it is crucial to seek the best evidence for teaching competency interventions. This report describes a protocol for a systematic review to identify and analyse interventions to enhance the teaching competencies of CNPs. The aims of this systematic review are to (1) summarise the characteristics, quality, effectiveness and limitations of existing intervention programmes that support or train CNPs in teaching competencies; and (2) identify knowledge gaps related to teaching competencies interventions for CNPs, thereby supporting future research on constructing and improving preceptor intervention programmes.

METHODS AND ANALYSIS

This protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols 2015 checklist. We will report this systematic review following the updated PRISMA 2020 checklist. Between 1 May 2024 and 30 May 2024, we will search PubMed, Web of Science, CINAHL, MEDLINE, EMBASE and ProQuest (Health & Medical Collection). The intervention studies that focus on enhancing and supporting the core competencies of CNPs will be included. The two researchers will conduct the study screening, data extraction and quality appraisal independently. Disagreements will be addressed by discussion or the involvement of a third researcher. We will evaluate the quality of the included studies using the modified Educational Interventions Critical Appraisal Tool. Furthermore, we will label the training programme levels using Kirkpatrick's Four Levels of Training Evaluation Model.

ETHICS AND DISSEMINATION

Ethical approval is not applicable to this study. We will share the findings from the study at national and/or international conferences and in a peer-reviewed journal in the field of nurse education.

The mediating effect of social intelligence in the association between social anxiety and mental health among Chinese nursing students

Social anxiety is highly prevalent among nursing students and is associated with poor mental health. However, the underlying mechanism in such an association remains unclear. This study aimed to examine the potential mediating role of social intelligence in the association between social anxiety and mental health using the Stress-Coping Model (SCM) as the theoretical framework. A cross-sectional study was conducted among 748 nursing students recruited from a Chinese University from December 2022 to March 2023. Students completed an online questionnaire to assess their social anxiety, social intelligence, and mental health. The PROCESS SPSS Macro (model 4) was used to test the mediation effect of social intelligence on the association between social anxiety and mental health. The results showed that nursing students had moderate levels of social anxiety, social intelligence, and mental health, which varied according to their profile characteristics. Social anxiety was negatively associated with mental health, and the association was partially mediated by social intelligence. Our study offers fresh insights into the impact of social anxiety on mental health and sheds light on the intricate mediating role of social intelligence. These findings offer valuable insights for research and clinical endeavors aimed at formulating psychosocial interventions to enhance the mental health of nursing students.

Symptoms of Anxiety and Depression in Italian Nursing Students: Prevalence and Predictors

Background/Objectives: Mental disorders in nursing students, although very common under normal circumstances, have worsened over time due to the COVID-19 pandemic. This study aimed to assess (1) what the prevalence of anxiety and depression symptoms in Italian nursing students was and (2) what factors were associated with them. Methods: In May 2023, a cross-sectional study was conducted on the bachelor's degree Nursing course in an Italian university. Levels of anxiety and stress were assessed using the Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), respectively. In addition, socio-demographic variables and data on mental health, drug intake, and substance use were collected. Multiple binary logistic regression adjusted analyses were used to identify predictive factors. Results: A total of 148 nursing students completed the questionnaire. A total of 9.5% reported a previous diagnosis of a mental disorder, and, of these, 35.7% reported that it was diagnosed after the start of the COVID-19 pandemic. The mean GAD-7 and PHQ-9 score was 9.68 (SD = 5.2) and 8.37 (SD = 5.6), respectively. Protective factors for depressive symptoms included not having a previous diagnosis of a mental disorder (adjusted odds ratio = 0.10, 95% CI: 0.002-0.47, p < 0.001) and a perceived high (adjusted odds ratio = 0.03, 95% CI: 0.003-0.22 p < 0.001) or medium (adjusted odds ratio = 0.14, 95% CI: 0.03-0.82, p < 0.05) socioeconomic level, while the predictor of anxiety symptoms was returning home once a month for students studying away from their residence (adjusted odds ratio = 6.4, 95% CI: 1.01-40.8, p < 0.05). Conclusions: Urgent investments are needed in universities to implement mental health promotion programmes and to offer counselling services to reduce and prevent mental health problems among students.

