Clinical placements in Australian general practice: (Part 1) the experiences of pre-registration nursing students

The influence of individual factors on the career preferences and specialty choices of final-year nursing students

BACKGROUND

Statistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students' viewpoints.

PURPOSE

The aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors influence the final-year nursing students' career decision-making process.

METHOD

A narrative inquiry approach using semi-structured interviews was carried out with purposively sampled nursing students (n = 12) who had undertaken a final-year clinical placement(s). Data was analysed using two main steps. First, the interviews were restoried and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes.

RESULTS

Data analysis generated three main themes: demographic factors, social factors, and career goals. Participants' characteristics and interactions with other individuals and systems influenced their nursing specialty preferences and professional career plans.

CONCLUSION

Nursing students' career interests are influenced by individual factors external to their nursing education, such as their age, gender, and life experiences. These student characteristics and experiences facilitated or inhibited a career in some nursing specialties, with the students gauging their ability to practice in a specialty during their CPs. Nursing education should expose and inform students about the core skills, career opportunities, and how to advance their careers in the different nursing specialties. Most importantly, final-year students may need formal career guidance to encourage nursing students' positive attitudes and career interests in different nursing specialties and make realistic career decisions.

An examination of the career decision-making self-efficacy of final-year nursing students

BACKGROUND

One in four newly graduated registered nurses leave their employment positions within the first year. To reduce this attrition, nursing stakeholders could focus on the final year of nursing education because students at this stage make professional career plans, including their practice destination for the graduate year and their commitment to the profession. Previous studies provide evidence of nursing students' career preferences and specialty choices. However, there is a dearth of data that focuses on the students' career decision-making process.

AIM

This study examined the self-efficacy or confidence of final-year nursing students in making career decisions and the factors that influence their career decision-making process.

SETTING AND PARTICIPANTS

Final year pre-registration nursing students (N = 222) at two public universities in Western Australia.

METHODS

An online survey was used to collect cross-sectional data. The Career Decision Self-Efficacy Scale - Short Form was used to investigate nursing students' confidence in making career decisions. Career decision-making self-efficacy refers to the confidence to successfully complete career decision-making tasks. Descriptive statistics were used to describe the participants' characteristics. The chi-square test was used to assess the significance of the difference between categorical data, and binary logistic regression was used to determine the odds of the factors that predict career decision self-efficacy.

RESULTS

Forty-seven percent of participants who answered all Career Decision Self-Efficacy Scale - Short Form questions had good confidence in making career decisions. Factors such as the setting of the final clinical placement, the intention to be employed in the specialisation or organisation of their final placement and the students' assessment of their clinical experience were associated with career decision-making confidence.

CONCLUSIONS

Most participants had low confidence in making career decisions. This study provides ideas for nursing stakeholders to implement measures to improve students' confidence to make informed career decisions.

Clinical mentorship of midwifery students: The perceptions of registered midwives

Background

Clinical mentors are experienced practitioners who play an important role in encouraging the professional development of students in clinical areas. The responsibility of clinical mentorship in nursing is often difficult to maintain. However, there is a dire need for clinical mentorship in maternity units, especially in South African hospitals were high maternal mortality rates remain alarmingly high.

Aim

This study aimed to describe the perceptions of registered midwives regarding the clinical mentorship of midwifery students.

Setting

The study occurred in a semi-rural state regional hospital in the eThekwini district, KwaZulu-Natal.

Methods

A qualitative exploratory and descriptive design was conducted using in-depth individual interviews with midwives in maternity units. A purposive and convenient sampling method recruited 17 registered midwives from 3 maternity care areas within a single setting. Interviews were audio-recorded and all data were analysed using qualitative content analysis.

Results

Five categories emanated from this study namely, sharing knowledge and skills; encouraging role model behaviour; promoting self-worth; Is a challenging task; and requiring additional support.

Conclusion

Clinical mentorship has a reciprocal effect on teaching and learning in maternity care areas and encouraged registered midwives to lead as role-models. The process demands competence, professionalism, and leading by example. Despite the confidence, satisfaction and interest in clinical mentorship, registered midwives often find the process challenged by patient care priorities. Therefore, registered midwives require additional support to mentor students in clinical practice.

Contribution

This article shows that clinical mentorship places various challenges on registered midwives and formal mentorship training could be beneficial.

Mapping interaction quality for nursing and medical students in primary care placement in municipal emergency care units: a systematic observational study

Introduction

Primary care placement for nursing and medical students is vital for developing the competence to accommodate the increasing number of patients with multimorbid and complex conditions. Prior studies have suggested that interaction quality in primary care placement empowers learning. However, research mapping interaction quality in primary care placements in municipal emergency care units is lacking. This study aimed to systematically map interaction quality for nursing and medical students in primary care placement in two municipal emergency care units.

