Activities and interactions of baccalaureate nursing students in clinical practica

Traditional Clinical Outcomes in Prelicensure Nursing Education: An Empty Systematic Review

BACKGROUND

Effectiveness of traditional apprenticeship models used in undergraduate nursing education has been questioned in the literature for over 50 years. This systematic review aimed to examine best evidence available upon which to base decisions regarding use of traditional clinical experience with prelicensure nursing students.

METHOD

A systematic review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine electronic databases were searched. Full-text review was completed for 118 articles meeting inclusion criteria.

RESULTS

No studies reported learning outcomes attributed to clinical education models, resulting in an empty review. Studies were commonly self-reports of perceptions and confidence, lacking quantitative outcomes.

CONCLUSION

No sufficient evidence was found to support traditional clinical models. The scope of nursing practice and patient complexity requires higher order thinking skills, ability to prioritize, and leadership in interdisciplinary care environments. This review raises serious concerns about how nurse educators assess learning in traditional clinical environments. [J Nurs Educ. 2021;60(3):136-142.].

Lack of respect, role uncertainty and satisfaction with clinical practice among nursing students: the moderating role of supportive staff

BACKGROUND AND AIMS

Clinical learning placements provide a real-world context where nursing students can acquire clinical skills and the attitudes that are the hallmark of the nursing profession. Nonetheless, nursing students often report dissatisfaction with their clinical placements. The aim of this study was to test a model of the relationship between student's perceived respect, role uncertainty, staff support, and satisfaction with clinical practice.

METHOD

A cross-sectional, descriptive survey was completed by 278 second- and third-year undergraduate nursing students. Specifically, we tested the moderating role of supportive staff and the mediating role of role uncertainty.

RESULTS

We found that lack of respect was positively related to role uncertainty, and this relationship was moderated by supportive staff, especially at lower levels. Also, role uncertainty was a mediator of the relationship between lack of respect and internship satisfaction; lack of respect increased role uncertainty, which in turn was related to minor satisfaction with clinical practice.

CONCLUSION

This study explored the experience of nursing students during their clinical learning placements. Unhealthy placement environments, characterized by lack of respect, trust, and support increase nursing students' psychosocial risks, thus reducing their satisfaction with their clinical placements. Due to the current global nursing shortage, our results may have important implications for graduate recruitment, retention of young nurses, and professional progression.

An investigation of nursing students' experiences in an Iranian psychiatric unit

This qualitative study aimed to investigate and explain clinical experiences of nursing students in a psychiatric unit in an Iranian hospital. The researcher performed a Heideggerian hermeneutic phenomenological study by conducting in-depth interviews of 13 participants. An analysis based on Diekelmann's method helped to interpret the data and uncover common themes. The following four correlated themes were obtained: anxiety, maturation, dissatisfaction and enthusiasm. These results present distinctive insights on contextualizing, developing and implementing clinical education in Iran, especially in psychiatric units. The exploration and description of students' experiences will help nurse educators to plan the clinical learning opportunities such that they are less stressful, thus ensuring that nursing students are equipped to act as therapeutic professionals.

Evaluation of a PBL strategy in clinical supervision of nursing students: patient-centred training in student-dedicated treatment rooms

AIM

The present study aimed at investigating staff members' and nursing students' perception of and satisfaction with an intervention involving patient-centred training in student-dedicated treatment rooms during clinical supervision.

BACKGROUND

It is well known that clinical education is important and that the clinical learning environment influences the development of nursing students' ability to solve clinical problems. In the present study, an intervention using a problem-based learning (PBL) strategy was introduced and evaluated in clinical education. The PBL strategy is called 'Patient-centred training in student-dedicated treatment rooms'.

DESIGN AND METHODS

Descriptive; both quantitative and qualitative methods were used. A questionnaire and focus group interviews were used.

RESULT

Most participants found the PBL strategy to be highly satisfactory, both for staff and for students. The students seemed to feel that their time in clinical education had been used efficiently.

