Sources of the knowledge-practice gap in nursing: Lessons from an integrative review

Exploring the Development of Early Career Nurses: Insights 4 Years After Graduation

AIM

To explore how Early Career Nurses perceive their preparedness for nursing practice, the teaching and learning experiences, and the role of professional experience placements on their professional development.

DESIGN

A qualitative study using a hermeneutic phenomenological approach.

METHOD

The study involved 25 Early Career Nurses who participated in follow-up interviews 4 years post-graduation in Australia between 2022 and 2024. Data were collected through semi-structured interviews and analysed using Thematic Analysis.

RESULTS

Three key themes emerged: gaps in preparedness, the power of being embedded and too many balls to juggle. Participants indicated a mixed sense of preparedness with significant gaps in clinical skills. They emphasised the critical role of professional experience placements and mentorship to bridge the gap between theoretical knowledge and practical application. Placements and mentorship opportunities were considered essential to develop confidence and competence for effective nursing practice.

CONCLUSION

The study highlights the necessity for nursing curricula to address significant gaps in clinical skills, particularly in surgical and emergency nursing. By incorporating more simulation-based learning, interprofessional education and robust mentorship programmes, nursing education can better prepare graduates for the realities of clinical practice. These enhancements will help ease the transition from academic training to clinical practice, reducing reality shock and fostering a more confident, competent and resilient nursing workforce.

IMPLICATIONS FOR THE PROFESSION

Nursing education must integrate more simulation-based learning and interprofessional education opportunities, which are crucial for bridging the gap between theoretical knowledge and practical application, ensuring that graduates are adequately prepared for the demands of clinical practice. Additionally, professional experience placements and mentorship should be prioritised to develop the confidence and competence for effective nursing practice.

REPORTING METHOD

This study adheres to the Consolidated criteria for reporting qualitative research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Impact of clinical leadership on frontline nurses' quality of care: work engagement as mediator role

BACKGROUND

Leadership behavior among staff nurses is a critical aspect of healthcare management. Work engagement, characterized by vigor, dedication, and absorption, is a strong predictor of job performance and is believed to enhance the quality of care. However, few studies have explored the relationship between clinical leadership by bedside nurses, work engagement, and quality of care.

AIMS

To explore relationships between clinical leadership and work engagement on the quality of care and to identify pathways through which clinical leadership may influence care quality via work engagement.

METHODS

A sample of 1,029 staff nurses from 20 hospitals participated in the study. Three standardized scales were used: The Clinical Leadership Inventory (CLI), the Utrecht Work Engagement Scale-9 (UWES-9), and the nurse-reported quality of care scale. The study followed the STROBE guidelines for cross-sectional research.

RESULTS

Findings revealed that clinical leadership, work engagement, and quality of care scores were 4.10 ± 0.66, 4.09 ± 1.16, and 3.26 ± 0.60, respectively. Positive correlations were found between all three variables, with correlation coefficients ranging from 0.297 to 0.960 (p <.01). Clinical leadership showed both direct and indirect effects on care quality. When work engagement was included as a mediator, the effect size increased by 0.154 (< 0.001), resulting in a value of 0.411 (< 0.001), with a mediation proportion of 37.56%. The explanatory power of clinical leadership and work engagement for care quality was 75.9%.

CONCLUSION

Enhanced clinical leadership practices are significantly associated with increased nurse work engagement and improved care quality. Clinical leadership directly influences care quality, as well as indirectly through work engagement. These findings could stimulate further international discussions on healthcare management perspectives.

IMPLICATIONS FOR PRACTICE

Nursing management should implement clinical leadership development programs tailored for frontline nurses, promoting positive leadership behaviors and work engagement. Creating supportive organizational environments that encourage open communication and standardized practices can further enhance clinical leadership and quality of care. This study found that 1) Nursing management should focus on implementing clinical leadership development programs; 2) Clinical leadership training program for bedside nurses can be enhanced through the use of simulation;3) Supportive organizational environments that promote open communication, and standardized practices should be provided by nurse managers.