Materials and methods

This study adopted a systematic descriptive observational design. Systematic observations (n = 201 cycles) of eight nursing students (n = 103 cycles) and six medical students (n = 98 cycles) were used to map interaction quality across six learning situations between March and May 2019. Observations were coded using the Classroom Assessment Scoring System-Secondary (CLASS-S). Data were analyzed using descriptive statistics and Spearman correlations.

Results

Interaction quality is described in three domains: (I) emotional support, (II) framework for learning, and (III) instructional support, and the overall measure, student engagement. The results indicated middle-quality interactions in the emotional and instructional support domains and high quality in the framework for learning domain and student engagement. Correlations exhibited similar patterns and ranged from non-significant to strong correlations.

Conclusion

The interaction qualities indicated a generally positive and supportive learning environment contributing to nursing and medical students' learning and active participation in work tasks related to their professional roles. Thus, this new form for primary care placement for nursing and medical students in the municipal emergency care units was found to be a positive learning arena. These results may enhance nursing and medical education programs in countries with similar health services and education. Health education, supervisors, peers, and others contributing to students' learning should recognize which interaction qualities may affect learning and how to improve quality, thus affecting supervisors' approach to training students. While the CLASS-S showed potential for mapping interaction qualities for nursing and medical students in primary care placement in municipal emergency care units, further studies are needed to validate the CLASS-S for use in clinical placement settings.

General practice nurse trainees' perspectives on general practice nursing as a career choice: qualitative findings from a vocational training scheme in the United Kingdom (UK)

BACKGROUND

There is a shortage of general practice nurses worldwide to deal with an ever-increasing workload, and the need to attract new staff into general practice nursing is therefore vital. As part of this, a one-year Vocational Training Scheme (VTS) for new to general practice nurses was developed in 2020 by the South Yorkshire Primary Care Workforce and Training Hub.

METHODS

The aim of the study was to examine the VTS trainees' views on general practice nursing as a career. A pragmatic, convenience sample of trainees was recruited. Of the 21 trainees, 17 agreed to take part in the study. Data were collected from the trainees using a series of four regular, timed, online focus groups designed to follow the trainees' trajectory on the programme over a 12-month period. The data were analysed using framework analysis.

RESULTS

The timed nature of the focus groups meant that the analysis of the data was linked to the trainees' trajectory over the course of the year. Three themes were generated from the data: 'pathways into general practice'; 'learning to be a GPN'; and 'the future GPN'. In theme one, the trainees talked of the difficulties in accessing general practice as a new graduate, specifically the need for prior experience and how to get it. In the second, the transition to being a general practice nurse was discussed, and the expectation of being able to 'hit the ground running' once in post. The new graduate participants were also concerned over the opportunities for clinical supervision and support in the role after the programme. Finally, the participant s expressed concern over future opportunities for professional development and the prospects for a long-term career in general practice.

CONCLUSION

To address the worldwide workforce 'crisis' in general practice nursing, sustainable career pathways are needed to encourage new graduate nurses to consider working in general practice. Starting at university, changing the culture and providing the necessary infrastructure to support ongoing professional development in general practice nursing are key to its success.

Primary care nursing competencies in Canadian undergraduate nursing programs: A national cross-sectional survey

AIM

To assess the extent to which Canadian undergraduate baccalaureate nursing programs have incorporated Canadian competencies for Registered Nurses in primary care into their curricula.

BACKGROUND

Canadian competencies for Registered Nurses in primary care have several benefits, including their ability to inform primary care education in undergraduate nursing programs and to assist in building a robust primary care nursing workforce.

DESIGN

We conducted a national cross-sectional survey of undergraduate baccalaureate nursing programs (n = 74).

METHODS

The survey was conducted between April-May 2022. We used a modified version of the "Community Health Nurses' Continuing Education Needs Questionnaire". Respondents indicated their level of agreement on a 6-point Likert scale with 47 statements about the integration of the competencies in their program (1 = strongly disagree; 6 = strongly agree).

RESULTS

The response rate was 51.4%. The overall mean across the six competency domains was 4.73 (SD 0.30). The mean scores of each domain ranged from 4.23 (SD 1.27) for Quality Assurance, Evaluation and Research to 5.17 (SD 0.95) for Communication.

CONCLUSIONS

There are gaps in how these competencies are included in undergraduate education programs and opportunities to strengthen education for this growing workforce in Canada.

Integration of primary care education into undergraduate nursing programs: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to examine and map literature related to primary care education in undergraduate nursing programs and to describe the attributes and extent of primary care education.

