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

The mediating effect of transition shock on the relationship between readiness for practice and turnover intention of new graduate nurses in South Korea: A longitudinal study

BACKGROUND

Nurses' turnover intention has garnered significant global attention due to the shortage of the nursing workforce. New graduate nurses encounter challenges as they transition from students to professional nurses. Many new graduate nurses have experienced transition shock, which impacts their turnover intention. Researchers show that undergraduate readiness for practice is linked to transition shock and turnover intention, but there is a lack of longitudinal studies investigating their associations and causality.

OBJECTIVES

To explore the longitudinal factors affecting turnover intention among new graduate nurses, as well as the mediating role of transition shock in the relationship between readiness for practice and turnover intention.

DESIGN

A retrospective longitudinal design.

SETTINGS

This study was conducted in 54 nursing schools in South Korea.

PARTICIPANTS

A total of 232 new graduate nurses who participated in the New Nurse e-Cohort Panel Study as students and have continued working at the same hospital since graduation were included.

METHODS

Surveys were conducted during three periods: two months before graduation (T0), six months after graduation (T1), and one year after graduation (T2). Hayes' PROCESS macro Model 4 was utilized to analyze the mediating effect of transition shock (T1) on the relationship between readiness for practice (T0) and turnover intention (T2) among new graduate nurses.

RESULTS

Readiness for practice (β = -0.140, p = 0.028) and transition shock (β = 0.259, p < 0.001) were significantly associated with turnover intention. Transition shock acted as a mediator between readiness for practice and turnover intention (β = -0.165, 95 % confidence interval -0.311 to -0.051) among new graduate nurses after controlling for work experience, working in desired units, and completion of internship before nursing school graduation.

CONCLUSIONS

This study explored the causal relationships among readiness for practice, transition shock, and turnover intention of new graduate nurses. The findings suggest that higher readiness for practice decreases transition shock and influences the intention to leave. To retain a valuable nursing workforce, nursing schools should strive to create a supportive learning environment that prepares students with a high level of readiness for practice. Additionally, hospitals' nursing managers and administrators should implement a structured adaptation program for new graduate nurses to facilitate a smooth transition into the profession.

The impact of a student death doula service-learning experience in palliative care settings on nursing students: A pilot mixed-methods study

Through a mixed-methods approach (randomized controlled trial and thematic analysis of pre and post-service-learning reflections), this study evaluated the impact of a student death doula service-learning experience on nursing students' palliative competencies and learning experiences. The intervention group underwent a 2-day student death doula training workshop followed by a 6-month service-learning experience, while the control group received standard palliative care education. Attitudes toward the care of the dying significantly improved for the intervention group but not for compassion competence and palliative care knowledge. Six themes were developed: (1) Motivations for being a student death doula, (2) Improved perceptions of palliative care patients, (3) Perceptions of a good death, (4) Confidence in caring for palliative care patients, (5) Understanding the multifaceted nature of palliative care, and (6) Joys and challenges during service-learning. Service-learning helped students to understand palliative care patients and acquire confidence in engaging with them.

Development and psychometric testing of the clinical adjustment scale for student nurses (CAS-SN): A scale for assessing student nurses' adaptation in clinical settings

BACKGROUND

Nurse education is critical for preparing student nurses for clinical practice, but the transition to clinical settings poses numerous challenges. A standardized scale to assess student nurses' adjustment in the clinical area is lacking in the Philippines.

OBJECTIVE

This paper described the development and evaluation of the Clinical Adjustment Scale for Student Nurses (CAS-SN).

DESIGN

An exploratory sequential research design.

SETTINGS

Nursing schools in three government owned universities in the Philippines.

METHODS

Expert panels and field pretesting established content and face validity. Inter-item and inter-total correlations and Cronbach's α were used to assess the reliability of the scale. Construct validity was evaluated using exploratory factor analysis (EFA). Criterion validity was evaluated with established measures.

RESULTS

The CAS-SN comprises 15 items across three subscales: (1) Professional Growth and Interpersonal Engagement, (2) Clinical Competence and Confidence, and (3) Coping and Support Strategies Reliability was excellent and the validity was satisfactory, with significant correlations with academic adjustment, psychological distress, and dropout intention.

