The Ascent to Competence conceptual framework: an outcome of a study of belongingness

Why and when does job satisfaction promote unethical pro-organizational behaviours? Testing a moderated mediation model

This study examined the relationship between job satisfaction and unethical pro-organizational behaviours (UPB) by testing a moderated mediation model that focused on how employees' belongingness mediates the relationship between job satisfaction and UPB and how corporate ethical values moderate this mediated relationship. Our investigation included 369 employees from different organizations in Southeast China. The regression analysis revealed that job satisfaction positively influences UPB through belongingness. In addition, a moderated regression analysis indicated that low corporate ethical values strengthen not only the effect of belongingness on UPB but also the indirect effect of job satisfaction on UPB. These findings deepen our understanding of UPB by showing that individuals with a high level of job satisfaction are more likely to engage in UPB through belongingness when corporate ethical values are low. Finally, the theoretical and managerial implications of these results are discussed.

Operating Room Nurses' Perceptions of the Clinical Learning Environment: A Survey Study

BACKGROUND

Authors commonly agree that the clinical learning environment significantly affects student learning. Studies of how operating room nurses perceive the clinical learning environment during their specialist studies are sparse.

METHOD

This study aimed to examine newly graduated operating room nurses' perceptions of the clinical learning environment during their specialist education. Fifty newly graduated operating room nurses answered a questionnaire gaging their perceptions of clinical education.

RESULTS

Most participants perceived the clinical learning environment as good and highly associated with the supervisor's ability to supervise, enjoy supervision, and show interest in the participants' degree project. The management at the clinical setting, which was perceived to emphasize the importance of supervision, time allocated especially for supervision, and perceived cooperation between the University and hospital, also had an impact.

CONCLUSION

Social interactions and structures within the operating room affect how the clinical learning environment is perceived. J Contin Educ Nurs. 2018;49(9):416-423.

Belongingness and its implications for undergraduate health professions education: a scoping review

Belongingness is well recognised within higher education to have an important influence on the performance and well-being of learners. There appears to be little awareness of its importance in undergraduate health professions education. To identify how belongingness has been defined and measured, its impact on the performance and well-being of learners, and how it can be fostered in educational settings. A scoping review to map the published research in the wider higher education literature (including undergraduate health professions education). PubMed and ERIC were used. Only peer-reviewed articles in the English Language between 1996 and 2016 were included. Fifty-one relevant articles were identified with 16 related to nurse clinical education. No studies were found in undergraduate medical education or in primary care educational settings. Common features were identified within the several definitions of belongingness. A thematic analysis of articles revealed that belongingness has an important role in student motivation and learning identity formation and in facilitating positive mental health. The scoping review highlighted the importance of belongingness in higher and undergraduate health professions education, with implications for future practice and policy. Further research is recommended. There are important implications for curriculum development and delivery, including clinical placements; within secondary and primary care health professional education.

Nurse link lecturers' perceptions of the challenges facing student nurses in clinical learning environments: A qualitative study

In the United Kingdom student nurses spend approximately half of their education programme in a practical setting commonly referred to as the Clinical Learning Environment (CLE). The significant amount of time student nurses spend in CLEs, combined with reports of negative experiences, indicate that it is important to consider the challenges of learning within this environment. Nurse Link Lecturers spend up to 20% of their teaching time supporting student nurses in CLEs. Link lecturers' proximity to the CLE means that they are well-placed to articulate the challenges facing student nurses in this context. This paper reports on a study that used interviews and focus groups to collect experienced adult field Link Lecturers' views on the challenges facing student nurses in CLEs. Link Lecturers reported that students often find themselves in polarised positions of either 'fitting in' with the pressures of the environment and thereby potentially gaining 'access to learning' opportunities or 'falling out' and merely 'learning to get through' their placement. Mentors were thought to have a significant influence on student nurses' negotiation of learning. This insight is timely due to the changes in supervisory and assessment arrangements required by the new Nursing and Midwifery Council Standards (NMC, 2018).

