Nurse socialization: issues and problems

Association between quality of ward nursing care and students' assessment of the ward as a learning environment

The aim of this study was to explore the association between the characteristics of a ward and its evaluation as a learning environment by students. The data were collected using a structured questionnaire in one college of nursing in southern Finland. Respondents were 162 second- and third-year students enrolled on a three-and-a-half year nursing programme. The quality of nursing care correlated strongly with the quality of the nursing environment. The method and implementation of the supervisory relationship was also a signifant factor in students' assessment of the ward as a learning environment. The role of staff nurses as mentors was very important. Clinical supervision is not only important in nurse education; it is also closely interwoven with nursing care in clinical wards in general.

Finessing incivility: The professional socialisation experiences of student nurses' first clinical placement, a grounded theory

BACKGROUND

Clinical practice is where student nurses are socialised into a professional role and acquire the distinct behaviour, attitudes and values of the nursing profession. Getting it right at the outset can maximise the development of a professional identity and the transmission of robust value systems.

OBJECTIVES

To explore the impact of the first clinical placement on the professional socialisation of adult undergraduate student nurses in the United Kingdom.

DESIGN

Data of a longitudinal qualitative nature were collected and analysed using grounded theory.

SETTINGS

First year student nurses in hospital ward placements comprising a rural District General Hospital and a large inner city Hospital kept daily unstructured diaries for six weeks.

PARTICIPANTS

A total of 26 undergraduate adult student nurses were purposefully sampled between 2008 and 2010 before undertaking their initial clinical placement.

METHODS

Data collection and analysis used grounded theory and the key question asked of the diarists 'tell me what it is like to be a first year nurse on a first placement' was theoretically adjusted during constant comparison and as the theory emerged. Ethical approval and consent was obtained.

RESULTS

The theory of finessing incivility comprises a conceptual framework depicting how student nurses deal with professional incivility during their initial clinical placement and sustain a student identity. Being disillusioned with their role as worker rather than learner yields a sense of 'status dislocation'. Despite needing professional benevolence, they remain altruistic and seek recompense from significant others to negotiate for learning opportunities and relocate their student status.

CONCLUSIONS

Despite the stressful transition into clinical practice rather than 'fit in', the student nurses want to belong as learners. His or her own resilience to learn nursing and be a professional student maintains their resolve, their altruism and strengthens their existing values to be benevolent towards an indifferent profession. This behaviour ultimately mirrors the social nature of the practice community.

'Newcomer adaptation': a lens through which to understand how nursing students fit in with the real world of practice

Aims and objectives

To present a discussion on newcomer adaptation as a lens through which to understand how nursing students adapt to clinical practice and raise awareness of strategies that can be used to enhance their learning experiences.

Background

Socialisation is an important factor that facilitates students’ learning in the clinical setting. Therefore, it is beneficial to examine organisational socialisation literature, particularly that pertaining to newcomer adaptation.

Design

This is a critical review of organisational socialisation literature.

Methods

Seminal literature and more recent research in the field of organisational socialisation and newcomer adaptation were accessed. In addition, nursing and allied health literature examining students’ socialisation and the clinical learning environment was retrieved.

Conclusions

It is revealed in this article that to create an appropriate clinical learning environment, an understanding of socialisation tactics could be beneficial. Role modelling is deemed crucial to successful newcomer adaptation. Peer support is necessary but must be advocated with caution as it can have a negative impact when students form a ‘parallel community’. Students with some knowledge of the workplace tend to adapt more easily. Likewise, students’ disposition and, in particular, their confidence can also enhance the socialisation process.

Relevance to clinical practice

Both the organisation and the student can impact on how successfully the nursing student ‘fits in’. Understanding this through the lens of newcomer adaptation means that strategies can be put in place to facilitate this process.

Experiences and learning during a graduate nurse program: an examination using a focus group approach

The graduate nurse year requires individuals to make a huge transition from university student to registered nurse as part of the health care workforce. New graduates experience steep learning curves throughout the first year of professional practice. This study sought to explore experiences and learning occurring throughout the graduate nurse program for a group of seven new nurse graduates. Focus group interviews were conducted at six months and 12 months into the program using the same set of guiding questions. The first interview highlighted that graduates early in the graduate year were internalised, concentrating on their own survival in managing workloads, facing practice realities and coming to terms with themselves as nurses. Learning was primarily about survival strategies and performing tasks. By the second interview, graduates were much less focussed on themselves. They understood their place in the health care team, had gained confidence in their relationships, and were showing concern for the next graduates arriving. Learning at this stage involved more higher order skills, including critical thinking.

Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study

BACKGROUND

Early-career burnout among nurses can influence health and professional development, as well as quality of care. However, the prospective occupational consequences of study burnout have not previously been investigated in a national sample using a longitudinal design.