The relationship between difficulties in emotion regulation and solution-focused thinking in nursing students

AIM

The aim of this study was to investigate the relationship between emotion regulation difficulty and solution-focused thinking in nursing students.

BACKGROUND

It is essential for nursing students to possess solution-focused thinking and emotion regulation skills to cope effectively with stressors arising from their developmental processes, the nature of education and the profession. This is crucial for enhancing the quality of nursing care.

DESIGN

The study design was cross-sectional descriptive and correlational design.

METHODS

The convenience sample of the study consisted of 416 nursing students. The research was conducted between January 20 and February 15, 2024. Data were collected in Türkiye with the difficulties in emotion regulation scale-brief form and the solution focused inventory. Data were analyzed using multivariate linear regression analysis.

RESULTS

An increase of 1 unit in the level of emotion regulation difficulty was associated with a decrease of 0.236 units in participant resource activation and 0.524 units in problem disengagement (p<.001). An increase of 1 unit in the level of emotion regulation difficulty was also associated with an increase of 0.876 units in participant goal orientation (p<.001). Grade point average, grade and age were identified as factors influencing the sub-dimensions of solution-focused thinking (p<.05).

CONCLUSIONS

The study showed that emotion regulation difficulty is an important predictor of solution-focused thinking in nursing students. Therefore, students' emotion regulation difficulties and solution-focused thinking should be evaluated by academic nurses from the beginning of students' enrollment. Also, it is recommended that intervention programs focusing on developing emotion regulation and solution-focused thinking skills for nursing students should be included and implemented in the nursing curriculum.

"This should be a compulsory placement for all nursing students": An evaluation of pre-registration nursing students' perceptions of learning on a mental health clinical placement

AIM

To conduct a longitudinal exploration of pre-registration nursing students' perceptions of their learning on an immersive mental health clinical placement grounded in learning from people with a lived experience of mental illness (otherwise known as consumers).

BACKGROUND

Enriching mental health clinical learning environments are crucial for positive mental health nursing outcomes. Though non-traditional clinical placement (i.e. non-hospital-based) models effectively increase student learning in a range of domains, little is known about the specific features of contemporary non-traditional placement settings that may be supporting student learning over time.

DESIGN

A survey design in the form of a standardised evaluation tool with additional qualitative response questions was used to examine nursing students' perceptions of learning whilst on a non-traditional clinical placement over a 5-year period. Non-traditional placement settings are alternative placement options to traditional inpatient/community mental health settings. The TREND Statement Checklist was adhered to.

METHODS

Second- and third-year students studying a Bachelor of Nursing (N = 753) from eight Australian Universities completed a Student Placement Feedback Survey between 2019 and 2023. Data were collected via an evaluation survey including 7-items (rated on a 5-point agreement scale) and three free-response questions. Quantitative and qualitative responses were analysed over all observations and compared between the five years of student evaluations.

RESULTS

Across five years, the immersive mental health placement was consistently rated by students as a highly valuable learning experience. Utilizing a Multivariate Analysis-of-variance (MANOVA) for the quantitative component revealed that student 'learning from lived experience' remained uniformly high and steady throughout 2020-2023. This was despite disrupted learning that ceased face-to-face tuition caused by the COVID-19 pandemic. An increase in 'student enthusiasm for nursing' was identified after the return to face-to-face learning. Qualitative analysis identified a greater need for preparedness prior to attending the placement and wellbeing support amongst students.

CONCLUSIONS

Over the five years, pre-registration nursing students report clinical skill improvement and enhanced knowledge following the immersive mental health placement alongside an increased desire for further skill development. Learning from people's lived experience of mental illness and specialised facilitators was valuable for student learning outcomes. Increased support is needed for student mental health vulnerabilities and wellbeing ahead of clinical placements. Further research is recommended on the aspects of non-traditional clinical placements that may be protective for student learning.