INTRODUCTION

Primary care is a model of first-contact, continuous, comprehensive, and coordinated health care. Registered nurses are integral in successful collaborative team models of primary care. However, it is unclear how undergraduate nursing programs offer opportunities to learn about nursing practice within primary care settings. A better understanding of the attributes and extent of primary care education in undergraduate nursing programs will direct research, inform teaching-learning, and develop a stronger primary care nursing workforce.

INCLUSION CRITERIA

This review will consider articles that include faculty/administrators, preceptors, or students of nursing programs that qualify graduates for entry-level registered nursing practice. Articles that report on undergraduate teaching-learning related to primary care will also be considered. Practical nursing, advanced practice, and post-licensure programs will be excluded. Teaching-learning related to settings other than primary care will also be excluded.

METHODS

The Framework of Effective Teaching-Learning in Clinical Education will be the organizing framework for this scoping review. A 3-step search strategy will be followed to identify published and unpublished literature. Articles published in English or French will be included. Data extracted from eligible articles will include details on the study design/method, participants, context, type of teaching-learning activity, attributes associated with dimensions of the teaching-learning environment, and relevant outcomes. The results will be reported in tabular and/or diagrammatic format, accompanied by a narrative summary.

REVIEW REGISTRATION NUMBER

Open Science Framework: https://osf.io/cw5r3.

Comprehensive initial evaluation of an innovative yearlong population health internship for undergraduates

BACKGROUND

The innovative Population Health Internship (PHI) addresses the evolving need for baccalaureate-prepared nurses to achieve population health competency. A comprehensive evaluation of the inaugural year of the PHI was conducted using the Centers for Disease Control and Prevention (CDC) Framework for Program Evaluation in Public Health and the Context, Input, Process, Product (CIPP) curricular evaluation model. Students and community agency partners-both key stakeholders-contributed to the evaluation.

METHODS AND RESULTS

Quantitative data were used to address functional and outcome areas of the PHI for purposes of PHI logistics, student learning gains, and program impact and sustainability. Qualitative data were used to provide insights into challenges in instituting curricular change, complexity in student-agency communications, importance of student preparedness/attitude, issues of role confusion, misperceptions about the population health nursing role, student learning, and impacts on partner agencies and their populations.

IMPLICATIONS

Educational implications include the importance of assessing both learning gains and student buy-in, the need for a long-term evaluation approach to accommodate for challenges related to radical curriculum change, and the importance of strong stakeholder support to facilitate mutually beneficial relationships and a positive learning experience.

Belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment: A scoping review

AIM

The aim of this scoping review was to map the literature investigating belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment.

BACKGROUND

The concept of belongingness, which encompasses feelings of acceptance, connection and value alignment, has been tied to positive outcomes in undergraduate/pre-licensure nursing students including increased learning, participation, confidence and professional socialization. It is critical for educators and clinical staff to foster a sense of belongingness for nursing students to promote positive and effective clinical learning experiences.

DESIGN

The scoping review strategy established by the Joanna Briggs Institute was followed. The databases searched were CINAHL Complete (EBSCO), Education Source, Medline Complete (EBSCO), APA PsycINFO (EBSCO) and Epistemonikos.

METHODS

Following a search of the five databases, studies were screened by title and abstract by two independent reviewers for inclusion. Data including population, concept, context, methods and key findings relevant to the review question were extracted and synthesized using an instrument developed by the reviewers.

RESULTS

A total of 47 articles with varying methodologies were critically appraised. Three overarching focus areas emerged: outcomes resulting from feelings of belongingness versus alienation, factors that contribute to a sense of belongingness in the clinical learning environment and interventions to promote a sense of belongingness while students are immersed in the clinical learning environment.

CONCLUSIONS

Belongingness in the clinical learning environment is an important concept that lends itself to positive learning experiences and increased satisfaction of undergraduate/pre-licensure nursing students. Environmental, relational and experiential factors can be maximized and specific interventions employed to promote belongingness. This review identifies a lack of evidence on measured interventional effectiveness at the student, school and clinical unit level. Future research to address these gaps is recommended.

TWEETABLE ABSTRACT

Scoping review suggests environmental, relational and experiential factors promote positive outcomes in belongingness of nursing students.

A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce

Aim

The aim of this scoping review was to provide an overview of the development of practice nurses, and the learnings that could be applied to improve the profile of dietetics practice in primary care.

Methods

A scoping review synthesising peer‐reviewed and other literature relevant to the development of Australian practice nurses was conducted. Structured searches using keywords ‘general practice’, ‘nurse’ and ‘Australia’ were conducted in PubMed and Google Scholar in June 2021. Key government websites, Department of Health and Services Australia, were searched to identify grey literature. One reviewer screened the titles and abstracts against inclusion criteria; two reviewers conducted full‐text screening independently. Data on the evolution of practice nursing were extracted based on its interest and transferability to the dietetics workforce.

