Belongingness: A critique of the concept and implications for nursing education

Views and perceptions of nursing students on their clinical learning environment: teaching and learning

INTRODUCTION

The clinical learning environment constitutes an initial area of professional practice for nurses and student opinion contributes to its improvement.

PURPOSE

The assessment of students' views and perceptions of a Greek nursing school on their clinical learning environment.

MATERIAL AND METHODS

The study was concurrent and included 196 students. We used the published questionnaire "Clinical Learning Environment Inventory (CLEI)" which is a tool for identifying and assessing Nursing students' perceptions of the psychosocial characteristics of their clinical learning environment. The questionnaire was anonymous and completed by the students themselves during their clinical training at the hospital. We conducted inductive and descriptive statistics. The level of statistical significance was set at p<0.05. The statistical program SPSS 16.0 was used.

RESULTS

The highest mean score for the Actual Clinical Learning Environment was observed in the scales of "Personalization" (23.97) and "Task orientation" (23.31) while for the Preferred Clinical Learning Environment in the scales of "Personalization" (27.87), "Satisfaction" (26.82) and "Task orientation" (26.78). The lowest mean score for the Actual Clinical Learning Environment was found in the scales of "Innovation" (19.21) and "Individualization" (19.24) while for the Preferred Clinical Learning Environment in the scales of "Individualization" (22.72) and "Involvement" (24.31). Statistically significant positive correlation was found between "Satisfaction" and all other scales of the CLEI.

CONCLUSIONS

There is a noticeable gap between the expectations and reality of the clinical learning environment for the students in nursing. Reorganization of the educational framework is needed with an emphasis on innovation and individualization.

Workplace learning through peer groups in medical school clerkships

PURPOSE

When medical students move from the classroom into clinical practice environments, their roles and learning challenges shift dramatically from a formal curricular approach to a workplace learning model. Continuity among peers during clinical clerkships may play an important role in this different mode of learning. We explored students' perceptions about how they achieved workplace learning in the context of intentionally formed or ad hoc peer groups.

METHOD

We invited students in clerkship program models with continuity (CMCs) and in traditional block clerkships (BCs) to complete a survey about peer relationships with open-ended questions based on a workplace learning framework, including themes of workplace-based relationships, the nature of work practices, and selection of tasks and activities. We conducted qualitative content analysis to characterize students' experiences.

RESULTS

In both BCs and CMCs, peer groups provided rich resources, including anticipatory guidance about clinical expectations of students, best practices in interacting with patients and supervisors, helpful advice in transitioning between rotations, and information about implicit rules of clerkships. Students also used each other as benchmarks for gauging strengths and deficits in their own knowledge and skills.

CONCLUSIONS

Students achieve many aspects of workplace learning in clerkships through formal or informal workplace-based peer groups. In these groups, peers provide accessible, real-time, and relevant resources to help each other navigate transitions, clarify roles and tasks, manage interpersonal challenges, and decrease isolation. Medical schools can support effective workplace learning for medical students by incorporating continuity with peers in the main clinical clerkship year.

Supporting student nurses in practice with additional online communication tools

Student nurses' potential isolation and difficulties of learning on placement have been well documented and, despite attempts to make placement learning more effective, evidence indicates the continuing schism between formal learning at university and situated learning on placement. First year student nurses, entering placement for the first time, are particularly vulnerable to the vagaries of practice. During 2012 two first year student nurse seminar groups (52 students) were voluntarily recruited for a mixed method study to determine the usage of additional online communication support mechanisms (Facebook, wiki, an email group and traditional methods of support using individual email or phone) while undertaking their first five week clinical placement. The study explores the possibility of strengthening clinical learning and support by promoting the use of Web 2.0 support groups for student nurses. Results indicate a high level of interactivity in both peer and academic support in the use of Facebook and a high level of interactivity in one wiki group. Students' qualitative comments voice an appreciation of being able to access university and peer support whilst working individually on placement. Recommendations from the study challenge universities to use online communication tools already familiar to students to complement the support mechanisms that exist for practice learning. This is tempered by recognition of the responsibility of academics to ensure their students are aware of safe and effective online communication.