Belongingness: Student ODPs' learning experiences in clinical placements

The aim of this qualitative study is to explore student operating department practitioners' (ODPs') experiences of belongingness in clinical placements. Belongingness has been shown to be significant for learning in clinical placements for student nurses and midwives. This study was designed to look specifically at student ODPs' experiences. Semi-structured interviews were conducted with eight student ODPs. The interviews were transcribed and coded. All student ODPs could describe clinical placement experiences where they felt they belonged and those where they felt they did not belong. Both had a significant impact on students' learning experience. Students also described their own sense of responsibility for belonging while in placement. This study provides qualitative data to help understand how belongingness can positively or negatively affect the learning experiences of student ODPs in clinical placements.

Understanding perceptions of nursing professional identity in students entering an Australian undergraduate nursing degree

Developing a professional identity is an essential transition for nursing students as they move through their undergraduate degree. Professional identity is described as a person's perception of themselves within a profession or the collective identity of the profession. The formation of a professional identity is an evolving process, shaped by the media, educational experiences and role modelling. The aim of this study was to develop a greater understanding of the perceptions that students, about to embark on their undergraduate nursing degree, had of the nursing profession. A drawing and mind mapping exercise was conducted with a convenience sample of commencing nursing students to explore how they viewed their future profession. The data underwent thematic analysis and then grouped into sub-themes and themes. Four key themes were identified, 'To be a nurse, I have to look the part', 'To be a nurse, I have to perform in a variety of roles', 'To be a nurse, I have to connect with others', and 'To be a nurse, I have to care for myself.' The formation of a strong pre-professional identity is important for nursing students due to the link between future job satisfaction and the development of a robust nursing workforce.

Educational intervention to decrease stigmatizing attitudes of undergraduate nurses towards people with mental illness

Health professionals can hold stigmatizing views about people with mental illness. In addition to being discriminatory, these beliefs cause anxiety that can affect learning in the clinical environment. A review of an undergraduate nursing curriculum introduced the Modern Apprenticeship curriculum model and provided an opportunity for an educational intervention designed to address stigmatizing beliefs about people with mental health and addiction problems. The aim of the present study was to measure the extent to which an educational intervention - guided clinical experience in an acute mental health unit during the first year of the curriculum - decreased stigmatizing beliefs of undergraduate nurses towards those with mental health and addiction issues. In a before-and-after design, Corrigan's Attribution Questionnaire was used to collect data pre- and post-guided clinical experience in an acute mental health unit. The intervention resulted in a significant positive change in stigmatizing attitudes for four of the nine factors tested. There was a non-significant positive change in three factors, while two factors showed a non-significant negative change. Using guided clinical experience as an educational intervention in the first year of an undergraduate nursing curriculum can contribute to positive change in undergraduate nurses' stigmatizing beliefs. The findings have implications for teaching of mental health content in undergraduate nursing programmes.

"I was yelled at, intimidated and treated unfairly": Nursing students' experiences of being bullied in clinical and academic settings

AIMS AND OBJECTIVES

To present findings from a study that explored nursing students' experiences of bullying in clinical and academic settings, the strategies used to negotiate bullying and recommendations for empowering future students.

BACKGROUND

Nursing students are identified as a group who are at particular risk of bullying. Numerous studies have examined students' experiences of bullying in clinical contexts by qualified nurses; however, there has been far less attention to the bullying that occurs in academic settings where the perpetrators are university staff and other students.

DESIGN

The qualitative findings presented in this paper form one component of a mixed-methods, multisite study that examined the nature and extent of bullying in one cohort of nursing students.

METHODS

A convenience sample of 29 first-, second- and third-year undergraduate nursing students from one semimetropolitan Australian university was recruited for semistructured interviews in 2014. Interview data were analysed using NVivo.

FINDINGS

Participants described multiple examples of bullying occurring in both clinical and academic settings. Perpetrators included clinicians, facilitators, academics and fellow students. Bullying ranged from incivility to physical attacks. The impact of the bullying was profound; it caused many of the participants to feel anxious and distressed, it undermined their confidence and perception of competence, and it often led them to question their career choice. Strategies described by participants to cope with or manage the bullying included avoidance, trying to "just survive" and seeking support from trusted academic staff, family and friends. No episodes of bullying were formally reported.