CONCLUSION

Integration of theory and practice during clinical training has been emphasized as a necessary component, and the new strategy, which involves a method of promoting students' reflection, represents one way of facilitating such integration, in that it may bridge the gap between theory and practice. More extensive and more specific research is need in the future.

Supernumerary status – An unrealised ideal

Supernumerary status, for pre-registration student nurses, should have fundamentally changed the way they learn in practice. Research suggests, however, that for many students the apprenticeship model still exists and that supernumerary status has created new challenges for learning in practice. Common themes found in the literature on supernumerary status are: confusion over the meaning of supernumerary status, the effect of supernumerary status on becoming part of the team, importance of the mentor, power relationships and operationalising supernumerary status. These themes are explored further with reference to the international literature and recommendations made as to how nurse education can respond to the challenges posed in order to ensure the quality of student learning in practice.

A phenomenographic study of registered nurses’ understanding of their role in student learning—An Australian perspective

BACKGROUND

Students may be 'buddied' with registered nurses during their clinical experience since the designated clinical facilitator cannot be available for each student at all times. Little is known about the way registered nurses understand this informal role.

OBJECTIVES

The rationale for this study was to gain an insight of the variation of understanding registered nurses have of their role with students, and explored the qualitatively different ways registered nurses perceive their role with students on clinical experience and the implications of this understanding for student learning.

DESIGN

A phenomenographic approach was used to identify the variation of understanding and meaning of the role of the registered nurse with students on clinical practice from the perspective of the registered nurse. Phenomenography is a field of descriptive research concerned with the variation in ways people experience and understand similar phenomena.

SETTINGS AND PARTICIPANTS

A purposive sample of 30 registered nurses from 15 public and private hospitals in central and south eastern Queensland, Australia.

METHODS

Individual semi-structured interviews from a final sample of 28 interviews were analysed to identify Categories of Description.

RESULTS

Eight variations of understanding registered nurses have of their informal role with students were identified. The registered nurses' understanding varies from a focus that is 'student-centred', to 'completion of workload-centred', to 'registered nurse control', to a preference for no contact with students. As a consequence some students may have positive learning experiences while others will have limited learning opportunities.

CONCLUSIONS

The research highlights the varied ways registered nurses understand their role with students that may promote or impede the quality of student learning and development to meet professional competency standards. Formal recognition of the complexity of the registered nurse role by health care agencies and tertiary education providers is essential to ensure registered nurses have adequate preparation for their role with students.

The CCARE model of clinical supervision: bridging the theory-practice gap

Clinical supervision of nursing students is a key component of nursing education. The clinical setting provides students with an opportunity to develop a professional identity, knowledge base, and the ability to transfer classroom knowledge to the clinical setting. This paper suggests a model of clinical supervision that will address how to bridge the pre-existing theory-practice gap in nursing education through an attitude of caring and the utilization of caring behaviours based on Leininger's theory of culture care. Key concepts included in this model are: communication, collaboration, application, reflection and evaluation, these concepts comprise the CCARE model of clinical supervision.

An emancipatory praxis study of nursing students on clinical practicum in New Zealand: pushed to the peripheries

The purpose of this qualitative study was to gain a better understanding of the learning experiences of nine nursing students on clinical placement in New Zealand. The students were in their third and final year of their baccalaureate nursing degree. The study specifically examined what impinged upon their learning experience in the clinical venue. Data was obtained from interviewing the students, initially individually and finally in a focus group. Themes emerged through words and concepts as the data was analysed. The themes included powerlessness; marginalization; the move from a holistic to a reductionist approach in care; the exploitation of minority students and the myth of praxis. Clinical practice was a time for nursing students to apply their knowledge to their practice, and to gain experience and confidence. Their clinical practice was normally a positive experience, but, each student spoke of the occasional negative episode. These left them with feelings of powerlessness and marginalization. The Maori students felt exploited. The students were concerned about the lack of time to debrief at the end of the day, and to share their experiences with their educator and colleagues. The students' negative experiences were often the result of a clinical practitioner's high workload, under resourcing and the nurse educator's unavailability. An emancipatory praxis methodology was used to guide the research and hence Habermasian critical theory underpinned this study. It has demonstrated within this research the necessityfor strategic action, by exposing the current situation to create an awareness for favourable change. The findings from this research will enable educators and clinical practitioners to have a clearer understanding of the needs of nursing students in clinical practice. Recommendations from this study included the need for further research into nursing students clinical supervision models, and the identication of the special learning needs of indigenous nursing students.