A virtual reality environment for supporting mental wellbeing of students on remote clinical placement: A multi-methods evaluation

BACKGROUND

Nursing and Allied Health Profession (NAHP) students undertake clinical placements as part of their pre-registration training. The remote nature of some placement sites, shiftwork and the emotionally challenging nature of the workload has led to mental wellbeing issues in many students.

AIM

This project aimed to evaluate a novel 3D immersive virtual reality environment that supports mental wellbeing for NAHP students on clinical placement. It comprises a calming 3D tropical beach environment where students and tutors can meet for reflection and mutual support.

DESIGN

A multi-methods design gathered quantitative impact data with validated measurement tools and qualitative output related to the lived experience of students.

SETTINGS AND PARTICIPANTS

All 600 pre-registration NAHP students within the institution undertaking clinical placements were invited to participate, irrespective of mental wellbeing status. Students were randomly assigned to either a VR or Conventional cohort; all participants received the control support mechanism in a subsequent placement.

METHODS

All participants completed an initial demographic and Readiness for Therapy survey followed by weekly Beck Anxiety and Depression Inventories during placement. All participants were invited to a semi-structured interview.

RESULTS

Overall, 32 participants engaged with the application; although the VR cohort demonstrated improved scores on both Beck inventories, these were not statistically significant. This is probably due to the low response rate for the control cohort. A total of 15 interviews were conducted and several themes emerged from the data in relation. to both experiential outcomes (escapism, anonymity and sense of community) and instrumental outcomes (calming, mindfulness and combatting loneliness).

CONCLUSIONS

User feedback indicates that a VR environment can provide a calming escape from the pressures and anxiety arising from clinical placement for healthcare students. The relaxing beach environment facilitated mindfulness meditation and the additional opportunities for pseudo-anonymous interactions with peers and tutors were wellreceived by students.

Experiences of Nursing Students Regarding Challenges and Support for Resilience during Clinical Education: A Qualitative Study

Nursing students require resilience to navigate the complexities of clinical practice. This characteristic is essential for managing demanding workloads, unpredictable patient situations, and emotional stressors while maintaining performance and well-being. Fostering resilience helps students develop the capacity to adapt to adversity, overcome setbacks, and remain committed to providing high-quality patient care. This qualitative study explores the challenges and supports influencing nursing students' resilience during clinical education. Interviews with 28 Thai nursing students revealed two key themes: the "experience of vulnerability" and the "experience of meaningfulness". The sub-themes of vulnerability included "navigating uncertainty", "transcending professional struggles", and "being exposed to diverse encounters". The sub-themes of meaningfulness focused on restoring strength through social interactions and engaging in positive transformation. This study highlights the need for comprehensive support systems that address personal and professional vulnerabilities. Integrating caring theory principles could further enhance resilience by emphasizing compassionate care and fostering student empathy. This suggests that instructors and stakeholders can significantly impact student well-being by creating supportive environments built on collaboration, empathy, and mentorship, all of which are aligned with caring theory.

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.

Effect of aligners on patients' oral health-related quality of life and anxiety: a prospective pilot study

BACKGROUND

This prospective study explored the impact of aligners on the oral health-related quality of life and anxiety of patients during the first month of orthodontic treatment and the first month of the retention phase.

METHODS

A total of 23 male and female patients (median age 25 y) treated with clear aligners were included. The OHRQoL questionnaire was used at certain time points during treatment (T1: placement of the first aligner; T2: after one day of use; T3: after seven days; T4: after one month; and T5: after one month in the retention phase). The State-Trait Anxiety Inventory (STAI) was also self-administered to assess state and trait anxiety (Y1 and Y2 subscales, respectively) at the T1, T4 and T5 time points. A population average generalized estimating equations logistic regression model was fit to assess the effect of time on the responses, and the Wald test was used to examine the overall effect of time.

RESULTS

Overall time was a significant predictor for most of the questions. However, time was marginally significant for the OHRQoL questions evaluating oral symptoms such as bad taste/smell, sores, and food accumulation. Tooth discolouration did not differ between time points. The general activity disturbance was significantly lower in the retention phase. Higher depression and anxiety scores were reported at the initial appointment and decreased thereafter.