OBJECTIVES

To prospectively monitor study burnout for a national sample of nursing students during their years in higher education and at follow-up 1 year post graduation. Further, to relate the possible development of study burnout to prospective health and life outcomes, as well as student and occupational outcomes.

DESIGN

A longitudinal cohort of Swedish nursing students (within the population-based LANE (Longitudinal Analysis of Nursing Education/Entry) study) from all sites of education in Sweden was surveyed annually. Data were collected at four points in time over 4 years: three times during higher education and 1 year post graduation.

PARTICIPANTS

: A longitudinal sample of 1702 respondents was prospectively followed from late autumn 2002 to spring 2006.

METHODS

Mean level changes of study burnout (as measured by the Oldenburg Burnout Inventory, i.e. the Exhaustion and Disengagement subscales) across time, as well as prospective effects of baseline study burnout and changes in study burnout levels, were estimated using Latent Growth Curve Modeling.

RESULTS

An increase in study burnout (from 30% to 41%) across 3 years in higher education was found, and levels of both Exhaustion and Disengagement increased significantly across the years in education (p<0.001). Baseline levels, as well as development of study burnout, predicted lower levels of in-class learner engagement and occupational preparedness in the final year. At follow-up 1 year post graduation, earlier development of study burnout was related to lower mastery of occupational tasks, less research utilization in everyday clinical practice and higher turnover intentions.

CONCLUSIONS

The results suggest that study burnout may have interfered with learning and psychological well-being. Aspects related to work skills and intention to leave the profession were also affected. Thus, burnout development during higher education may be an important concern, and effective preventive measures to counteract burnout development may be necessary already at the outset of nursing education.

Professional socialization in dietetics: a review of the literature

The process of professionalization has been widely studied in nursing, but little is known about it in dietetics. We explored the process of professionalization using an integrative review of nursing literature. Three research questions were addressed: 1. What are the stages of professional socialization? 2. Who are the participants in the socialization process? 3. What challenges are associated with the socialization process? From an initial list of 322 articles compiled from a search of relevant databases, 49 English-language primary research papers were selected for review. A form of constant comparative analysis was conducted to extract relevant data into categories based on the research questions. Findings suggest that the process of professional socialization is a complex and stressful process, which occurs in three phases and begins before entry into the formal education system. Within the formal education system, faculty and preceptors can have a positive or negative impact on an individual's professional growth and development. Much work is needed to develop an understanding of this process in dietetics, but the findings will have immediate relevance to dietitians' educational and practice contexts.

The role of the nurse teacher in clinical practice: an empirical study of Finnish student nurse experiences

This paper focuses on the role of the nurse teacher (NT) in supporting student nurse education in clinical practice. The paper draws on the outcomes of a study aimed at exploring student nurse experiences of the pedagogical relationship with NTs during their clinical placements. The participants (N=549) were student nurses studying on pre-registration nursing programmes in Finland. Data were analysed using descriptive statistics, cross-tabulation and ANOVA. The study showed that the core aspect of NTs work in clinical practice revolved around the relationship between student, mentor and NT. Higher levels of satisfaction were experienced in direct proportion to the number of meetings held between the student and NT. However, whilst the importance of this relationship has been reported elsewhere, an additional aspect of this relationship emerged in the data analysis. Those NT who facilitated good face to face contact also used other methods to enhance the relationship, particularly e-mail, virtual learning environment and texting. This outcome suggests that NT's interpersonal and communicative skills are as important as their clinical knowledge and skills in promoting effective learning in the clinical practice area. The paper argues for such approaches to be utilised within the emergent opportunities afforded by new communication and educational technologies.

The role of legitimation in the professional socialization of second-year undergraduate athletic training students

CONTEXT

Professional socialization during formal educational preparation can help students learn professional roles and can lead to improved organizational socialization as students emerge as members of the occupation's culture. Professional socialization research in athletic training is limited.

OBJECTIVE

To present the role of legitimation and how it influences the professional socialization of second-year athletic training students.

DESIGN

Modified constructivist grounded theory and case study methods were used for this qualitative study.

SETTING

An accredited undergraduate athletic training education program.

PATIENTS OR OTHER PARTICIPANTS

Twelve second-year students were selected purposively. The primary sample group (n = 4) was selected according to theoretical sampling guidelines. The remaining students made up the cohort sample (n = 8). Theoretically relevant data were gathered from 14 clinical instructors to clarify emergent student data.

DATA COLLECTION AND ANALYSIS

Data collection included document examination, observations, and interviews during 1 academic semester. Data were collected and analyzed through constant comparative analysis. Data triangulation, member checking, and peer-review strategies were used to ensure trustworthiness.

RESULTS

Legitimation from various socializing agents initiated professional socialization. Students viewed trust and team membership as rewards for role fulfillment.