Exploring the Relationship Between Nurses' Lifelong Learning Levels and Their Web-Based Information Search Strategies and Digital Literacy

This study aimed to determine the relationship between nurses' levels of lifelong learning and their Web-based information search and interpretation strategies and digital literacy. This descriptive correlational study was conducted at a training and research hospital in Istanbul province. Data were obtained from 302 nurses who consented to participate in the study between April 17 and June 23, 2023. The data were collected using a questionnaire, the Lifelong Learning Scale, the Digital Literacy Scale, and the Web-Based Information Search and Interpretation Strategies Scale. The mean age of the nurses was 31.52 ± 7.4 years. A positive correlation was found between nurses' lifelong learning levels and digital literacy levels. In addition, nurses' lifelong learning levels positively affect Web-based information search and interpretation strategies. It was determined that the mean scores of the subdimensions of the Scale of Information Search and Interpretation Strategies in the Web Environment were high. Nurses with an average age of 31 years and above have a high level of lifelong learning and level of digital literacy. Nurses' willingness to learn throughout their lives has positively affected their digital literacy levels. Nurses use different sources and professional Web sites more frequently when seeking information than other strategies.

Continuing Professional Development Among Nurses in Jordan: Perceptions, Importance, Motives, and Barriers

BACKGROUND

Continuing professional development (CPD) is a type of lifelong learning and a means of gaining career security and personal development and assuring the public that professional knowledge is up-to-date. This study assessed Jordanian nurses' perceptions of the importance of CPD, their motives for obtaining CPD, and barriers to receiving CPD.

METHOD

A descriptive cross-sectional design was used. Data collected included demographic information and responses to a questionnaire about CPD for nurses.

RESULTS

The findings showed that the motives subscale had the highest mean score (M = 4.09, SD = 0.58), and the CPD activities subscale had the lowest mean score (M = 2.96, SD = 0.75).

CONCLUSION

Nurses understand the importance of CPD to improve nursing qualifications, enhance nursing practice, and promote health care quality. However, there are differences in how nurses perceive and engage in CPD. Addressing barriers and aligning intentions with actions could improve CPD participation. [J Contin Educ Nurs. 2025;56(3):111-117.].

Psychometric evaluation of the Turkish version of the nurses' perception of the gap between knowledge and practice scale

BACKGROUND

Progress in the nursing profession and clinical decision-making are largely sustained by the coherence between theory and practice. The quality of healthcare provided by nurses and patient outcomes are adversely impacted by the gap between knowledge and practice. Measurement tools used to assess nurses' perceptions of this gap are inadequate in Türkiye. This research aimed to adapt the nurses' perception of the gap between knowledge and practice scale into Turkish and to evaluate its reliability and validity.

METHODS

The study, in which a methodological design was employed, was conducted with 406 nurses between March and June 2022. A descriptive information form and the nurses' perception of the gap between knowledge and practice scale (NPGKPS) were employed to gather data. The validity study included content and construct validity analyses, and the reliability study included item analysis, split-half test, and Cronbach alpha coefficients.

RESULTS

The scale had 35 items and four dimensions, which explained 54.65% of the total variance. The goodness of fit values, which were found following a confirmatory factor analysis, were estimated as follows: CMIN = 1808.984, DF = 512, CMIN/DF = 3.533, IFI = 0.89, TLI = 0.87, RFI = 0.83, CFI = 0.89, RMSEA = 0.079, and NFI = 0.86. Cronbach's alpha coefficient of the total scale was estimated as 0.95 and it was in the range of 0.84 to 0.93 for four factors.

CONCLUSION

In conclusion, the nurses' perception of the gap between knowledge and practice scale was a reliable and valid measure which could be applied to Turkish society.

Living Lab Dementia: process evaluation of an academic-practice partnership in German long term care for people living with dementia - study protocol

BACKGROUND

Living Labs, as a type of academic-practice partnerships, possess the potential to transform care and research into a participatory partnership and narrow the research-practice gap to improve evidence-based and Person-centred care. Given the lack of systematic investigations of Living Labs in healthcare, we will establish a dementia-specific academic-practice partnership (Living Lab Dementia) in Germany and conduct a process evaluation. The aim of this study is to gain insights into the intervention itself (mechanisms of impact) and its implementation process (degree of implementation, barriers, and facilitators).