CONCLUSIONS

CAT has a negative impact on quality of life and psychological status during the initial days of treatment. These impairments ameliorate at later treatment stages.

Integrative Review of Sources of Baccalaureate Nursing Students' Clinical Practice Anxiety

BACKGROUND

Nursing education research and anecdotal literature has revealed that undergraduate nursing students report anxiety related to clinical practice. Most published studies have focused on the effectiveness of interventions to reduce anxiety; only a few identify specific sources of clinical practice anxiety.

METHOD

We conducted an integrative literature review to understand the sources of nursing students' practice-related anxiety and how this anxiety has been measured.

RESULTS

We classified sources of practice-related anxiety into nine themes grouped into five categories: consequences of making a mistake; fear of the unknown; incivility of staff members or teachers; threat to self-concept, image, or health; and theory-practice gap. Practice-related anxiety was measured quantitatively with various surveys and qualitatively using semistructured individual or group interviews and students' journal entries.

CONCLUSION

Different sources of practice-related anxiety likely require distinct interventions. Further research is recommended to identify effective interventions to reduce anxiety related to each of the identified themes. [J Nurs Educ. 2024;63(6):349-355.].

In situ simulation training strengthened bachelor of nursing students' experienced learning and development process- a qualitative study

BACKGROUND

In advanced clinical learning labs on campus, high-fidelity simulation has become an essential educational approach in the Bachelor of Nursing Education programme. However, simulation while in clinical placement, in situ, is rarely used in Bachelor of Nursing Education. The aim of the present study was to explore how in situ simulation training at a surgical hospital ward, according to Bachelor of Nursing students, influenced their learning and development process.

METHODS

A qualitative descriptive study was conducted. Data were collected through individual interviews with a sample of 21 s-year Bachelor of Nursing students who completed 40 in situ simulations during their eight-week clinical placement at a Norwegian University Hospital. Data were analysed using inductive content analysis.

RESULTS

The data analysis generated six subcategories constituting two descriptive categories: building professional confidence and internalising nursing knowledge. Although the students found in situ simulation stressful and uncomfortable for being assessed by student peers, the teacher and preceptor, the process of managing clinical situations in simulation helped build professional confidence. What the students had learned in the simulation was directly transferable to real clinical situations because they were in the hospital setting. The simulation sessions enabled them to connect theoretical knowledge and clinical skills. They could test their skills in a safe environment, performing procedures that made them aware of how their knowledge could be used in real life.

CONCLUSION

According to the Bachelor of Nursing students' own experiences, in situ simulation supported the students' learning process, connected theory and practice and contributed to developing confidence in the performance of clinical skills. Including simulation in clinical practice could prove to be an effective way of teaching and learning clinical skills in nursing regarding resources and learning outcomes.

Exploring clinical learning experiences of novice physiotherapy students in a hospital setting

BACKGROUND

Exposure to clinical practice experiences ensures undergraduate physiotherapy students meet the clinical competencies required to graduate as autonomous practitioners. Much of the research literature has investigated the clinical experiences of medical students. While recent studies have explored physiotherapy students' experiences with simulation, few have explored their perspectives of a clinical placement in a hospital setting at the early learning stage of a four-year programme.

OBJECTIVE

To explore the perspectives of novice undergraduate physiotherapy students on a clinical placement in a real hospital setting.

METHODS

Fifteen Year 3 undergraduate physiotherapy students participated in semi-structured interviews midway through a three-week tertiary care clinical placement. Interviews were transcribed, coded and analyzed using thematic analysis.

RESULTS

Three main themes emerged: 1) student attributes affecting placement experience; 2) impact of the educator on student experience; and 3) effects of the clinical environment on student experiences.

CONCLUSION

The real clinical environment promotes a rich learning experience for students, while the clinical educator is pivotal to guiding student learning through provision of resources and feedback. Provision of early orientation and timely clarification of expectations is important to alleviate anxiety and allow students to prepare themselves.

Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review

AIMS

To systematically identify, appraise and synthesise qualitative studies investigating Registered Nurse students' (RNS) experiences of workplace violence (WPV) while on clinical placement. It is expected that the literature review findings will guide the development of targeted programs and policies to address WPV against RNS.