Results

A total of 102 results (82 peer‐reviewed and 20 other literature) were included in the review. Key drivers for practice nurse role development in Australia were government funding, practice nurse practice standards, cost–benefit analyses of practice nurses, career and education opportunities, general practitioner and patient perspectives of practice nurses and, individual, community and local needs.

Conclusions

The practice nurse role has grown and strengthened and there are three key learnings that could be translated to strengthen the dietetics workforce in primary care. (1) Use and expansion of government funding, (2) furthering post‐tertiary education and career opportunities, including dietetic primary care practice standards and (3) targeting underserviced areas such as those that are rural and remote and building positive relationships with other stakeholders including practice nurses, general practitioners, patients and the broader primary care team.

Exploring the contribution of clinical placement to student learning: A sequential mixed methods study

BACKGROUND

Increasing demand and limited supply of clinical placements in nursing underscore the need to better understand the role of clinical placements in students' learning. Identifying pedagogically rich activities that support work place learning alongside factors that influence educational outcomes has the potential to optimise professional placement experiences.

OBJECTIVE

To explore student nurses perceptions of the value of nursing clinical placements to their learning.

DESIGN AND METHODS

A descriptive research design was employed using a sequential mixed method approach. A cross-sectional student survey captured students' perceptions of work integrated learning based on the perceived contribution of a pre-determined list of activities undertaken on clinical placement.

SETTING AND PARTICIPANTS

Four Australian universities took part. Participants included students undertaking entry to practice programs.

RESULTS

Four hundred and sixty-nine students completed the survey. Thirty-eight students participated in 12 focus groups. Participants rated PRA including interacting and time with patients and performing assessments as the most useful activities. Less useful, were activities that took them away from the patient.

CONCLUSIONS

To maximise workplace learning, consideration must be given to ensuring students are presented with goal directed activities that support learning and are focused on an expanding scope of practice with opportunities to discuss and engage with staff.

Understanding nursing students' perceptions of the general practice environment and their priorities for employment settings

AIM

To explore final year nursing students' perceptions of the general practice environment and their priorities when choosing a workplace.

DESIGN

Online survey, reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

METHODS

The validated Profession Scale from the Scale on Community Care Perceptions (SCOPE) tool was used to identify characteristics within the general practice environment and the importance of these in choosing a workplace. To explore the factor structure, exploratory factor analysis was undertaken which was used to revise the survey language and flow before widespread dissemination.

RESULTS

Three hundred and fifty-five responses were received. Factor analysis revealed three factors: Provision of care, Employment conditions and Nature of work. Respondents exposed to general practice in the Bachelor of Nursing program or who had a general practice clinical placement had significantly different perceptions across all factors. Although wages, advancement opportunities, work pressures and the physical nature of work were perceived as important in choosing a workplace, they were seen as only moderately present in general practice.

New graduate employment in general practice: Perceptions of final-year nursing students

AIM/OBJECTIVE

This paper sought to investigate the perceptions of final-year nursing students regarding general practice nursing as a new graduate career path.

BACKGROUND

General practice nurses have become increasingly important in providing community-based care, in response to the growing burden of chronic conditions and the ageing population. To sustain this workforce, there is a need to optimise strategies to promote a consistent supply of new graduate nurses.

DESIGN

This qualitative descriptive study was undertaken within a sequential explanatory mixed methods project.

METHODS

Data were collected through semi-structured telephone interviews with sixteen final-year nursing students from five Australian universities. Interviews were analysed using thematic analysis.

RESULTS

Four main themes were identified, namely; a) general practice is not a priority career path, b) opportunities for skills development and consolidation, c) perceptions of employment conditions, and d) transition support is limited.

CONCLUSION

To meet current workforce needs in areas with increasing demand, nurse educators need to support undergraduate nursing students to explore a wide range of career pathways following graduation. Informed career choices and well-structured educational preparation during undergraduate education may be an effective strategy in building a sustainable future workforce in settings such as general practice.

Final-year undergraduate nursing students' perceptions of general practice nursing: A qualitative study

AIM

To explore final-year nursing students' perceptions of general practice nursing.

BACKGROUND

The need for general practice nurses has increased due to growing demands for health care in the community. This demand is exacerbated by a shortage in the general practice nursing workforce. Understanding final-year nursing students' perceptions of general practice nursing is important as these may influence career choices.

DESIGN

Qualitative descriptive study within a mixed methods project.

METHODS

Telephone interviews were conducted with sixteen final-year nursing students. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Reporting follows the COREQ checklist.