CONCLUSIONS

My findings are consistent with the socialization literature that shows how learning a social or professional role, using rewards to facilitate role performance, and building trusting relationships with socializing agents are important aspects of legitimation and, ultimately, professional socialization.

Intraprofessional relations in nursing

AIM

This paper is a report of a study to explore the way in which Registered Nurses relate to and interact with each other in the workplace, and to identify factors that influence nurses' interactions with each other.

BACKGROUND

Intraprofessional relations are an important topic both for nurses and nursing as we face the ongoing challenges of nurse shortages. Poor colleague relationships, together with workplace conflict, cause job dissatisfaction. As a consequence, some nurses leave the profession while others continue working but remain chronically unhappy.

METHOD

An explanatory multiple case study design was adopted. Data were collected from multiple sources on three different wards within one hospital in Australia between July 2005 and January 2006.

FINDINGS

The workplace can be a difficult place for both very experienced and less experienced nurses, regardless of the clinical environment. Nurses navigate their way in the workplace through a series of complex negotiations with each other and develop skills to assess the potential success of an interaction before approaching another nurse. Some also develop a resilience to conflict in their workplace, accepting it as part of working life.

CONCLUSION

Creation of a more positive work environment requires increased understanding of the way nurses relate to each other and appreciation of the factors in the environment that contribute to conflict and a negative atmosphere. This appreciation is a necessary prerequisite to developing a more satisfying and productive workplace enhancing the recruitment of new nurses and the retention of experienced nurses.

Specialist nurses for older people: implications from UK development sites

AIM

This paper is a report of a study to explore the development of specialist staffing for older people in six case study sites in the United Kingdom.

BACKGROUND

In the United Kingdom there has been some concern about the health care available to older people, leading to the development of a National Service Framework. A key theme of this framework is the development of specialist staff skilled in providing services tailored to the needs of older people.

METHOD

A soft systems methodology was used in 2004-2005 to carry out interviews with key people, including specialist nurses for older people, other service providers, patients and informal carers (n = 132) in six case study sites identified from a national questionnaire. Interviewees were asked to describe their perceptions of the development, its history and its impact.

FINDINGS

The development of specialist nursing services seemed to be shaped by national policy drivers for service development, which may not have been directly linked to the needs of older people. The ideal qualities of a specialist nurse for older people were described by participants as including not only knowledge and skills, but also personal characteristics.

CONCLUSION

While progress has been made in establishing specialist posts, much remains to be explored about the roles of postholders, the qualities needed, and the support and preparation required. While advanced practice is a professional aspiration, a number of questions arise about the development of nursing as a self-directing profession in diverse international settings. Theories of specialist nursing practice also need to address the tensions between universal and local models and to consider theories about nursing older people.

Is the humanistic view of the nurse role still alive--in spite of an academic education?

AIM

This paper is a report of a study exploring what 'being a good nurse' means by following nursing students during their pre-registration education and for some years after graduation.

BACKGROUND

There have been few studies focusing on the nurse role in the transition from student to experienced nurse. Studies with a qualitative design, in particular, are limited in number.

METHODS

A longitudinal survey design was adopted, using an open-ended questionnaire at the beginning of education (n = 164), just before graduation (n = 123), and 3-5 years after graduation (n = 77). The participants were students in the nursing programme at a Swedish university. The data were collected during the period 1993-2002. Latent and manifest content analyses were used.

FINDINGS

Four categories were identified in the data. 'To do good for others', with the sub-category 'to care for others', was most frequent over time and quite stable. The category 'to be competent and skilled' was frequent and increased over time. 'To have professional courage and pride' and 'to seek professional development' were mentioned to lesser extent and showed a slight increase over time. The meaning of being a good nurse grew in complexity over time and informants' professional awareness seemed to increase, especially concerning 'to be competent and skilled'.

CONCLUSION

Attention needs to be paid both to nursing education and practice. Clinical supervision given by nurses with Master's degrees is suggested in order to convey positive attitudes towards nursing development and research into practice. Further studies are needed to compare what 'a good nurse' means to graduate nurses and how they actually behave when performing good nursing care.

Career Intentions of Nursing Students and New Nurse Graduates: A Review of the Literature

This paper highlights findings from a literature search to examine the role of nursing education in preparing nurses to meet healthcare demands. The review focused on nursing students’ perceptions of nursing and whether these views change during their nursing studies and impact workplace preferences. Nursing students often enter their program with preconceived ideas of where they want to work following graduation. Large urban hospitals were favored over community care because of the perceived opportunities for support. Of particular importance were the negative views relating to care of elderly patients. Unless attitudes are changed during their nursing studies, they may affect initial job selection. Implications for nursing education include provision of educational experiences that foster an optimistic career outlook in areas where there is a growing need for nursing services. More research is needed to determine how to enable appropriate learning experiences when there are limited resources and practice placements.