BACKGROUND

WPV affects RNS during clinical placements as they are vulnerable to violence due to their limited experience and skills to challenge abusive behaviour. In this review, RNS are students enrolled in a Bachelor of Nursing program to become registered nurses and exclude students who are enrolled in nursing program that does not lead to registration as a registered nurse. For example, enrolled in nursing programs and postgraduate nursing programs. RNS are chosen for their scope of practice and the training requirements. RNS reported experiencing WPV mainly from colleagues, staff, teachers, doctors and supervisors, which resulted in leaving nursing practice, impacting students' progression and healthcare systems. This review examines all types of violence RNS face irrespective of the abuser.

METHODS

A qualitative systematic review of existing literature was conducted through a comprehensive database search of eight databases MEDLINE, CINAHL, Web of Science, Scopus, Embase, Cochrane Central and ProQuest. Furthermore, reference lists of included studies were searched to identify further research. English language qualitative primary studies of any study design were searched from inception to 6th June 2022 and included if they met the inclusion criteria. Double review process utilised from screening until data synthesis reported according to PRISMA. JBI critical appraisal tools were used to assess the studies, and data extraction utilised JBI QARI tool and screened for credibility and confidence in findings.

RESULTS

A total of 18 studies met the inclusion criteria, and the studies were conducted in nine countries. Five main themes relating to RNS experiences of WPV while on clinical placement were identified, including: 'Types of workplace violence', 'Perpetrators', 'Causes', 'Consequences' and 'Management of workplace violence'.

CONCLUSIONS

This qualitative systematic review provides new and significant knowledge in understanding the phenomenon of WPV experienced by RNS while on clinical placement.

RELATIVE TO CLINICAL PRACTICE

This review highlights the unwillingness of RNS to reach out to instructors or clinical placement leaders in many situations and identifies avenues of support and awareness that are crucial to empower and enabling students to seek support.

Magnitude of general anxiety disorder among nursing students and its associated factors

Background

University training in nursing together with other student variables can increase the risk of anxiety in students. It is important to assess the student's level of anxiety, which can have repercussions on their training and mental health. There are several validated tools such as the generalized anxiety disorder scale (GAD-7).

Objective

To know which factors are associated with the appearance of anxiety and which protect against it in university nursing students.

Method

A cross-sectional descriptive study was carried out in which 170 university nursing students from University of Jaén participated. A bivariate and multivariate analysis was performed, calculating odds ratio and adjusted odds ratio (aOR) with 95% confidence intervals (CIs) to determine which factors were associated with a higher score on the GAD-7 questionnaire, and therefore with the presence of anxiety.

Results

In total, 66.5% (113) of the students have suffered an anxiety crisis on some occasion and 48.8% (83) of the students did not carry out activities of any kind to control anxiety and stress. Practicing religious and spiritual beliefs increased the probability of having anxiety compared to those who did not have religious beliefs (aOR = 3.92; 95% CI = 1.09, 14.08), as well as having previously suffered an anxiety crisis (aOR = 5.13; 95% CI = 2.39, 11.04). Protective factors against anxiety appear to be second-year students (aOR = 0.33; 95% CI = 0.16, 0.72) and being deeply satisfied with the teaching staff (aOR = 0.03; 95% CI = 0.01, 0.79).

Discussion/Implications for practice

Knowing the factors that are associated with the appearance of anxiety is necessary to facilitate early detection and care in nursing university students.

An integrative review of resilience among nursing students in the context of nursing education

AIM

This integrative review aimed to examine empirical research on resilience among nursing students in the context of nursing education. Resilience helps nursing students handle challenges, such as changing learning styles and experiencing their first clinical practice.

DESIGN

An integrative review.

METHODS

The search terms focused on resilience and health in nursing students and nursing education. The database used in this review were CINAHL Plus, PubMed and MEDLINE. The Mixed Methods Appraisal Tool appraised the studies' quality.