METHODS

This process evaluation of the multi-center research project PraWiDem (German acronym for linking professional nursing practice and research in dementia) will be conducted applying a convergent mixed methods design and will be based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. The intervention is presented in a logic model which describes relevant basic theoretical assumptions, intervention components, implementation aspects, mechanisms of impact, relevant outcomes, and the context in which the intervention is delivered. Data will be collected before the intervention (T0), during the intervention period, and at follow-up after 18 months (T1). Qualitative data will be collected through semi-structured interviews and focus groups. Quantitative data sources will be process documents and questionnaires.

DISCUSSION

Our study will provide important insights into the Living Lab Dementia intervention and its implementation processes. The results of this evaluation will contribute to the refinement of the intervention and its implementation processes, and will enable to measure the impact of these processes in future studies.

Integrated measure for training transfer in nursing practice: Development and validation study

BACKGROUND

The persistent knowledge-practice gap in nursing, where competencies gained through continuing professional development fail to integrate into practice, remains a significant challenge. Effective transfer of acquired knowledge and skills to the workplace is essential for bridging this gap. However, there is a lack of comprehensive, validated instruments to assess factors influencing training transfer in nursing practice.

OBJECTIVE

This study aims to develop a questionnaire capable of assessing training transfer as an integrated construct, encompassing all factors influencing this process in nursing practice.

DESIGN

The study followed a developmental, iterative approach guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN).

SETTING(S)

Eight tertiary teaching hospitals in the Netherlands.

PARTICIPANTS

Educational experts (n = 8) and nurses (n = 1588).

METHODS

The questionnaire development consisted of three phases: Phase 1) content development, in which instruments were identified based on a literature study and translation of included instruments into Dutch, Phase 2) pilot phase: content validation and usability testing using Delphi studies with experts and nurses, Phase 3) psychometric validation: construct validation using exploratory and confirmatory factor analysis, composite reliability and discriminant validity. The phases were completed from January 2023 till June 2024.

RESULTS

The literature review led to the inclusion of two key instruments: the Learning Transfer System Inventory (LTSI) and the Learning Climate Questionnaire (LCQ). Following item reduction based on Delphi rounds, nurses completed the adapted instruments. Psychometric validation demonstrated a good fit for these instruments in nursing practice. The adapted LTSI showed loadings ranging from 0.37 to 0.99, with a Normed Χ2 of 1.996, TLI of 0.908, CFI of 0.920, and RMSEA of 0.050 [CI = 0.047-0.054]. The adapted LCQ exhibited loadings from 0.64 to 0.94, with a Normed Χ2 of 3.385, TLI of 0.963, CFI of 0.974, and RMSEA of 0.069 [CI = 0.061-0.078]. The combined model demonstrated a Normed Χ2 of 2.014, TLI of 0.900, CFI of 0.907, and RMSEA of 0.051 [CI = 0.048-0.054].

CONCLUSIONS

The adapted LTSI and LCQ, both separately and combined, are reliable and valid instruments for use in the Dutch nursing hospital context. Together, they provide a comprehensive assessment of factors influencing training transfer. They can also be used independently to examine specific components such as trainers (LCQ), context (LTSI), personal aspects (LTSI), or training (LTSI/LCQ). Furthermore, these instruments can facilitate discussions between nurses, managers, and educational experts to address barriers to training transfer in nursing practice.

Navigating transition shock: The role of system thinking in enhancing nursing process competency among early career nurses

BACKGROUND

Building nursing process competency among beginner nurses is a pivotal need in contemporary, complex, fast-paced nursing practice. However, transitioning from the educational phase to practicing as a nurse can be a significant adjustment. New practitioners often experience a period of shock, which may present challenges in developing nurse competency. Fostering system thinking among those nurses could buffer the negative signs of transition shock and cultivate nursing process competencies at earlier times.