The Nursing Extern Program

Within the present context of a shortage of nursing personnel, it seems crucial for organizations to find strategies that facilitate the transition from the student to the nurse role in order to recruit and retain caring and competent professionals. Early exposure to clinical nursing practice can (1) promote an appreciation of the organization and functioning of the clinical unit, (2) facilitate the application of knowledge and acquisition of nursing interventions, and (3) engage motivated nursing students in the learning process. L'Ordre des Infirmières et Infirmiers du Québec initiated the Nursing Extern Program (the Program) to ease the severe nursing shortage, which was expected to worsen over the summer. The Program was seen as a way for students to consolidate the learning acquired during clinical rotations. Nursing students were employed as externs over the summer period. Within the confines of the Program, nursing students had the opportunity to practice 21 nursing care activities while under the direct supervision of an expert nurse. This article describes the L'Ordre des Infirmières et Infirmiers du Québec Program and identifies the key elements of a hospital-based program. In the first 2 years of implementation, the Program retained 62% of the externs as graduates.

Caring: the socialisation of pre-registration student nurses: a longitudinal qualitative descriptive study

BACKGROUND

This study explores the impact of the process of socialisation on pre-registration student nurses views about care, and their personal ability to cope with becoming a nurse.

OBJECTIVES

It aims to identify the effect time has on participants attitudes and views of care and becoming a nurse, during pre-registration nurse training, by using a descriptive longitudinal qualitative design.

SETTING

Data collection took place within the School of Health or on student's clinical placement areas, using a random sample of 16 pre-registration student nurses obtained from a convenience sample of 52 volunteers.

METHODS

Participants were involved in two semi-structured in depth interviews, the first 6-9 months after entering nurse training and the second 6-9 months prior to completion. Interviews were tape recorded, transcribed verbatim and analysed using Morse and Field's (1996) four stages of analysis.

RESULTS

Identified changes between data collection stages suggest socialisation results in a loss of idealism about care within nursing, as well as the identification of negative aspects of care. Loss of care is linked to increased abilities to cope with the nursing role, although this is not uniform and some participants clearly discriminate and reject negative exposures. In conclusion this study identifies an under recognised dichotomy between the caring ethos of professional nursing and the professional socialisation processes student nurses are subject to, which directly mitigate against the individual nurses abilities to care.

A comparison of nurse teachers' and student nurses' attitudes toward hospitalised older adults

Studies have demonstrated that gerontological content can have a positive effect on student nurses' attitudes toward older adults. However, few studies have attempted to investigate nurse teachers' attitudes toward older people. Yet authors acknowledge the importance of both clinical nurses and teachers in the socialisation process. The aim of this study is to compare the attitudes of student nurses with those of nurse teachers toward working with hospitalised older adults. A questionnaire was developed, piloted and refined until the final outcome was a 20 item questionnaire. The questionnaire was distributed to nurse teachers (n=59); first year student nurses who had completed their first term of theory (n=82); student nurses who had completed a theory and a clinical placement (n=80). Statistical analysis of the data included ANOVA with a post hoc comparison. Results indicated that nurse teachers were most positive for a number of items on the questionnaire. However, they were least positive about their role in promoting an interest in older people and keeping up to date about advances in the field of older people. It is the responsibility of both teachers and clinical staff to dispel stereotypes that student nurses bring in to nursing.

'It's not like the wards'. Experiences of nurses new to critical care: a qualitative study

BACKGROUND

Critical care is both emotionally and intellectually challenging, yet little is currently known about the experience of nurses' new to this environment.

AIMS

The aims of the study were to: 1. Explore the experience of nurses' new to critical care. 2. Identify what factors influence the nurses' experiences during this time. 3. Evaluate methods used to facilitate nurses' development such as education and preceptorship.

METHODS AND PARTICIPANTS

This longitudinal qualitative study was undertaken using hermeneutic phenomenology and involved all nurses (n=14) recruited to the unit during two cohort intakes in 2002. Data collection was by means of semi-structured interviews at one, three and six months. All interviews were tape recorded, transcribed, and analysed for emerging themes and concepts.

FINDINGS

Participants described a variety of unique experiences throughout the interviews, many of these related to four key themes: support, knowledge and skills, socialisation and moving on. There were also a number of key factors influencing these experiences including foundation programme, support, preceptors, staff and pre-requisites. Although strategies such as education and preceptorship were positively evaluated, areas for improvement were also identified.

CONCLUSION

This study captures the unique experiences of nurses new to critical care and demonstrates the complexity of socialisation to the critical care milieu.

Attitudes towards hospitalized older adults

BACKGROUND

A number of studies have explored nurses' attitudes toward older people. However many of those have produced inconclusive results. Moreover dated attitudinal measures have been used to answer a broad range of questions relating to older people.

AIM

The aim of this paper is to report a study examining whether negative attitudes and beliefs toward older adults persist.