CONCLUSION

Bullying remains a pervasive phenomenon occurring in both clinical and academic settings. Students are, in many respects, a vulnerable and disempowered population who often fear the consequences of making a formal complaint. Thus, reporting structures and support strategies need to be re-examined, and resilience training is imperative.

RELEVANCE TO CLINICAL PRACTICE

Bullying remains a continuing concern in undergraduate nursing degrees. Efforts must be made in clinical and academic settings to heed the advice of undergraduates using broader strategies to address the issues.

Nursing students' belongingness and workplace satisfaction: Quantitative findings of a mixed methods study

BACKGROUND

The relationship between nursing students' belongingness and workplace satisfaction has received limited attention in the literature to date.

AIM

The aim of this study was to explore the relationship between, and factors that may influence final semester nursing students' need to belong, sense of belonging and workplace satisfaction while on clinical placements.

METHODS

A cross-national longitudinal multiphase explanatory sequential mixed methods study underpinned by a pragmatic theoretical framework was used for this study. A convenience sample of third-year nursing students from two Australian and one Canadian university (n=468) were recruited. Participants were asked to complete a 62 item survey which was a composite of three previously validated surveys: the 10 item 'Need to Belong Scale', the 34 item 'Belongingness Scale: Clinical Placement Experience (BES:CPE)' and the 18 item 'Nursing Workplace Satisfaction Questionnaire'. Data were analysed using descriptive and inferential statistics.

RESULTS

Key results indicated that participants wanted to have someone to turn to, and to be accepted; they found nursing work interesting and considered it worthwhile to make an effort in this meaningful job. Participants were usually comfortable to ask for and accept help but many felt discriminated against during clinical placements. Only belongingness was strongly correlated with workplace satisfaction.

CONCLUSIONS

Irrespective of site, nursing students' satisfied sense of belonging influenced their workplace satisfaction while on clinical placements. Workplace satisfaction is a key determinant of career decisions and the results from this study have the potential to inform clinical placement practices and policies and to influence beginning nurses' decisions to continue in the profession.

A sense of belonging and perceived stress among baccalaureate nursing students in clinical placements

INTRODUCTION

The rigorous efforts students put into baccalaureate nursing programs to become a professional nurse is compounded by their need to have a sense of belonging in their clinical placements. In addition, the students' perceived stress may contribute to their physiological and psychological wellbeing undermining academic achievements and confidence.

BACKGROUND

A sense of belonging and perceived stress have research history in psychological and sociological realms; but not used together in the nursing profession as applied in clinical placements. The Perceived Stress Scale is a psychological instrument used globally; however, the Belongingness Scale-Clinical Placement Experience (BES-CPE) measurement tool has not been used in published research in the United States.

METHODS

A descriptive correlational research design examining the relationship between a sense of belonging and perceived stress among baccalaureate nursing students in clinical placements. Three measurement tools were used for data collection: BES-CPE, Perceived Stress Scale (PSS-10) and demographic questionnaire. Students were able to access the online survey through SurveyMonkey®.

PARTICIPANTS

A national study was conducted using 1296 volunteer nursing students from the National Student Nurses Association (NSNA) database. These nursing students were currently enrolled in a baccalaureate nursing program, 18years of age and completed at least one clinical experience.

RESULTS

The findings from this study revealed a statistically significant low inverse relationship (r=-.277) between a sense of belonging and perceived stress among baccalaureate nursing students in their clinical placements. The findings also supported the use of BES-CPE as a reliable and valid measurement tool for nursing students in clinical placements.

CONCLUSION

The results of this study supported the concept of a sense of belonging as a fundamental human need, having a positive influence and impact on students' learning, motivation and confidence. In contrast, perceived stress has negative consequences on the students' self-concept, learning skills and competence.

The clinical learning environment in nursing education: a concept analysis

AIM

The aim of this study was to report an analysis of the clinical learning environment concept.

BACKGROUND

Nursing students are evaluated in clinical learning environments where skills and knowledge are applied to patient care. These environments affect achievement of learning outcomes, and have an impact on preparation for practice and student satisfaction with the nursing profession. Providing clarity of this concept for nursing education will assist in identifying antecedents, attributes and consequences affecting student transition to practice.