AIM

This study explores the relationship between transition shock and nursing process competency among early career nurses and investigates the moderating effect of system thinking on this relationship.

METHOD

This cross-sectional correlational exploratory study was conducted at four large hospitals in Egypt. Data were collected from 393 nurses from the first of February 2024 to the end of April 2024 using the transition shock scale, the competency of nursing process questionnaire, and the system thinking scale. Correlational and hierarchical regression analyses were used to test the study variables.

RESULTS

A statistically significant negative correlation exists between transition shock, nursing process competency, and system thinking among early-career nurses. System thinking is positively associated with nursing process competency. System thinking positively moderates the relationship between transition shock and nursing process competency among early-career nurses. Transition shock and system thinking account for 23.9% of the variance in nursing process competency among early-career nurses.

LINKING EVIDENCE TO ACTION

Transition shock is an inevitable phenomenon among early-career nurses, negatively affecting their competency in the nursing process. System thinking buffers this adverse effect and significantly augments nursing process competency among this set of nurses. Predicting and mitigating transition shock among early-career nurses is pivotal in building nursing process competency. Nurse educators must develop curricula that cultivate system thinking skills among nursing students, which enables them to buffer transition shock after graduation.

Evaluation of the knowledge, attitude and practice towards ischaemic stroke among healthcare workers in neurology and neurosurgery department: a cross-sectional study in Shaanxi province, China

OBJECTIVES

Healthcare workers play an important role in the timely recognition and treatment of patients who had an ischaemic stroke. However, their knowledge, attitude and practice (KAP) towards ischaemic stroke have not been well studied. This study aimed to assess the KAP towards ischaemic stroke among healthcare workers in the neurology and neurosurgery department in Shaanxi province, China.

DESIGN

Cross-sectional study.

SETTING

Medical centres in Shaanxi province.

PARTICIPANTS

Healthcare workers in the neurology and neurosurgery department at Shaanxi province.

PRIMARY AND SECONDARY OUTCOME MEASURES

Demographic characteristics and KAP towards ischaemic stroke were collected by a self-designed questionnaire.

RESULTS

A total of 259 (96.6%) valid questionnaires were collected. Their mean KAP scores were 19.56±3.72 (total score: 23), 36.56±3.56 (total score: 40) and 27.45±3.00 (total score: 30), respectively. Multivariate logistic regression analysis demonstrated that education (bachelor's degree or above vs college or below: OR=2.704 (1.286-5.685), p=0.009), gender (female vs male: OR=0.401 (0.227-0.710), p=0.002) and professional title (intermediate vs no title: OR=0.280 (0.107-0.731), p=0.009) were independently associated with good knowledge; knowledge score (OR=1.266 (1.157-1.387), p<0.001) and hospital (private hospital vs public hospital: OR=0.544 (0.313-0.944), p=0.030) were independently associated with good attitude; and attitude score (OR=1.480 (1.326-1.652), p<0.001), gender (female vs male: OR=0.511 (0.264-0.993), p=0.047) and occupation (other healthcare workers vs physicians: OR=0.252 (0.129-0.495), p<0.001) were independently associated with good practice.

CONCLUSION

The healthcare workers in the neurology and neurosurgery department demonstrated a satisfactory KAP towards ischaemic stroke. Targeted and tailored training programmes might be an optional way to improve their practice.

Competence and Confidence With Quality and Safety Education for Nurses Competencies by Newly Licensed Registered Nurses

Understanding newly licensed registered nurses' perceived confidence in the Quality and Safety Education for Nurses (QSEN) competency domains and corresponding knowledge, skills, and attitudes will help inform clinical leaders to develop successful transition-to-practice programs. Newly licensed registered nurses and prelicensure nursing students had confidence in their understanding of QSEN competencies as they began their transition to practice. Online learning and virtual practicums were effective for attaining QSEN competencies, offering support for using these interventions in academic settings and transition-to-practice programs.