RESULTS

Perceptions of general practice nursing varied between participants and related to three main themes; ways of working; a broad role to meet diverse health needs; and relationships with patients. General practice nurses were seen to have stable and collaborative working relationships, with their role ranging from supporting general practitioners to being autonomous professionals. The nurse's broad role was associated with diverse presentations and was considered interesting and challenging. Participants perceived that general practice nurses had more time to spend with patients, and this helped establish trust, and facilitated patient-centred care.

CONCLUSION

Participants' perceptions of general practice nursing varied, with some students recognising the diversity of the role and others perceiving it as limited. These views were often impacted by others experiences rather than personal experience. These variations underscore the need for students to receive greater exposure to general practice nursing. Review of undergraduate curricula to increase focus on preparing nursing students to work in general practice may help shape students' interest to seek employment in this setting.

RELEVANCE TO CLINICAL PRACTICE

Students perceptions of a clinical setting can influence their career decisions. Understanding these perceptions can inform clinicians and managers and highlight areas that may need to be addressed to promote career opportunities.

What Academic Factors Influence Satisfaction With Clinical Practice in Nursing Students? Regressions vs. fsQCA

Clinical practices are considered one of the cornerstones in nurses' education. This study provides a framework to determine how factors in the academic environment, influence nursing student's satisfaction with their practices. A cross-sectional analytical study was conducted in a convenience sample of 574 nursing students at a private university in Valencia, during the 2016/2017 academic year, 79% (456) were women. Two statistical methodologies were used for data analysis: hierarchical regression models (HRM) and fuzzy sets qualitative comparative analysis (fsQCA). The HRM indicate that the students' mean score influences all dimensions of satisfaction. Furthermore, in the fsQCA, the type of service and center, as well as the type of management, the preference in the choice of the practice center and the number of students per period per clinical educator influence satisfaction with clinical practices. These results could be used to understand how academic factors influence nursing students' satisfaction with their clinical practices and to create intervention programmes that improve it. This will help prepare students to be the future nursing workforce.

Attracting Israeli nursing students to community nursing

BACKGROUND

The shift from inpatient care to community patient care has had an essential impact on the nursing profession. Despite the growing demand for community nurses in many countries, their number remains relatively low and many students do not perceive this field as an interesting career to pursue. In this review we aimed to understand if exposure of undergraduate nursing students to various nursing work settings during their studies affects their work setting choices after graduation.

METHODS

A literature search of papers relating to work setting preferences of nursing students in Israel and other countries was performed. Israel Ministry of Health, Nursing Administration documents and other related documents were also reviewed, with a focus on the nursing training program in Israel.

FINDINGS

While most first-year nursing students have limited knowledge regarding the profession, in later years, their preferences for post-graduation work settings are affected by their exposure to the various clinical fields through knowledge gained in courses together with clinical practice placements. In Israel, specific classroom courses in community nursing are allocated only 6% of the total time allocated to all classroom courses in nursing, and a single clinical placement in community nursing takes place during the third or fourth year of the nursing program, exposing students to a single aspect of community nursing during their nursing training. Studies in other countries have reported that students' experience during clinical placement contributes to shaping students' opinions of nurses' roles within that field. Nursing students who had a primary healthcare placement showed greater intention for working in this setting after graduation.

CONCLUSIONS

The lack of exposure to the various aspects of community nursing during undergraduate studies contributes to a lack of motivation for entering this field. Therefore, a profound change is needed in nursing training programs' curricula to prepare graduates to face future challenges in community nursing. Whilst both hospital and community nursing are equally important, nursing leaders and policy makers must be made aware of the various factors that contribute to new registered nurses' preferences of hospital over community nursing and build strategies for directing nurses to work in the community in order to respond to the expected nurse shortage in this setting.

A cross-sectional study on preferred employment settings of final-year nursing students in Israel

BACKGROUND

Despite the growing demand for community nurses, their number remains relatively low. We examined perceptions of final-year nursing students regarding their preferred work setting after graduation and the factors affecting their choice.

METHODS

A cross-sectional survey using a structured questionnaire was developed specifically for this study. The questionnaire was distributed among fourth-year students from all nursing training frameworks across Israel.

RESULTS

Of 281 respondents (76.6% women, average age, 29.3 years), most (80.9%) preferred working in hospitals, while 5% preferred community settings; 14% were undecided. Students' knowledge on hospital nurses' tasks was greater compared to their knowledge on community nurses' tasks. Moreover, hospital nurses' tasks were perceived as more important than those of community nurses. The contribution of clinical placement in hospital nursing was perceived as significantly more meaningful than the contribution of clinical placement in community nursing. The vast majority of students (94.3%) stated that they would prefer to undergo a hospital nursing internship. A significant correlation was noted between students' clinical placement, the exposure to community nursing roles, and the perception of the community nurse's role: clinical placements that were perceived as a positive experience led to a more positive perception of community nurses' roles.