DESIGN

The clinical learning environment was investigated using Walker and Avant's concept analysis method.

DATA SOURCES

A literature search was conducted using WorldCat, MEDLINE and CINAHL databases using the keywords clinical learning environment, clinical environment and clinical education. Articles reviewed were written in English and published in peer-reviewed journals between 1995-2014.

METHODS

All data were analysed for recurring themes and terms to determine possible antecedents, attributes and consequences of this concept.

RESULTS

The clinical learning environment contains four attribute characteristics affecting student learning experiences. These include: (1) the physical space; (2) psychosocial and interaction factors; (3) the organizational culture and (4) teaching and learning components. These attributes often determine achievement of learning outcomes and student self-confidence.

CONCLUSION

With better understanding of attributes comprising the clinical learning environment, nursing education programmes and healthcare agencies can collaborate to create meaningful clinical experiences and enhance student preparation for the professional nurse role.

Psychological Sense of University Membership: An Adaptation Study of the PSSM Scale for Turkish University Students

The Psychological Sense of School Membership Scale (PSSM) is a widely used instrument to assess the sense of belonging to a school among adolescents. Despite its widespread use in middle and high school students, to date no particular adaptation study has been conducted for its use among university students. For this reason, the present study conducted an adaptation of the PSSM scale for these students. Five hundred and nine students at a Turkish university voluntarily participated in the study, and the PSSM Scale's factor structure was examined by exploratory and confirmatory factor analyses, identifying three factors representing the students' sense of university membership with acceptable internal consistencies: acceptance by faculty members (.70), belonging (.75), and acceptance by students (.76). The internal consistency of the 18-item scale was calculated as .84. As hypothesized, the convergent and discriminant validity of the scale was also tested. The self-report sense of belonging and degree of satisfaction with the university were positively correlated with the three dimensions of the scale. Also, the scores regarding the students' intention to drop out of university along with loneliness were negatively correlated with all the dimension of the PSSM scale.

Learning to ensure patient safety in clinical settings: comparing Finnish and British nursing students' perceptions

AIMS AND OBJECTIVES

To explore and compare Finnish and British nursing students' perceptions of their learning about patient safety in clinical settings.

BACKGROUND

Patient safety culture and practices in different health care organisations and clinical units varies, posing challenges for nursing students' learning about patient safety during their clinical placements. Patient safety as a growing international concern has challenged health care professionals globally requiring a comprehensive review. International studies comparing nursing education about patient safety are lacking.

DESIGN

A cross-sectional comparative study.

METHOD

The participants were final year preregistration nursing students from two universities of applied sciences in Finland (n = 195) and from two universities in England, UK (n = 158). The data were collected with the Patient Safety in Nursing Education Questionnaire and analysed with principal component analysis, Pearson Chi-Square and Mann-Whitney U tests and logistic regression.

RESULTS

Finnish nursing students had significantly more critical perceptions on their learning about patient safety in clinical settings than their British peers. A strong predictor for differences was supportive and systems-based approaches in learning to ensure patient safety. Notably, fewer Finnish students had practiced reporting of incidents in clinical settings compared to British students. In both countries, the students held learning about patient safety in higher esteem compared to their learning experiences in clinical settings.

CONCLUSIONS

Nursing students appear to want more learning opportunities related to patient safety compared to the reality in clinical settings. Learning systematically from errors in a supportive environment and having systems-based approaches to ensure patient safety are essential elements for nursing students' learning about safe practice. Finnish students seem to experience more barriers in learning about safe practices and to report errors than the British students.

RELEVANCE TO CLINICAL PRACTICE

Health care organisations and professionals with responsibilities for patient safety should seek to standardise the preparation of nursing students incorporating requisite international standards and benchmarks.

Psychometric testing of the Persian version of the Belongingness Scale-Clinical Placement Experience

BACKGROUND

Belongingness has been identified both as a fundamental human need and as a prerequisite for nursing students' clinical learning. Belongingness has also been associated with students' academic achievement, retention, self-esteem, self-directed learning, and self-efficacy. The Belongingness Scale-Clinical Placement Experience is a valid and reliable measure of nursing students' belongingness scores; however, a Persian version of this scale is not currently available.