The meaning of preceptorship: nurses' lived experience of being a preceptor

AIM OF THE STUDY

This phenomenological study is aimed at illuminating nurses' lived experience of the process of preceptoring and the meaning of preceptorship in a Swedish context.

METHODS

Seventeen nurses from the North of Sweden with varied previous experience of preceptorship volunteered to participate. Their narratives, describing their experience of being a personal preceptor for a student nurse during practical training on a hospital ward in the third year of a 3-year diploma programme within a university college of nursing in Sweden, were transcribed verbatim. A phenomenological-hermeneutic interpretation disclosed the themes 'sheltering the students when learning' and 'facilitating the students' learning', together with eight sub-themes, which created an understanding of the meaning of preceptorship.

FINDINGS AND DISCUSSION

The meaning of preceptorship was understood as reducing the risk of the students learning helplessness and empowering the students when learning in practice. The meaning of preceptorship highlighted the need for further preceptor support and development of the role of the preceptor. On the basis of the findings, suggestions were made to increase the preceptors' awareness of values in nursing practice and use of pedagogical strategies in the process of preceptoring. Through such strategies a reciprocal development of the preceptors' and the faculty's knowledge may take place, to the best advantage of the students' learning and the development of the profession.

Student nurses' lived experience of preceptorship. Part 2--the preceptor-preceptee relationship

Student nurses' experience of preceptorship was the focus of this second part of a phenomenological study. The aim was to illuminate student nurses' lived experience of the preceptor-preceptee relationship on hospital wards. A phenomenological-hermeneutic analysis was made of tape-recorded interviews with seventeen student nurses. The interpretation process culminated in four themes, namely: (a) creating space for learning; (b) providing concrete illustrations; (c) exercising control and (d) seeking reflection. Each theme included sub-themes with internal variations. The theme 'creating space for learning' was understood as basic in relation to the other themes and as the foundation of student learning and preceptoring. The ongoing process of preceptoring meant that the preceptors acted as role models, were with the students and also exercised control. Control was directed both to patient safety and to student learning. The students' 'seeking reflection' included attempts to find peace and quiet either by themselves or with the preceptor. The reflection together with the preceptor facilitated the students' transformation of knowledge, from the specific situation to a general knowledge and increased the value of learning.

Learning on clinical placement: the experience of six Australian student nurses

Concerns about the adequacy of clinical education in nursing courses in Australia have escalated since the transfer of pre-registration nursing education into the tertiary sector. This descriptive, interpretative study, informed by the tradition of critical social science, sought to understand the clinical learning experiences of undergraduate nursing students. At the same time, it fostered an active participation of students in their own learning. Daily post-clinical conferences with the students were taped and transcribed verbatim to provide data for the study. Additional data was collected from informal discussions and observations of the students during the placement. Analysis revealed three main categories, which reflected the students' experiences. These included: (1) I don't belong; (2) doing and practising: progress at last; and (3) transitions in thinking. Feeling part of the team was closely linked to the opportunity to learn, emphasizing the important role not only of educators but also clinicians in undergraduate learning on clinical placement. Though the findings reflect age-long problems associated with student learning in the clinical field, it serves to remind all nurses of the importance they play in the learning process. This study reflects the importance of effective communication between the health and education sectors and the need to concentrate on strategies which will strengthen this bond.