METHODS

Focus group interviews were used identifying factors which may influence attitudes and beliefs both negatively and positively. Nine Registered Nurses from care of older adult areas, four from acute areas, six nurse teachers, and 17 nursing students participated in the study. Ten themes were identified from the findings.

FINDINGS

The findings show that the student nurses had varying experiences in older adult settings. Some of which had the effect of turning them away from the specialty. However, nurses who worked with older adults were very positive about their work and the nursing opportunities they had to offer student nurses. They were rather critical of the content of the pre-registration curriculum, which they perceived to over-rely teaching the negative aspects of ageing, and there was also criticism of the currency of teachers' knowledge. Nurses who worked in acute settings also did not escape criticism, in that they were identified as attributing a lack of sense of humour to older adults. The limitations include the small sample size although it is congruent with qualitative research.

CONCLUSIONS

All nursing staff need to be more aware of their influence on the attitudes of student nurses toward older people. Good practice includes the ability to demonstrate that older people in hospital settings are valued. Nurse teachers need to review the way they prepare students for this specialist work in order to avoid inadvertently conveying negative attitudes.

Nursing Students’ Perceptions of Nursing as a Subject and a Function

This study, conducted at one University College in Norway, describes nursing students' perceptions of nursing as a theoretical subject and as a function. A descriptive/explorative design was selected. Thirty students from the first year and 30 students from the third year wrote down their perceptions in response to four open-ended questions. Fifteen students from each year (n = 30) were interviewed. A qualitative content analysis was performed. According to the results, the content of the subject of nursing encompasses various fields of knowledge; therefore, the subject of nursing is unclear. The findings indicate that the third-year students either did not gain new insights on the subject or were still unable to verbalize such insights, contrary to the expectations expressed in the curriculum. Regarding the functions of nursing, the first-year students believed there is considerable report writing, which affected their nursing care, but the third-year students believed nurses are obliged to lead and plan nursing care. The students' perceptions of the content of the subject of nursing related only in part to professional functions, both at the beginning and end of their nursing education.

Mature women's experiences of preregistration nurse education

BACKGROUND

The government of the United Kingdom is encouraging more flexible recruitment strategies to overcome the shortage of qualified nurses. Mature women returning to education, often after completing their families, are a major target, but there has been little evaluation of their experiences as higher education students of nursing.

AIM

The aim of the study was to follow-up a previous quantitative study of mature women students' outcomes on preregistration diploma courses in order to gain a deeper understanding of their experiences, and consider ways in which their needs might be addressed.

METHODS

Five focus groups were conducted in one higher education institution, and data were analysed using thematic analysis, assisted by the 'spike' feature of Word for Windows.

FINDINGS

Three major themes were identified: 'Didn't know what to expect', 'Reality shock' and 'Learning the game'. Subthemes of 'Learning the game' were 'Academic study', 'Practice placements and shift work', 'Managing the effect of course workload on domestic roles', 'Personal growth and changing relationships', and 'Support systems and friendships'.

CONCLUSIONS

The findings are discussed in relation to reports of women's experiences in higher education in general. We conclude that the situation and needs of mature women preregistration nursing students are such that fundamental curriculum redesign is needed so that they can participate in higher education in ways that allow integration of their family and student lives, and permit them to benefit from the higher education experience in the same ways as younger students. The study is limited by its local nature, but the findings mirror those of other work, giving reassurance of its wider applicability. Recommendations are made for changes in the philosophy and organization of future programmes to improve their appropriateness and acceptability to mature women nursing students.

The presence of nursing students and its influence on the quality of care provided by staff nurses

BACKGROUND

Research on the field practice of nursing students has focused mainly on the effects of this experience for the students. Although it has been suggested that the presence of students may influence the behavior of practitioners, this has yet to be empirically validated.

PURPOSE

The purpose of the study was to test the hypothesis claiming the presence of students in hospital wards will improve the quality of care given by the nurses. The theoretical model supporting this was based on 2 main concepts: self-focus and social role.

METHOD

Systematic observations were carried out in 15 hospital wards in a medical center in Israel. Observations were conducted according to a strict protocol based on the Israeli Standard Nursing Procedures. Observers graded nursing activities on a specially designed quality of care scale, which allowed for the computing of "quality of care" indices. A within-subject design was used, in which each subject was compared with his or her own performance (with/without students).

RESULTS

The results were consistent with the hypothesis. In the presence of students, nurses provided higher quality care when compared with their own performance in the absence of students.

CONCLUSIONS

The presence of students seemed to have a beneficial effect on nurses' performance and quality of care. Data analysis supported the hypothesized theoretical model. Implications for further research and practice are discussed.