Nurses' perspectives on professional self-concept and its influencing factors: A qualitative study

BACKGROUND

Nurses with a strong professional self-concept tend to exhibit a positive mindset and strong work engagement, delivering high-quality patient care. Although numerous quantitative studies have examined the factors impacting professional self-concept, there remains a limited exploration of these factors from the perspective of nurses themselves.

METHODS

This qualitative descriptive study uses the PERMA theory and Social Cognitive Theory as the theoretical framework. Semi-structured interviews were conducted with 15 nurses from six public hospitals in China. The data were analyzed thematically using a combination of inductive and deductive approaches.

RESULTS

Nurses' understanding of professional self-concept could be divided into four categories: professional identity, competence, care, and knowledge. Factors influencing nurses' professional self-concept were categorized into eight subthemes in three domains: (1) personal factors, including psychological qualities and attitude towards the nursing profession; (2) occupational-related behavioral factors, including role-oriented behavior and knowledge-oriented behavior; and (3) work environment and external factors, including external evaluation and perceptions of nurses, time allocation, nursing work tasks, work atmosphere, school education, and perceived supports.

CONCLUSIONS

This study found that, although nurses had different personal experiences, their perceptions of professional self-concept were similar. Nurses' professional self-concept is a multidimensional concept and involves various factors, such as personality, work-related characteristics, environment, and family. To thrive in a nursing career, nurses must discern the factors that can enhance or hinder their professional self-concept. By identifying and adjusting these factors, personalized support and positive interventions can be tailored to meet nurses' specific needs, which ultimately nurtures their professional development.

TRIAL REGISTRATION

This study was registered on December 14, 2022, in the Chinese Clinical Trial Registry (ChiCTR2200066699) as part of our ongoing study.

Nursing Students' Beliefs and Willingness to Implement Evidence-Based Nursing Practice at Umm Al-Qura University: A Descriptive Cross-Sectional Study

Background It is essential to provide evidence-based practice (EBP) courses for undergraduate nursing students. For this reason, students' beliefs and intentions to implement EBP should be measured to ensure that EBP courses are effective. Aim The aim of this study is to evaluate Saudi nursing students' EBP beliefs (EBPB) and implementation before they enroll in an EBP course. Methods A descriptive cross-sectional study was conducted. Two scales were used: the EBPB scale and the EBP implementation (EBPI) scale. The questionnaire was available for completion a single time before the second-year nursing students were introduced to the EBP course. Results The study revealed that the mean age for students is 20 ± 0.83. Nearly two-thirds (61.54%) of students are female. It can be noted that 71.5% have not attended any EBP programs. Additionally, 65.38% of students understand the concept of EBP, and 68.46% are willing to apply EBP nursing care. Therefore, there is a positive correlation between the EBPB scale variable and the EBPI scale. Conclusion This study highlights the positive attitude of undergraduate nursing students toward EBP. Nursing education programs must place more emphasis on integrating EBP curricula into their teaching strategies, with a focus on developing students' knowledge, skills, and values in EBP.

How nurses perceive the gap between knowledge and practice

BACKGROUND

Identifying nurses' perceptions of the knowledge-practice gap is a critical step toward developing evidence-based practice. Currently, multiple factors contribute to the gap between nursing education and actual practice. Addressing this gap requires a new perspective, not yet adequately represented in the literature, that includes nurses' perceptions.

AIM

This study aims to describe nurses' perceptions of the knowledge-practice gap in the domains of knowledge, practice, environment, and learning. And it analyzes how nurses' professional characteristics are associated with their perceptions of the gap in each of these domains as well as the relationships between the domains themselves.

METHODS

The study used a cross-sectional descriptive correlational design. A sample of 513 staff nurses recruited through a convenience sampling technique provided information on professional variables such as education and experience and completed a Likert-scale survey about their perceptions of the knowledge-practice gap.

RESULTS

Their answers were found to vary with educational level and history of workshop attendance. Items from the knowledge domain were positively and significantly correlated with items from the environment and learning domains, which were also positively and significantly correlated with each other. However, the knowledge and practice domains were not significantly correlated. In addition to showing correlations among the major domains (or aspects) of the knowledge-practice gap, the study highlights how nurses' professional characteristics contribute to differences in their perceptions of this gap.