CONCLUSIONS

Nursing students' perception of community nursing is based upon limited information which does not reflect community nurses' actual role and work.

Alternative mental health clinical placements: Knowledge transfer and benefits for nursing practice outside mental healthcare settings

AIM AND OBJECTIVES

To explore whether nursing student's experiences at Recovery Camp have impacted their current nursing practices.

BACKGROUND

Recently, there has been a move towards more holistic models of nursing care, which seek to break down barriers of stigmatisation and embrace the tenets of self-determination, to acknowledge people with lived experiences of mental illness and their ability to manage their recovery. In that regard, future health professionals such as nursing students will need to be educated in a manner that recognises the importance of lived experience. In this paper, we propose that Recovery Camp, an alternative clinical placement setting model, enhances clinical practice in multiple domains and is beneficial for both nursing practitioners and people with lived experiences of mental illness, as well as offering an effective nontraditional alternative to conventional clinical placement opportunities.

METHODS

This study employed a phenomenological research design, involving individual semi-structured telephone interviews. The Standards for Reporting Qualitative Research (SRQR) checklist was adhered to.

RESULTS

Three main themes were identified from the analysis: (a) engagement, (b) understanding mental health and (c) holistic care. "I definitely look at people with mental health conditions in a different light." At Recovery Camp, participants felt that they had greater opportunities for engagement with people with lived experiences, and through this engagement, their preconceptions of mental illness began to change.

CONCLUSIONS

Recovery Camp may have facilitated the transfer of knowledge that is more person-centred among nursing students, consequently impacting their current nursing practices.

RELEVANCE TO CLINICAL PRACTICE

Nurses should be equipped with mental health skills regardless of their career trajectory. While Recovery Camp represents a promising approach to facilitate knowledge transfer, further investigation will be required to determine which other factors are instrumental. This approach may have wider implications for nursing education.

Student nurses' career intentions following placements in general practice through the advanced training practices scheme (ATPS): findings from an online survey

BACKGROUND

The demand for General Practice services in the UK, and elsewhere, is rising quickly. In part, the increasing demand is from an aging population that requires management of multiple long-term conditions. The General Practice Nurse is increasingly taking on the role. It is acknowledged that if general practice is to be able to recruit sufficient General Practice Nurses (GPNs) to meet this increasing demand in the future, new graduate nurses must be encouraged to consider general practice as a viable career option. This research is part of a review of the Advanced Training Practice Scheme (ATPS) which supported clinical placements in participating general practices.

METHODS

The aim of the study was to examine nursing students' perceptions of GP placements, and their effect upon career intentions following graduation from Sheffield Hallam University (SHU), in the UK. Interviews and an online survey were used collect data. Only the survey is reported here. The bespoke survey examined students' views of: opportunities for learning new clinical skills and consolidating existing clinical skills; the learning environment in general practice and their views on a career in general practice.

RESULTS

One thousand one hundred twenty undergraduate adult-field nursing students were contacted, with a response rate of 41% (N = 462). Ninety respondents had a placement and, 92% (N = 84) viewed practice nursing positively, and 77% (N = 70) felt that the placement had transformed their views on general practice. The opportunity to participate in the management of the various aspects of chronic disease was identified by 84% (N = 76) of the students as a key new skill they had acquired. They also reported that they valued a team ethos, control over aspects of work, and the variety of health problems they encountered.

CONCLUSION

The findings from this study demonstrate a positive experience arising from the provision of General Practice placements for nursing students. The use of 'targeted' placement schemes with appropriate support such as this may be seen as a viable way of exposing nursing students to General Practice nursing, and of encouraging new graduate nurses to consider General Practice nursing as a viable career option.

The student experience of a 'kidney CAMP' as a primary care clinical placement for undergraduate nursing students

BACKGROUND

Historically clinical placements have been within acute care settings. In a more contemporary society, the future focus of health care is primary care, with an emphasis in expanding primary care clinical placements, to meet the needs of increasing workforce requirements. An innovative collaborative educational model was designed to provide a high quality learning experience and to increase numbers of students experiencing a primary care clinical placement.

OBJECTIVE

To explore student nurses' lived experiences within an innovative primary care setting.

METHODS

A qualitative case study was undertaken to analyse nursing students' experiences at the Kidney Kids Camp primary care clinical placement.

FINDINGS

Participants described how the primary care placement changed their view of nursing and the nurses' role. Five themes emerged from the research: developing knowing through children's eyes; entering the world of primary care; facing a journey of self-discovery; it's all in the way you communicate and; it makes you think differently about nursing.

DISCUSSION

The experience of this primary care placement enabled nursing students to enter the world of children living with chronic illness. Immersing students into this unique environment enabled them to gain a greater insight into primary care through the eyes of the children.