Certificate-Trained Staff Nurses' Perceptions of the Changes in Nursing Education in Ireland From Certificate to Diploma Level

Over the past decade, nursing education in Ireland has experienced revolutionary changes, during which the hospital-based apprenticeship certificate model of nurse training was replaced with a college (diploma level) education model. This article reports on a qualitative study that explored traditionally trained staff nurses' perceptions of their role in the facilitation of learning for diploma students in clinical contexts and their attitudes toward such students. A central issue that emerged was participants' perceptions of the diploma program vis-à-vis the traditional apprenticeship training to which they themselves had been exposed. Guided by the strategy of grounded theory, in-depth interviews were conducted with 16 participants, and interview transcripts were analyzed. Three subthemes emerged: feeling the old way was best, confusion and uncertainty, and acceptance of change. These subthemes reflect the finding that although certificate-trained staff nurses thought the traditional apprenticeship model of educating nurses was superior and expressed confusion and uncertainty about the concept of supernumerary status, a sense of acceptance of change also mediated their accounts.

Being a good nurse and doing the right thing: a qualitative study

Despite an abundance of theoretical literature on virtue ethics in nursing and health care, very little research has been carried out to support or refute the claims made. One such claim is that ethical nursing is what happens when a good nurse does the right thing. The purpose of this descriptive, qualitative study was therefore to examine nurses' perceptions of what it means to be a good nurse and to do the right thing. Fifty-three nurses responded to two open-ended questions: (1) a good nurse is one who...; and (2) how does a nurse go about doing the right thing? Three hundred and thirty-one data units were analysed using qualitative content analysis. Seven categories emerged: personal characteristics, professional characteristics, patient centredness, advocacy, competence, critical thinking and patient care. Participants viewed ethical nursing as a complex endeavour in which a variety of decision-making frameworks are used. Consistent with virtue ethics, high value was placed on both intuitive and analytical personal attributes that nurses bring into nursing by virtue of the persons they are. Further investigation is needed to determine just who the 'good nurse' is, and the nursing practice and education implications associated with this concept.

Communication skills training in healthcare: a review of the literature

This article is based on a literature review carried out as part of a study of communication skills teaching in pre-registration nurse education in England in 2000. The rationale for the study was two-fold: the history of patient dissatisfaction with communications and information-giving in the National Health Service and concern about skills deficits in alumnae of recent educational programmes. A lack of research evaluating communications skills training was found in relation to both pre- and post-registration nursing education, and in other healthcare disciplines. Furthermore, the research that has been done is limited by methodological deficiencies in many cases. Recommendations are made concerning improved methods for future research evaluating communication skills training.

Communication skills: some problems in nursing education and practice

This article is based on a literature review carried out as part of a study of communication skills training in pre-registration nursing education in England in 2000. A systematic literature search was conducted and 200 articles were found that were relevant to the study. Definitional problems were found, with terms such as communication skills and interpersonal skills being used interchangeably. The term communications strategies is suggested to overcome these problems, as it reflects the logical organization of a number of different communication skills within a theoretical or empirical framework. Problems in current communication skills teaching and social barriers to using communication skills in practice are discussed. It is concluded that problems continue to exist in these areas and that an emphasis on both aspects is needed if patient and staff satisfaction is to be improved.

'Knowing your place': student midwives' views of relationships in midwifery in Ireland

OBJECTIVE

to explore the feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences.

DESIGN

phenomenology, using the technique of triangulation in a number of ways.

SETTING

all seven midwifery schools in Southern Ireland.

PARTICIPANTS

all students in the first intake of 1995 in every midwifery school in Ireland (n=125).

DATA COLLECTION

individual and group interviews, diary-keeping and questionnaires.

KEY CONCLUSIONS

the findings presented in this paper illustrate the students' views of their relationships with qualified midwives and obstetricians.

IMPLICATIONS FOR PRACTICE

an attitude of respect for all students needs to be fostered in hospitals educating midwives if we are to produce caring midwives in the future. The new, extended programme of midwifery education in Ireland should include an emphasis on communication skills and conflict management. A re-organisation of the hierarchical structures evident in midwifery management would lead to an improvement in the experiences of students and childbearing women alike.

Measuring the socialization of graduate and diplomate nurses using the Corwin Role Orientation Scale

The nature of United Kingdom (UK) nursing education has changed significantly as the responsibility has been transferred from hospitals to the University sector. More information is needed on the outcome of the Project 2000 diploma and degree courses given the rapidly changing health care context. This paper focuses on the role socialization of graduate and diploma nurses. As part of a larger study, this research investigated the role orientations of 52 nursing graduates and 28 diplomates from two different universities at three time points; on graduation and at 6 and 12 months postgraduation. The Corwin Role Orientation Scale was selected and modified for the study. It comprised of three separate scales measuring professional, bureaucratic and service orientation. The data from the two groups of nurses were examined to identify nurses' ideal role orientations and role discrepancies over the transitionary period from graduate to qualified nurse. Although the results showed observed differences between the groups over time, none of these differences were statistically significant. The findings raise a number of questions about the value of the instrument as a measure in the contemporary nursing context. Furthermore, each of the Corwin subscales had a low internal reliability. A possible explanation may be that the instrument, which was developed in the United States of America (USA) in the 1960s, and modified, for this study, has little relevance for contemporary UK nursing. The study findings are also limited by the small size of the sample. In spite of these limitations, the study suggests there are few differences between the role orientations and socialization experiences of UK nursing graduates and diplomates. Indeed, both programmes commonly take place in university settings and students receive the same amount of clinical experience. Further instrument development and exploratory research is recommended to identify the role socialization and orientations of UK nurses through larger national studies.