Constructing nurses' professional identity through social identity theory

The profession of nursing continues to struggle with defining and clarifying its professional identity. The definitive recognition of nursing as a profession was the moving of training from the hospital apprentice model to the tertiary sector. However, this is only part of the story of professional identity in nursing. Once training finishes and enculturation into the workplace commences, professional identity becomes a complicated social activity. This paper proposes social identity theory as a valuable research framework to assist with clarifying and describing the professional identity of nurses. The paper outlines the key elements of a profession and then goes on to describe the main concepts of social identity theory. Lastly, a connection is made between the usefulness of using social identity theory in researching professional identity in nursing, recognizing the contextual nature of the social activity of the profession within its workplace environment.

The South African Military Nursing College Pupil Enrolled Nurses’ experiences of the clinical learning environment

The study focused on the clinical learning experiences of Pupil Enrolled Nurses (PENs) within the military health service. The purpose of the research was to explore and describe the learning experiences of PENs within the Military health clinical learning environment. An explorative, descriptive, contextual design which is qualitative in nature was used to guide the study. The military as a training institution prides itself on preparing nurses both as soldiers and nurses, this could be both challenging and exasperating for students, as the scopes are diverse. Being notably very hierarchical, the military’s rules constantly take precedence over nursing rules. For the duration of nursing training, students are allocated in the clinical learning area to acquire competencies such as problem solving, cognitive and psychomotor skills (Kuiper & Pesut 2003:383). Students learn how to merge theory and practice and apply theories in the practical sense. This is however, not done in isolation from the military codes, as they are intertwined. Attendance of military parades and drills are incorporated during this phase. This could create missed opportunities from the clinical learning as students are expected to leave the clinical setting for this purpose. Three focus group sessions were conducted and the experiences of the students, as narrated by themselves, yielded valuable insights. The researcher wrote field notes and assisted with the management of the audio tapes for easy retrieval of information. Data was analysed by the researcher, independent of the cocoder. Two themes relating to the PENs’ learning experiences emerged from the data analysed: (1) facilitators of clinical learning, (2) and barriers to clinical learning. The findings obtained depicted those factors which facilitated and obstructed student learning. These findings made it possible for the researcher to make recommendations concerning positive interventions which could be taken to enhance learning.Die studie het gefokus op die kliniese leerervarings van leerling-ingeskrewe verpleegkundiges (LIV’s) in die militêre gesondheidsdiens. Die doel met die navorsing is om die kliniese leerervarings van LIV’s binne die militêre gesondheidsomgewing te verken en te beskryf. ’n Verkennende, beskrywende, kontekstuele ontwerp, kwalitatief van aard, is gebruik om die studie te rig. As ’n opleidingsinstituut roem die weermag hulle op die opleiding van verpleegkundiges as soldate, en nie slegs verpleegkundiges nie. Dit kan uitdagend sowel as frustrerend vir studente wees omdat die omvang van hierdie opleiding so divers is. In die weermag, bekend vir sy hiërargie, geniet militêre reëls gedurig voorrang bo verpleegkundige reëls. Vir die duur van die verpleegopleiding word studente aan die kliniese leerareas toegewys om vaardighede soos probleemoplossing en kognitiewe en psigomotoriese vaardighede te bekom (Kuiper & Pesut 2003:383). Studente leer hoe om teorie en praktyk te verenig en teorie in die praktyk toe te pas. Dit word egter nie geïsoleerd van militêre kodes gedoen nie, aangesien dit alles vervleg is. Bywoning van militêre parades en drilsessies moet in hierdie fase geïnkorporeer word. Dit kan tot verbeurde kliniese opleidingsgeleenthede lei, aangesien daar van studente verwag word om die kliniese omgewing vir hierdie doeleindes te verlaat. Drie fokusgroepsessies is gehou en die ervarings van die studente, soos deur hulleself vertel, het waardevolle insigte gelewer. Die navorser het veldnotas gemaak en was behulpsaam met die hantering van bandopnames om die herroeping van inligting te vergemaklik. Die navorser het die data onafhanklik van die medekodeerder geanaliseer. Twee temas met betrekking tot die leerervarings van LIV’s het na afloop van die data-analise aan die lig gekom: (1) fasiliterende faktore vir kliniese leerervaring, (2) struikelblokke tot kliniese leerervaring. Die bevindinge dui op faktore wat die studente se leerervaring fasiliteer, asook struikelblokke tot leerervaring. Na aanleiding van hierdie bevindinge het dit moontlik gemaak vir die navorser om aanbevelings te maak aangaande positiewe intervensies wat toegepas kan word ter bevordering van die leerervaring.