RESULTS

This study explored 52 records and revealed three current research focuses related to nursing students' resilience: (1) the concept and description of resilience, (2) the characteristics affecting resilience and (3) the mediating role of resilience in maintaining holistic health. Recommendations include adding a resilience topic to the nursing curriculum, providing resilience enhancement programs, examining the relationship between resilience and holistic health and exploring the influence of resilience about global health crises.

PUBLIC CONTRIBUTION

Resilience among nursing students plays a vital role in helping them to overcome adversities during their nursing education. Additionally, after graduation, nursing students can continue contributing to society as resilient Registered Nurses in the future.

Undergraduate Nursing Student Mental Health Clinical Experiences in Saudi Arabia: Findings From a Qualitative Study

BACKGROUND

Clinical experience is an important way of resolving preregistration challenges. Negative feelings toward pursuing a career in mental health nursing may be modified by well-structured practicums.

AIMS

To explore nursing student perspectives of clinical practicums in mental health in Saudi Arabia for the purpose of enhancement of nurse education in mental health care.

METHODS

This qualitative study used thematic analysis from semistructured focus group interviews of 20 female undergraduate nursing students. Inductive outcomes and emergent conceptual data were reviewed by investigators, doctoral prepared faculty peers, and members of the sample. NVivo 10.1 software was used to suggest conceptual groupings into themes based on inductive codes.

RESULTS

The core theme-enhancement of mental health care skills-comprised four emerging subthemes, including the application of theory for clinical improvement, positive feelings, and motivation toward removal of discrimination and stigmatization, experience with apprehension, anxiety, fear, and stress, and therapeutic communication skills.

DISCUSSION

Clinical placement in mental health-related practice may assist undergraduate nursing students in addressing anxiety and stress related to contacting patients, confronting stigmatizing and negative emotions, applying theoretical knowledge to clinical practice, having therapeutic communication skills, and enhancing overall professional experiences of nursing students. It is hoped that undergraduate clinical mental health placement will contribute valuable skills and viewpoints to nursing students who aim to enter professional practice in all areas and especially mental health.

Nursing students' experiences of workplace violence in clinical practice: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to investigate the experience of workplace violence against nursing students on clinical placement.

INTRODUCTION

Workplace violence affects nursing students during clinical placements in hospitals and other health care settings. Nursing students are uniquely vulnerable to workplace violence due to their limited experience and skills in challenging abusive behavior. Up to half of nursing students have reported experiencing horizontal or lateral physical or verbal violence during clinical placement, both from colleagues and patients. As a result of workplace violence, many students consider leaving nursing practice within their first year. This has implications for individual students' progression and for health care systems that rely on nursing graduates to deliver health care services.

INCLUSION CRITERIA

Only qualitative primary studies will be included. The population is registered nurse students, the phenomenon of interest is the experience of workplace violence, and the context is clinical placement.

METHODS

A comprehensive database search of MEDLINE, CINAHL, Web of Science Core collection, Scopus, Embase, Cochrane Central Register of Controlled Trials, ERIC, ProQuest Central, ProQuest Social Science Premium Collection, and ProQuest Dissertations and Theses. Databases will be searched from inception to present for English-language qualitative literature of any study design that meets the inclusion criteria. A search of unpublished and gray literature will also be conducted. The JBI critical appraisal checklist for qualitative research will be used to assess the studies. Findings and illustrations will be extracted and assigned a level of credibility. Meta-aggregation of findings will be performed, and a ConQual Summary of Findings will be presented.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42022337674.

Validation of General Anxiety Disorder (GAD-7) questionnaire in Spanish nursing students

Background

Nursing students are at risk of anxiety during their university education.

Objective

To determine the psychometric characteristics of the General Anxiety Disorder (GAD-7) questionnaire in a population of university nursing students.

Methods

A cross-sectional study was carried out with 170 students at the University of Jaen (Spain) in 2022. An online questionnaire was administered that included sociodemographic and student profile variables, the GAD-7 questionnaire, and the Goldberg anxiety subscale. An exploratory factor analysis (EFA), validation with convergence, and reliability analysis using Cronbach's α were performed.