"Is there a place for "care" within nursing?"

This paper explores the assumption that care and nursing are both interchangeable and symbiotic concepts, and argues through exploration of the literature on the nature of care, its relationship to nursing, the socialisation process, and the personal human difficulties nurses experience when carrying out their daily role, that this assumption needs serious reconsideration. This has major implications for the nursing profession when attempting to define its roles and boundaries, as current views appear inconsistent with each other and in conflict with the actual process of nursing, and need to be resolved to reflect the actual practice of nursing and work of the nurse.

A phenomenological study of early nursing experiences in Hong Kong

The experience of primary professional socialization is crucial for neophytes to learn to become a nurse. These early nursing encounters may also have long-term effects on professional development of individual nurses. However, research into the early experiences of nurses has been poorly documented. This study endeavours to reveal the early lived nursing experience amongst a group of nurses in Hong Kong. This study adopts a phenomenological approach which involves the thematic analysis of the critical incidents provided by 77 subjects. Findings revealed that incidents associated with death and dying, and clinical learning embracing interpersonal relations and professional development, were the most memorable events. Nurses were in general not equipped adequately to communicate with the dying and the grieving relatives. The subjects disclosed that positive clinical encounters confirmed their value of nursing work and motivated them to stay in the profession. Conversely, the negative experiences made them seriously consider leaving nursing. A number of implications for nursing education have been drawn from the research findings.

Student midwives' views of 'learning to be a midwife' in Ireland

OBJECTIVE

To explore the opinions, feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences.

DESIGN

Quantitative and qualitative methods. A phenomenological approach was used to guide the qualitative section of the study.

SETTING

All seven midwifery schools in Southern Ireland.

PARTICIPANTS

All students in the first intake of 1995 in every midwifery school in Ireland (n = 125).

DATA COLLECTION

Individual and group interviews, diary-keeping and questionnaires.

KEY CONCLUSIONS

The findings presented in this paper illustrate the students' views of their education. Students perceived themselves as part of the workforce and believed that their educational needs were denied. They were given little clinical teaching and guidance and were not assisted to learn the skills of decision-making or judgement. Much of their learning took place by trial and error. The 13 weeks allocated for theoretical input in the midwifery education programme in Southern Ireland is far too short and many students thought that time was wasted. Relationships with the teaching staff were good, although some authoritarian attitudes were evident and teaching did not appear to be student-focused.

IMPLICATIONS FOR PRACTICE

Theoretical teaching needs to be broadened and thought given to the integration of theory and practice. Clinical teaching is a necessity throughout the two-year programme and opportunities to teach while giving care should be identified and utilised. The use of prepared mentors, sufficient support staff and longer allocations to each area are recommended.

The impact of 'Project 2000' educational reforms on the occupational socialization of nurses: an exploratory study

There is much in both nursing and sociological literature concerning the socialization of students into health care professions. In the case of nursing, concern has been expressed at the disparity between the values espoused by the educational establishment and those in the clinical areas. This study aimed to explore the changes in nursing occupational socialization since the implementation of recent educational reforms. Ethical approval was obtained from the local Research and Ethics Committee. The sample (n = 18) was drawn from qualified nurses working in a range of departments within three Welsh hospitals, half had undergone traditional training and half had received Project 2000 education. Data collection and analysis techniques were based on a grounded theory approach; this approach was deemed appropriate in that it allows the possibility of developing fresh perspectives on the subject without being too constrained by earlier studies. A strongly emerging theme from the data was that the nature of nursing socialization was related to the work contexts in which it was experienced; in particular respondents offered sharply contrasting accounts of nursing culture in 'acute' and 'chronic' areas of health work. The process of socialization was found to be harsher in acute areas with numerous instances of negative sanctions used to ensure compliance to ward culture, whilst in chronic areas occupational socialization was a more satisfactory process and nurses experienced less dissonance between ward and educational establishments. The size of this study mitigates against any firm conclusions; however, the early indications suggest that it would be a fruitful area for further research with a wider sample group drawn from diverse areas. This exploratory study suggests that the location of nursing work, in terms of whether it is in acute or chronic areas, is a determining factor in the experience of contemporary occupational socialization of nurses.