Development and psychometric testing of the Ascent to Competence Scale

AIM

This paper reports the development and psychometric testing of the Ascent to Competence Scale, an instrument designed to measure nursing students' perceptions of the quality of their clinical placement experience.

BACKGROUND

The key purpose of clinical placements is to facilitate students' learning and progress toward the attainment of competence. The attainment of competence requires personal commitment and active involvement of students; support and guidance of clinical and academic staff; and clinical environments that are welcoming and inclusive of students.

METHOD

The items for the Ascent to Competence Scale were identified following a critical review of the literature. Content and face validity were established by an expert panel. During 2010 the instrument was tested with third year nursing students (n=88) from one Australian university. Exploratory factor analysis with promax oblique rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability.

RESULTS

The final scale demonstrated satisfactory internal consistency (alpha 0.98). Exploratory factor analysis yielded a three-component structure termed "Being welcomed"; "Belongingness" and "Learning and competence". Each subscale demonstrated high internal consistency: 0.89; 0.96; and 0.95 respectively.

CONCLUSION

The Ascent to Competence Scale provides a fresh perspective on clinical placements as it allows for the relationship between belongingness, learning and competence to be explored. The scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work.

RELEVANCE TO CLINICAL PRACTICE

The Ascent to Competence Scale profiled in this paper will be of benefit to both educational and healthcare institutions. The use of a quantified yardstick, such as the Ascent to Competence Scale, is important in evaluating the efficacy of programs, placements and partnerships between higher education and health services.

Preparing nursing students to be community health practitioners

There is currently a greater emphasis on community-based health care and, with that, a shift in focus for pre-registration nursing education within policy documents and standards (Nursing and Midwifery Council (NMC), 2010). This paper reports a mixed methods study that examined the implementation of an initiative that enabled third year adult field student nurses the opportunity to spend the final year of their education within the community setting. Using a questionnaire and focus groups, the views of students at the end of the 12-month period were captured. The diverse approach to the placement provision enabled undergraduate nurses to be fit for purpose and ensured that practice at the point of registration would meet the challenges of working in the community setting. Students developed confidence through the diverse placement provision, opportunities for lone working and the support provided by mentors. This model of placement provision is worthy of consideration by service leads and curriculum planners, particularly in view of the present focus of the NMC's (2010) standards for pre-registration nursing programmes.

Evaluating Hub and Spoke models of practice learning in Scotland, UK: a multiple case study approach

BACKGROUND

Most of UK students' practice learning experience is based on a rotational placement model which often leads to students lacking confidence and feeling anxious about the complexities of the care environment.

OBJECTIVES

To evaluate the impact of Hub and Spoke model(s) of clinical practice placement across geographically diverse locations, with a particular focus on enhancing the student practice learning experience.

DESIGN

Multiple case study design.

SETTING & PARTICIPANTS

Comprised undergraduate student nurses from Adult, Learning Disability and Mental Health programmes from 3 Scottish Schools of Nursing.

METHODS

A mixed methods approach which included quantitative and qualitative date tools.

RESULTS

All three Hub and Spoke models shared two broad findings: 1) In the three Hub and Spoke models detailed in this paper, there is a continuum of student led learning which supports the process with opportunities for individual students to be positively innovative and creative in their learning approaches. Depth of learning was achieved in two ways; a) the method in which Hub placements are organised, managed and structured and, b) the depth of empathy and sensitivity to the individual at the centre of the care. 2) Placement capacity is increased: The classification of placements is reviewed to produce broader categories, Engagement of mentors/enhanced student/mentor relationship.

CONCLUSIONS

Practice Learning must be seen as an academic endeavour that promotes deep, meaningful, person-centred learning rather than superficial, compartmentalised placement-centred learning.