CONCLUSION

These findings can guide hospital-specific measures for bridging the gap. In addition, the scale can be employed by leaders as a tool for the purpose of conducting assessments.

Toxic Leadership in Emergency Nurses: Assessing Abusive Supervision and Its Team-Level Impacts on Conflict Management and Organizational Commitment

Background

Emergency departments suffer from authoritarian and manipulative leadership styles that affect team dynamics, emotional exhaustion, and quality patient care. However, little research specifically explores these toxic leadership effects on conflict management and nurses' organizational commitment.

Objectives

This cross-sectional study aimed to assess the correlations between perceived toxic leadership, conflict resolution strategies, and commitment dimensions among emergency nurses while evaluating conflict tendencies as a mediating mechanism.

Methods

A cross-sectional design that included multiple regression and mediation analyses was utilized. The sample consisted of 387 emergency nurses from five major Saudi hospitals surveyed using validated scales that measure perceived toxic leadership, conflict styles, and organizational commitment.

Results

High prevalence rates for perceived authoritarian (77%), narcissistic (75%), and unpredictable (63%) leadership were reported. Increased toxicity was positively related to dominating and avoiding conflict styles but negatively related to integrating and compromising strategies. Toxic leadership is also associated with lower affective/normative commitment but higher continuance commitment. Conflict management partially mediated the leadership-commitment relationship, which explained 29% of the total effect. Finally, higher experience and education predicted greater perceived toxicity.

Conclusions

The significant correlations between destructive leadership, adverse conflict, and reduced commitment in emergency nurses underscore the need for context-specific leadership training. Fostering supportive environments through multifaceted interventions can counteract toxicity impacts, impart constructive communication techniques, improve nurse well-being, and ensure high-quality patient care. As conflict tendencies and nurse characteristics influence susceptibility to detrimental leadership, tailored programs addressing experience levels are vital.

Clinical learning environment for nursing students in operating rooms: Development of an evaluation scale

Aim

To develop a measurement tool to evaluate the clinical learning environment for nursing students in operating rooms.

Background

In this study, a scale for evaluating the clinical learning environment for nursing students in operating rooms was developed and subjected to reliability and validity tests.

Design

A cross-sectional, methodological study.

Methods

Qualitative interviews, the Delphi method, a literature review and pilot testing were employed to develop the scale. A purposive sampling method was used to select September 2021 through May 2022; a total of 227 nursing students with internship experience in operating rooms at several teaching hospitals in North China were selected to evaluate the reliability and validity of the scale.

Results

The 32-item, four-dimensional evaluation scale was developed through two rounds of consultation with 17 experts. The reliability and validity test showed that the overall Cronbach's alpha was 0.984 and 0.96. The split-half reliability for the total scale was 0.937, indicating good reliability.

Conclusion

The proposed scale has high reliability and validity in evaluating the clinical learning environment of nursing students in operating rooms and improving clinical nursing education.

Experience in developing innovative practical ability for Master of Nursing Specialist degree program in China: A qualitative descriptive study of postgraduates

BACKGROUND

Nursing talent training should be adjusted in accordance with policies and regulations, the priority areas of health care, the development of nursing disciplines, and changes in nurses' roles. Experience from nursing education stakeholders indicates that postgraduate education faces numerous challenges. Thus, it is necessary to discuss postgraduates' experience in cultivating innovative practical ability.

OBJECTIVES

To analyze the experiences of nursing specialist postgraduates in cultivating innovative practical ability to provide a reference for further improvement of the Master of Nursing Specialist program.

DESIGN

A qualitative study.

SETTING

A university and its three affiliated tertiary hospitals in H city, China.

PARTICIPANTS AND METHODS

Individual, semi-structured interviews were conducted face-to-face with 12 postgraduates currently in clinical practice and six postgraduate nurses within two years of graduation between April and June 2022. All interviews were audio-recorded and transcribed verbatim, and the data were analyzed using the Colaizzi method.