CONCLUSION

The CAS-SN was found to be a valid and a reliable for assessing student nurses' clinical adjustment.

IMPLICATIONS FOR NURSE EDUCATION

The CAS-SN provides a structured framework to assess and monitor student nurses' clinical adaptation, enhancing our understanding of their competence, resilience, and professional identity development. Its integration into nurse education programs can significantly improve the assessment of clinical learning experiences and contribute to better student learning outcomes.

How lack of support and recognition for RN preceptors is affecting nursing students' learning on placement

The clinical placement environment plays a pivotal role in shaping the learning experiences and outcomes of nursing students. In this article, the challenges and dynamics within the clinical placement environment are examined, with a particular focus on the role of registered nurse preceptors. The multifaceted nature of the clinical landscape is highlighted with consideration given to the impact on both students and preceptors. Key to the success of any placement is the relationship between nursing students and their preceptors. The quality of this relationship directly influences the learning journey of students, with positive interactions contributing to enhanced learning outcomes and professional growth. However, within the literature, a range of challenges faced by nurse preceptors are captured, including limited support, recognition, and formal training. This lack of preparation and support not only impacts the well-being of preceptors but also compromises the quality of education provided to nursing students. In this article, the complexities of the clinical environment, including high patient acuity, demanding workloads and limited teaching time, are highlighted. If we are serious about preparing quality nurses, then we need to get serious about supporting those who are key to their learning and transition into practice.

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

AIM

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

DESIGN

Scoping review.

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

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

IMPACT

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

REPORTING METHOD

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

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Assessment of clinical competence of graduating medical students and associated factors in Ethiopia

BACKGROUND

Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors.

METHODS AND MATERIALS

A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value < 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores.

RESULTS

Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture.

CONCLUSIONS

Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates' licensing examinations is also a way forward.

Do nursing students' attitudes to clinical practice training affect the levels of vocational motivation?

BACKGROUND

It is extremely important for nursing students to be professionally motivated to train qualified future professional nurses. Students' vocational motivation is affected by their experiences in clinical and academic learning environments.

OBJECTIVE

The aim of this study was to investigate the correlation between the vocational motivation levels of nursing students and their attitudes toward clinical practice.

METHODS

292 nursing students participated in the cross-sectional, descriptive study. The Student Information Form, Nursing Students' Attitudes Towards Clinical Practices Scale, Motivation Sources and Problems Scale (MSPS) were used to gather the data.

RESULTS

The average score for students' attitudes toward clinical practice was 107.08±18.13, while the total score for MSPS stood at 3.80±0.63. A positive correlation was identified between the attitude toward clinical practice and vocational motivation levels (r = 0.367; p < 0.001). There were positive correlations between the intrinsic motivation (r = 0.572; p < 0.001) and extrinsic motivation (r = 0.58; p < 0.001), and negative correlations were observed between the negative motivation (r = -0.324; p < 0.001) and the attitude toward clinical practice scale. There were positive correlations between belief and expectation (r = 0.492; p < 0.001) and positive approach (r = 0.532; p < 0.001) with the MSPS. In the multiple regression analysis, intrinsic motivation, extrinsic motivation, satisfaction with studying nursing, and participation in vocational courses were determined as effective predictors of attitudes towards clinical practice and explained 60.4% of the variance.

CONCLUSIONS

The study concluded that nursing students' attitudes toward clinical practices affect vocational motivation. Clinical learning environments should be arranged in a way to increase the motivation level of students towards professional learning.

Nursing Students’ Experiences With Patient Death and Palliative and End-of-life Care: A Systematic Review and Meta-synthesis

AIM

To synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settings BACKGROUND: Nurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.

DESIGN

A qualitative systematic review and meta-synthesis METHODS: PubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012-25 Feb 2023. Qualitative studies of any design reporting nursing students' experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso's 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.

RESULTS

The review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.

CONCLUSIONS

While caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.