Nursing students' perceptions of learning in practice environments: a review

Effective clinical learning requires integration of nursing students into ward activities, staff engagement to address individual student learning needs, and innovative teaching approaches. Assessing characteristics of practice environments can provide useful insights for development. This study identified predominant features of clinical learning environments from nursing students' perspectives across studies using the same measure in different countries over the last decade. Six studies, from three different countries, using the Clinical Leaning Environment Inventory (CLEI) were reviewed. Studies explored consistent trends about learning environment. Students rated sense of task accomplishment high. Affiliation also rated highly though was influenced by models of care. Feedback measuring whether students' individual needs and views were accommodated consistently rated lower. Across different countries students report similar perceptions about learning environments. Clinical learning environments are most effective in promoting safe practice and are inclusive of student learners, but not readily open to innovation and challenges to routine practices.

Factors Affecting the Self-directed Learning of Students at Clinical Practice Course for Advanced Practice Nurse

PURPOSE

The current study aimed to examine the casual relationships among belongingness during clinical practice, stress, satisfaction with clinical practice, and self-esteem, which are factors affecting the self-directed learning that results from the clinical practice of advanced practice nurse (APN) students.

METHODS

Data were collected between April 5 and May 19, 2010, from 202 students in 11 APN training institutions located in and outside of Seoul, who were selected using convenience sampling. For hypothesis testing, the collected data were analyzed using AMOS 8.0.

RESULTS

Analysis of the path coefficients in this study showed that 37% of the variation in self-directed learning could be explained by variations in the model. Self-esteem and belongingness during clinical practice directly affected the self-directed learning of APN students, and belongingness also had an indirect effect via self-esteem. However, stress and satisfaction with clinical practice had no significant mediating effect on self-directed learning. At the same time, belongingness during clinical practice was found to be a good predictive factor to explain stress and satisfaction with clinical practice.

CONCLUSIONS

This study demonstrated the hierarchical relationship among belongingness, self-esteem, and self-directed learning based on the conceptual framework developed by Levett-Jones and Lathlean, thus proving the usefulness of this framework for application in the field. Therefore, this study found that there are needs of high self-esteem and belongingness in order to improve self-directed learning for APN students in clinical practice.

Evaluation of mentorship programme in nursing education: a pilot study in Turkey

Mentorships increase the students' confidence, help ease the difficulties associated with their new environment and reality, increase self-esteem and help socialize students into the nursing role. The main objective of the programme was to support mentee students in facilitating their transition to the university and nursing. This descriptive, exploratory study was designed using Maslow's hierarchy of needs and a pre/post test Rotter's locus of control. Sixty-two (62) first-year students and fifty-eight (58) fourth-year students were eligible to be in the mentoring programme. Mentors and mentees contacted each other weekly as required to provide information and support. Nursing lecturers were available to support the mentors for regular contact over the 13 weeks of the programme. The data were collected by questionnaire for the first-year and fourth-year students. In addition, in order to determine the efficacy of the mentoring programme, Rotter's Locus of Control Scale was administered to first-year students both at the beginning and the end of the study. The majority of first-year students stated that they benefited from the programme. It was established that the mentoring programme influenced the locus of control positively. The mentoring programme may be used to improve the adaptation of nursing students to both the university and nursing profession.

Tradition meets technology: building caring community online

Community has historically provided an essential psycho-spiritual framework for nursing. Changes in communication technology pose challenges for nurses internationally who create communities across borders. This article discusses The Bamboo Bridge online community, a project responding to the global call for nursing education about the complementarity of nursing and healing traditions. The project explores how technologies such as Centra and Ning promote community building and encourage belonging in members from 5 continents and 10 countries. This article includes detailed accounts of the project design, examples of cultural diplomacy as the emerging theoretical framework, and an African member's perspective of online community.