Results

The EFA identified a single component that explained 63.50% of the variance. It was positively correlated with the Goldberg anxiety subscale (r = 0.653; p < 0.001). A statistically significant association was observed with academic year, gender, and having experienced an anxiety crisis (p < 0.005). Internal consistency with Cronbach's α was 0.903.

Conclusion

The GAD-7 presents appropriate psychometric characteristics for use in a university population of nursing students. It is capable of detecting symptoms and generalized anxiety disorder, making it a useful and simple tool for detecting anxiety-related problems in this population.

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.

Clinical learning during the pandemic: Experiences of LPN-BN undergraduate nursing students

Background

When the COVID-19 pandemic was declared in March 2020, nursing programs made rapid decisions regarding clinical placement experiences for students. In many nursing programs, this meant ending clinical placements early, delaying clinical courses, and moving clinical courses to simulation.

Purpose

The purpose of this study was to explore LPN-BN students' experiences in clinical courses during the COVID-19 pandemic.

Method

A qualitative descriptive approach was employed in this study. Fifteen semi-structured conversational interviews with nursing students and recent graduates were conducted. Inductive content analysis was used to analyse the data.

Results

Four main concepts were identified: (1) logistics of learning; (2) shifts in clinical learning; (3) mental health matters; (4) readiness to practice.

Conclusion

It is important to understand the experience of nursing students as this is an inordinately stressful and impressionable time for them. Insight into the student experience, will inform educators in the areas of curriculum and competency-based evaluation as well as supports for student mental health and well-being.

Diagnostic Concordance between the Visual Analogue Anxiety Scale (VAS-A) and the State-Trait Anxiety Inventory (STAI) in Nursing Students during the COVID-19 Pandemic

Anxiety is one of the most common problems among nursing students. The State-Trait Anxiety Inventory (STAI) is used to detect anxiety in this population; however, its length hinders speedy detection. For this reason, a faster and more efficient instrument is needed for early detection. This study aimed to determine the relationship between the anxiety measurement scales State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale for Anxiety (VAS-A) by establishing a discrimination threshold through the contrast of true positive rates (VPR) and false positive rates (FPR). To this end, a cross-sectional quantitative observational and analytical study was carried out on 185 fourth-year nursing students. The data collected were anxiety (STAI and VAS-A) and socio-demographic variables during the COVID-19 pandemic. The results showed a correlation between the two scales (VAS-A and STAI). The VAS-A is a useful instrument for assessing students in a crisis that could potentially generate anxiety. The study established a reasonably safe error probability range (>5%), allowing the VAS-A scale to be used as a rapid diagnostic or pre-diagnostic tool, depending on the scores. The study shows that speedy detection of anxiety using the VAS-A and an in-depth approach with the STAI by teaching staff in crises is possible.

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.

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

Aim

To explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.

Background

The World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.

Design

Cross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.

Methods

A cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.

Results

Of 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.

Conclusions

Students were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.

The experiences of adult nursing students completing a placement during the COVID-19 pandemic

BACKGROUND

The emergency measures implemented by the Nursing and Midwifery Council in response to the COVID-19 pandemic provided nursing students in their final 6 months of study with the opportunity to complete a paid consolidation clinical placement and thus increase their personal responsibility for the care they delivered under supervision.

AIM

To explore the experiences of third-year nursing students who completed their final clinical placement during the COVID-19 pandemic.

METHODS

Semi-structured interviews were conducted via a virtual platform.

FINDINGS

Three themes were identified: the importance of support mechanisms, the development of confidence, and innovative learning opportunities. Students reported improved confidence in the transition period to registered practitioner and felt well supported, which enabled them to take greater responsibility.

CONCLUSION

This study provided insight into the experience of nursing students during the COVID-19 pandemic, and found that support mechanisms, and a sense of belonging, helped to increase their confidence in clinical practice.

The predict of metacognitive awareness of nursing students on self-confidence and anxiety in clinical decision-making

PURPOSE

This study was conducted to investigate the affect that metacognitive awareness in nursing students has on self-confidence and anxiety with respect to clinical decision-making.