CONCLUSION

Kidney Kids camp experiences presented nursing students with an enhanced appreciation of primary care nursing, working with children, and an understanding of the impact of chronic health illnesses, through the primary care lens.

Using "Knowing That" and "Knowing How" to Inform Learning of Peripheral Vein Cannulation in Nursing Education

Background Peripheral vein cannulation is one of the most common invasive practical nursing skills performed by registered nurses. However, many registered nurses lack competence in this practical skill. Learning peripheral vein cannulation associated with successful placement and maintenance is not well understood. Framework Ryle's ways of knowing, "knowing that" and "knowing how", can be used during peripheral vein cannulation learning to guide development and competence in this practical skill. Aim The aim of the article was to provide an overview of Ryle's ways of knowing and to make recommendations for best practices for nurse teachers and nurses teaching students peripheral vein cannulation. Conclusion Ryle's ways of knowing can assist nursing students in their learning and development of peripheral vein cannulation.

A conjoint analysis of the acute and critical care experiential learning preferences of Baccalaureate student nurses

With the increasing need for competent nurses specializing in acute and critical care, educators must consider the needs and preferences of students in designing experiential learning programs. This cross-sectional, choice-based conjoint analysis determined the acute and critical care experiential learning preferences of student nurses. From March to July 2016, 213 randomly-selected student nurses from a higher education institution in Manila, Philippines were surveyed and ranked 20 choice bundles with 5 selected attributes of the experiential learning program. Results showed that duration of unit exposure (48.73%) and group structure (7.46%) were the most and least valued attributes, respectively. Additionally, student nurses prefer an experiential learning program that lasts for 1 week (21 h) per unit (utility = 0.93), has a stay-in instructor (utility = 0.30), encourages full student involvement (utility = 1.08), deploys 2-3 students per group (utility = 0.09), and provides both single program and on-going unit orientation (utility = 0.52). Part-worth utilities of duration of unit exposure (t = 3.65, p = 0.0001) and group structure (t = 3.46, p = 0.001) differed between gender. With a model explaining the acute and critical care experiential learning preferences of student nurses, nursing institutions can restructure their clinical placement to maximize positive learning.

Characteristics of a critical care clinical placement programme affecting critical care nursing competency of baccalaureate nursing students: A structural equation modelling

AIM AND OBJECTIVES

To evaluate and determine the characteristics of a critical care clinical placement programme affecting the critical care nursing competency of baccalaureate nursing students.

BACKGROUND

The increase in global demand for competent critical care services and human resources translates to an educational focus in preparing students for their eventual role as critical care health professionals. Albeit clinical placement in critical care units can promote competency, evidence supporting such claim remains inadequate.

DESIGN

Cross-sectional, descriptive correlational design.

METHOD

Employing structural equation modelling, 236 randomly selected baccalaureate nursing students from a clinically intensive university in the Philippines were recruited from January-March 2016. A three-part online survey, composed of the robotfoto, Critical Care Nursing Rotation Evaluation Questionnaire, and Intensive and Critical Care Nursing Competence Scale, was completed. The STROBE checklist was followed in reporting this study.

RESULTS

Five characteristics of clinical placement were extracted as follows: sufficient clinical exposure, adequate area orientation, supportive clinical instructor, diversified medical cases and supplemental learning resources. Four characteristics affected critical care nursing competency and built a good model (χ² /df = 1.52; comparative fit index = 0.94; parsimonious normal fit index = 0.77; root mean square error of approximation = 0.047). Adequate area orientation had the most diverse influence on all competency domains, while supportive clinical instructor had the strongest positive influence on critical care nursing skill (β = 0.30, p = 0.005).

CONCLUSION

The model highlights the characteristics of a critical care clinical placement programme which influences critical care nursing competency among nursing students. It emphasised the importance of a supportive clinical instructor and adequate area orientation in promoting critical care nursing skills and values and attitude.

RELEVANCE TO CLINICAL PRACTICE

The proposed model highlights the role of clinical instructors and appropriate orientation which provides impetus in improving the clinical placement design to maximise competency development.

Experiences of registered nurses in a general practice-based new graduate program: a qualitative study

Nurses are increasingly needed in primary healthcare settings to support community-based healthcare delivery. Programs to facilitate transition of new graduate nurses are well established in acute care; however, there are few similar programs reported in settings like general practice. This paper sought to explore the experiences of new graduate registered nurses and their registered nurse mentors in a new graduate program within Australian general practice. New graduates (n = 9) and their mentors participated in interviews before, during and at the conclusion of a 12-month new graduate program. Interviews were digitally audio-recorded and professionally transcribed verbatim before being analysed using thematic analysis. Eighteen new graduate and 10 mentor interviews were conducted, revealing four themes. Preparation and Opportunities describes the influence that pre-registration education had on preparing nurses for general practice employment. Exceeding Expectations highlights the positive experiences within the program. Program Challenges draws attention to the difficulties experienced by participants, and Future Career Intentions explores future career plans. This study highlights that a general practice new graduate nurse program has the potential to build the workforce. However, strengthening undergraduate preparation of nurses around primary health care and addressing funding issues in general practice, are important to promote the success of such programs.