AIM

This study aimed to translate the Belongingness Scale-Clinical Placement Experience into Persian, to evaluate its psychometric properties, and to measure the belongingness experiences of Iranian nursing students.

METHODS

Following translation and initial validity and reliability testing of the scale, 300 nursing students from three universities in Iran completed the survey. Further psychometric testing was undertaken followed by analysis of descriptive statistics.

RESULTS

Based on the results of confirmatory factor analysis two items were removed from the scale. The mean score of Persian version of the Belongingness Scale-Clinical Placement Experience was 3.21 (0.57). The whole scale had a high internal consistency (Cronbach's alpha=0.92). The alpha coefficients of the subscales of "self-esteem", "connectedness", and "efficacy" were 0.85, 0.86, and 0.80 respectively.

CONCLUSION

Similar to previous versions of the Belongingness Scale-Clinical Placement Experience, the Persian version demonstrated strong psychometric properties with strong validity and reliability, indicating its utility and appropriateness when measuring Iranian nursing students' belongingness experiences. Further testing with other cohorts would strengthen these results.

Nursing Students Achieving Community Health Competencies through Undergraduate Clinical Experiences: A Gap Analysis

In Canada, it is widely believed that nursing practice and health care will move from acute care into the community. At the same time, increasing numbers of nursing students are engaged in non-traditional clinical experiences for their community health rotation. These clinical experiences occur at agencies not organizationally affiliated with the health care system and typically do not employ registered nurses (RNs). What has yet to be established is the degree to which nursing students are actually being prepared for community health nursing roles through their community health clinical rotations. In this paper we report the findings of a mixed method study that explored the gap between desired and observed levels of competence in community health of senior nursing students and new graduates. The gap was quantified and then the nature of the gap further explored through focus groups.

Educational preparation for clinical nursing: the satisfaction of students and new graduates from two Australian universities

BACKGROUND

Attrition rates among young and newly registered nurses are high; the capacity of nurse education programmes to prepare nurses for their professional role and the extent to which they are supported during the transition from student to registered nurse may be important factors.

OBJECTIVES

This paper examines nursing student and recent graduate satisfaction with their education, focusing on their preparation for work.

DESIGN

A descriptive cohort design was used, combining qualitative and quantitative methods to measure and interpret satisfaction.

SETTING

Two Australian universities, one urban and one regional.

PARTICIPANTS

530 undergraduate nursing students and recent graduates from the Bachelor of Nursing programmes at the two universities.

METHODS

Data were collected via an online survey. Satisfaction with the programmes was measured with closed format questions covering different aspects of the programmes and a single open ended question. Responses were compared between older and younger respondents and between graduates and students at different stages of the programme.

RESULTS

Older students were more dissatisfied than younger students with the amount and type of training and their preparation for nursing work. First year students reported the highest levels of satisfaction, and third year students the lowest. The majority of graduates and third year students thought that the programme only partly prepared them for work in nursing. The free text comments particularly highlighted concerns with the amount and quality of clinical education.

CONCLUSIONS

Programmes need to take account of the learning requirements of students to maximise the integration of theory and skill development in hospital environments with limited staffing and resources. The clinical environment and support received impact on the quality of learning and satisfaction of student nurses. Students who are dissatisfied with their educational and clinical experiences may choose to change their career direction.

Third year nursing students' viewpoints about circumstances which threaten safety in the clinical setting

BACKGROUND

Evidence emphasizes that learners, educators, clinicians, programs, and organizations share the responsibility for establishing and maintaining safety throughout undergraduate nursing education. Increased knowledge about students' perceptions of threats to safety in the clinical setting may guide educators' efforts to promote the development of safe novice practitioners while preserving patient safety.

OBJECTIVE

The purpose of this study was to describe third year nursing students' viewpoints of the circumstances which threaten safety in the clinical setting.

METHODS

Using Q methodology, 34 third year Bachelor of Science in Nursing students sorted 43 theoretical statement cards. Each card identified a statement describing a threat to safety in the clinical setting. These statements were generated through a review of nursing literature and consultation with experts in nursing education. Centroid factor analysis and varimax rotation identified viewpoints regarding circumstances that most threaten safety.