DESIGN AND METHODS

The sample for this descriptive, correlational, and cross-sectional study consisted of 186 nursing students who voluntarily participated. Data were collected using the Metacognitive Awareness Inventory and Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale. Correlation and regression analyses were then performed on the data.

FINDINGS

Nursing students' metacognitive awareness level explained the three subdimensions of self-confidence in clinical decision-making by 26.7% (r²  = 0.267, p < 0.01), 24.6% (r²  = 0.246, p < 0.01), and 26.8% (r²  = 0.268, p < 0.01), respectively. Nursing students' metacognitive awareness level explained the three subdimensions of anxiety in clinical decision-making by 3.7% (r²  = 0.037, p < 0.01), 3.2% (r²  = 0.03, p < 0.05), and 2.4% (r²  = 0.024, p < 0.05), respectively.

IMPLICATIONS FOR NURSING PRACTICE

Clinical decision-making skills can be supported by increasing students' metacognitive awareness.

Clinical placement experience of nursing students during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

The impact of the COVID-19 pandemic on our society is profound, not least for the healthcare sector. On the one hand, this exceptional situation created unprecedented learning opportunities for nursing students. Yet, on the other hand, this situation can jeopardise nursing students learning trajectory.

OBJECTIVES

To study nursing students' experiences during clinical placement during the COVID-19 pandemic.

DESIGN

Cross-sectional survey design.

SETTINGS

Clinical placements during the COVID-19 pandemic.

PARTICIPANTS

Nursing students from nine Belgian nursing schools.

METHODS

All students enrolled in nursing education are eligible to participate. The survey consists of five dimensions: demographics, risk perception, self-efficacy, support and communication, and resilience.

RESULTS

The gaps that were identified by students focused on the need for more psychosocial support, establishing (regular) contact with their clinical placement supervisor, recognition of the difficult work situation, and the need for more space to unwind.

CONCLUSIONS

Nursing students expressed a strong need to be heard, prepared, and supported. Most students felt supported by their nursing schools. Because of COVID-19, the role of the preceptor became more important. However, due to several reasons, the perceptor did not always meet the student's expectations. Preparing students for specific competencies is needed. In spite of the efforts of nursing schools and clinical sites, students often got lost in the chaos of the pandemic. This resulted in practical worries, fewer learning opportunities, and even fundamental doubts about their choice to become a nurse. Finally, it crucial that nursing schools and clinical sites communicate about matters such as the responsibility for testing nursing students, the provisions of uniforms and personal protective equipment, and structurally sharing guidelines with students to provide safe patient care.

Nurses and undergraduate student nurses' experiences in collaborative clinical placement programs in acute hospitals: An integrative literature review

OBJECTIVES

To identify, and critically review student, nurse clinician and clinical facilitator/educator experiences of collaborative clinical placement models in acute hospitals.

DESIGN

An integrative review that followed Whittemore and Knafl's (2005) framework.

DATA SOURCES

Studies published between 2009 and 2019 were identified via a comprehensive search of the following databases: CINAHL, OVID Medline, EMBASE, EMCARE, PsychINFO, Johanna Briggs Institute, ERIC and SCOPUS.

REVIEW METHODS

The initial search located 2309 Articles. After screening and checking for eligibility 14 articles were critically appraised using the Critical Appraisal Skills Program checklist for qualitative papers, the McMaster's Critical Review Form for quantitative papers and MMAT Appraisal tool for mixed method papers. The papers were then analysed thematically.

RESULTS

Thirteen studies met the inclusion criteria for the review (four quantitative, six mixed method, three qualitative). We identified an overarching central theme of sense of belonging and acceptance along with the following four sub themes: familiarity and continuity, confidence and competence, preparedness and lastly supervising relationships and faculty support.

CONCLUSION

This review indicates collaborative clinical placement programs have a positive impact on the student experience. Further research is needed regarding experiences of clinical nurses, health organisation leaders and Faculty to better understand what will improve support of students in collaborative clinical placement programs as there were few research findings found related to these non-student participant groups. Exploring student placement experiences that include both traditional and Collaborative models would provide greater insight into the value of these programs.