Masters at work: a narrative inquiry into the experiences of mental health nurses qualifying with an undergraduate Masters degree

The University of Nottingham provides a unique course in the UK that enables undergraduate students to obtain a Masters degree and registration with the Nursing and Midwifery Council (NMC). The curriculum equips graduates with the skills to practice nursing with an analytical attitude and adopt both professional and humanistic values. This research aims to explore significant experiences of graduates, from the undergraduate Masters course, relating to their education and nursing practice in mental health care. A narrative approach to data collection was employed using unstructured individual interviews. Participants worked through a process of contemplation. Their commitment to working with people in a relational manner and studying at graduate level were of high importance. The process continued with assimilation to a philosophy which was intrinsic to the course, including developing therapeutic relationships, self awareness and critical thinking. Participants encountered conflict relating to a perceived dissonance between this philosophy and nursing practice. As a consequence, participants questioned mental health nursing and their abilities as nurses. Resolution occurred when participants were able to work within the constraints of the system whilst effectively realising their philosophy. The findings demonstrate the importance of supportive networks to maintain values and criticality.

The trainee assistant in nursing: a pilot exercise in building and retaining a workforce

With increasing pressures on the skilled nursing workforce, strategies need to be developed to maximise the value of the existing workforce without impacting on the quality of care delivery. This paper reports on the introduction of a Commonwealth and State subsidised program for assistants-in-nursing (AINs) to assist in addressing the global nursing shortage. The program – which has included education sessions with registered nurses about the role of the AIN, delegation and supervision, and has also sustained support to the participants throughout the duration of their employment – has delivered benefits locally to the Princess Alexandra Hospital (PAH) and, broadly, to the nursing profession. Most of the participants completing the program have chosen to continue their employment at PAH or pursue further studies in nursing. What is known about the topic?The shortage of skilled nurses means there is a need for innovative solutions to support the existing workforce. What does this paper add?The development of an assistant-in-nursing role was seen as a successful development for a Queensland hospital. What are the implications for practitioners?The trained assistants have largely remained employed in the area and 68% have gone on to further nursing education.

Improving learning in the clinical nursing environment: perceptions of senior Australian bachelor of nursing students

Learning in the clinical environment has traditionally formed an integral part of nursing education programs in Australia. In tertiary-based nursing courses today, students can spend equal or more hours learning in the clinical workplace as they do in their classroom-based studies. Developing ways to improve teaching and learning in the clinical environment can help to develop a more positive workplace culture, which in turn, has been identified as producing more effective learning outcomes for students. This quantitative study used the Clinical Learning Environment Inventory (CLEI) questionnaire (Chan, 2002) as a platform for data collection to investigate Avondale College’s (an Australian tertiary education institution) senior Bachelor of Nursing (BN) students’ perceptions of their clinical learning environment. It was highlighted that even though the students perceived that their clinical experiences were generally positive, they indicated that there was still room for improvement. With respect to the five domains of the clinical environment identified by the CLEI (personalisation, student involvement, teacher innovation, task orientation and individualisation), the students identified the personalisation and student involvement domains as the most important in generating appropriate clinical environments, and even though the students expected less in the areas of task orientation, teaching innovation and individualisation, these were the areas they saw a need for greatest improvement. Students also suggested that the development of a positive relationship with the clinical teaching staff was paramount in generating the ideal clinical environment. Finally, the study indicated that student satisfaction is increased when there is an ongoing student involvement, that is, in the words of Lave and Wenger (1991), when they become an integral part of the ‘community of practice’ in their clinical nursing placement.

'Don't rock the boat': Nursing students' experiences of conformity and compliance

AIM

This paper profiles a cross national case study that examined nursing students' experience of belongingness when undertaking clinical placements. The aim of the paper is to present selected findings that focus on the relationship between belongingness, conformity and compliance.

BACKGROUND

Literature from the disciplines of psychology, social science and nursing is presented as a background to the study.

METHODS

This was a mixed methods case study; in this paper the qualitative phase is described. Eighteen third year nursing students from two universities in Australia and one in the United Kingdom were interviewed and the data thematically analysed.

FINDINGS

Three sub themes emerged within the category of conformity and compliance. These included: Don't rock the boat; getting the RNs offside; and speaking up. Students described how and why they adopted or adapted to the teams' and institution's values and norms, rather than challenging them, believing that this would improve their likelihood of acceptance and inclusion by the nursing staff.

CONCLUSION

Further research is required to examine the subtle interplay of factors that influence nursing students' attitudes and behaviours in relation to their need to belong, how conformity and compliance are acculturated in practice, and how students can be empowered to speak out against poor practice to become assertive and confident practitioners.