GP/GPN partner* perspectives on clinical placements for student nurses in general practice: can a community of practice help to change the prevailing culture within general practice?

Background

The UK Government document 5 year forward view describes the need to move chronic disease management from secondary to primary care, which will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no specific recruitment strategy to address this increased need. In recent times, a number of solutions have been suggested to address this impending GPN recruitment crisis. For example, Health Education England (HEE) commission General Practitioners (GPs), who are members of the Advanced Training Practice Scheme (ATPS), to provide placements for student nurses within general practice.

Methods

A descriptive qualitative study was undertaken, in which data were collected using semi-structured interviews with 16 GPs and 2 GPN partners*. Qualitative analysis used a framework approach and themes were cross-checked within the team and member checking was undertaken with a convenience sample of GPs. The research had ethical approval and anonymity and confidentiality were maintained.

Results

From the GP perspective, there were two key themes that emerged from the data. The first theme of ‘fishing in the same small pond’ included succession planning for the general practice workforce, the ‘merry go round’ of poaching staff from other practices, and the myths and misunderstandings that have grown up around general practice nursing. The second theme, ‘growing your own’, looked at the impact of the student nurse placements as a means to address the crisis in GPN recruitment. There was recognition of the need for cultural change in the way that GPNs are recruited, and that the ATPS was one way of helping to achieve that change. There were however a number of challenges to sustaining this cultural shift, such as the financial constrains placed upon the GP practice, and the need to function as a ‘small business’.

Conclusions

Despite all the challenges, the evidence is that, through the Community of Practice (CoP), the ATPS scheme is beginning to ‘bear fruit’, and there is a subtle but discernible move by GPs from a ‘why would we?’ to ‘why wouldn’t we?’ invest in education and training for nurses in general practice.

N.B. The term GPN partner* denotes a GPN who is a ‘full partner’ in the practice business, holding the same NHS contracts and the same status as a GP. For the purposes of the paper itself, the term GP will be used to denote both types of partner.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0842-2) contains supplementary material, which is available to authorized users.

An overview of the general practice nurse workforce in Australia, 2012–15

Several surveys of the general practice nurse (GPN) workforce have been undertaken in Australia over the last decade, but they have limitations, which mean that the workforce is not well-understood. The aim of this study is to describe the profile of the GPN workforce using the dataset available through the Australia Health Practitioner Registration Agency and to explore how it differs from the non-GPN nursing workforce, and if this workforce is changing over time. Data from labour force surveys conducted from 2012 to 2015 were used. Variables examined were age group, gender, remoteness area, hours worked, nurse type (enrolled (EN) or registered (RN)), years in the workforce and also intended years of work before exiting the workforce. When compared with the broader nursing workforce, a greater proportion of GPNs in 2015 were older (60 v. 51%), worked part-time (65 v. 48%) and worked in regional areas (35 v. 26%). Additionally, the characteristics of GPNs has changed between 2012 and 2015, with an increased proportion of younger nurses, more registered nurses and fewer working in remote areas. To ensure a sustainable workforce, particularly in rural and remote areas, strategies to recruit and retain this workforce will be needed.

Conditions Affecting the Performance of Peripheral Vein Cannulation during Hospital Placement: A Case Study

Learning practical nursing skills is an important part of the baccalaureate in nursing. However, many newly qualified nurses lack practical skill proficiency required to ensure safe patient care. The invasive skill peripheral vein cannulation (PVC) is particularly challenging to learn and perform. This study explored conditions influencing nursing students' learning and performance of the technical implementation of a PVC during their clinical placement period. A qualitative and descriptive case study design with two students in Norway practicing PVC during their clinical placement was conducted. One student who mastered the vein cannulation was compared with one student who did not. Data were collected in late 2012 using multiple data sources: semistructured interviews, ad hoc conversations, and video recordings. Video recordings of the two students' cannula implementations were used to help clarify and validate the descriptions and to identify gaps between what students said and what they did. Thematic analysis of the transcribed text data enabled identifying themes that influenced skill performance. There were two overall themes: individual and contextual conditions influencing the technical implementation of a peripheral vein cannula. These findings were evaluated in terms of Benner's work on scientific and practical knowledge, defined as “knowing that” and “knowing how.”

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

Background

Interdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps.

Methods and findings

An integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals.

Conclusion

A key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work.

Systematic review registration

International Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362.