RESULTS

Three discrete viewpoints and one consensus perspective constituted students' description of threatened safety. The discrete viewpoints were labeled lack of readiness, misdirected practices, and negation of professional boundaries. There was consensus that it is most unsafe in the clinical setting when novices fail to consolidate an integrated cognitive, behavioral, and ethical identity. This unifying perspective was labeled non-integration.

CONCLUSION

Third year nursing students and their educators are encouraged to be mindful of the need to ensure readiness prior to entry into the clinical setting. In the clinical setting, the learning of prepared students must be guided by competent educators. Finally, both students and their educators must respect professional boundaries to promote safety for students and patients.

Recruitment, selection and retention of nursing and midwifery students in Scottish Universities

BACKGROUND

High attrition rates from pre-registration nursing and midwifery programmes have been reported in both the UK and in other countries.

OBJECTIVES

A study was conducted to identify best practice in recruitment, selection and retention across Scottish Universities providing pre-registration programmes.

DESIGN

A survey of all universities providing pre-registration programmes in Scotland was conducted. Semi-structured interviews were conducted with key personnel in each university. Documentary evidence was collected to supplement interview data and evidence recruitment, selection and retention practices.

SETTINGS

All universities in Scotland providing pre-registration nursing and/or midwifery programmes.

PARTICIPANTS

All 10 identified universities agreed to take part and a total of 18 interviews were conducted.

METHODS

Semi-structured face to face and telephone interviews were conducted. Relevant documentary evidence was collected. All data were subject to thematic analysis.

FINDINGS

Universities are predominantly concerned with recruiting to the institution and not to the professions. Interviews are widely used, and are a requirement in the United Kingdom. However, there is no evidence base within the literature that they have predictive validity despite creating scales and scoring systems which are largely unvalidated. The study identified initiatives aimed at addressing attrition/retention, however most had not been evaluated often due to the multi-factorial nature of attrition/retention and difficulties with measurement.

CONCLUSIONS

Recruitment selection and retention initiatives were rarely evaluated, and if so, adopted a relatively superficial approach. Evidence from existing studies to support practices was mostly weakly supportive or absent. The study highlights the need for a coordinated approach, supporting the development of a robust evidence base through the evaluation of local initiatives, and evaluation of new strategies. Evaluation strategies must take account of the local context to facilitate transferability of findings across different settings.

Student nurse perceptions of client groups and clinical placement areas

Changes in healthcare provision have exposed preregistration student nurses to a wider scope of client groups and education settings than previous generations of student nurses. Student placements now involve non-NHS care provision. Evidence suggests that students perceive certain client groups and education settings to be less pertinent to their professional development and less attractive with regard to future employment. This article presents the results of the first part of a mixed-methods approach study, investigating the above assertions. The students in this study appeared to regard caring for patients who have long-term/ chronic conditions receiving care in non-NHS, non-acute settings, as a less attractive prospect in terms of professional development, than short-term, acute, NHS-based care provision, i.e. medical, surgical and critical care areas. Students associated non-NHS areas with non-nursing tasks and the opportunity to practise basic nursing care, while the NHS was associated with high-level skills and access to preferred client groups. Nurse educators should challenge this imbalance throughout their student nurse education programme design and delivery.

Undergraduate midwifery students' sense of belongingness in clinical practice

BACKGROUND

Clinical placements form a large and integral part of midwifery education. While much has been written about nursing students' clinical placements, less is known about clinical experiences of undergraduate midwifery students. In nursing, belongingness has been demonstrated to be a key factor in clinical learning but little is known about this in midwifery education.

OBJECTIVES

This study sought to examine undergraduate midwifery students' sense of belongingness in their clinical practice.

DESIGN

A quantitative design using an online questionnaire was employed. A tool adapted by Levett-Jones (2009a), and previously used with nursing students, was utilised to examine sense of belonging in undergraduate midwifery students.

PARTICIPANTS

Sixty undergraduate midwifery students from two campuses at one Australian university participated in the study. Students were drawn from a single Bachelor of Midwifery degree and a double Bachelor of Nursing/Bachelor of Midwifery degree.