Skills competency in nurse education: nurse managers' perceptions of diploma level preparation

This paper reports on part of a national study conducted between 1994 and 1996, the overall aim of which was to examine the 'fitness for purpose' of the Project 2000 nursing education reforms. The study used multiple methods of data collection, including an individual and group interview study of nurse managers (n = 132) and a national survey of Project 2000 diplomates and traditionally prepared registered nurses (n = 5417). Findings in relation to the managers' expectations and experiences of diplomates are presented. This includes views on the level of skills achievement and skills acquisition of diploma level education. The qualities of the diplomates are discussed and this includes those areas where the skills of the diplomates are felt to achieve what is required of the role. Also included is an exploration of those skills which the managers felt fell short of expectations. Managers raised the long-standing concerns of clinical skills and competencies and discussed these in relation to the changing health care environment and the relative roles of other health care workers. The conclusions highlight the need to identify what could be seen as the 'core skills' required of a registered nurse and the need to explore the environment in which the diplomate takes up first appointment.

The professional socialization of diploma of higher education in nursing students (Project 2000): a longitudinal qualitative study

This paper presents a new theory of professional socialization in relation to diploma of higher education in nursing students (Project 2000). It was derived from a 3-year, grounded theory, longitudinal study exploring the effects of supernumerary status and mentorship on students undertaking practice placements. A purposive sample of 17 students was used. Ten students volunteered to be interviewed on five separate occasions throughout their course and to keep a diary to record their experiences of mentorship during their practice placements. Their diary acted as an aide memoir during their tape-recorded interviews. The other seven students participated by diary only and kept written accounts of their experiences of being supernumerary and having a mentor whilst on practice placements. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that the mentor is the linchpin of the students' experience and that some students develop intuition much earlier than previous work has stated.

Toward building an international consensus in professional values

Although the importance of professional values has been espoused and national codes for nurses exist, there is a lack of systematic study to ascertain the commonalities of values among professional nurses. As part of a larger international study of professional values, nursing students from England and the USA (n = 130) were surveyed to determine congruence of values. The Professional Values Scale (PVS) instrument was used to collect data. Results showed a high degree of congruence among nursing students. The incongruencies found may be related to cultural differences in education and practice.

Project 2000: perceptions of the philosophy and practice of nursing: shifting perceptions--a new practitioner?

This is the first of two papers which address aspects of the findings of a large scale study commissioned by the English National Board which set out to examine the impact of Project 2000 on perceptions of the philosophy and practice of nursing. The findings presented here suggest that there have been fundamental shifts in perceptions of the nature and discipline of nursing. Students and diplomates of the course perceive themselves as knowledgeable doers, with their practice well grounded in theory and research. They value the interpersonal skills teaching and place the patient firmly at the centre of care delivery, viewing the patient holistically and being prepared to be fierce patient advocates where necessary. It is difficult to determine the extent to which these shifts can be attributed to the Project 2000 course, although the Project 2000 approach to education appears to be an important factor.

Socialization into Nursing: Nursing Students as Learners

In this article, we describe how the functionalist and interactionist approaches to socialization are exemplified in the learning experiences of nursing students in a 4-year baccalaureate program. A qualitative longitudinal exploratory research design was used to study the socialization of baccalaureate nursing students in a large western Canadian university. The findings suggest that student learning reflects a combination of functionalist and interactionist approaches, with the relative emphasis of each approach varying over the 4 years. In the first year, functionalist learning predominates as students learn the "ideal." In second and third year, students are confronting and adapting to reality, which requires a more interactionist approach. Fourth year students look beyond their practice situation as they anticipate and prepare for a reality beyond the student world. This article concludes with implications for nursing education.

Key influences on the professional socialisation and practice of students undertaking different pre-registration nurse education programmes in the United Kingdom

A principal aim of pre-registration nurse education programmes is the process of effective socialisation of students into the professional role. Key influences on the professional socialisation and practice of students undertaking such programmes were explored using a semi-structured interview approach (N = 99). This work formed part of a major comparative study of outcomes of pre-registration nurse education programmes in the United Kingdom. Analysis revealed differences between the programmes regarding positive influences of the respective courses; therapeutic influences of the practice environment; modelling performance on exemplars of high quality practice; and the identification of teachers within the educational setting and nurses in practice as key persons. This study has confirmed that the positive influence of the education programmes and the practice environment as well as high quality role models from both education and practice establishments are critical to the professional socialisation of student nurses.

The curriculum evolution and Project 2000: a critical examination

The changes in nursing education underway in the UK and the USA are designed to educate a new type of practitioner. These new practitioners will be emancipated, critically reflective, creative and autonomous in their practice. This paper looks at the progress of the revolution, with particular reference to the UK, by critically examining the literature arising out of it. The implications for nursing education and educators are examined.