RESULTS

Three key themes emerged: (1) the cognition of innovative practical ability; (2) the experience of cultivating innovative practical ability at school; and (3) the experience of cultivating innovative practical ability in the hospital.

CONCLUSIONS

With a full understanding of the training experience of postgraduates' innovative practical ability, policymakers and training units can clarify the shortcomings of the training model, make targeted improvements, and work together to build a more scientific and complete MNS training model. Our findings have the potential to inform faculty structure, catalyze curriculum reform, optimize clinical practice to facilitate the development of Master of Nursing Specialist programs, improve the quality of care, and promote patient recovery.

Learning in and across communities of practice: health professions education students' learning from boundary crossing

Learning to adapt to new contexts is crucial in health professions education (HPE). Boundaries between and within contexts challenge continuity in students' learning processes. Little is known about how HPE students can make these "boundary experiences" productive for learning. We investigated how and what nursing students learn from boundary experiences while they are simultaneously growing into a community of practice (CoP). Using a boundary-crossing lens, experiences of discontinuity were identified in pre-placement and post-placement interviews and diary fragments with 14 nursing students during their placement in an academic hospital. We found that students experience discontinuity as a result of different approaches to nursing care and to learning, both between (academic and clinical) settings and within a setting. When students feel safe enough, they can convert boundary experiences into meaningful learning situations, such as critical discussions with staff. Successfully overcoming boundary experiences improves students' understanding of healthcare and professional development and helps them to develop a personal approach to learning. Students critically address boundary experiences when they are motivated to learn and when they perceive a violation of ethical standards but not when they are concerned that it will affect their assessment. Objects designed to bridge theory and practice can generate additional barriers. This study adds to the HPE literature by demonstrating the learning potential of boundaries and to the broader literature by showing how responses to boundary experiences are intertwined with the process of growing into a CoP. The findings can be used to design future boundary objects.

Expectations of learner nurses in sampled clinical areas of the Limpopo province, South Africa

BACKGROUND

Nurse training in South Africa requires placing learner nurses in real-life setting for them to gain practical experience. To complete their training and be competent practitioners, learner nurses must have expectations and aspirations when they go for practice.

AIM

This study sought to understand learner nurses' expectations at clinical learning areas during placement.

SETTING

Four clinical learning areas in the Limpopo province were purposely sampled. Tertiary, regional and district hospitals were sampled to obtain information from different levels of care.

METHODS

A qualitative, descriptive and contextual design was used to explore the expectations of learner nurses during clinical placements. Permission to conduct the study was obtained from various bodies and ethical considerations were ensured. Nonprobability purposive sampling was used, and six focus groups were formed. Each focus group discussion (FGD) had six to eight participants. The FGDs were according to level of study, with the third and fourth levels each having two FGDs because of the number of participants.

RESULTS

The following three themes emerged: milieu in the clinical learning areas, learning in the clinical areas and self-actualisation.

CONCLUSION

The clinical learning areas are institutions of promoting learning through practice. They should promote learning and offer support to learners so that learners meet their expectations, which may prevent discouragement and attrition.

CONTRIBUTION

This study adds to the body of knowledge in nursing education and practice because when students' expectations are met, their training outcome might be positive leading to competent professional nurses.

Factors affecting nurses' professional values: A comprehensive integrative review

OBJECTIVES

Values should inform the care every nurse provides. Professional values equally affect patient care and organizational outcomes. In addition, they aid in forming a basis for moral judgments. The aim of this review is to elucidate the whole spectrum of factors affecting the development of nurses' professional values.

DESIGN

An integrative review approach was chosen.

DATA SOURCE

The review included searches in four databases - MEDLINE Complete, CINAHL Plus, ERIC, and Scopus - from January 2015 to November 2021, 572 articles were screened resulting in 35 quantitative and qualitative articles that met the inclusion criteria and passed the critical appraisal.

RESULT

Five major themes and subthemes emerged from the review: Individual determinants was the first theme. Education was the second theme. Experience was the third theme. The fourth theme was nurses' values perceptions. The final theme dealt with the impact of role models.