METHODS

On completion of a scheduled lecture, students were invited by one of the researchers to participate in the study by completing the online questionnaire and the link provided. Data were analysed using descriptive statistics.

RESULTS

Midwifery students generally reported similar perceptions of belongingness with previous studies on nursing students. However, a few differences were noted that require further exploration to fully understand.

CONCLUSIONS

Midwifery students experienced a sense of belonging in their clinical placements. The findings contribute to understandings of the experiences for midwifery students and provide a foundation on which to develop future clinical placement experiences.

Impact of engaging middle management in practice interventions on staff support and learning culture: a quasi-experimental design

AIM

This study evaluated the impact of different levels of engaging middle management in ward based strategies implemented by a project educator.

BACKGROUND

The challenge for learning in practice is to develop effective teams where experienced staff engage and foster learning with students and other novice staff.

DESIGN

A quasi-experimental pre- and post- intervention four group design was conducted from November 2009 to May 2010 across four general surgical and four general medical inpatient matched units in two settings in South East Queensland, Australia.

METHOD

Staff survey data was used to compare control and intervention groups (one actively engaging nurse managers) before and after 'practice learning' interventions. The survey comprised demographic data and data from two validated scales (support instrument for nurses facilitating learning and clinical learning organisational culture).

RESULTS

Number of surveys returned pre- and post-intervention was 336 from 713 (47%). There were significant differences across many subscales pertaining to staff perception of support in the intervention groups, with only one change in the control group. The number of significant different subscales in the learning culture was also greater when middle management supported the intervention.

IMPLICATIONS FOR NURSING MANAGEMENT

Middle management should work closely with facilitators to assist embedding practice interventions.

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.

Professional values, self-esteem, and ethical confidence of baccalaureate nursing students

Professional identity and competent ethical behaviors of nursing students are commonly developed through curricular inclusion of professional nursing values education. Despite the enactment of this approach, nursing students continue to express difficulty in managing ethical conflicts encountered in their practice. This descriptive correlational study explores the relationships between professional nursing values, self-esteem, and ethical decision making among senior baccalaureate nursing students. A convenience sample of 47 senior nursing students from the United States were surveyed for their level of internalized professional nursing values (Revised Professional Nursing Values Scale), level of self-esteem (Rosenberg’s Self-Esteem Scale), and perceived level of confidence in ethical decision making. A significant positive relationship (p < 0.05) was found between nursing students’ professional nursing values and levels of self-esteem. The results of this study can be useful to nursing educators whose efforts are focused on promoting professional identity development and competent ethical behaviors of future nurses.

Swedish nursing students' experience of aspects important for their learning process and their ability to handle the complexity of the nursing degree program

The aim of the study was to explore nursing students' experiences of aspects important for their learning process and their ability to handle the complexity of the nursing degree program. The study was longitudinal and qualitative based on interviews with nursing students, six women and two men aged 20-36, during their three years of education. In all, seven patterns were found embracing aspects of importance for the students' learning: Having a clear goal, being able to re-evaluate one's ideas, being acknowledged, when the abstract becomes tangible, using one's own experiences as a tool for learning, hovering between closeness and distance regarding one's future profession and handling theory and practice in relation to one another. The results show the importance of providing clinical courses, strongly connected to the theoretical parts of the program and to use reflection and experience-based learning in the nursing program.

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.

Shifting workplace behavior to inspire learning: a journey to building a learning culture

This article discusses the process of building a learning culture. It began with establishing acceptance and connection with the nurse unit manager and the ward team. In the early phases of developing rapport, bullying became apparent. Because bullying undermines sharing and trust, the hallmarks of learning environments, the early intervention work assisted staff to recognize and counteract bullying behaviors. When predominantly positive relationships were restored, interactions that facilitated open communication, including asking questions and providing feedback-behaviors commensurate with learning in the workplace-were developed during regular in-service sessions. Staff participated in role-play and role modeling desired behaviors. Once staff became knowledgeable about positive learning interactions, reward and recognition strategies began to reinforce attitudes and behaviors that align with learning. Through rewards, all nurses had the opportunity to be recognized for their contribution. Nurses who excelled were invited to become champions to continue engaging the key stakeholders to further build the learning environment.