CONCLUSION

Understanding the power of nursing values as an effective influencer of nursing practice is important because nurses' values can ensure high-quality care and strengthen the professional brand.

Effectiveness of the use of concept maps and simulated cases as a teaching-learning strategy in enhancing the learning confidence of baccalaureate nursing students: A qualitative approach

BACKGROUND

Didactic lectures and exam-oriented learning can lead to students becoming passive learners who rely on rote memory. This learning style negatively impacts their ability to cultivate the core nursing values and critical thinking.

OBJECTIVES

This study aimed to investigate the impact of a concept mapping teaching-learning strategy on undergraduate nursing students' ability to integrate theoretical biosciences knowledge into care practice and on their skills in critical thinking and teamwork.

METHODS

A qualitative research design was adopted. A course entitled Evaluation and Analysis of Adult Nursing Cases was developed based on a concept mapping strategy involving 24 simulated cases relevant to medical and surgical nursing. The participants were students from the two-year undergraduate nursing programme at a university in Taiwan. Data were collected from September 2020 to February 2021. Qualitative data were collected from semi-structured face-to-face interviews with 20 students and from 100 reflective reports on students' learning journeys. The data were analysed using qualitative content analysis.

RESULTS

Two major themes were identified: (1) changes in learning style and thinking and (2) rewards from learning. The participants reported that their learning style had changed from reliance on rote learning to image memory, and their thinking process from linear (cause-effect) to multifaceted thinking at different levels. The teaching and learning strategies contributed to feelings of ability advancement and psychological safety, which led to learning achievement and confidence.

CONCLUSION

The use of a concept mapping strategy and simulated cases enhanced students' learning by enabling them to integrate theoretical knowledge and improve their thinking abilities. The teaching and learning strategies helped participants in learning about psychological safety and increased their learning confidence.

Interactive Crossword Puzzles as an Adjunct Tool in Teaching Undergraduate Dental Students

Background

In the restorative dentistry module of the undergraduate dental program, dental students encounter many new terms and concepts in a short period of time. The provision of adequate learning support to reinforce key concepts can be challenging.

Aim

The purpose of this study is to determine student perceptions of how effective interactive crossword puzzles are as adjunctive tools to enhance the learning of restorative dentistry.

Methods

Students completed interactive crossword puzzles created by the authors, with a reward awarded to the first group of students who completed the puzzles successfully. The interactive crossword platform was programmed using the ReactJS framework and designed using Tailwind CSS. An evaluation of the student's perception of this educational method was conducted using textual feedback and Likert-scale questionnaires.

Results

Students found the crossword puzzles engaging, meaningful, and successful as indicated by their favorable Likert scores and feedback. Written comments revealed student enthusiasm for and a desire to be exposed to more of these exercises.

Conclusions

This work sheds light on the potential advantages of incorporating interactive crossword puzzles into the restorative dentistry course from a student's perspective. The crossword puzzles improved students' ability to review and reinforce concepts and terminology and proved to be meaningful and enjoyable. The web-based nature of the tool ensured good student responsiveness and engaged the entire class in an interactive, competitive setting. Application of the hint option, which offered a text of relevant reading material, helped students understand, retain more knowledge, and engage with course material more than they might have otherwise.

Development and psychometric evaluation of nurses' perception towards the gap between knowledge and practice

AIM

The aim of the study was to develop a survey instrument and psychometrically evaluate nurses' perceptions of the gap between knowledge and practice. Although the nursing literature has widely documented a gap between knowledge and practice, no instrument has been developed to measure this gap.

DESIGN

Psychometric analysis was done on 513 nurses working in different positions at two large hospitals in Jeddah City.

METHODS

Cronbach's alpha was used to determine the internal consistency and reliability of the research instrument, and a panel of experts evaluated the validity of the tool's content.

RESULT

The content validity index computed from expert rankings was 0.89. Factor analysis yielded four major components: knowledge, practice, environment and learning. Cronbach's alpha indicated a high level of internal consistency and reliability for the component items. The newly developed scale will facilitate measuring nurses' perceptions of the knowledge-practice gap in clinical settings.